After
transplantation, the frequency of reactivation (or
superinfection) by CMV is high. Less frequent, but more severe, is the primary form of the disease. The virological procedure to follow up the graft recipients includes: 1) The detection of the infectious virus and/or its
antigens in urine, blood, bronchial secretions or brushing, bronchiolar and alveolar washings, ... The laboratory will perform a rapid culture for detection of early CMV
antigen (24-72 h) associated with the more classical long-term culture, a reliable but slow method (2-3 weeks). 2) The detection of
antibodies, primarily
IgM, or even
IgA. The usual ELISA for
IgG and ELISA modified by addition of an immunocapture on a solid phase are the more reliable techniques. As a rule, the pattern
IgM+/
IgG- is common for the primary
infection. In the case of reactivation (or
superinfection), the pattern may be either
IgM+/IgG+ or
IgM-/IgG+. In the latter case, the increase of the
IgG during the next weeks will bring evidence of a reactivation process.