Oxford Handbook of Infectious Diseases and Microbiology by Török Estée; Moran Ed; Cooke Fiona

Author:Török, Estée; Moran, Ed; Cooke, Fiona
Language: eng
Format: epub
Publisher: Oxford University Press, Incorporated
Published: 2016-02-15T16:00:00+00:00

Diagnosis

Serology is unhelpful, given the high seroprevalence, so diagnosis relies on virus detection and pathological findings. Viral culture is difficult, as both JCV and BKV are very slow-growing.

• Viruria—cytological examination is useful for the detection of viruria, although a normal appearance does not exclude infection; infected cells have large nuclei with a large basophilic intranuclear inclusion. These changes can be confused with those caused by other viral infections, e.g. CMV, adenovirus. PCR detects the virus but is positive in a proportion of health controls and the elderly.

• Plasma PCR—results correlate with, and predict the risk of, BKV-associated nephropathy.

• PML and JCV—brain biopsy allows definitive diagnosis, demonstrating multiple asymmetric foci of demyelination, cytopathic changes apparent in oligodendrocytes, and EM revealing viral particles within their nuclei. Fluorescent antibody staining allows identification of JCV. CT scan appearance may be less dramatic than the severity of the clinical findings suggests—hypodense, non-enhancing white matter lesions. MRI is more sensitive. PCR of CSF to identify JCV DNA should only be used in combination with imaging and clinical findings—sensitivity is variable, depending on the technique, and may be positive in immunosuppressed patients without PML.

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