Rapid detection of cytomegalovirus DNA in urine samples with a dot blot hybridization immunoenzymatic assay

A dot blot hybridization immunoenzymatic assay for the rapid detection of cytomegalovirus DNA in urine samples was developed by using a digoxigenin-labeled probe which was immunoenzymatically visualized by antidigoxigenin Fab fragments labeled with alkaline phosphatase. A total of 516 urine samples from different groups of subjects were analyzed, and the hybridization assay was able to yield results within 24 h. The results obtained were compared with results for detection of cytomegalovirus antigens in infected cell cultures.

Effect of treatment of shell vial cell cultures with dimethyl sulfoxide and dexamethasone and age of MRC-5 monolayers for detection of cytomegalovirus

Pretreatment of MRC-5 cell monolayers in commercially prepared shell vials with 1% dimethyl sulfoxide (DMSO) and 10(-5) mol/L dexamethasone (DEX) was evaluated. Preliminary experiments indicated enhanced infectivity of AD-169 for pretreated MRC-5 cells in shell vials of ages 9 and 16 days. Compared with untreated shell vials, DMSO-DEX increased positivity (day 9, 19 vs. 26 shell vials, p less than 0.03; day 16, 13 vs. 29 shell vials, p less than 0.001) and increased the mean number of fluorescent foci (days 9 and 16, p less than 0.001). Pretreatment of 8-15-day-old monolayers was evaluated clinically using 146 urine specimens. Fifty specimens were positive for cytomegalovirus (CMV) in both treated and untreated shell vials with ten positive in untreated only and three positive in treated only (p = NS). The median number of fluorescent foci was not significantly higher in treated shell vials. Increased toxicity of MRC-5 cells was observed in treated monolayers (p less than 0.0001). Pretreatment with DMSO-DEX did not enhance CMV isolation from clinical specimens and can be toxic to MRC-5 monolayers.

Effect of age of shell vial monolayers on detection of cytomegalovirus from urine specimens

The effect of age of MRC-5 cell monolayers in shell vials on the detection of cytomegalovirus (CMV) from urine was evaluated. When the AD169 strain of CMV was used, 8-day-old monolayers had a higher mean count of fluorescent foci than 15-day-old monolayers did (5.78 versus 2.86) (P less than 0.02) and were more frequently positive (21 of 23 shell vials versus 14 of 22 shell vials) (P less than 0.04). Commercial shell vials used for clinical specimens were evaluated in groups of 8- to 11-, 12- to 15-, and 8- to 15-day-old monolayers. When compared with laboratory-prepared shell vials ranging in age from 3 to 9 days, commercial shell vials had a lower number of fluorescent foci in all groups (P less than 0.03, P less than 0.0001, and P less than 0.0001, respectively), the 12- to 15- and 8- to 15-day-old groups were less frequently positive (P less than or equal to 0.02 and P less than 0.02, respectively), and all three groups were more susceptible to the toxic effects of urine (P less than 0.0001, P less than 0.01, and P less than 0.0001, respectively). For all 191 specimens cultured (8- to 15-day-old group), one or both monolayers were destroyed in 60 (31.4%) specimens compared with 9 (4.7%) specimens toxic to laboratory-prepared shell vials (P less than 0.0001). Both the decreased sensitivity of older MRC-5 cells and the increased sensitivity to the toxic effects of urine made commercial shell vial less sensitive than laboratory-prepared shell vials for the detection of CMV.

Detection of cytomegalovirus DNA using probes labelled with digoxigenin

Cloned HindIII restriction fragments of cytomegalovirus (CMV) DNA (strain AD169) were labelled with biotin, digoxigenin or 32P and used as probes to detect CMV DNA. Probes biotinylated by nick translation, random hexanucleotide priming (RHP) or "photobiotin" were able to detect 10-50 pg of homologous DNA. Probes labelled with digoxigenin or 32P by RHP detected 0.1 pg of homologous DNA, and 1-10 CMV-infected fibroblasts. Comparison of digoxigenin- and 32P-labelled probes in a DNA hybridisation assay on 186 urine specimens demonstrated that these probes were of similar sensitivity, detecting CMV DNA in 40 and 41 specimens, respectively. Positive results were obtained using this hybridisation assay with 11 of 14 specimens (79%) yielding CMV by virus isolation, and with 35 other specimens obtained from patients with laboratory evidence of CMV infection or symptoms compatible with CMV disease. Thus digoxigenin-labelled probes may provide an assay that can detect CMV DNA in specimens yielding a negative result by virus isolation.

Recurrent ascites in an infant with perinatally acquired cytomegalovirus infection

We describe an infant with symptomatic perinatally-acquired cytomegalovirus (CMV) infection manifested by fever, anaemia, thrombocytopenia and hepatosplenomegaly. This infant developed recurrent episodes of severe ascites during which the virus was isolated from his urine. This rare hepatic manifestation of neonatal CMV infection has, to the best of our knowledge, only been reported twice in aborted fetuses with intrauterine systemic CMV infection.

Early diagnosis of cytomegalovirus infection in renal transplant and dialysis patients by DNA-DNA hybridisation assay

One hundred forty-eight urine specimens were collected from 47 renal transplant and dialysis patients and screened for the detection of cytomegalovirus (CMV). Diagnosis of CMV infection was suggested in 17 out of 47 patients (36.2%) by more than one of the five methods used. DNA hybridisation assay (DNA HA) using 32P-labelled probe detected CMV DNA in 15 (31.9%) of 47 patients, whereas virus isolation on conventional tube cell cultures (CTC), immunofluorescence incorporating monoclonal antibodies on centrifugation vial cultures (IF), complement fixation test (CFT), and electron microscopy (EM) yielded positive results in only nine (19.2%), 12 (25.2%), 11 (23.4%), and one (2.1%) of 47 patients, respectively. The significance of these results obtained by DNA HA lies not only in the apparent increase in number of patients diagnosed, but also in both early and rapid detection of CMV DNA. More importantly, the DNA HA is highly specific in that it correlates accurately with clinical and laboratory data characteristic of CMV disease. In respect of clinically manifest CMV disease, the specificity of DNA HA, CTC, IF, CFT, and EM was 87.5, 43.7, 56.3, 43.7, and 6.3%, respectively. These advantages of DNA HA make it the test of choice for early diagnosis of CMV infections in immunosuppressed patients.

Detection of cytomegalovirus DNA in short term cultures

Detection of human cytomegalovirus (CMV) by in situ DNA hybridisation six days after incubation of human diploid fibroblasts (ISDH-6) was evaluated prospectively in 205 urine samples, obtained from 57 kidney transplant and 17 bone marrow transplant recipients. The results were compared to those of conventional virus isolation (CVI) and the detection of CMV early antigens after one day of cultivation (EA-1). Of 42 samples positive for CMV by at least one of these methods, 40 (95%) were detected with ISDH-6. Thirty-five (83%) and 34 (81%) positive samples were found with CVI and EA-1, respectively. These data indicate that ISDH-6 is a sensitive method for detection of CMV. It can be used as a rapid and sensitive alternative to CVI in combination with EA-1.

Correlation of urine pH with the detection of cytomegalovirus by the shell vial technique

The influence of the pH of urine on the detection of cytomegalovirus (CMV) by the shell vial assay was evaluated. The pH values of 295 urine specimens ranged from 4.7 to 8.5 (mean 6.3) and were not significantly different in culture-positive versus culture-negative samples. None of the urine specimens appeared to be toxic for the cells used in the shell vial assay. We recommend inoculation of urine specimens into shell vials without adjustment of pH.

Potential of in situ hybridization for early diagnosis of productive cytomegalovirus infection

In situ hybridization with a probe specific for immediate-early genes was used for detection of cytomegalovirus (CMV) transcripts in peripheral blood mononuclear cells, and the potential use of this technique as a diagnostic tool was assessed. The results were compared with those obtained with conventional assay systems. In 8 of 18 continually observed patients who developed a productive CMV infection, a high number of hybridization-positive cells were observed 1 to 2 weeks before the conventional tests yielded positive results. Thus, quantitative evaluation of hybridization results provided an early and specific marker for beginning CMV infection or reactivation. In three cases, quantitative in situ hybridization assays provided the only laboratory marker indicating CMV infection or reactivation. It was also found that a probe specific for immediate-early genes was superior to a probe specific for late genes for diagnosis of productive infections.

Application of a dot blot hybridization assay for the diagnosis of CMV infection or reactivation

Dot blot hybridization was performed for the detection of cytomegalovirus (CMV) genomes in urine samples. This assay was applied to the diagnosis of CMV infection in transplant patients, who were tested continuously after transplantation and the results were compared to the detection of early antigen (EA) in fibroblasts inoculated with urine specimens as well as to serological methods. It turned out that discrepancies between EA-detection and dot blot hybridization are partially caused by the different appearance and disappearance of the two parameters at different time points. In most cases the dot blot hybridization assay proved to be an earlier marker than EA-detection in the course of infection. In several patients, however, hybridization showed positive signals although there was no sign for a productive CMV infection.

Detection of cytomegalovirus in bronchial lavage and urine using a monoclonal antibody to an HCMV early nuclear protein

Laboratory diagnosis of 24 cases of human cytomegalovirus (HCMV) infection in patients with the acquired immunodeficiency syndrome, renal transplant recipients and premature infants was achieved. These results were obtained by a rapid, sensitive and versatile HCMV-antigen detection method, which combined cell culture and immunoperoxidase staining with a monoclonal antibody to an HCMV "early" nuclear protein. The results were compared with HCMV isolation by the conventional cell culture method. While some of these immunocompromised patients lacked a significant antibody response, infective HCMV could be detected in the patients' urine and bronchial lavage fluid. The diagnostic procedure took no longer than 24 h. The usefulness of this antigen test for an effective diagnosis in immunocompromised individuals was demonstrated. We recommend routine analysis of various specimens, since recent developments in chemotherapy of HCMV infection and the risks of long-term damage demand immediate management of the patients concerned.

The use of ELISA and nonradioactive DNA hybridization assays for the detection of human cytomegalovirus

A hybridization assay using a biotinylated DNA probe was compared to both ELISA and direct isolation methods for detecting human cytomegalovirus (HCMV). The biotin labeled HCMV AD 169 HindIII-O-DNA fragment was used in a dot-blot assay to screen for the presence of HCMV in 186 urine specimens obtained from kidney transplant patients. The biotinylated HCMV HindIII-O probe could detect 3 log10 TCID50 units of HCMV. Urine specimens were also examined for the presence of HCMV by either ELISA or direct isolation of virus in tissue culture. The HindIII-O fragment detected 12 of 20 culture positive samples (sensitivity, 60%). There were 5 samples which were probe positive and cell culture negative (specificity, 97%). The ELISA assay also detected 12 of 20 culture positive samples (sensitivity, 60%). Eight samples were ELISA positive, cell culture negative (specificity, 95%). Seven specimens were positive by all three criteria. Five specimens which were both ELISA positive and probe positive were cell culture negative. The ELISA positive, probe positive, culture negative specimens originated from patients who gave a culture positive specimen within 10 days of the original sample. The combination of probe and ELISA assays detected 16 of the 20 culture positive specimens (sensitivity, 80%). The combined use of biotinylated DNA probes and ELISA allows the detection of HCMV in urine specimens with good sensitivity and specificity.

Comparison of dot-blot DNA hybridisation and immediate early nuclear antigen production in cell culture for the rapid detection of human cytomegalovirus in urine

The sensitivity and specificity of four modes of two assays, immediate early nuclear antigen detection in cell culture (IENAD) at 24 and 48 h post-infection (p.i.) by immunofluorescence using a murine monoclonal antibody, and dot-blot DNA hybridisation with overnight or prolonged autoradiography using the 32P-labelled HindIII J fragment of human cytomegalovirus (HCMV) DNA as probe, were compared for the rapid detection of HCMV in urine. The sensitivity of IENAD was enhanced by low-speed centrifugation at the time of inoculation. DNA hybridisation with overnight autoradiography was significantly less sensitive than IENAD at 24 h p.i. (P less than 0.001), and even with prolonged autoradiography the hybridisation assay was slower and significantly less sensitive than IENAD at 48 h p.i. (P less than 0.02). The specificity of the two assays was virtually 100%. The sensitivity of DNA hybridisation was thus clearly inferior to that of IENAD.

Detection of CMV in urine: comparison between DNA-DNA hybridization, virus isolation, and immunoelectron microscopy

Rapid detection of CMV-DNA in urine specimens by dot-blot hybridization was compared to conventional virus isolation and to virus identification using solid-phase immunoelectron microscopy (SPIEM). To detect viral DNA, 32P-labeled EcoR1 J fragment of CMV-DNA was used as a probe in the hybridization assay. In addition, DNA extracted from infected human embryo fibroblasts (amplified DNA) was also hybridized to the same probe. Urine specimens were obtained from 10 renal transplanted patients, seven premature infants, three family members, and five children suspected of CMV infection. CMV was isolated from 10 urine specimens and SPIEM detected viral particles in nine specimens. Ten positive samples were identified as such by hybridization with DNA extracted directly from urine specimens, while hybridization with amplified DNA yielded 17 positives. Only in one urine specimen, positive by virus isolation and SPIEM, DNA was not detected by the hybridization assays. Elevated IgG or IgM-specific antibodies were found in 10 patients. Hybridization with amplified DNA proved the most sensitive and relatively rapid assay, as compared with direct DNA detection in urine, tissue culture isolation, SPIEM, or serologic tests.

Cytomegalovirus infection in day nurseries

One hundred and seventeen children and 41 teachers in day nurseries were screened for cytomegalovirus (CMV) viruria over a period of one year. Thirty two (27%) children and two (5%) teachers were found to be excreting virus on at least one occasion. Restriction endonuclease typing showed that virus strains isolated from the children were dissimilar, with the exception of those from sibling pairs and one unrelated pair. The virus isolate from one teacher matched those from two unrelated children, while the isolate from another teacher could not be distinguished from that from a sibling pair. The CMV serological state of the 41 teachers was not significantly different from 500 matched controls and no seroconversions occurred. It is concluded that although transmission of CMV among children and teachers may occur in day nurseries, the dissimilarity of most of the virus strains indicates that infection predominantly occurs outside. Furthermore, teachers in day nurseries showed no evidence of an increased risk of past CMV infection when compared with matched controls.

Cytomegalovirus in urine specimens has host beta 2 microglobulin bound to the viral envelope: a mechanism of evading the host immune response?

We have previously reported that human cytomegalovirus (CMV) from urine specimens cannot be captured onto a solid phase by CMV-specific monoclonal antibodies that can capture CMV grown in vitro. We report here that CMV exists in vivo in body fluids such as urine as beta 2 microglobulin (beta 2 m)-coated particles. We have demonstrated the presence of beta 2m on CMV purified directly from urine by Western blotting and have shown that the beta 2m was associated with the viral envelope. Urinary CMV could be specifically bound by an affinity column comprising a monoclonal antibody specific for beta 2m bound to Sepharose. The beta 2m-coated urinary CMV could not be neutralized by hyperimmune globulin, human immune sera or murine monoclonal antibodies that could neutralize CMV grown in cell culture. We conclude that the binding of beta 2m by CMV masks the important antigenic sites necessary for neutralization which are recognized by man's immune response. We propose that CMV has evolved this mechanism of coating itself in a host protein as a mechanism of evading the host immune response and facilitating transmission between individuals.

Detection of human cytomegalovirus in urine by DNA-DNA and RNA-DNA hybridization

A diagnostic hybridization assay for detecting human cytomegalovirus (HCMV) DNA in urine specimens was developed by using cloned viral DNA and in vitro-synthesized RNA probes. Both probes detected 3 pg of homologous DNA and hybridized with DNA of HCMV but not with other viral or human cellular DNA tested. In 95 urine specimens simultaneously tested by cell culture, the sensitivity of hybridization was at least 83%, and the specificity was at least 92%. This assay will be useful for rapid viral diagnosis with wide clinical applications such as screening of immunocompromised patients and quantitation of viral shedding in patients with primary or reactivated HCMV infection who may be receiving antiviral therapy.

Detection of cytomegalovirus antigen and antibodies in the urine of small infants and children

The diagnostic efficacy of an enzyme immune assay to detect cytomegalovirus (CMV) antigen in the urine of infected infants and children was determined, and the effect that CMV-specific antibodies present in the urine have on the sensitivity of the test was ascertained. The antigen was detected in 84.4% of the CMV-culture-positive samples, while CMV-specific IgA was detected in 24% of CMV-culture-positive specimens. The absence of CMV-specific IgA correlated with detection of CMV antigen in the CMV-culture-positive urine specimens (p less than 0.05).

Differential diagnosis of acute allograft rejection and CMV-infection in renal transplantation by urinary cytology

Acute allograft rejection and CMV-infection are the most common complications after renal transplantation. Quick differential diagnosis between these two complications is still difficult but necessary, since both complications demand a different therapy. More than 2500 urinary samples from 33 transplanted patients were prospectively examined and part of them evaluated quantitatively. Urinary samples of patients with acute renal failure, long-term haemodialysis or immunosuppressive therapy served as controls. The following cytomorphological criteria proved to be useful: Tubular epithelial cells, casts, oxalate crystals (sand-glass shaped), dirty background, increasing erythrocyturia, mixed cell clusters, lymphocytes and mitoses. Rejection is going on when the number of renal tubular cells is increased and two or more further criteria are positive. 25 acute allograft rejections without acute renal failure were diagnosed clinically. All 25 rejections were also diagnosed by urinary cytology. Nevertheless, it is not possible to differentiate between acute allograft rejection and acute renal failure of other origin. CMV-infection was serologically detected in 7 patients. In 6 of them viral infected cells were found in the urine shortly after the onset of unspecific clinical symptoms. Besides the typical "owl-eye" cells milkglass nuclei, sometimes with eosinophilic condensation, were seen while criteria for transplant rejection were never observed at the same time. Cytologic examination of voided urine is a simple diagnostic help for the differentiation between allograft rejection and CMV-infection after renal transplantation.

A prospective study of maternal cytomegalovirus infection and its effect on the fetus

In order to define the effects of maternal cytomegalovirus infection in pregnancy and to identify risk factors associated with delivery of a cytomegalovirus-infected infant, a cohort of 1089 adolescents were prospectively evaluated during pregnancy. One hundred twenty-four subjects (11.4%) manifested cytomegaloviruria during pregnancy. Primary cytomegalovirus infection, defined virologically and serologically, occurred in three subjects. Infants of 119 cytomegalovirus-excreting mothers were cultured at birth, with detection of 12 congenital infections (10%), including one infant delivered of a mother with a third-trimester primary infection. A high titer of urinary virus or a fourfold or greater increase in antibody during the third trimester was significantly associated with delivery of a congenitally infected infant. All maternal and infant infections were asymptomatic. None of the congenitally infected infants manifested adverse effects during the first year of life. Our data demonstrate that pregnant women with cytomegaloviruria are at increased risk of being delivered of congenitally infected infants, particularly if active infection occurs late in pregnancy. If the maternal infection represents reactivation, overall probability of a poor fetal outcome is low.

Rapid detection of cytomegalovirus in MRC-5 cells inoculated with urine specimens by using low-speed centrifugation and monoclonal antibody to an early antigen

A commercially available monoclonal antibody directed against an early nuclear protein of cytomegalovirus was used with low-speed centrifugation for the rapid detection of this virus from urine specimens inoculated onto MRC-5 cells. A total of 19 of 162 (11.7%) urine specimens inoculated were positive by both immunofluorescence and peroxidase-antiperoxidase procedures (sensitivity, 100%), whereas only 18 of the samples produced cytopathic effects in conventional cell culture (specificity, 94.7%). All specimens were positive by immunofluorescence and peroxidase-antiperoxidase procedures at 36 h postinfection, whereas an average of 9 days was required for cytopathic effects to develop in cell cultures.

Rapid detection and quantitation of human cytomegalovirus in urine through DNA hybridization

We detected cytomegalovirus DNA in clinical urine specimens after immobilization on nitrocellulose filters and hybridization with a radioactively labeled, cloned fragment of cytomegalovirus DNA. We accomplished the specific detection and quantitation of viral DNA within 24 hours with 39 urine specimens from nine patients with cytomegalovirus viruria, mostly at a tissue-culture infective titer of 10(3) per milliliter or higher. None of 57 urine specimens from 21 patients that were culture-negative for cytomegalovirus gave false-positive results. Analysis of specimens from patients with cytomegalovirus viruria showed a correlation of the infective titer with the intensity of DNA hybridization (r = 0.77). Hybridization of sequential urine specimens from a patient undergoing treatment with interferon for cytomegalovirus retinitis revealed quantitative variations in hybridizable viral DNA over a period that correlated with clinical findings. This assay can be useful in the selection of patients for antiviral therapy and for the assessment of its efficacy.

Pteridines as a new marker to detect human T cells activated by allogeneic or modified self major histocompatibility complex (MHC) determinants

Evidence is presented that activation of T cells by allogeneic or modified autologous cells leads to the specific production of two distinct molecular compounds of the PT class. One of these two PT has previously been identified as neopterin. The structure of the other is still under investigation. This conclusion was based on the following findings: a) In vitro both PT were produced by T cells proliferating in response to HLA incompatible allogeneic or to autologous EB-virus-transformed or TNP-haptenized cells. b) In vitro stimulation of T cells with mitogenic lectins or protein antigens, of macrophages with zymosan-complement, of B cells with PWM or EB-virus, and of NK effector cells with tumor targets failed to induce comparable release of these PT. c) In vivo increased amounts of both PT were excreted via the urine during allograft rejection and viral infections. It thus appears that the production of these PT is primarily a feature of activated T cells involved in the control of self integrity.

The outcome in children with congenital cytomegalovirus infection. A longitudinal follow-up study

Infants with congenital cytomegalovirus (CMV) infection were identified through urine cultures of 15,212 consecutive neonates and studied prospectively to determine whether their neurodevelopmental and audiologic status was different from that of matched uninfected control subjects. Of 64 children with congenital CMV infection, three died, 11 could not be located for follow-up, one had quadriplegic cerebral palsy, and seven had varying degrees of sensorineural hearing loss. All matched control subjects were normal neurologically, and none of them had sensorineural hearing impairment. The Stanford-Binet test revealed scores within the normal range, at 3 and 5 years of age, for both children with CMV infection and matched control subjects, as did the preschool assessment (Wide Range Achievement Test) in children older than 5 years. However, in children with CMV infection, the home environment was less stimulating, discipline and punishment were more readily implemented, and behavioral problems were significantly greater than in the matched control subjects.

Nonfebrile seizures after febrile convulsions: possible role of chronic cytomegalovirus infection

Twelve hundred children with convulsions when feverish were studied during a period of five years. Among them 52 subjects (4.33%) developed nonfebrile seizures after a period of eight months to five years from the first febrile convulsion (group A). Twenty-three children had neither afebrile seizures nor EEG abnormalities during the period of observation (group B). The two groups were comparable for age of the first febrile convulsion onset, sex, and socioeconomic status. None had risk factors for subsequent epilepsy or clinical signs of congenital cytomegalovirus infection. The isolation rate of CMV from urine was 53.84% in patients of group A, 26.09% in children of group B, and 26.83% in healthy control children. Twelve CMV-positive children from group A were followed for one to more than three years. In five of seven children with persisting EEG abnormalities, cytomegaloviruria was still present 13 to 41 months after the first isolation, whereas none of five patients with normal electroencephalograms had viruria after a comparable period. We found that CMV-positive children generally lacked cell-mediated immunity to the virus, whereas CMV-negative patients had positive reactions. Our data suggest a correlation between persistence of neurologic abnormalities and CMV excretion in children with nonfebrile seizures and CMV infection.

Excretion of cytomegalovirus in mothers: observations after delivery of congenitally infected and normal infants

Shedding of cytomegalovirus (CMV) was studied in 142 women who gave birth to congenitally infected infants and in 81 seropositive control mothers (mothers of uninfected infants). Viral cultures from the throat, vagina, and urine were obtained at intervals between one month and nearly 12 years after delivery. In both groups the prevalence of excretion of CMV was greater in younger women and fell to low levels by age 30. Considering all of the sites of infection, 60% of the mothers of infected infants were shedding CMV within the first three months post partum compared with 18% of the control mothers; CMV shedding rates declined during the first 12 months post partum to 35% in the former group and to 3% in the latter. More than three years after delivery, seven (15%) of 45 mothers who transmitted CMV still had viruria. The excretion of CMV is common and persistent in mothers of children with congenital infections due to CMV.

Studies of cytomegalovirus infection in renal allograft recipients

A prospective study of cytomegalovirus (CMV) infections has been carried out in 28 renal graft recipients. The protocol called for frequent blood and urine sampling during the first year after transplantation, but death or graft loss caused earlier termination in nearly half the patients. In this material 5/7 (71%) susceptible patients developed primary infections and 20/21 experienced a secondary infection (95%). Viruria was detected in 79% and viremia in 43%. The type of blood cell responsible for the viremic phase was studied by separating the blood cells on a density gradient. The polymorphonuclear cell fraction was the most common source of virus but virus could also be recovered from the mononuclear cell fraction. As some samples that were freeze-thawed repeatedly never yielded virus, it would appear that viable cells are needed for virus isolation. In both primary and secondary infections isolation of CMV from blood cells often preceded the isolation of CMV from urine. Among variables tested for a possible relationship to the occurrence of CMV viremia the only one to display such an association was the time at which rejection episodes occurred. In 19/28 such episodes recorded in 19 patients there was a temporal relationship to viremia (p less than 0.03). Seven of the patients experienced clinical symptoms suggestive of CMV infection as fever, cough, myalgia, arthralgia, chest pain and pneumonia. Laboratory signs included elevated amino acid transferase levels, leukopenia and thrombocytopenia and a specific anti-CMV antibody response.

Congenital cytomegalovirus infection in an urban Canadian community

congenital cytomegalovirus (CMV) infection was diagnosed in 64 (0.42%) of 15,212 infants born in Hamilton, Ontario, Canada, during a period of 44 consecutive months. Urine specimens collected within 48 hr of birth were screened for CMV by inoculation into cell cultures. Only four infants had clinical or laboratory findings in the first week of life that suggested cytomegalic inclusion disease; CMV infection was mild or inapparent in the remainder. Fourteen CMV-positive infants (21.9%) had birth weights of less than or equal to 2,500 g, including eight of 11 premature infants (less than or equal to 37 weeks of gestation). Only five CMV-positive infants were small for gestational age. Overall, there were no significant differences between CMV-positive and CMV-negative infants in mean gestational age or mean measurements of weight and head circumference at birth. Mothers of CMV-positive infants were predominantly younger, primiparous women of lower educational and economic status, and the number who were unmarried was about threefold greater than among mothers of uninfected infants.

Identification of viruses in the urine of renal transplant recipients by cytomorphology

This study was designed to reassess the cytomorphology of viral infections in urinary cells obtained from renal transplant patients and to examine the association, if any, between these cytologic changes and the transplant rejection. A total of 2,354 cytologic specimens obtained from 91 renal transplant recipients was evaluated. A combination of techniques, including cellulosic filters, immunofluorescence, hemagglutination inhibition and electron microscopy, was utilized. Cytologic observations were correlated with the patient's clinical history. Thirty-eight patients revealed cytologic evidence of viral infections (herpes simplex, cytomegalovirus and papovavirus). These viral infections had distinct cytomorphology. Cytomegalovirus infection may manifest as intracytoplasmic, orangeophilic inclusions, in addition to the classical intranuclear inclusion. In the majority of renal transplant patients there appeared to be no relationship between the viral infection and the renal transplant rejection episodes.

Cytomegalovirus infection in patients with renal transplants: potentiation by antithymocyte globulin and an incompatible graft

Fifty-six of 67 patients with antibody to cytomegalovirus before transplantation shed cytomegalovirus from urine and/or saliva postoperatively. Symptomatic reactivation occurred in 17 (25%) patients, five of whom had pneumonitis. The symptomatic patients were more likely to have received a cadaver kidney (P = 0.004) and high-dosage antithymocyte globulin (P = 0.003) and to be viremic (P < 0.0001), compared to patients with silent infection. Forty-eight of 49 patients treated with antithymocyte globulin received cadaver or parent donor kidneys. Twenty-four were given a low-dosage intramuscular regimen, and 25 received a higher dosage intravenously. In the latter group 48% experienced symptomatic reactivation adn 48% viremia, compared to 21% and 17%, respectively, in the former group (P < 0.05 for both comparisons). There were no symptomatic cytomegaloviral infections among 18 patients not treated with antithymocyte globulin, all of whom received related donor kidneys. Renal transplant patients who receive both a poorly matched graft and antithymocyte globulin are at increased risk of morbidity due to cytomegalovirus.

Comparative study of diagnostic procedures for congenital cytomegalovirus infection

In a prospective study the incidence of congenital cytomegalovirus (CMV) infection was 2.2% (31 OF 1,412) as evidenced by viruria during the first week of life. Among immunoserologic methods used to screen these neonates, the rheumatoid factor test, although non-specific, proved to be the most convenient; its sensitivity for identifying infants with CMV infection was 35% to 45% with no false-positives. The rates for correct and incorrect identification of neonates at risk was, respectively, 33% and 3.1% when testing for increased levels of IgM; 5% and 10% when testing for increased levels of IgA; 76% and 21% when testing for IgM anti-CMV (IgM immunofluorescent test) antibody, and 0% when testing for IgA anti-CMV antibody. Rapid virologic diagnosis was achieved by assessing urine specimens. Confirmation by electron microscopy was possible in less than one hour in 92% of cases. The detection of early induced CMV-specific nuclear antigens by anticomplement immunofluorescence was diagnostic in 91% of cases within one day of inoculation of specimens in tissue culture. Infectivity of CMV in urine was well preserved for a least seven days at 4 C. Thus, in order to achieve a rapid diagnosis of congenital CMV infection, in sick as well as asymptomatic neonates, urine specimens may, if necessary, be transported at 4 C to distant laboratories.

Cytological diagnosis of virus-infected cells in Papanicolaou smears and its application in clinical practice

The cytopathic changes of herpes simplex virus, varicella-zoster virus, the human polyomaviruses, and the trachoma agent can be recognised in smears prepared from a wide variety of specimens. The morphology of virus-infected cells is described, and the clinical value of these observations is discussed. Cytological diagnosis offers a rapid and convenient method of detecting infection with these viruses which can be confirmed by conventional virological method while the patient is still in the acute stages of the disease. Confirmation can also be made retrospectively by reprocessing cells, identified in the Papanicolaou smear, for electron microscopy. Screening for virus-infected cells in cytological smears is a technique that can be developed in any pathology laboratory prepared to provide a comprehensive cytology service, and it is proving to be a useful tool in clinical diagnosis and applied research.

Occurrence of secondary cystathioninuria in children with inherited metabolic disorders, liver diseases, neoplasms, cystic fibrosis and celiac disease

Secondary cystathioninuria was found in two of 46 children suffering from tumors, leukemia, liver disease, inherited metabolic disorders, cystic fibrosis and celiac disease. Of these two patients, one had congenital biliary atresia and the other cytomegalovirus infection. Seven further children had only moderately elevated excretion of cystathionine. It is suggested that secondary cystathioninuria is uncommon in the disease investigated.

Autistic symptoms in a child with congenital cytomegalovirus infection

A case of intrauterine cytomegalovirus infection with onset of autistic symptoms apparently after 6 months of age is reported. Physicians who find autistic symptoms in very young children might include cytomegalovirus in their differential to document the presence or absence of a correlation.

Use of the cytocentrifuge for the detection of cytomegalovirus inclusions in the urine of renal allograft patients. A case roport

The cytodiagnosis of virus infected cells in the urine of immunosuppressed patients is a new and important aspect of exfoliative cytology. A case report is presented which demonstrates the detection of diagnostic viral inclusions in a renal allograft recipient with CID. Diagnostic cells with good cytologic detail are observed using a Cytocentrifuge technique.

Effect of leukocyte interferon on urinary excretion of cytomegalovirus by infants

Five infants with symptomatic cytomegalovirus infections and high urinary titers of cytomegalovirus were treated with interferon in doses of 1.7-3.5 X 10(5) reference units/kg per day for seven to 14 days. Six courses of treatment were given. One of two infants treated with the largest dose of interferon had transient suppression of viruria; no suppression was noted during the other five courses of treatment. Adverse effects noted included a low rate of weight gain, a transient elevation of serum aspartate aminotransferase and fever. Further trials are needed to determine whether larger doses of a more purified preparation of interferon will eliminate viruria in infants with sytomegalovirus infection, but careful assessment of toxicity will be necessary in this population of patients.

Effect of human exogenous leukocyte interferon in cytomegalovirus infections

Human leukocyte interferon was injected into nine patients with cytomegalovirus infections; four of these patients were congenitally infected, and five had acquired infections. In three patients viruria was completely inhibited. In five patients viral excretion in the urine was only transiently inhibited. Viremia was not significantly suppressed. The lymphocyte response to phytohemagglutinin was suppressed in two patients.

Comparative serial virologic and serologic studies of symptomatic and subclinical congenitally and natally acquired cytomegalovirus infections

Infants with congenitally (38) and natally (17) acquired cytomegalovirus infection were prospectively studied by means of virologic and multiple serologic assays. These infections were characterized by chronic viral excretion (measured in years). The quantity of virus excreted in the urine during early infancy was significantly greater in infants who acquired infection in utero, particularly amon those born with overt disease; thereafter, all three groups (congenital symptomatic, congenital asymptomatic, and natal) excreted similar amounts of virus. The patterns of antibody responses, particularly the fluorescent antibody response to the early antigen and the complement-fixing antibody response, further indicated that congenitally infected infants (especially symptomatic ones) bear a greater antigenic burden than do natally infected infants. From a diagnostic standpoint, the test for fluorescent antibody to the late antigen was the most sensitive assay, whereas the test for complement-fixing antibody proved to be the least useful, The indirect hemagglutination assay, although performed only in infants with natal infection, was only slightly less sensitive than the fluorescent antibody procedure; by the former technique, diagnostic rises were detected in all but one infant after the onset of viruria.

Primary cytomegalovirus infection and liver involvement in early infancy

Virus isolation and determination of serum transaminase activity in 237 patients under one year of age were undertaken to clarify the etiologic significance of primary infection with cytomegalovirus (CMV) in infancy. The rates of virus recovery from infants with liver involvement were 37% (29/78) and 42% (28/66), as determined by serum glutamic oxaloacetic (S-GOT) and serum glutamic pyruvic (S-GPT) transaminase values. In contrast, CMV was recovered from 14% (18/127) and 13% (18/141) of infants with normal S-GOT and S-GPT values. The differences in the rates of virus recovery between both groups were more pronounced in infants under three months of age, that is, 5 to 7 times higher rates in infants with liver involvement. Correlation between complement-fixing antibody and liver involvement, however, was not significant, probably because of the influence by maternal antibody. Majority of infants infected with CMV are postulated to involve liver during immediate months after onset of virus excretion.