CMV (DNA detection by Real time PCR Plasma)

Immunity

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Detects CMV viremia.

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CMV (DNA detection by Real time PCR Plasma) - Comprehensive Medical Test Guide

Why is it done?
- Detects Cytomegalovirus (CMV) DNA in blood plasma using highly sensitive real-time polymerase chain reaction (PCR) technology to identify active viral infection
- Diagnosis of active CMV infection in immunocompromised patients, including those with HIV/AIDS, transplant recipients, and patients undergoing chemotherapy
- Monitoring viral load during antiviral therapy to assess treatment response and efficacy
- Screening for CMV viremia in high-risk patients before symptoms develop
- Evaluation of suspected CMV-related complications such as retinitis, pneumonitis, colitis, or encephalitis
- Post-transplant surveillance in solid organ and hematopoietic stem cell transplant recipients
- Timing: Performed when CMV infection is suspected or in routine surveillance protocols for high-risk populations
Normal Range
- Normal/Negative Result: < 50 copies/mL or "Not Detected"
- Reference Range: Most laboratories use a lower limit of detection (LLD) of 50-100 copies/mL
- Units of Measurement: Copies/mL or IU/mL (International Units per milliliter)
- Interpretation of Negative Result: Indicates no detectable CMV DNA in plasma; suggests either absence of active CMV infection or viral load below detection threshold
- Interpretation of Positive Result: > 50 copies/mL indicates detectable CMV viremia; confirms active infection and may require clinical intervention
- Clinical Significance: Normal (negative) result suggests no active CMV replication; abnormal (positive) result indicates viral replication and potential for clinical disease
Interpretation
- Negative (<50 copies/mL): No detectable CMV viremia; indicates absence of active infection or successful viral suppression with treatment; reassuring in immunocompromised patients
- Low-level viremia (50-3,000 copies/mL): Early stage of infection or initial phase of reactivation; requires close monitoring and possible initiation of antiviral therapy depending on CD4 count and clinical symptoms
- Moderate viremia (3,000-10,000 copies/mL): Established active infection; strongly suggests risk of CMV disease; antiviral therapy typically indicated; warrants investigation for organ-specific manifestations
- High viremia (>10,000 copies/mL): Significant active replication with high risk of CMV disease; immediate antiviral treatment recommended; urgent evaluation for CMV-associated complications (retinitis, pneumonitis, colitis)
- Factors Affecting Results:
- CD4+ T-cell count: Lower counts (typically <50 cells/µL) increase risk of CMV disease and reactivation
- Antiviral therapy: Ganciclovir, foscarnet, or cidofovir use suppresses viral replication and reduces viral load
- Time from transplant: CMV disease risk varies by transplant type and timing; occurs 30-100 days post-transplant typically
- Immune reconstitution: HIV patients on antiretroviral therapy may show viral load reduction with improved immune function
- Sample timing and handling: Results reflect viral load at time of collection; improper storage may affect accuracy
- Clinical Significance of Patterns:
- Rising trend: Indicates inadequate viral suppression despite therapy; may suggest antiviral resistance or non-compliance
- Declining trend: Suggests positive treatment response and viral suppression
- Persistent positivity: Indicates chronic or recurrent infection requiring ongoing management
Associated Organs
- Primary Organ Systems:
- Hematologic system: CMV replicates in white blood cells (monocytes, lymphocytes) and circulates in plasma
- Immune system: Virus targets CD4+ T-cells and dendritic cells, causing immunosuppression
- Diseases and Conditions Associated with Abnormal Results:
- CMV retinitis: Viral infection of the retina causing vision loss; most common CMV manifestation in HIV patients with CD4 <50 cells/µL
- CMV pneumonitis: Viral infection of lungs causing respiratory compromise; common in transplant recipients
- CMV colitis: Inflammation of the colon causing severe diarrhea, abdominal pain, and potential perforation
- CMV encephalitis: Central nervous system infection causing confusion, seizures, or neurological deficits
- CMV esophagitis: Ulcerative infection causing severe dysphagia and esophageal pain
- CMV hepatitis: Viral infection of the liver causing elevated liver enzymes and hepatic dysfunction
- Immune recovery uveitis (IRU): Inflammatory response in eyes during immune reconstitution in HIV patients
- Transplant rejection: CMV infection increases risk of graft rejection and graft failure
- Potential Complications:
- Blindness from CMV retinitis if untreated
- Respiratory failure from CMV pneumonitis
- Intestinal perforation from CMV colitis
- Neurological sequelae from CMV encephalitis
- Death from disseminated CMV disease if untreated
Follow-up Tests
- Based on Positive CMV PCR Results:
- Repeat CMV DNA PCR: Performed 1-2 weeks after antiviral therapy initiation to assess treatment response; helps determine therapy effectiveness
- CD4+ T-cell count: Essential in HIV patients; determines risk stratification and need for CMV prophylaxis
- CMV resistance testing: Performed if viral load remains detectable despite adequate antiviral therapy; identifies resistance mutations
- Ophthalmologic examination: Dilated retinal exam for detection of CMV retinitis, especially if CD4 count <50 cells/µL
- Chest X-ray or high-resolution CT: To evaluate for CMV pneumonitis if respiratory symptoms present
- Colonoscopy with biopsy: If gastrointestinal symptoms (severe diarrhea, abdominal pain) to diagnose CMV colitis
- Lumbar puncture with CSF analysis: If neurological symptoms present to evaluate for CMV encephalitis; CSF CMV PCR may be performed
- Liver function tests: To assess for CMV hepatitis if transaminases elevated
- CMV IgG and IgM serology: To assess immune response and confirm prior exposure; less useful during acute infection
- Monitoring Frequency:
- High-risk patients (CD4 <50): Weekly CMV PCR monitoring initially, then every 2-4 weeks depending on results
- Transplant recipients: Surveillance protocols vary; typically weekly to biweekly during high-risk periods (first 100 days)
- On antiviral therapy: Repeat testing 1-2 weeks after initiation, then every 2-4 weeks until negative and clinical improvement confirmed
- Related Complementary Tests:
- CMV PCR in other body fluids: Urine CMV, CSF CMV, vitreous fluid CMV depending on suspected disease site
- HIV RNA viral load and CD4 count: Essential in HIV-positive patients to assess immune status and CMV risk
- CBC with differential: To assess white blood cell counts and immune cell populations
- Comprehensive metabolic panel: To monitor organ function during antiviral therapy
Fasting Required?
- Fasting Required: NO
- No fasting period is necessary before this test; patient may eat and drink normally before blood collection
- Special Preparation Instructions:
- Maintain current antiviral medications: Do not discontinue ganciclovir, foscarnet, or cidofovir unless directed by physician; timing of sampling relative to medication may affect results
- Medication documentation: Inform phlebotomist and laboratory of all current medications, supplements, and antivirals
- Timing of collection: Optimal timing may be specified by physician; preferably in morning for consistency
- Sample collection: Standard venipuncture into purple-top (EDTA) or other appropriate tube as specified by laboratory
- Temperature stability: Sample must be transported promptly; some laboratories prefer refrigeration (2-8°C); confirmation with laboratory before collection is recommended
- Processing time: Results typically available within 24-48 hours; some laboratories offer expedited processing for immunocompromised patients
- No medication restrictions: No specific medications need to be avoided; continue all prescribed therapies
- General hydration: Adequate hydration is helpful for blood draw but not required; may improve vein accessibility

How our test process works!