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Diagnostic tests for cytomegalovirus*

Diagnostic tests for cytomegalovirus*
  Serology Quantitative PCR AntigenemiaΔ Culture Histopathology◊ Resistance testing
Immunocompetent
Acute or recent infection IgM or fourfold increase of IgG Plasma or whole blood        
Past infection IgG          
Critically ill   Plasma or whole blood; consider BAL        
Immunocompromised
Assessing risk of CMV disease IgG          
Diagnosis of disease            
Viral syndrome   Plasma or whole blood PBMCs      
Pneumonitis   Plasma or whole blood; consider BAL PBMCs BAL or lung tissue BAL or lung tissue  
Gastrointestinal disease   Plasma or whole blood§ PBMCs§ Tissue Tissue  
Central nervous system disease   CSF, plasma, whole blood        
Retinitis   Vitreous or aqueous fluid        
Decisions regarding preemptive therapy   Plasma or whole blood PBMCs      
Monitoring response to therapy   Plasma or whole blood PBMCs      
Treatment failure   Plasma or whole blood PBMCs     Yes
PCR: polymerase chain reaction; IgM: immunoglobulin M; IgG: immunoglobulin G; BAL: bronchoalveolar lavage; CMV: cytomegalovirus; CSF: cerebrospinal fluid; PBMCs: peripheral blood polymorphonuclear leukocytes.
* Refer to the UpToDate topic reviews on diagnosis of CMV for detailed recommendations regarding the use of these assays. This table does not address diagnostic testing for CMV infection in neonates with congenital or perinatal CMV infection. For details on diagnostic testing in newborns, refer to the UpToDate table on laboratory tests for the detection of CMV in neonates with suspected congenital infection and topic reviews on congenital and perinatal CMV infection.
¶ Quantitative PCR assays offer several advantages over the antigenemia assay, including better assay standardization, increased stability of the specimen, smaller specimen volume, and the ability to test patients with leukopenia. For these reasons, quantitative PCR assays are more widely used than the antigenemia test, and we prefer them for the diagnosis and monitoring of immunocompromised patients with CMV infection and disease.
Δ The CMV antigenemia assay is insensitive when the patient has a low neutrophil count (<1000 cells/microL).
◊ This includes histopathology and immunohistochemical staining.
§ Negative results are common with gastrointestinal disease.
Graphic 101937 Version 2.0

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