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Title: | Incidental mucocutaneous cytomegalovirus detection and its predictive value for systemic disease. | Authors: | Hughes C.M.;Dendle C. ;Radalage R.;Spring S. ;Graham M. ;Rogers B.A. | Monash Health Department(s): | Infectious Diseases and Clinical Microbiology Pathology Infectious Diseases and Clinical Microbiology |
Institution: | (Hughes, Spring, Radalage, Graham, Dendle, Rogers) Monash Infectious Diseases, Monash Medical Centre, Monash Health, Clayton, Victoria, Australia (Hughes, Graham) Department of Microbiology, Monash Pathology, Monash Health, Clayton, Victoria, Australia (Dendle, Rogers) Centre for Inflammatory Diseases, Monash University, Melbourne, Victoria, Australia | Issue Date: | 26-May-2020 | Copyright year: | 2020 | Publisher: | Elsevier B.V. | Place of publication: | United States | Publication information: | Pathology. 52 (4) (pp 478-482), 2020. Date of Publication: June 2020. | Journal: | Pathology | Abstract: | Multiplex polymerase chain reaction (PCR) testing has revolutionised microbiological practice but also increased the number of positive results of uncertain significance. This phenomenon has been seen in the increasing detection of cytomegalovirus (CMV) in mucocutaneous swabs for herpesviruses, the microbiological significance of which is a priori unclear. The aim of our study was to determine if an incidental finding of a positive CMV result represented CMV disease, if it facilitated a timely diagnosis of CMV disease or whether there were any deleterious outcomes. We performed a retrospective review of patients with an incidentally positive PCR result for CMV on external and mucosal swabs, including medical comorbidities and presence of immunosuppression, subsequent investigations, whether a diagnosis of CMV disease was made, and treatment. CMV detection was infrequent, detected in 158 (3.4%) of 4626 herpes multiplex PCR tests performed. The majority (60.4%) of patients were immunocompromised, and amongst these patients a positive swab represented a new diagnosis or already known CMV disease in 14%. In seven patients (5%), all of whom were immunocompromised, the positive CMV PCR on a swab led to further investigation and subsequent diagnosis and treatment of CMV disease. Whilst not recommended for diagnosis of CMV disease, if CMV is detected on a mucocutaneous swab in an immunocompromised patient, further assessment and investigation for CMV disease should be undertaken.Copyright © 2020 Royal College of Pathologists of Australasia | DOI: | http://monash.idm.oclc.org/login?url=http://dx.doi.org/10.1016/j.pathol.2020.02.009 | PubMed URL: | 32354659 [http://www.ncbi.nlm.nih.gov/pubmed/?term=32354659] | ISSN: | 0031-3025 | URI: | https://repository.monashhealth.org/monashhealthjspui/handle/1/29260 | Type: | Article | Subjects: | aged article bullous pemphigoid/dt [Drug Therapy] cancer combination chemotherapy child comorbidity controlled study *Cytomegalovirus *cytomegalovirus infection/di [Diagnosis] *cytomegalovirus infection/dt [Drug Therapy] *cytomegalovirus infection/th [Therapy] diagnostic test accuracy study diffuse large B cell lymphoma/dt [Drug Therapy] female human immunocompromised patient immunosuppressive treatment incidental finding infant liver failure/dt [Drug Therapy] liver failure/su [Surgery] liver transplantation lupus erythematosus nephritis/dt [Drug Therapy] major clinical study male medical record review middle aged mouth ulcer *mucus multiplex polymerase chain reaction newborn outcome assessment palliative therapy pathologist pemphigus vulgaris/dt [Drug Therapy] predictive value preschool child priority journal retrospective study rheumatoid arthritis/dt [Drug Therapy] school child prednisolone/dt [Drug Therapy] valganciclovir/dt [Drug Therapy] polymerase chain reaction system *mucosal swab 2012-15 AusDiagnostics Easy-Plex 12-well assay 2015-16 AusDiagnostics High-Plex Herpes, Enterovirus and Adenovirus 16-well assay antiviral therapy skin biopsy skin injury *smear statistically significant result *systemic disease T cell lymphoma/dt [Drug Therapy] very elderly virus detection young adult azathioprine/dt [Drug Therapy] mycophenolic acid/dt [Drug Therapy] cyclophosphamide plus doxorubicin plus etoposide plus prednisolone plus rituximab plus vincristine/dt [Drug Therapy] cyclophosphamide plus doxorubicin plus prednisolone plus rituximab plus vincristine/dt [Drug Therapy] ganciclovir/dt [Drug Therapy] ganciclovir/iv [Intravenous Drug Administration] methotrexate/dt [Drug Therapy] adolescent adult aged bullous pemphigoid cancer combination chemotherapy Cytomegalovirus cytomegalovirus infection diagnostic test accuracy study diffuse large B cell lymphoma immunocompromised patient immunosuppressive treatment incidental finding infant liver failure liver failure [Surgery] liver transplantation lupus erythematosus nephritis medical record mouth ulcer mucus multiplex polymerase chain reaction newborn palliative therapy pathologist pemphigus vulgaris rheumatoid arthritis school child prednisolone valganciclovir polymerase chain reaction system mucosal swab 2012-15 AusDiagnostics Easy-Plex 12-well assay 2015-16 AusDiagnostics High-Plex Herpes, Enterovirus and Adenovirus 16-well assay antiviral therapy skin biopsy skin injury smear statistically significant result systemic disease T cell lymphoma very elderly virus detection azathioprine mycophenolic acid cyclophosphamide plus doxorubicin plus etoposide plus prednisolone plus rituximab plus vincristine cyclophosphamide plus doxorubicin plus prednisolone plus rituximab plus vincristine ganciclovir methotrexate diagnostic test accuracy study diffuse large B cell lymphoma / drug therapy female human immunocompromised patient immunosuppressive treatment incidental finding infant liver failure / drug therapy / surgery liver transplantation lupus erythematosus nephritis / drug therapy major clinical study male medical record review middle aged mouth ulcer *mucus multiplex polymerase chain reaction newborn outcome assessment palliative therapy pathologist pemphigus vulgaris / drug therapy predictive value preschool child priority journal retrospective study rheumatoid arthritis / drug therapy school child skin biopsy aged *smear statistically significant result *systemic disease T cell lymphoma / drug therapy very elderly virus detection young adult adult adolescent skin injury antiviral therapy Article bullous pemphigoid / drug therapy cancer combination chemotherapy child comorbidity controlled study *Cytomegalovirus *cytomegalovirus infection / *diagnosis / *drug therapy / *therapy |
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