Molecular detection of Cytomegalovirus in hospitalized children: a cross-sectional study in Makassar, Indonesia

Abstract

Introduction: Human cytomegalovirus (HCMV) is a significant pathogen in pediatric populations, yet serological diagnosis lacks specificity. This study aimed to identify active CMV infection through molecular methods in hospitalized children previously diagnosed serologically. Methods: a hospital-based descriptive cross-sectional study was conducted from December 2024 to March 2025 at Wahidin Sudirohusodo Hospital, a tertiary referral and teaching hospital in Makassar, Indonesia. Blood samples from 50 pediatric inpatients with serological evidence suggesting CMV exposure were subjected to conventional polymerase chain reaction (PCR) targeting the HindIII-X fragment (406 bp). PCR-positive samples were sequenced for local phylogenetic description. Descriptive statistics assessed molecular findings stratified by demographics, serology, and clinical manifestations. Results: of 50 blood samples examined, 9 (18%) were positive for CMV DNA by PCR. Positivity rates were higher in male children (21.4%) compared to females (13.6%), with the highest prevalence in infants <1 year (24.1%). Among serology-reactive cases, the highest detection rate was observed in patients with concurrent IgM and IgG reactivity (50%), compared to IgG alone (10.3%). Phylogenetic analysis of HindIII-X sequences revealed two descriptive, well-supported clades (bootstrap 98-99%) within human betaherpesvirus 5 in this hospital cohort. Notably, 82% of serologically positive samples were negative for CMV DNA in blood, suggesting limited systemic viremia despite positive antibody status; CMV replication may still occur in end-organ compartments without being detected in peripheral blood, particularly when using conventional PCR with lower analytic sensitivity than quantitative assays. Conclusion: molecular confirmation via PCR is essential to distinguish active CMV infection from serological evidence of past or latent infection. The substantial discordance between serology and blood PCR findings supports integration of molecular testing as a confirmatory standard in pediatric CMV evaluation, particularly in IgM-positive cases-to prevent unnecessary antiviral therapy and strengthen antimicrobial stewardship in resource-limited, high-seroprevalence settings.

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