Diagnosis of human cytomegalovirus infection of the nervous system by pp65 detection in polymorphonuclear leukocytes of cerebrospinal fluid from AIDS patients.

Detection of human cytomegalovirus (HCMV) pp65 in cerebrospinal fluid (CSF) polymorphonuclear leukocytes (PMNL) was investigated in 32 CSF samples from 25 AIDS patients with neurologic symptoms. HCMV pp65-positive PMNL were detected in 9 CSF samples from 3 patients with polyradiculoneuropathy (frequency, 1.2%-20.8%) and 1 with encephalitis (frequency, 56%). pp65-positive PMNL appeared hypersegmented compared with peripheral blood PMNL. HCMV was isolated from 3 CSF samples from 2 patients with polyradiculoneuropathy. Retrospective quantitation of viral DNA by polymerase chain reaction (PCR) was in agreement with pp65 detection in 27 of 28 samples tested (96.4% concordance). Specificity and sensitivity of pp65 assay versus PCR were 100% (17/17 negative samples) and 90.9% (10/11 positive samples), respectively. Examination of CSF for presence of pp65-positive PMNL appears to be a sensitive and specific test for diagnosis of HCMV infections of the nervous system.