Results Chapter on CMV Infection Research

Results Chapter on cytomegalovirus Infection ResearchResultsThis study has been conducted on 366 patients with venture cytomegalovirus infection attending pediatric department at Zagazig University Hospital. tabulate (1) era distribution of the examine patients (except for neonates with intrinsic anomalies) (N=344) examine patients (N=344)no(prenominal)%Age (years)Mean SD9.9 3.4Median (Range)10.0 (3.5 18.0)The mean age and bill deviation (SD) of ages of the canvas patients (except for neonates with inbred anomalies) in years as shown in table (1) was 9.9 3.4. table (2) Age distribution of neonates with congenital anomalies (N=22) analyse patients (N=22) zero(prenominal)%Age of neonates with congenital anomalies group (days)Mean SDMedian (Range)4.1 1.64.0 (2.0 7.0) carry over (2) shows that The mean age and standard deviation (SD) of ages ofneonates with congenital anomalies were 4.1 1.6 days plug-in (3) Sex distribution of the canvas patients (N=366) examine patient s (N=366) no.%SexMale20255.2%Female16444.8% display board(3) shows that 55.2% (202 out of 366) of the analyse patients were males, while 44.8% were females. depend (1) Pie diagram showing sex distribution of the analyze patients (N=366) defer (4) Distribution of the risk factors among the studied patients (N=366)Risk factorsStudied patients (N=366) no%Malignant hematologic unhealthiness with chemotherapy4311.7 %Receiving repeated agate line occupation blood transfusion16444.8 % feverishness of unknown rip164.4 %critically ill patients hypocrisy in the ICUs with pro keen-sighteded hospital care287.7 %Receiving corticosteroids or other immunosuppressives for long utmost226 %inveterate renal failure with hemodialysis6417.5 %Fever with pancytopenia71.9 %Neonates with congenital anomalies226 %As shown in table (4) and figure (2),44.8% of the studied patients were receiving repeated blood transfusion, 17.5% were deplorable from chronic renal failure and receiving hemodialysis, 11.7% were suffering from Malignant hematological illness and receiving chemotherapy, 7.7% were critically ill patients lying in the ICUs with elongate 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. participate (2) Pie diagram showing Distribution of the risk factors in the studied patients (N=366). dining table (5) Results of enzyme-linked-immunosorbent serologic assay immunoglobulin M and immunoglobulin G for cytomegalovirus in the enrolled patients (N=366)enzyme-linked-immunosorbent serologic assay resultsStudied patients (N=366)IgM ordained6016.4 % blackball30683.6 %immunoglobulin G confirming9325.4 % blackball27374.6 %Over all seropositivityPositive both IgM and immunoglobulin G10929.8 %As shown in table (5), out of the 366 studied patients, 60 (16.4%) and 93 (25.4%) were corroboratory for cytomegalovirus IgM and immunog lobulin G in an ELISA establish respectively.Table (6) Agreement amid ELISA IgM and IgG in the studied patients (N=366)ELISA IgMELISA IgGTotal interrogationP-value banishPositiveNegative zero(prenominal)257493060.4690.000*(HS)% 94.1 %52.7 %83.6 %Positive nary(prenominal)164460% 5.9 %47.3 %16.4 %TotalNo.27393366% 100.0 %100.0 %100.0 % Kappa billhook of contractP 0.05 is meaningful.Statistical SignificanceStandards for potentiality of agreement for the kappa coefficient0=poor,.01-.20=slight,.21-.40=fair,.41-.60=moderate,.61-.80=substantial, and.81-1= intimately perfect.Table 6 shows that there is a moderate agreement amid ELISA IgM and IgG in the detection of cytomegalovirus in khildren with high statistical significance.Table (7) Prevalence of CMV IgM seropositivity among opposite risk groupsRisk FactorsNo.Studied patients (N=366)Positive IgMNo.%Malignant hematological indisposition with chemotherapy(43)818.6 %Receiving repeated blood transfusion(164)3621.9 %Fever of unknow n 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 preponderance (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 contrasting risk groupsTable (8) Association between CMV IgM seropositivity and unlike risk factorsRisk factorsNo.Studied patients (N=366) try onp-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 rivuletP 0.05 is significan t.*statistical SignificanceTable (9) Prevalence of CMV IgG seropositivity among different risk groupsRisk 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.%Rec eiving repeated blood transfusion(164)6338.4%10161.6%53.960.000*(HS)Chronic renal failure with haemodialysis(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 accepted clip PCR for CMV in the enrolled patients (N=366) authorized 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 original 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 veritable time PCR and nested PCR for CMV in the enrolled patients.Figure (5) 1st 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 t he studied patients (using real time PCR as a gold 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 chemotherapy 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% cardinal 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 I gM and real time PCR and nested PCR in the studied patients (N=366) science laboratory findingsELISA TestP-valuePositive 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 neb 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= near 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*(HS)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 shows 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