Clinical applications of interferon-γ releasing assays for cytomegalovirus to differentiate cytomegalovirus disease from bystander activation: a pilot proof-of-concept study
Open Access
- 1 September 2017
- journal article
- research article
- Published by Korean Association of Internal Medicine in The Korean Journal of Internal Medicine
- Vol. 32 (5), 900-909
- https://doi.org/10.3904/kjim.2015.354
Abstract
We evaluated the proposed clinical application of the combined interpretation of host factors and viral factors in two different cytomegalovirus (CMV) co-infection models. We prospectively enrolled all human immunodeficiency virus non-infected patients with confirmed Pneumocystitis jirovecii pneumonia (PCP) and those with suspected gastrointestinal CMV disease in a tertiary hospital. All patients underwent CMV interferon-γ releasing assay (IGRA) for CMV (T-track CMV, Lophius Biosciences). We created the 2-axis model with the CMV IGRA results as the x-axis and the results for CMV virus replication as the y-axis, and hypothesized that cases falling in the left upper quadrant (high viral load and low CMV-specific immunity) of the model would be true CMV infections. The CMV IGRA results were concealed from the attending physicians. Of 39 patients with PCP, four (10%) were classified as combined CMV pneumonia, 13 (33%) as bystander activation, and the remaining 22 (56%) as no CMV infection. The data for all four patients with PCP and CMV pneumonia fell in the left upper quadrant of the 2-axis model. Of 24 patients with suspected gastrointestinal CMV disease, 12 (50%) were classified as gastrointestinal CMV disease and the remaining 12 (50%) as bystander activation with no gastrointestinal CMV disease. The data for 11 of the 12 patients (92%) with gastrointestinal CMV disease were located in the left upper quadrant of the 2-axis model. Cases yielding low CMV IGRA results and high CMV viral replication appear to be true CMV infections. Further studies with large number of cases in different types of CMV disease should be proposed.Keywords
Funding Information
- Korean Society of Internal Medicine
This publication has 19 references indexed in Scilit:
- State-of-the-Art Monitoring of Cytomegalovirus-Specific Cell-Mediated Immunity After Organ Transplant: A Primer for the ClinicianClinical Infectious Diseases, 2012
- Efficacy and safety of low-dose ganciclovir preemptive therapy in allogeneic haematopoietic stem cell transplant recipients compared with conventional-dose ganciclovir: a prospective observational studyJournal of Antimicrobial Chemotherapy, 2012
- Outcomes of non-HIV-infected patients with Pneumocystis pneumonia and concomitant pulmonary cytomegalovirus infectionScandinavian Journal of Infectious Diseases, 2012
- Diagnostic yield of the cytomegalovirus (CMV) antigenemia assay and clinical features in solid organ transplant recipients and hematopoietic stem cell transplant recipients with CMV pneumoniaTransplant Infectious Disease, 2012
- Paradoxical Rising Cytomegalovirus Antigenemia during Preemptive Ganciclovir Therapy in Hematopoietic Stem Cell Transplant Recipients: Incidence, Risk Factors, and Clinical OutcomesJournal of Clinical Microbiology, 2011
- Primary Cytomegalovirus Phosphoprotein 65–Specific CD8+ T-Cell Responses and T-bet Levels Predict Immune Control During Early Chronic Infection in Lung Transplant RecipientsThe Journal of Infectious Diseases, 2011
- Diagnostic Performance of the Cytomegalovirus (CMV) Antigenemia Assay in Patients with CMV Gastrointestinal DiseaseClinical Infectious Diseases, 2009
- Protection from cytomegalovirus after transplantation is correlated with immediate early 1–specific CD8 T cellsThe Journal of Experimental Medicine, 2005
- Cytomegalovirus in the Lungs of Patients with AIDS: Respiratory Pathogen or Passenger?American Review of Respiratory Disease, 1990
- Cytomegalovirus in the Bronchoalveolar Lavage Fluid of Patients with AIDSSocial psychiatry. Sozialpsychiatrie. Psychiatrie sociale, 1990