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Questions and Answers
What method is primarily used for monitoring treatment response in CMV infections?
What method is primarily used for monitoring treatment response in CMV infections?
Which type of antibodies indicates recent or ongoing CMV infection?
Which type of antibodies indicates recent or ongoing CMV infection?
Which drug is considered the drug of choice for treating severe CMV infections?
Which drug is considered the drug of choice for treating severe CMV infections?
What laboratory technique detects CMV-specific antigens in peripheral blood leukocytes?
What laboratory technique detects CMV-specific antigens in peripheral blood leukocytes?
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For what purpose is CMV immunoglobulin administered with ganciclovir?
For what purpose is CMV immunoglobulin administered with ganciclovir?
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What type of inclusions does CMV produce in urine?
What type of inclusions does CMV produce in urine?
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Which of the following methods is most effective for virus isolation in a laboratory setting?
Which of the following methods is most effective for virus isolation in a laboratory setting?
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Which of the following is true about IgG antibodies in relation to CMV?
Which of the following is true about IgG antibodies in relation to CMV?
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What is the most likely provisional diagnosis for the 38-year-old pregnant woman experiencing fatigue, pallor, and atrophic changes of the tongue?
What is the most likely provisional diagnosis for the 38-year-old pregnant woman experiencing fatigue, pallor, and atrophic changes of the tongue?
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What peripheral smear finding is most indicative of iron-deficiency anemia?
What peripheral smear finding is most indicative of iron-deficiency anemia?
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What is one of the beneficial effects of acute inflammation?
What is one of the beneficial effects of acute inflammation?
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In acute inflammation, which of the following cellular events is primarily responsible for phagocytosis of pathogens?
In acute inflammation, which of the following cellular events is primarily responsible for phagocytosis of pathogens?
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Which stain would be most useful to demonstrate hemosiderin in hepatocytes during an autopsy?
Which stain would be most useful to demonstrate hemosiderin in hepatocytes during an autopsy?
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Which form of immunity is primarily responsible for dealing with tuberculosis infection given the patient's symptoms?
Which form of immunity is primarily responsible for dealing with tuberculosis infection given the patient's symptoms?
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What complication is the pregnant woman with deep, boring thigh pain at risk for?
What complication is the pregnant woman with deep, boring thigh pain at risk for?
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What karyotype is most likely associated with a nineteen year old female presenting with short stature, wide spread nipples, and primary amenorrhea?
What karyotype is most likely associated with a nineteen year old female presenting with short stature, wide spread nipples, and primary amenorrhea?
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Which histological appearance is characteristic of necrosis?
Which histological appearance is characteristic of necrosis?
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Which type of tumor is most likely indicated by cytoplasmic positivity for cytokeratin in an undifferentiated malignant tumor?
Which type of tumor is most likely indicated by cytoplasmic positivity for cytokeratin in an undifferentiated malignant tumor?
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What is the assertion regarding the relationship of bcl2 overexpression and cellular proliferation?
What is the assertion regarding the relationship of bcl2 overexpression and cellular proliferation?
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Which assertion about metaplasia and its association with cancer risk is accurate?
Which assertion about metaplasia and its association with cancer risk is accurate?
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Which of the following correctly matches amyloidosis with its associated condition?
Which of the following correctly matches amyloidosis with its associated condition?
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In which condition is arterial thrombosis most likely to occur?
In which condition is arterial thrombosis most likely to occur?
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Which of the following statements about Klinefelter's syndrome is true?
Which of the following statements about Klinefelter's syndrome is true?
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What contributes to enhanced cancer cell survival?
What contributes to enhanced cancer cell survival?
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Study Notes
Cytomegalovirus (CMV) Infections
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Laboratory Diagnosis:
- Cytopathology detects inclusion bodies (owl's eye appearance)
- Virus isolation from throat washings and urine using human fibroblasts
- Antibody detection: ELISA detects CMV IgM (recent infection) and IgG (past/current infection). IgG avidity testing distinguishes recent from past.
- Antigen detection: Immunofluorescence using monoclonal antibodies, less preferred for its time-consuming and technical demands.
- Molecular methods: PCR/real-time PCR for CMV DNA (UL54, UL55, UL83) in body fluids/blood. Quantitative nucleic acid testing (QNAT) is the preferred method for monitoring treatment response.
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Detection of Inclusion Bodies:
- In urine, CMV produces characteristic perinuclear cytoplasmic inclusions
- Also intranuclear inclusions (similar to other herpesviruses)
- (Fig. 79.1) illustrated
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Virus Isolation:
- Human fibroblasts are the ideal cell lines for CMV isolation
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Cytopathic Effect (CPE):
- After 2-3 weeks of incubation, typical inclusions and multinucleated giant cells may be observed
- Infected cells enlarge
- Shell vial technique for early growth detection (1-2 days)
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Antibody Detection:
- ELISA detects antibodies to various antigens, including matrix phosphoproteins (pp150, pp65), glycoproteins (gB, gH), and DNA-binding protein (pp52).
Prophylaxis and Treatment
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Treatment: Ganciclovir is the drug of choice for CMV infections (cytomegalic inclusion disease, severe, or neonatal CMV infections such as retinitis or transplant infections). Other alternatives are Valganciclovir, foscarnet, and cidofovir.
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Treatment using CMV immunoglobulin: given along with treatments like ganciclovir to treat CMV infections in bone marrow transplant recipients.
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Prophylaxis:
- Ganciclovir and Valganciclovir effectively prevent CMV infection in transplant recipients
- CMV immunoglobulin can prevent congenital CMV infection if administered to the mother during pregnancy
Neonatal Herpes
- Rare; estimated 10 cases per 100,000 births. Causes significant neurological disability or death.
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Transmission:
- Most commonly during birth from the mother’s genital tract
- Transmission can occur in utero or after birth
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Risk and Severity:
- More likely to cause neonatal herpes if the mother recently acquired the virus (primary infection) – ~10 times higher risk than recurrent infection.
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Forms:
- Neonatal herpes
- Congenital herpes
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Causative Virus:
- HSV-2 (more frequent than HSV-1 in neonatal herpes – accounts for 50-70% of total cases)
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Description
Explore laboratory diagnosis methods for Cytomegalovirus (CMV) infections, including cytopathology, virus isolation, and antibody detection techniques. Understand the significance of inclusion bodies and the molecular methods used for accurate diagnosis and treatment monitoring.
