Human Cytomegalovirus infection in febrile patients with hematological malignancies at Uganda Cancer Institute

Abstract

Background: Sub-Saharan Africa is experiencing a marked increase in the burden of cancer-related morbidity and mortality, with more than 1 million incident cancers and nearly 800 000 cancer-related deaths projected annually by 2030. Among the patients with hematological cancers, chemotherapy as well as disease-specific factors are associated with the impairment of granulocyte number and function, predisposing patients to high risk of opportunistic infectious complications, which often manifest as fever. Among the viral infectious complications, Human Cytomegalovirus (HCMV) has been reported elsewhere to be a major opportunistic complication among patients with hematological cancers. However, limited data exists on the seroprevalence and contribution of HCMV infection among febrile patients with haematological cancers at the Uganda Cancer Institute (UCI). Objective: To investigate the seroprevalence of HCMV exposure and active infection as well as risk factors for HCMV infection among hematological cancer patients with fever at the UCI. Methods: In a cross-sectional study conducted between June and August 2017, blood samples were collected from 161 feverish patients receiving chemotherapy for various hematological cancers 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: Overall, HCMV seroprevalence based on IgG and/or IgM antibody positivity was found to be 106/161(66%). HCMV seroprevalence based on IgG or IgM antibody positivity was 84/161(52%) and 49/161 (30%), respectively. HCMV seroprevalence based on IgG alone, IgM alone, and combined IgG/IgM antibody positivity was 57/161(35.4%), 22/161 (13.6%) and 27/161(16.7%), respectively. HCMV DNA PCR positivity was detected in 5/161 (3%) of the samples. One of these was IgG alone positive, the other two were IgM alone positive while the remaining two where both IgG and IgM seropositive. Conclusion: Overall seroprevalence of 66% was detected indicating that two thirds of the febrile patients with hematological cancers had been infected with HCMV, where active infection based on positive IgM and HCMV DNA PCR was detected in 23/161(14.3%) of the analysed samples. This result provides useful information to clinicians for proper management of patients with febrile illness on chemotherapy for underlying hematological cancers.