Results
This study has been conducted on 366 patients with suspected CMV infection attending pediatric department at Zagazig University Hospital.
Table (1): Age distribution of the studied patients (except for neonates with congenital anomalies) (N= 344)
The mean age and standard deviation (SD) of ages of the studied patients (except for neonates with congenital anomalies) in years as shown intable (1)was 9. 9 ± 3. 4.
Table (2): Age distribution of neonates with congenital anomalies (N= 22)
Table (2)shows that The mean age and standard deviation (SD) of ages ofneonates with congenital anomalieswere4. 1 ± 1. 6 days
Table (3): Sex distribution of the studied patients (N= 366)
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 risk factors among the studied patients (N= 366)
As shown intable (4)andfigure (2), 44. 8% of the studied patients were receiving repeated blood transfusion, 17. 5% were suffering from chronic renal failure and receiving haemodialysis, 11. 7% were suffering from Malignant hematological disease 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 ELISA IgM and IgG for CMV in the enrolled patients (N= 366)
As shown intable (5), out of the 366 studied patients, 60 (16. 4%) and 93 (25. 4%) were positive for CMV IgM and IgG in an ELISA test respectively.
Table (6): Agreement between ELISA IgM and IgG in the studied patients (N= 366)
# Kappa measure of agreement
P < 0. 05 is significant.
Statistical Significance
Standards for strength of agreement for the kappa coefficient:
≤0= poor,
. 01-. 20= slight,
. 21-. 40= fair,
. 41-. 60= moderate,
. 61-. 80= substantial, and
. 81-1= almost perfect.
Table 6shows that there is a moderate agreement between ELISA IgM and IgG in the detection of CMV in children with high statistical significance.
Table (7): Prevalence of CMV IgM seropositivity among different risk groups
Table (7)andfigure (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 groups
Table (8): Association between CMV IgM seropositivity and different risk factors
# chi square test
P < 0. 05 is significant.
*statistical Significance
Table (9): Prevalence of CMV IgG seropositivity among different risk groups
Table (9)andfigure (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 factors
# chi square test
P < 0. 05 is significant.
*highly statistical Significance
Table (11): Results of real time PCR for CMV in the enrolled patients (N= 366)
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)
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): 1 st run nested PCR showing band at 435 bp.
Figure (6): 2 nd run nested PCR showing band at 159 bp.
Table (13): Prevalence of CMV infection in the studied patients (using real time PCR as a gold standard test)
As shown intable (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 chemotherapy
The mean titer and SD of titers of CMV viremia in patients with malignant hematological disease receiving chemotherapy as shown intable (14)was 6907. 30 ± 15846. 04.
Table (15): Results of Nested PCR for CMV among different risk groups
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 intable (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)
# Kappa measure of agreement
P < 0. 05 is significant.
Statistical Significance
Standards for strength of agreement for the kappa coefficient:
≤0= poor,
. 01-. 20= slight,
. 21-. 40= fair,
. 41-. 60= moderate,
. 61-. 80= substantial, and
. 81-1= almost perfect.
As shown intable 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)
# Kappa measure of agreement
P < 0. 05 is significant.
*highly statistical Significance
Standards for strength of agreement for the kappa coefficient:
≤0= 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 intable 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)
# Kappa measure of agreement
P < 0. 05 is significant.
*highly statistical Significance
Standards for strength of agreement for the kappa coefficient:
≤0= poor,
. 01-. 20= slight,
. 21-. 40= fair,
. 41-. 60= moderate,
. 61-. 80= substantial, and . 81-1= almost perfect.
Table 18shows 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