Abstract:
Introduction: The use of chemotherapy as well as disease specific factors have been recognized as the main predisposing factors for life-threatening opportunistic infection among patients with hematological malignancy, which often presents as fever. Among the viral infectious complications, Human cytomegalovirus (HCMV) has been reported outside Uganda as a major opportunistic complication. However limited data exists on the burden and contribution of HCMV infection among febrile patients with hematological malignancy at Uganda Cancer Institute and this greatly hampers therapy strategy in managing febrile illness. To evaluate the frequency and risk factors for HCMV in febrile patients with underlying hematological malignancies.
Methods: We conducted a cross-sectional study between June and August 2017, blood samples were collected from 161 feverish patients receiving chemotherapy for various hematological malignancies at the Uganda Cancer Institute. Detection of HCMV IgG and IgM as markers of infection was performed with an Indirect ELISA while a qualitative PCR was used to detect HCMV DNA extracted from whole blood at MBN Clinical Laboratories. Results: Of the161 participants evaluated for HCMV infection, 86(53%) were females. The median age in the study was 29 years [IQR 17- 43], 128(80%) were on intensive chemotherapy. Interestingly, HCMV seroprevalence based on IgG and/IgM positivity was found in 106/161(66%) and active infection based on a positive IgM and HCMV DNA PCR was detected in 23/161(14.3%) while 5/161(3%) tested positive for HCMV DNA in the analyzed samples. Conclusion: Evidence from this study suggests that two thirds of febrile patients with hematological malignancy had been infected with HCMV. Overall, the rate of HCMV infection/reactivation ranges between 3 and 66% and that high dose steroid therapy appears as the most relevant, though putative, risk factor. Taken together, this finding highlights the need for routine screening and monitoring of febrile patients with underlying hematological malignancies for HCMV active infection.
