Cytomegalovirus in the Bronchoalveolar Lavage Fluid of Patients with AIDS

Miles, Patricia R.; Baughman, Robert P.; Linnemann, Calvin C.

doi:10.1378/chest.97.5.1072

Cited by 95 publications

(46 citation statements)

References 25 publications

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“…The present study demonstrated a high incidence of CMV in BAL specimens from patients with AIDS, a finding previously reported by several investigators [4,8,171. In more than half of these instances (55%), l?…”

Section: Discussionsupporting

confidence: 91%

“…Others have not been able to confirm this view [2,3] and some groups have shown that the presence of CMV in the lungs is not necessarily associated with a poor clinical outcome [4-61. Previous studies [4,7,8], have demonstrated a high (44%) incidence of CMV-infected cells in BAL specimens from AIDS patients with and without signs of pulmonary infection, both in the presence and absence of other associated pathogens. This suggests that the detection of CMV in BAL specimens is of questionable clinical significance.…”

mentioning

confidence: 91%

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Cytomegalovirus in bronchoalveolar lavage specimens from patients with AIDS: comparison with antigenaemia and viraemia

Angelici

Contini²,

Sebastiani³

et al. 1996

Journal of Medical Microbiology

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Pulmonary infection with cytomegalovirus (CMV) is a well recognised complication of AIDS. It is often possible to detect CMV-infected cells in bronchoalveolar lavage (BAL) specimens with monoclonal antibodies, but the clinical significance of their presence remains unclear. To investigate this, 24 AIDS patients were tested for CMV antigenaemia and viraemia, in addition to CMV detection in BAL. CMV was detected in the BAL of nine patients (38%), five with clinical and laboratory evidence of pulmonary infection and four without pulmonary involvement. Blood samples positive for CMV antigen were observed in two patients with CMV-positive BAL specimens and, in both cases, antigenaemia resolved without therapy. No case of viraemia was detected. Pneumocystis carinii was detected concomitantly with CMV in the BAL of four of the patients with pulmonary involvement and in one without signs of pulmonary infection. These data suggest that CMV-positive BAL results are of limited significance in the diagnosis of CMV pneumonia in AIDS patients, unless associated with high levels of antigenaemia or viraemia and compatible clinical symptoms.

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Section: Discussionsupporting

confidence: 91%

mentioning

confidence: 91%

Cytomegalovirus in bronchoalveolar lavage specimens from patients with AIDS: comparison with antigenaemia and viraemia

Angelici

Contini²,

Sebastiani³

et al. 1996

Journal of Medical Microbiology

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“…This high prevalence is in accordance with previous studies in which CMV has been detected in up to 72% of BAL fluid samples from HIV-infected patients with pulmonary symptoms [2]. From most studies it has been concluded that CMV is not the primary pathogen in the pathogenesis of pneumonia [13,14]. Thus, in contrast to patients with the iatrogenically-induced immunosuppression (posttransplantation), CMV pneumonitis is rare in HIVinfected patients [15].…”

Section: Discussionsupporting

confidence: 88%

Herpesvirus type 1–8 in BAL fluid from HIV-1-infected patients with suspected pneumonia and from healthy individuals

Tarp

Jensen-Fangel²,

Obel³

2001

Eur Respir J

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Pneumonia is still a major problem in human immunodeficiency virus (HIV)-infected patients, and despite extensive investigation the aetiology remains unknown in many cases. The prevalence of the eight human herpesviruses was determined by polymerase chain reaction in 91 samples of bronchoalveolar lavage (BAL) fluid from 72 HIV-infected patients with 91 episodes of suspected pneumonia. The presence of herpesviruses was related to clinical and immunological findings and the prevalence of herpesviruses in HIV-infected patients was compared with the prevalence in BAL fluid from 50 healthy, immunocompetent individuals.Epstein-Barr virus, cytomegalovirus and human herpesvirus-8 (HHV8) were found in 5.5%, 36%, and 5.5% of BAL fluid samples from HIV-infected patients. No herpesviruses were detectable in BAL fluid from healthy, immunocompetent individuals. The herpesviruses occurred mainly in patients with CD4z counts v200610 6 L -1 . All patients with herpesviruses recovered without specific antiviral treatment. Two patients with HHV8 had the diagnosis of Kaposi9s sarcoma.It is concluded that cytomegalovirus, Epstein-Barr virus, and human herpesvirus-8 are frequently present in bronchoalveolar lavage fluid from severely immunocompromised human immunodeficiency virus-infected patients with pulmonary symptoms. In bronchoalveolar lavage fluid from healthy, immunocompetent individuals, herpesviruses are absent. Apart from human herpesvirus-8, the present results indicate that the herpesviruses do not play a serious pathogenic role in the development of pulmonary symptoms in human immunodeficiency virus-infected patients.

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“…Mycobacterium avium complex compartió el segundo lugar como agente etiológico por frecuencia (co-existiendo con otros agentes en 3/7 de los casos); no obstante, es infrecuente que este agente constituya una causa primaria de neumonía y habitualmente su aislamiento representa colonización o enfermedad diseminada 14,15 . Citomegalovirus fue aislado en los cultivos de LBA en 50% de los casos; sin embargo, en todos los pacientes se identifi có algún diagnóstico alternativo y mejoraron sin requerir tratamiento específi co, tal como ha descrito por varios autores 16,17 . La tuberculosis pulmonar fue diagnosticada en sólo tres pacientes, probablemente debido a que la tuberculosis en Chile ha bajado durante la última década llegando a 15,7 casos por cien mil habitantes en el año 2005 18 .…”

Section: Discussionunclassified

Etiología de la neumonía en pacientes chilenos infectados por el virus de la inmunodeficiencia humana

Carmona

et al. 2011

Rev. chil. infectol.

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Objectives:To establish the etiology of pneumonia and to compare the yield of diagnostic techniques for diagnosis of Pneumocystis jiroveci and Mycobacterium tuberculosis infections in HIV-1-infected patients. Patients and Methods: Subjects underwent sputum induction and bronchoalveolar lavage (BAL). Gram, Ziehl-Neelsen, silver stain (SS) and immunofl uorescense staining (IF) for P. jiroveci, fl uorescent stain for mycobacteria, PCR for P. jiroveci and M. tuberculosis, aerobic, fungal and mycobacterial cultures, respiratory viruses and CMV cultures were performed on the sputum and BAL. IgM for Mycoplasma pneumoniae and Chlamydophyla pneumoniae, and Legionella pneumophila urinary antigen were also obtained. Results: Sixty patients were included. An etiologic diagnosis was made in 97%. Pneumocystis jiroveci was the most frequent etiology (58%) followed by Streptococcus pneumoniae (12%), and Mycobacterium avium complex (12%). Mycobacterium tuberculosis was found in 5%. Conclusions:The comparison of diagnostic methods for P. jiroveci showed a higher sensitivity of IF and SS in BAL than in sputum, however PCR was equally sensitive in both samples. With this approach a precise etiologic diagnosis was reached in the great majority of patients. The most common etiology was P. jiroveci. IF in BAL remains the gold standard for diagnosis of P. jiroveci pneumonia.Key words: Pneumonia, Acquired Immunodefi ciency Syndrome, HIV, AIDS-Related Opportunistic Infections, Etiology.Palabras clave: Neumonía, síndrome de inmunodefi ciencia adquirida, VIH, infecciones oportunistas, etiología. Pontificia Universidad Católica de ChileDepartamento de Medicina Interna (CPC,MCA, JLL, MBM, PGG, GAL). Departamento de LaboratorioClínico (PGC). Departamento de EnfermedadesRespiratorias (TBW, RMB)Departamento de Pediatría (PVC). Programa de EnfermedadesInfecciosas (CPC, PGC, JLL, GAL). . El sistema respiratorio es un sitio donde frecuentemente se producen infecciones fúngicas (Pneumocystis jiroveci, anteriormente denominado Pneumocystis carinii), bacterianas y por micobacterias. La tasa de neumonía por P. jiroveci en los pacientes con recuentos de linfocitos CD4 ≤ a 200 céls/mm 3 , sin uso de profi laxis, es de 8,08 casos por 100 personas-año 2 . La neumonía bacteriana se presenta con una incidencia entre 2,3 y 10,8 episodios por 100 personas-año en los pacientes infectados por VIH (comparado con 0,9 por 100 personasaño en individuos sanos) 3,4 . La broncoscopia con lavado bronco-alveolar (LBA) se considera el método estándar para el diagnóstico etiológico de la neumonía en pacientes infectados por VIH. No obstante, puesto que es un método invasor, el esputo inducido aparece como una estrategia diagnóstica sensible y costo-efectiva. Las nuevas técnicas de diagnóstico molecular podrían disminuir la necesidad de procedimientos invasores para el diagnóstico etiológico de la neumonía en estos pacientes.El objetivo primario de este estudio fue establecer el diagnóstico etiológico de la neumonía en pacientes infectados por VIH utilizando métodos tradic...

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Cytomegalovirus in the Bronchoalveolar Lavage Fluid of Patients with AIDS

Cited by 95 publications

References 25 publications

Cytomegalovirus in bronchoalveolar lavage specimens from patients with AIDS: comparison with antigenaemia and viraemia

Cytomegalovirus in bronchoalveolar lavage specimens from patients with AIDS: comparison with antigenaemia and viraemia

Herpesvirus type 1–8 in BAL fluid from HIV-1-infected patients with suspected pneumonia and from healthy individuals

Etiología de la neumonía en pacientes chilenos infectados por el virus de la inmunodeficiencia humana

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