TY - JOUR
T1 - Detection of cytomegalovirus in bronchoalveolar lavage fluid from immunocompromised patients with pneumonitis by viral culture and DNA quantification
AU - Berengua, C.
AU - Miró, E.
AU - Gutiérrez, C.
AU - Sánchez, M.
AU - Mulero, A.
AU - Ramos, P.
AU - del Cuerpo, M.
AU - Torrego, A.
AU - García-Cadenas, I.
AU - Pajares, V.
AU - Navarro, F.
AU - Martino, R.
AU - Rabella, N.
N1 - Publisher Copyright:
© 2023 The Authors
PY - 2023/7
Y1 - 2023/7
N2 - Purpose: To compare the detection of human cytomegalovirus (HCMV) in bronchoalveolar lavage (BAL) fluid by viral culture and quantitative polymerase chain reaction (qPCR), and to establish a viral load threshold that can identify cases of HCMV replication indicative of pneumonitis. There is currently no universal viral load cut-off to differentiate between patients with and without pneumonitis, and the interpretation of qPCR results is challenging. Methods: 176 consecutive BAL samples from immunosuppressed hosts with signs and/or symptoms of respiratory infection were prospectively studied by viral culture and qPCR. Results: Concordant results were obtained in 81.25% of the BAL samples. The rest were discordant, as only 34% of the qPCR-positive BAL samples were positive by culture. The median HCMV load was significantly higher in culture-positive than in culture-negative BAL samples (5038 vs 178 IU/mL). Using a cut-off value of 1258 IU/mL of HCMV in BAL, pneumonia was diagnosed with a sensitivity of 76%, a specificity of 100%, a VPP of 100% and VPN of 98%, and HCMV was isolated in 100% of the BAL cultures. Conclusion: We found that a qPCR-negative was a quick and reliable way of ruling out HCMV pneumonitis, but a positive result did not always indicate clinically significant replication in the lung. However, an HCMV load in BAL fluid of ≥ 1258 IU/mL was always associated with disease, whereas < 200 IU/mL rarely so.
AB - Purpose: To compare the detection of human cytomegalovirus (HCMV) in bronchoalveolar lavage (BAL) fluid by viral culture and quantitative polymerase chain reaction (qPCR), and to establish a viral load threshold that can identify cases of HCMV replication indicative of pneumonitis. There is currently no universal viral load cut-off to differentiate between patients with and without pneumonitis, and the interpretation of qPCR results is challenging. Methods: 176 consecutive BAL samples from immunosuppressed hosts with signs and/or symptoms of respiratory infection were prospectively studied by viral culture and qPCR. Results: Concordant results were obtained in 81.25% of the BAL samples. The rest were discordant, as only 34% of the qPCR-positive BAL samples were positive by culture. The median HCMV load was significantly higher in culture-positive than in culture-negative BAL samples (5038 vs 178 IU/mL). Using a cut-off value of 1258 IU/mL of HCMV in BAL, pneumonia was diagnosed with a sensitivity of 76%, a specificity of 100%, a VPP of 100% and VPN of 98%, and HCMV was isolated in 100% of the BAL cultures. Conclusion: We found that a qPCR-negative was a quick and reliable way of ruling out HCMV pneumonitis, but a positive result did not always indicate clinically significant replication in the lung. However, an HCMV load in BAL fluid of ≥ 1258 IU/mL was always associated with disease, whereas < 200 IU/mL rarely so.
KW - Cytomegalovirus
KW - HCMV
KW - Immunosuppressed
KW - Pneumonitis
KW - Quantitative PCR
KW - Viral culture
KW - Viral load
KW - Bronchoalveolar Lavage Fluid
KW - Cytomegalovirus/genetics
KW - Pneumonia/diagnosis
KW - Humans
KW - Lung Transplantation
KW - Cytomegalovirus Infections/diagnosis
KW - Immunocompromised Host
KW - DNA, Viral
UR - http://www.scopus.com/inward/record.url?scp=85158860392&partnerID=8YFLogxK
UR - https://www.mendeley.com/catalogue/4ab5d0e1-ff0a-3477-a86e-8b2dbf091f3e/
U2 - 10.1016/j.jviromet.2023.114743
DO - 10.1016/j.jviromet.2023.114743
M3 - Article
C2 - 37116585
AN - SCOPUS:85158860392
SN - 0166-0934
VL - 317
JO - Journal of Virological Methods
JF - Journal of Virological Methods
M1 - 114743
ER -