Cytomegalovirus - CSF Diagnosis

11/14/2005

Question:  What is the accuracy of CSF diagnosis of cytomegalovirus infections?

Ovid recovery search string (copy and paste into Ovid search entry panel)

-------------------------------------

8602619.ui or 8261075.ui or 8399884.ui or 8380909.ui or 1357442.ui or 1660706.ui or 1656691.ui or 2173744.ui or 2984601.ui or 182099.ui

-------------------------------------------------------

PubMed recovery search string (copy and paste into PubMed search entry panel)

-------------------------------------

8602619[PMID] OR 8261075[PMID] OR 8399884[PMID] OR 8380909[PMID] OR 1357442[PMID] OR 1660706[PMID] OR 1656691[PMID] OR 2173744[PMID] OR 2984601[PMID] OR 182099.ui

-------------------------------------------------------

<1>

Unique Identifier [PMID]: 8602619

Authors: Granter SR. Doolittle MH. Renshaw AA.

Institution: Department of Pathology and Division of Cytology, Brigham and Women's Hospital, Boston, Massachusetts, USA.

Title: Predominance of neutrophils in the cerebrospinal fluid of AIDS patients with cytomegalovirus radiculopathy.

Source: American Journal of Clinical Pathology. 105(3):364-6, 1996 Mar.

Abstract: Cytomegalovirus (CMV) radiculopathy has been associated with both viral cytopathic inclusions and an increased number of neutrophils in the cerebrospinal fluid (CSF) of patients with AIDS. The significance of these findings is unknown. To evaluate this, the authors reviewed all CSF cytology specimens from patients with a history AIDS or HIV infection over a 9-year period. Of 193 specimens identified, 42 (22%) had neutrophils present. Neutrophils were rare (<6 per slide) in the majority of specimens (57%). Occasional neutrophils (<2/hpf) were observed in three patients; one with suspected CMV myelitis, one with bacterial meningitis, and one with cryptococcal meningitis. All 6 cases (3 patients) with numerous neutrophils (>10/hpf) had positive CMV CSF cultures and symptoms of radiculopathy. Definite viral inclusions were not seen. The prognosis was poor in all cases. The authors conclude that diagnostic CMV inclusions are quite rare. However, the presence of elevated numbers of neutrophils in the CSF of a patient with AIDS without an identified infectious agent is highly suggestive of CMV radiculopathy.

Publication Type: Journal Article.

<2>

Unique Identifier [PMID]: 8261075

Authors: Stark E. Haas J. Schedel I.

Institution: Neurological Clinic, Hannover Medical School, Germany.

Title: Diagnosis of cytomegalovirus infections of the nervous system by immunocytochemical demonstration of infected cells in cerebrospinal fluid.

Source: European Journal of Medicine. 2(4):223-6, 1993 Apr.

Abstract: OBJECTIVES: Infections caused by the cytomegalovirus (CMV) are frequent complications in patients with the acquired immunodeficiency syndrome. Diagnosis of CMV infections of the nervous system is still difficult. METHODS: We evaluated immunocytochemical staining for a CMV early antigen in cells prepared from the cerebrospinal fluid of patients with clinical evidence for neural CMV infections and from controls. RESULTS: CMV positive cells were found in four samples of patients with clinical evidence of CMV infection. Three of these patients were suffering from myeloradicalitis, one had a severe brain stem encephalitis. No CMV positive were found in controls. CONCLUSIONS: Immunocytochemical staining of CSF cells may be helpful in the diagnosis of CMV infection of the central nervous system and of the nerve roots.

Publication Type: Case Reports. Journal Article.

<3>

Unique Identifier [PMID]: 8399884

Authors: Singh N. Anderegg KA. Yu VL.

Title: Significance of hypoglycorrhachia in patients with AIDS and cytomegalovirus meningoencephalitis.

Source: Clinical Infectious Diseases. 17(2):283-4, 1993 Aug.

Publication Type: Case Reports. Letter.

<4>

Unique Identifier [PMID]: 8380909

Authors: Clifford DB. Buller RS. Mohammed S. Robison L. Storch GA.

Institution: Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110.

Title: Use of polymerase chain reaction to demonstrate cytomegalovirus DNA in CSF of patients with human immunodeficiency virus infection.

Source: Neurology. 43(1):75-9, 1993 Jan.

Abstract: We used the polymerase chain reaction (PCR) to demonstrate cytomegalovirus (CMV) DNA in the CSF of a patient with the CMV radiculomyelopathy syndrome. To investigate the significance of this finding, we also performed PCR for CMV on CSF samples from 30 patients with human immunodeficiency virus (HIV) infection and neurologic disease, four patients with solid organ transplants including three with active CMV infection, and 10 patients with no clinical suspicion of HIV or CMV infection. There was CMV DNA only in patients with HIV, and it was present more often in patients with evidence of spinal cord dysfunction. Our results suggest that PCR may be useful in the rapid diagnosis of CMV infection of the CNS in patients with HIV and that the radiculomyelopathy syndrome may represent only part of a spectrum of CMV-induced spinal cord dysfunction in these patients.

Publication Type: Case Reports. Journal Article.

<5>

Unique Identifier [PMID]: 1357442

Authors: Studahl M. Ricksten A. Sandberg T. Bergstrom T. Elowson S.

Title: Cytomegalovirus encephalitis in four immunocompetent patients.

Source: Lancet. 340(8826):1045-6, 1992 Oct 24.

Publication Type: Letter.

<6>

Unique Identifier [PMID]: 1660706

Authors: Marmaduke DP. Brandt JT. Theil KS.

Institution: Department of Pathology, Ohio State University, Columbus.

Title: Rapid diagnosis of cytomegalovirus in the cerebrospinal fluid of a patient with AIDS-associated polyradiculopathy.

Source: Archives of Pathology & Laboratory Medicine. 115(11):1154-7, 1991 Nov.

Abstract: Polyradiculopathy is an uncommon but serious neurologic disorder that can complicate the course of the acquired immunodeficiency syndrome. We report a case in which the presence of cytomegalovirus was detected in cerebrospinal fluid by immunoperoxidase staining. In addition, large atypical cells with flocculogranular cytoplasmic inclusions were present. These cells were found to be positive for cytomegalovirus by immunoperoxidase staining. Rapid diagnosis by this method permitted early intervention with ganciclovir.

Publication Type: Case Reports. Journal Article.

<7>

Unique Identifier [PMID]: 1656691

Authors: Pantoni L. Inzitari D. Colao MG. De Mayo E. Marini P. Mazzota F.

Institution: Department of Neurological and Psychiatric Sciences, University of Florence, Italy.

Title: Cytomegalovirus encephalitis in a non-immunocompromised patient: CSF diagnosis by in situ hybridization cells.

Source: Acta Neurologica Scandinavica. 84(1):56-8, 1991 Jul.

Abstract: Cytomegalovirus (CMV) encephalitis in immunologically normal patients is rarely reported in the literature. CMV infection was diagnosed by viral DNA probe techniques on CSF cells in a 32-year-old, immunologically normal male presenting with a severe clinical picture due to encephalitis. Administration of ganciclovir was followed by an immediate improvement in the patient's condition. More sensitive techniques for CMV detection could allow to discover more cases of CMV encephalitis in non-immunocompromised patients than previously recognized.

Publication Type: Case Reports. Journal Article.

<8>

Unique Identifier [PMID]: 2173744

Authors: de Gans J. Tiessens G. Portegies P. Tutuarima JA. Troost D.

Institution: Department of Neurology, Academisch Medisch Centrum Amsterdam, The Netherlands.

Title: Predominance of polymorphonuclear leukocytes in cerebrospinal fluid of AIDS patients with cytomegalovirus polyradiculomyelitis.

Source: Journal of Acquired Immune Deficiency Syndromes. 3(12):1155-8, 1990.

Abstract: Cytomegalovirus (CMV) polyradiculomyelitis was diagnosed in 4 of 241 consecutive neurologically assessed human immunodeficiency virus type (HIV-1) seropositive patients. CMV-related neurologic disease was suspected on clinical grounds and was subsequently confirmed by CMV culture from cerebrospinal fluid (CSF) and/or CMV in situ hybridization on specific specimens. All four patients showed CSF pleocytosis with predominance of polymorphonuclear leukocytes (PMNs). Retrospective analysis of the results of CSF examination, performed in 143 of 241 patients with neurologic symptoms, showed pleocytosis in 58 of 143 patients. Predominance of PMNs was found in seven patients, including the four with CMV polyradiculomyelitis. It is concluded that in HIV-1 seropositive patients with a clinical diagnosis of polyradiculomyelitis, a predominance of PMNs in CSF could be an indication that the condition is CMV related. This should lead to early diagnosis and institution of specific antiviral therapy.

Publication Type: Journal Article.

<9>

Unique Identifier [PMID]: 2984601

Authors: Edwards RH. Messing R. McKendall RR.

Title: Cytomegalovirus meningoencephalitis in a homosexual man with Kaposi's sarcoma: isolation of CMV from CSF cells.

Source: Neurology. 35(4):560-2, 1985 Apr.

Abstract: A 36-year-old homosexual man developed a lymphocytic meningoencephalitis, lymphadenopathy, decreased helper/suppressor ratio in peripheral blood, and Kaposi's sarcoma. After repetitive evaluations for bacterial and fungal agents were negative, viral cultures were positive for cytomegalovirus. Virus was isolated only from CSF cells obtained from a large volume of fresh CSF. We present this case to document the association of CMV meningoencephalitis and acquired immunodeficiency syndrome (AIDS), and to emphasize that aggressive attempts to isolate CMV from CSF cells may be warranted in undiagnosed meningoencephalitis in patients at risk for AIDS.

Publication Type: Case Reports. Journal Article.

<10>

Unique Identifier [PMID]: 182099

Authors: Kabins S. Keller R. Naragi S. Peitchel R.

Title: Viral ascending radiculomyelitis with severe hypoglycorrachia.

Source: Archives of Internal Medicine. 136(8):933-5, 1976 Aug.

Abstract: Ascending radiculomyelitis in a 52-year-old woman was accompanied by transient marked hypoglycorrachia and polymorphonuclear pleocytosis of the CSF. Examination of the CSF later in the course of illness revealed albuminocytologic dissociation. This unusual sequence of findings was associated with serologic evidence of a recent cytomegalovirus (CMV) infection. In addition, the illness was associated with a nonthrombocytopenic purpuric rash. We proposed that the rash and neurologic disease were consequences of vasculitis caused by CMV infection.

Publication Type: Case Reports. Journal Article.