Improved detection of cytomegalovirus viremia in AIDS patients using shell vial and indirect immunoperoxidase methodologies

One hundred twelve peripheral blood specimens were tested for the presence of cytomegalovirus (CMV) by the tube culture indirect immunoperoxidase (TC‐IPA) procedure, the shell vial assay [shell vials were pre‐ and postinoculation treated with medium containing 2 of 10% fetal bovine serum (FBS) or 100 μg% cortisol] (SV‐IFA), and conventional (MRC‐5) tube cultures (TC‐CPE). CMV was detected in 25 (22%) of the 11 2 specimens tested by at least one of these methods. The detection/isolation of CMV among the 25 positive specimens in shell vials maintained with 2% FBS, 100 μg% cortisol + 2% FBS, and 10% FBS was 36,44, and 52%, respectively. Detection/ isolation of the virus from blood by TC‐IPA and TC‐CPE was 52% and 76%, respectively. A significantly greater CMV detection rate occurred using TC‐CPE compared to SV‐IFA treated with medium supplemented with an FBS concentration of 2% ( P = .01321, but not medium containing the higher serum supplement or the glucocorticoid ( P > .05). Differences in the identification of a CMV viremia were observed by IPA, SV‐IFA, and TC‐CPE methodologies on a patient‐to‐patient basis, denoting the necessity of incorporating each methodology into the CMV screening panel. Demographic analysis of 82 AIDS patients showed a CMV viremia prevalence of 9% (2128) in intravenous drug users, 57% (27/47) in homosexual patients, and 22% (2/9) in heterosexual and transfusion patients, Overnight (24 hr) storage of whole blood at 4 or 24°C, respectively, reduced CMV recovery by 40% and 6570, when tested by TC‐CPE. Improved culture‐based detectioniisolation of CMV in peripheral blood is contingent upon prompt specimen processing, and the utilization of combined SV‐IFA, TC‐IPA, and TC‐CPE methods. © 1992 Wiley‐Liss, Inc.