Department of Immunology and Molecular Biology, Makerere University College of Health Sciences, Kampala, Uganda.
National Tuberculosis Reference Laboratory/WHO Supranational Reference Laboratory, Kampala, Uganda.
Microbiol Spectr. 2024 Nov 5;12(11):e0048124. doi: 10.1128/spectrum.00481-24. Epub 2024 Sep 19.
Hematological cancers, including Leukemias and Lymphomas, and their associated chemotherapy and disease-specific factors, are linked to impaired granulocyte function and numbers, increasing the risk of opportunistic infections, often presenting as fever. Human cytomegalovirus (HCMV) is one of the significant opportunistic infections in these patients, but limited data exists on its seroprevalence and active infection burden among febrile hematological cancer patients in Uganda. We conducted a cross-sectional study from June to August 2017 at the Uganda Cancer Institute (UCI). Blood samples from 161 febrile hematological cancer patients were collected. HCMV exposure was assessed using indirect enzyme-linked immunosorbent assay for IgG and IgM antibodies, and active infection was confirmed with PCR testing and gel electrophoresis. IgG positivity indicated previous exposure, while positive IgM or PCR results indicated active infection. Overall, HCMV seroprevalence based on IgG and/or IgM positivity was 106/161 (66%). IgG alone, IgM alone, and combined IgG/IgM positivity prevalence rates were 57/161 (35.4%), 22/161 (13.6%), and 27/161 (16.7%), respectively. HCMV DNA PCR was positive in 5 of the 161 (3%) samples. Among PCR-positive patients, one (20%) was positive for IgG alone, two (40%) for IgM alone, and two (40%) for both IgG and IgM. Active infection based on positive IgM and HCMV DNA PCR was found in 23 of the 161 (14.3%) patients. Two-thirds of febrile patients with hematological malignancies in Uganda had been exposed to HCMV infection, with 14.3% showing active infection. Routine testing for active HCMV infection among febrile hematological cancer patients at the UCI is essential for timely and appropriate antiviral treatment.
In this paper, we demonstrated that over two-thirds of feverish patients with blood cancers such as leukemia at the Uganda Cancer Institute are already exposed to a type of virus infection called the human cytomegalovirus (HCMV), and 14% of the patients have active disease due to this virus. This was confirmed through finding blood samples testing positive for a type of protective antibody called IgM and also upon virus DNA detection in the blood of those patients. Routine testing for this virus is not usually done in the study settings. Our findings reveal and emphasize the importance of routinely testing blood samples for active infection with this virus among the feverish patients with blood cancers in the study settings, and prompt initiation of antiviral treatment of the actively infected patients.
本研究旨在乌干达癌症研究所（UCI）的发热血液癌症患者中，评估人类巨细胞病毒（HCMV）的血清流行率和活动性感染负担。
我们于 2017 年 6 月至 8 月在 UCI 进行了一项横断面研究，共纳入 161 例发热血液癌症患者。采集血样，通过间接酶联免疫吸附试验（ELISA）检测 IgG 和 IgM 抗体，采用 PCR 检测和凝胶电泳法确认 HCMV 活动性感染。IgG 阳性表示既往暴露，而 IgM 阳性或 PCR 阳性表示活动性感染。
161 例患者中，106 例（66%）HCMV 血清学 IgG 和/或 IgM 阳性。单纯 IgG 阳性、单纯 IgM 阳性和 IgG/IgM 联合阳性的发生率分别为 57/161（35.4%）、22/161（13.6%）和 27/161（16.7%）。HCMV DNA PCR 阳性 5 例（3%）。PCR 阳性患者中，单纯 IgG 阳性 1 例（20%），单纯 IgM 阳性 2 例（40%），IgG/IgM 联合阳性 2 例（40%）。161 例患者中，23 例（14.3%）存在活动性 HCMV 感染，其中 16 例（69.6%）为 IgM 阳性，7 例（30.4%）为 HCMV DNA PCR 阳性。
乌干达 UCI 发热血液恶性肿瘤患者中，超过 2/3 已感染 HCMV，14.3%存在活动性感染。因此，在 UCI 发热血液恶性肿瘤患者中，常规检测 HCMV 活动性感染至关重要，以便及时进行适当的抗病毒治疗。
