Detection of CMV Pneumonitis after Lung Transplantation Using PCR of DNA from Bronchoalveolar Lavage Cells

Abstract

Background: Cytomegalovirus (CMV) is known as a common pathogen causing infections after lung transplantation. Rapid diagnosis of CMV infection is important for the initiation of a specific treatment. Objective: Evaluation of methods for the rapid diagnosis of CMV pneumonitis. Methods: The detection rates of CMV DNA in bronchoalveolar lavage (BAL) and bronchial brushes by polymerase chain reaction (PCR), of viral antigens (p52 and IE1) in BAL and of pp65 antigen in peripheral blood leukocytes were compared to the clinical status after lung transplantation. In 28 patients, 105 BAL, 96 blood samples and 14 brushes were analyzed. Results: In 6 patients, a total of eight episodes of CMV pneumonitis occurred. Five of the 6 with positive CMV antigens in BAL (p52 or IE1) showed signs of CMV pneumonitis. All episodes of CMV pneumonitis were detected by the PCR of BAL cells. Fourteen samples positive for CMV pp65 antigen in blood were negative in BAL PCR. In these cases, no clinical signs of pulmonary CMV infection occurred. Overall sensitivity, specificity, and positive and negative predictive values for the detection of CMV pneumonitis by PCR of BAL cells were 100, 98.9, 88.9 and 100%, respectively. In brush samples, PCR did not provide additional information to the results of the PCR of BAL cells. Conclusions: PCR of DNA from BAL cells is suitable for reliable and rapid detection of CMV pneumonitis.

Prevalence of Human Herpes Viruses in Bronchoalveolar Lavage of Critically Ill Children Undergoing Mechanical Ventilation at a Pediatric Intensive Care Unit

“…For example, in a study by Bewig et al in an adult population, CMV was the most commonly detected HHVs (24%) in new onset acute lung injury or ARDS patients. The other less common isolated viruses in this study were EBV: 18%, HSV-1: 13%, HHV-6: 2% and HHV-7: 1% (40). In another study by Germi et al EBV was the most common isolated virus (28%) followed by CMV/HHV-6 (18%) and HSV-1 (12%) (27).…”

CMV Infection Presenting as a Cavitary Lung Lesion in a Patient with Systemic Lupus Erythematosus Receiving Immunosuppressive Therapy

“…PCR for CMV in BALF was demonstrated to be useful for the diagnosis of CMV pneumonitis (11,12). Honda et al (12) …”

Cytomegalovirus Pneumonitis Presenting Small Nodular Opacities

“…Cytopathic effect specific to CMV infection, as was noted in the lung specimen in the present case, can be pathognomonic, however, such effects may not always be available from critically ill patients. Thus, immunoassay for CMV pp65 antigen (11) and demonstration of CMV DNA by PCR can be a useful alternative to diagnosing CMV pneumonitis (12), although specificity has been questioned (13). Only CMV was demonstrated in the present patient, and the administration of gancyclovir was efficacious, leading to the resolution of the lung disease.…”