AKURASI SERODIAGNOSIS PADA INFEKSI CYTOMEGALOVIRUS

OKTANIA CANDRAWATI, Prof. dr. Budi Mulyono, Sp.PK(K), MM; Dr. dr. Osman Sianipar, DMM, M.Sc, Sp.PK(K)

2022 | Tesis | MAGISTER ILMU KEDOKTERAN KLINIS

Latar belakang: Penyakit Cytomegalovirus (CMV) memiliki prevalensi, tingkat morbiditas dan mortalitas yang tinggi terutama pada penyakit CMV kongenital, bayi prematur dan berat badan lahir rendah, pejamu dengan penyakit autoimun, dan resipien transplantasi. Pemeriksaan PCR real-time mendeteksi DNA CMV merupakan alternatif baku emas kultur isolasi virus CMV namun tidak semua laboratorium dapat mengerjakan. Pemeriksaan serodiagnosis IgM dan IgG anti-CMV mendeteksi respon imun antibodi spesifik terhadap CMV namun interpretasi hasil sulit karena kadar antibodi dapat bertahan lama dan seropositif tinggi. Tujuan: Mengevaluasi akurasi pemeriksaan serodiagnosis CMV dibandingkan PCR CMV pada diagnosis penyakit CMV. Metode: Penelitian ini merupakan penelitian observasional, retrospektif dari data sekunder rekam medis dan hasil laboratorium bulan Januari 2017-Desember 2021 pada pasien yang dicurigai terinfeksi CMV di RSUP Dr. Sardjito. Uji diagnostik untuk menilai akurasi pemeriksaan serodiagnosis CMV, IgM anti-CMV, dan IgG anti-CMV terhadap PCR CMV ditampilkan dengan interval kepercayaan 95% (IK 95%). Hasil: Sebanyak 65 subjek diperiksa serodiagnosis CMV dan PCR CMV. Pemeriksaan serodiagnosis CMV, berupa pemeriksaan IgM anti-CMV positif, IgG anti-CMV positif; atau IgM anti-CMV positif, IgG anti-CMV negatif; atau IgM anti-CMV negatif, IgG anti-CMV positif dan aviditas IgG anti-CMV rendah, dibandingkan PCR CMV memiliki akurasi 84,62% (IK 95%=73,52-92,37%). Pemeriksaan IgM anti-CMV dibandingkan PCR CMV memiliki akurasi 84,62% (IK 95%=73,52-92,37%). Pemeriksaan IgG anti-CMV dibandingkan PCR CMV memiliki akurasi 30,77% (IK 95%=19,91 -43,45%). Angka deteksi pada pemeriksaan IgG anti-CMV (88,16%) signifikan lebih tinggi dibanding PCR CMV (16,92%) dan IgM anti-CMV (4,62%) (p<0,001). Simpulan: Akurasi serodiagnosis CMV, IgM anti-CMV dan IgG anti-CMV dibandingkan pemeriksaan PCR CMV pada diagnosis penyakit CMV berturut-turut sebesar 84,62%, 84,62%, dan 30,77%.

Background: The prevalence, morbidity and mortality rates of Cytomegalovirus (CMV) disease are high especially in congenital CMV, host with autoimmune disease, immunocompromised condition, and transplant recipient. Real-time PCR which detects DNA CMV is an alternative for virus isolation technique of which the gold standard in CMV disease diagnosis. Serodiagnostic tests of IgM and IgG anti-CMV tests detect specific antibodies to CMV but result interpretation in diagnosing CMV disease needs caution because antibodies can persist for a long time and seropositive rate is high. Aim: To evaluate the accuracy of serodiagnostic CMV compared to PCR in diagnosing CMV disease. Method: This was a retrospective observational study on medical records and laboratorium data of patients suspected with CMV disease at Dr. Sardjito Hospital from January 2017-December 2021. Diagnostic test with 95% confidence intervals (95% CI) was performed to assess the accuracy serodiagnotic of CMV, IgM anti-CMV, and IgG anti-CMV compared to CMV PCR. Result: Total 65 subjects were test for serodiagnostic of CMV and CMV PCR. The serodiagnostic of CMV, i.e IgM anti-CMV positive, IgG anti-CMV positive; or IgM anti-CMV positive, IgG anti-CMV negative; atau IgM anti-CMV negative, IgG anti-CMV positive and low avidity of IgG anti-CMV compared to CMV PCR had accuracy 84.62% (95% CI=73.52-92.37%). The IgM anti-CMV compared to CMV PCR had accuracy 84.62% (95% CI=73.52-92.37%). The IgG anti-CMV compared to CMV PCR had accuracy 30.77% (95% CI=19.91-43.45%). Detection rate of IgG anti-CMV (88.16%) was significantly higher than PCR CMV (16.92%) and IgM anti-CMV (4.62%) (p<0.001). Conclusion: The accuracy of serodiagnostic of CMV, IgM anti-CMV, and IgG anti-CMV compared to CMV PCR was 84.62%, 84.62%, and 30.77%.

Kata Kunci : IgM anti-CMV, IgG anti-CMV, DNA PCR real-time, diagnosis, penyakit Cytomegalovirus