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Cytomegalo Virus (CMV) - IgM

Bacterial/ Viral
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Cytomegalovirus (CMV) is a common herpesvirus that can infect people of all ages. Detects Immunoglobulin M (IgM) antibodies against CMV in the blood

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CMV IgM - Comprehensive Medical Test Guide

  • Why is it done?
    • Detects IgM antibodies produced during acute or recent CMV infection
    • Helps differentiate recent/active infection from past or chronic infection
    • Ordered when symptomatic patients present with fever, lymphadenopathy, atypical lymphocytosis, hepatomegaly, or splenomegaly
    • Particularly important in immunocompromised patients (HIV/AIDS, transplant recipients, chemotherapy patients)
    • Used in pregnant women to detect primary infection that could affect fetal development
    • Typically performed within 1-2 weeks of symptom onset for optimal detection
  • Normal Range
    • Negative/Normal Result: Less than 0.90 index or negative by ELISA/immunoassay; indicates absence of IgM antibodies
    • Borderline/Equivocal: Index 0.90-1.10; results in this range may require repeat testing in 7-10 days
    • Positive/Abnormal Result: Greater than 1.10 index or positive by ELISA; indicates recent or acute CMV infection
    • Units of Measurement: Index value (ratio) or antibody units; reported qualitatively as negative, equivocal, or positive
    • Clinical Interpretation: Negative typically means no acute infection; positive suggests recent primary or reactivated infection within past 2-3 weeks
  • Interpretation
    • Positive IgM Result: Indicates acute CMV infection, likely primary infection or reactivation in immunocompromised patients; patient is potentially infectious
    • Negative IgM Result: No evidence of recent/acute infection; suggests either past infection with immune memory, chronic/latent infection, or CMV-negative status
    • Equivocal/Borderline Result: Unclear significance; warrants repeat testing after 1-2 weeks to confirm seroconversion or to exclude false positive
    • Clinical Context Matters: Results must be interpreted with clinical symptoms, timing of illness onset, immunologic status, and CMV IgG results
    • Timing Sensitivity: IgM appears early (within 1-2 weeks), peaks at 2-3 weeks, and typically disappears within 3-4 months; late testing may result in false negatives
    • Factors Affecting Results: Immunocompromised status may blunt antibody response; rheumatoid factor can cause false positives; cross-reactivity with EBV or HHV-6 possible
    • Combined Interpretation with IgG: IgM positive + IgG negative = primary infection; IgM positive + IgG positive = reactivation or recent reinfection; IgM negative + IgG positive = past infection or immunity
  • Associated Organs
    • Primary Organ Systems: Immune system (lymphocytes), respiratory tract, gastrointestinal tract, and potentially CNS
    • CMV Infection Sites: Salivary glands, lungs, liver, spleen, esophagus, colon, retina (in severe immunosuppression), and CNS
    • Conditions Associated with Positive Results: CMV mononucleosis, CMV pneumonitis, CMV colitis, CMV retinitis, CMV esophagitis, congenital CMV infection, CMV encephalitis
    • High-Risk Patient Populations: HIV/AIDS patients (CD4 <50), bone marrow transplant recipients, solid organ transplant recipients, patients on immunosuppressive therapy
    • Potential Complications: Secondary bacterial infection, hemorrhagic complications, organ failure, vision loss if retinitis develops, birth defects if infection in pregnancy
    • Congenital CMV Risks: Sensorineural hearing loss, microcephaly, intellectual disability, intrauterine growth restriction, chorioretinitis, hepatosplenomegaly
  • Follow-up Tests
    • CMV IgG Antibody Test: Essential to determine if infection is primary (IgM+ IgG-) or reactivation (IgM+ IgG+)
    • CMV DNA PCR Test: Highly sensitive molecular test to detect active viral replication; useful for immunocompromised patients and organ-specific disease confirmation
    • Repeat CMV IgM Testing: If initial result is equivocal, repeat 7-10 days later to detect seroconversion or confirm negative status
    • Complete Blood Count (CBC): May show atypical lymphocytosis, elevated white blood cell count, or thrombocytopenia in acute infection
    • Liver Function Tests: To assess hepatic involvement; elevated transaminases may indicate CMV hepatitis
    • Imaging Studies: Chest X-ray for pneumonitis, CT abdomen for colitis or other organ involvement if clinically indicated
    • Ophthalmologic Examination: For immunocompromised patients with positive CMV IgM to screen for CMV retinitis
    • CD4 Count and HIV Status: For HIV-positive patients to assess immunosuppression level and risk for severe CMV disease
    • Prenatal Screening: Amniotic fluid CMV PCR if positive IgM detected in pregnant women to determine fetal infection status
    • Monitoring Frequency: For immunocompromised patients, periodic CMV DNA PCR monitoring may be warranted (frequency depends on CD4 count and clinical status)
  • Fasting Required?
    • Fasting Required: No
    • Food and Drink: No restrictions; patient may eat and drink normally before test
    • Specimen Collection: Simple blood draw (serum or plasma); can be performed at any time of day
    • Medications: No medications need to be held or avoided; take all regular medications as prescribed
    • Patient Preparation: Minimal; patient should come to appointment in comfortable clothing with accessible arm for blood draw
    • Timing Considerations: Test is most reliable when performed 1-2 weeks after symptom onset; too early testing may result in false negatives
    • Special Instructions: Inform laboratory staff if on immunosuppressive therapy or if patient is pregnant, as this may affect interpretation

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