Quantitative Cultures of the Cell Fraction and Supernatant of Bronchoalveolar Lavage Fluid for the Diagnosis of Cytomegalovirus Pneumonitis in Lung Transplant Recipients

Abstract

Results of quantitative shell vial cultures of cell and supernatant fractions of bronchoalveolar lavage (BAL) fluid from lung transplant recipients were compared with results of transbronchial lung biopsies. Cytomegalovirus (CMV) was present in both the cell and supernatant fractions, including 28 (80%) and 29 (83%), respectively, of 35 BAL samples with corresponding biopsies that showed evidence of CMV pneumonitis and 34 (15%) and 75 (33%), respectively, of 227 BAL samples with corresponding biopsies that did not. Cultures of unseparated BAL fluid had a similar yield to cultures of supernatant. Virus titers of cell fractions and supernatants from BAL samples with corresponding biopsies that were positive for CMV pneumonitis were higher than those from BALs with negative corresponding biopsies. Culture of the unseparated fluid is recommended for simplicity and to maximize detection of CMV. Quantitative results may help in the identification of CMV pneumonitis, but additional studies are needed before quantitative cultures can be recommended for routine use.

Updated International Consensus Guidelines on the Management of Cytomegalovirus in Solid-Organ Transplantation

“…A positive culture or qualitative NAT from bronchoalveolar lavage (BAL) specimens in lung and nonlung transplant recipients may reflect viral shedding rather than pulmonary disease (51,52). Immunocytochemistry of BAL cells may improve the predictive value of a positive culture.…”

Prevention and Treatment of Infectious Complications After Solid Organ Transplantation in Children

“…26 A positive culture from bronchoalveolar lavage specimens may not correlate with disease. 27,28 The presence of a positive measurement of CMV load in the peripheral blood (measured by either nucleic acid amplification techniques (NAT) or pp65 antigenemia assay) in a patient with a compatible CMV clinical syndrome is strongly suggestive of CMV disease. However, the CMV load may be positive before the onset or in the absence of clinical disease and may be seen in the presence of disease from other causes.…”

Relationship Between Cytomegalovirus Cells and Survival in Acquired Immunodeficiency Syndrome Patients

“…Previous studies have demonstrated that BAL provides a good sample of the inflammatory response of the lung. Using quantitative cultures for CMV, Storch et al 23 demonstrated that with CMV-positive culture, patients are more likely to have CMV pneumonitis. However, we were unable to find any difference in the amount of cytopathic changes of CMV and Figure 5).…”

“…14 The most frequently identified pulmonary infectious agent is Pneumocystis carinii (PC), followed by CMV. 7,9,16,18,20,23 Bronchoalveolar lavage (BAL) is a safe, consistent diagnostic tool for detection of pulmonary pathogens in AIDS patients. 17,21,24 Studies that attempted to correlate the presence and number of CMV infected cells in BAL specimens with morbidity and mortality have shown variable results.…”