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Abstract
Human cytomegalovirus is one of the herpesviruses group which is acquired throughout the life. HCMV usually becomes latent in immunocompetent persons although it cause severe diseases and even life-threatening illness in many types of immunocompromised patients as in organ transplant recipients and patients undergoing dialysis due to renal failure.
The aim of this study was to assess the presence of HCMV infection in patients with chronic renal failure undergoing first time hemodialysis and candidates to organ transplantation. Also to asses diagnosis of an active HCMV infection in renal haemodialysis patients comparing serologic assays with HCMV-DNA amplification by real- time PCR ,and follow up of HCMV-DNA PCR negative for 4-6 weeks.
The study was conducted on 100 patients at end stage of chronic renal failure of different etiologies after an oral informed consent. They were attending the Renal Dialysis Department, Kobry El qopa Hospital, Cairo during the period from July to December 2007 undergoing first time renal dialysis.
Patients were subjected to first time hemodialysis, they were 66 males and 34 females . Their ages ranged between 25 and 65 years (Mean =42.5 ± 11.3 years) .
All patients were subjected to full clinical history, and ELISA test for HCMV IgM and HCMV IgG before starting of haemodialysis of patients. Six weeks after regular haemodialysis the HCMV IgM in serum was repeated for all the patients and HCMV DNA in their plasma was measured using real time PCR technique.
As regard HCMV IgM and IgG before the first time haemodialysis, they were detected in 0 patients (0%) and 100patients (100%) respectively with no statistically significant difference.
After 6 weeks of regular haemodialysis, it was found that HCMV IgM antibodies and HCMV DNA were detected in 10% and 0%; respectively with statistically significant difference.
The result of the present study revealed that the Predictive value positive of HCMV-IgM = 0% and the Predictive value negative of HCMV-IgM = 100% which mean that HCMV IgM is a good negative Predictive test.
Sensitivity and specificity of HCMV-IgM when confirmed by HCMV-DNA by real – time PCR. Showed that out of no positive CMV/DNA patients, there were 10 patients with positive HCMV/IgM may be false result due to no confirmatory test. However, Out of 100 negative CMV/DNA patients, there were 90 patients with negative HCMV/IgM indicating specificity to be 100%. So, the Predictive value positive of HCMV-IgM = 0% and Predictive value negative of HCMV-IgM = 100% .
Blood transfusion may be an important cause of infection with CMV IgM antibodies and HCMV DNA were detected in higher percentage of patients with frequent blood transfusion than those with infrequent or no blood transfusion.