CMV-DNA detection in patients with thrombocytopenia

Abstract

The production of platelet autoantibodies may have an idiopathic pathogenesis or may occur in conjunction with other autoimmune diseases, cancer, the use of certain drugs 1 or infections such as human immunodeficiency virus (HIV) and cytomegalovirus (CMV), resulting in secondary autoimmune thrombocytopenia. 1,2 Recently, we reported an unusual case of severe thrombocytopenia associated with CMV infection in a healthy person whose response to treatment with ganciclovir was followed by an improvement in the platelet count. 3 Based on this finding, we have assessed the prevalence and possible clinical implications of CMV-DNA positive patients with thrombocytopenia attended at a university teaching hospital. From June 1996 to January 1997 we studied 84 patients with chronic thrombocytopenia (63 females and 21 males). The median age of these individuals was 37.4 years (range: 3 to 82 years) and the median follow-up was 25 months (range: 2 to 140 months). Idiopathic thrombocytopenia purpura (ITP) was diagnosed in 61 out of the 84 patients (73%). In the remaining 23 patients, the cause of thrombocytopenia was a systemic autoimmune disease in 15 cases, drug consumption in four cases, related to HIV infection in two cases, and cancer in two cases. All patients were screened for the presence of CMV-DNA. Genomic DNA was extracted from peripheral blood and the CMV-DNA was amplified by nested polymerase chain reaction (PCR) using the primers described by Demmler et al. 4 Amplification of the b-globin gene was used as an internal control. CMV-DNA was detected in two out of the 84 patients. In both of these patients, there was a concomitant HIV infection. Thrombocytopenia is a common hematological complication which affects almost half of HIV-infected patients. 5 In one of the two CMV-positive patients with HIV, the platelet count returned to normal only after specific antiviral therapy with ganciclovir. The improvement in the platelet count only after treatment with ganciclovir suggests that the CMV infection was probably the cause of this thrombocytopenia. The demonstration of CMV-DNA by nested-PCR is very useful in this situation because of the difficulty in detecting CMV-IgM antibody in immunosuppressed patients, particularly those with acquired immune deficiency syndrome (Aids). 6 The absence of CMV-DNA in the other patients confirmed the rarity of thrombocytopenia occurrence caused by CMV infection among non-immunosuppressed

Cytomegalovirus Has No Impact on Immune Thrombocytopenia Bleeding Scale or Prognostic Outcomes in Egyptian Pediatric Immune Thrombocytopenia

“…15 CMV-DNA detection by PCR is very useful in immunosuppressed patients when detection of CMV-IgG antibody is difficult. 34 Hence, DiMaggio et al suggested that CMV screening using PCR should be routinely requested for those patients on immunosuppressive therapy, if they develop refractory thrombocytopenia. In this study, the specificity and sensitivity of serological assay were 72.4, and 20.7%, respectively in comparison to PCR assay with a negative predictive value of 25.8%, and a positive predictive value of 66.7% (►Table 6).…”

Clinical characteristics and treatment courses for cytomegalovirus-associated thrombocytopenia in immunocompetent children after neonatal period

“…Thus, it is a good diagnostic tool for early diagnosis of CMV infection for initiating timely treatment [ 29 ]. Recent studies, including the present study, are using CMV PCR to confirm CMV infection [ 6 7 13 ].…”

“…Several cases of thrombocytopenia caused by CMV infection in immunocompetent adults or children have been reported [ 4 5 6 7 8 10 11 12 13 14 ]. Further, the importance of studying and understanding CMV infection in immunocompetent children is being emphasized because some of them can result in hepatitis, anemia, thrombocytopenia, neurodevelopmental problems, hearing loss, or growth retardation [ 10 15 ].…”