Results Chapter on CMV Infection Research

Results Chapter on cytomegalovirus Infection ResearchResultsThis study has been conducted on 366 patients with suspected CMV infection attending pediatric department at Zagazig University Hospital.Table (1) Age distribution of the examine patients (except for neonates with congenital anomalies) (N=344) Studied patients (N=344) nary(prenominal)%Age (years)Mean SD9.9 3.4Median (Range)10.0 (3.5 18.0)The mean age and standard deviation (SD) of ages of the studied patients (except for neonates with congenital anomalies) in years as shown in table (1) was 9.9 3.4.Table (2) Age distribution of neonates with congenital anomalies (N=22)Studied patients (N=22) none%Age of neonates with congenital anomalies theme (days)Mean SDMedian (Range)4.1 1.64.0 (2.0 7.0)Table (2) shows that The mean age and standard deviation (SD) of ages ofneonates with congenital anomalies were 4.1 1.6 daysTable (3) Sex distribution of the studied patients (N=366)Studied patients (N=366)No.%SexMale20255.2%Fem ale16444.8%Table(3) shows that 55.2% (202 out of 366) of the studied patients were males, while 44.8% were females.Figure (1) Pie diagram showing sex distribution of the studied patients (N=366)Table (4) Distribution of the luck factors among the studied patients (N=366)Risk factorsStudied patients (N=366)No.%Malignant hematological affection with chem some otherapy4311.7 %Receiving restate short letter transfusion16444.8 % febricity of unknown origin164.4 %Critically ill patients lying in the ICUs with prolonged hospitalisation287.7 %Receiving corticosteroids or other immunosuppressors for long period226 % degenerative renal failure with haemodialysis6417.5 %Fever with pancytopenia71.9 %Neonates with congenital anomalies226 %As shown in table (4) and figure (2),44.8% of the studied patients were receiving iterate blood transfusion, 17.5% were suffering from chronic renal failure and receiving haemodialysis, 11.7% were suffering from Malignant hematological indisposition and receiving chemotherapy, 7.7% were critically ill patients lying in the ICUs with prolonged hospitalization, 6% were receiving immunosuppressive agents for long period, 6% were neonates with congenital anomalies, 4.4% had fever of unknown origin, and 1.9% suffered from fever with pancytopenia.Figure (2) Pie diagram showing Distribution of the risk factors in the studied patients (N=366).Table (5) Results of enzyme-linked-immunosorbent serologic assay immunoglobulin M and immunoglobulin G for CMV in the enrolled patients (N=366)enzyme-linked-immunosorbent serologic assay resultsStudied patients (N=366)immunoglobulin M constructive6016.4 % invalidating30683.6 %IgG confident(p)9325.4 %Negative27374.6 % all over all seropositivityPositive both IgM and IgG10929.8 %As shown in table (5), out of the 366 studied patients, 60 (16.4%) and 93 (25.4%) were positive for CMV IgM and IgG in an enzyme-linked-immunosorbent serologic assay test respectively.Table (6) Agreement amongst enzyme-linked-i mmunosorbent serologic assay IgM and IgG in the studied patients (N=366)ELISA IgMELISA IgGTotal rivuletP-valueNegativePositiveNegativeNo.257493060.4690.000*(HS)% 94.1 %52.7 %83.6 %PositiveNo.164460% 5.9 %47.3 %16.4 %TotalNo.27393366% 100.0 %100.0 %100.0 % Kappa tax of commensuratenessP 0.05 is significant.Statistical SignificanceStandards for strength of concord for the kappa coefficient0=poor,.01-.20=slight,.21-.40=fair,.41-.60=moderate,.61-.80=substantial, and.81-1=almost perfect.Table 6 shows that in that location is a moderate harmony between ELISA IgM and IgG in the detection of CMV in qildren with high statistical significance.Table (7) Prevalence of CMV IgM seropositivity among opposite risk groupsRisk FactorsNo.Studied patients (N=366)Positive IgMNo.%Malignant hematological affection with chemotherapy(43)818.6 %Receiving repeated blood transfusion(164)3621.9 %Fever of unknown origin(16)850 %Critically ill patients lying in the ICUs with prolonged hospitalization(28)00 %Receiving corticosteroids or other immunosuppressives for long period(22)00 %Chronic renal failure with haemodialysis(64)812.5 %Fever with pancytopenia(7)00 %Neonates with congenital anomalies(22)00 %Table (7) and figure (3) show that the highest prevalence (50%) of CMV IgM seropositivity was reported from patients suffering from fever of unknown origin.Figure (3) Bar chart showing prevalence of CMV IgM seropositivity among different risk groupsTable (8) Association between CMV IgM seropositivity and different risk factorsRisk factorsNo.Studied patients (N=366) stressp-valueELISA IgMPositive (N=60)Negative(N=306)No.%No.%Malignant hematological disease with chemotherapy(43)818.6 %3581.4%11.170.010(S)Receiving repeated blood transfusion(164)3621.9 %12878%Fever of unknown origin(16)850 %850%Chronic renal failure with haemodialysis(64)812.5 %5687.5% chi square testP 0.05 is significant.*statistical SignificanceTable (9) Prevalence of CMV IgG seropositivity among different risk groups Risk factorsNo.Studied patients (N=366)Positive IgGNo.%Malignant hematological disease with chemotherapy(43)00 %Receiving repeated blood transfusion(164)6338.4 %Fever of unknown origin(16)00 %Critically ill patients lying in the ICUs with prolonged hospitalization(28)00 %Receiving corticosteroids or other immunosuppressives for long period(22)00 %Chronic renal failure with haemodialysis(64)812.5 %Fever with pancytopenia(7)00 %Neonates with congenital anomalies(22)22100 %Table (9) and figure (4) show that the highest prevalence (100%) of CMV IgG seropositivity was reported from neonates with congenital anomalies.Figure (4) Bar chart showing prevalence of CMV IgG seropositivity among different risk groups.Table (10) Association between CMV IgG seropositivity and different risk factorsRisk factorsNo.Studied patients (N=366)Testp-valueELISA IgGPositive (N=93)Negative (N=273)No.%No.%Receiving repeated blood transfusion(164)6338.4%10161.6%53.960.000*(HS)Chronic renal failure with haemod ialysis(64)812.5%5687.5%Neonates with congenital anomalies(22)22100%00% chi square testP 0.05 is significant.*highly statistical SignificanceTable (11) Results of accredited time PCR for CMV in the enrolled patients (N=366)Real time PCRStudied patients (N=366)Positive369.8%Negative33090.2%Table (11) shows that 9.8% (36 out of 366) of the studied patients were positive for CMV in real time PCR test.Table (12) Results of nested PCR for CMV in the enrolled patients (N=366)Nested PCRStudied patients (N=366)Positive297.9%Negative33792.1%Table (12) shows that 7.9% (29 out of 366) of the studied patients were positive for CMV in nested PCR test.Figure (4) Results of real time PCR and nested PCR for CMV in the enrolled patients.Figure (5) world-class run nested PCR showing band at 435 bp.Figure (6) 2ndrun nested PCR showing band at 159 bp.Table (13) Prevalence of CMV infection in the studied patients (using real time PCR as a favourable standard test)Risk factorsNo.Studied patients(N=366 )PositiveNo.%Malignant hematological disease with chemotherapy(43)3683.7%Receiving repeated blood transfusion(164)00%Fever of unknown origin(16)00%Critically ill patients lying in the ICUs with prolonged hospitalization(28)00%Receiving corticosteroids or other immunosuppressives for long period(22)00%Chronic renal failure with haemodialysis(64)00%Fever with pancytopenia(7)00%Neonates with congenital anomalies(22)00%As shown in table (13), CMV infection (using real time PCR as a gold standard test) was only reported from patients suffering from malignant hematological disease and receiving chemotherapy, where 83.7% of these patients were positive for CMV.Figure (7) Figure (8) Table (14) Titer of CMV viremia in patients with malignant hematological disease receiving chemotherapyQuantitative PCRStudied patients (N=366)Mean SD6907.30 15846.04Median (Range)623.50 (3.70 57500)The mean titer and SD of titers of CMV viremia in patients with malignant hematological disease receiving chemo therapy as shown in table (14) was 6907.30 15846.04.Table (15) Results of Nested PCR for CMV among different risk groupsRisk factorsNo.Studied patients(N=366)PositiveNo.%Malignant hematological disease with chemotherapy(43)2967.4%Receiving repeated blood transfusion(164)00%Fever of unknown origin(16)00%Critically ill patients lying in the ICUs with prolonged hospitalization(28)00%Receiving corticosteroids or other immunosuppressives for long period(22)00%Chronic renal failure with haemodialysis(64)00%Fever with pancytopenia(7)00%Neonates with congenital anomalies(22)00%Twenty nine out of 43 patients suffering from malignant hematological disease with chemotherapy with a percentage of 67.4 were positive for CMV in a nested PCR test as shown in table (15).Table (16) Relation between ELISA IgM and real time PCR and nested PCR in the studied patients (N=366)Agreement between ELISA IgM and real time PCR and nested PCR in the studied patients (N=366) research lab findingsELISA TestP-valu ePositive IgM(N=60)Negative IgM(N=306)No.%No.%Real time PCRPositive (n=36)822.2 %2877.8 % 0.050. 320(NS)Negative (n=330)5215.8 %27884.2 %Nested PCRPositive827.6 %2172.4 %0.0820.090(NS)Negative5215.4 %28584.6 % Kappa measure of agreementP 0.05 is significant.Statistical SignificanceStandards for strength of agreement for the kappa coefficient0=poor,.01-.20=slight,.21-.40=fair,.41-.60=moderate,.61-.80=substantial, and.81-1=almost perfect.As shown in table 16, there is poor statistical agreement between ELISA IgM and PCR reactions in the detection of CMV in children with no significance.Table (17) Relation between ELISA IgG and real time PCR and nested PCR in the studied patients (N=366)Agreement between ELISA IgG and real time PCR and nested PCR in the studied patients (N=366)Laboratory findingsELISATestP-valuePositive IgG(N=93)Negative IgG(N=273)No.%No.%Real time PCRPositive (n=36)00 %36100 % -0.1370.001*(HS)Negative (n=330)9328.2 %23771.8 %Nested PCRPositive00 %29100 %-0.1650.000*(H S)Negative9327.6 %24472.4 % Kappa measure of agreementP 0.05 is significant.*highly statistical SignificanceStandards for strength of agreement for the kappa coefficient0=poor,.01-.20=slight,.21-.40=fair,.41-.60=moderate,.61-.80=substantial, and .81-1=almost perfect.A high statistically significant non-agreement is present between ELISA IgG and PCR reactions in the detection of CMV in childrenas shown in table 17.Table (18) Relation between real time PCR and nested PCR in the studied patients (N=366)Agreement between real time PCR and nested PCR in the studied patients (N=366)Laboratory findingsNested PCRTestP-valuePositive(N=29)Negative (N=337)No.%No.%Real time PCRPositive (n=36)29100 %72.1 % 0.8820.000*(HS)Negative (n=330)00 %33097.9 % Kappa measure of agreementP 0.05 is significant.*highly statistical SignificanceStandards for strength of agreement for the kappa coefficient0=poor,.01-.20=slight,.21-.40=fair,.41-.60=moderate,.61-.80=substantial, and .81-1=almost perfect.Table 18 s hows that there is an almost perfect statistical agreement between real time PCR and nested PCR in the detection of CMV in children with high significance.Table (19) Relation between real time PCR and nested