Drew W L
Gerson Biskind Pathology Research Laboratory, Mount Zion Hospital, San Francisco, California 94120.
Rev Infect Dis. 1988 Jul-Aug;10 Suppl 3:S468-76. doi: 10.1093/clinids/10.supplement_3.s468.
Diagnostic procedures for documenting cytomegalovirus (CMV) infection include culture, cytology, serology, and the detection of CMV antigens and/or nucleic acids within infected tissues. Each procedure is useful, but each has specific pitfalls. A positive urine, blood, or genital culture confirms CMV infection but does not prove that CMV is causing a specific clinical syndrome, since excretion of virus may continue for months to years following primary infection and may reoccur when a patient is immunocompromised. Seroconversion from negative to positive for specific IgG antibody is usually diagnostic of primary infection but does not provide a rapid diagnosis. CMV-specific IgM antibody is associated with primary CMV infection in nonimmunocompromised patients but may be present in immunocompromised (e.g., AIDS) patients who are infected by but do not have disease due to CMV. Conversely, tests for IgM may be negative in immunocompromised patients or neonates who are actively infected and may be falsely positive in infants who are not congenitally infected. Lastly, detection of CMV antigen in tissue by monoclonal antibodies or of CMV nucleic acids by genetic probes helps confirm tissue infection. Demonstration of CMV inclusions by cytologic or histologic examination is diagnostic of infection, but this method is not sensitive.
记录巨细胞病毒（CMV）感染的诊断程序包括培养、细胞学检查、血清学检查以及在受感染组织中检测CMV抗原和/或核酸。每种程序都有用，但每种都有特定的缺陷。尿、血或生殖器培养呈阳性可确诊CMV感染，但不能证明CMV正在引起特定的临床综合征，因为初次感染后病毒排泄可能持续数月至数年，且在患者免疫功能低下时可能再次出现。特定IgG抗体从阴性转为阳性通常可诊断为初次感染，但不能提供快速诊断。CMV特异性IgM抗体与非免疫功能低下患者的原发性CMV感染有关，但在因CMV感染但未患病的免疫功能低下（如艾滋病）患者中也可能存在。相反，在积极感染的免疫功能低下患者或新生儿中，IgM检测可能为阴性，而在非先天性感染的婴儿中可能出现假阳性。最后，通过单克隆抗体检测组织中的CMV抗原或通过基因探针检测CMV核酸有助于确认组织感染。通过细胞学或组织学检查显示CMV包涵体可诊断感染，但该方法不敏感。
