Correlation of viral infection, histology, and mortality in immunocompromised patients with pneumonia. Analysis by in situ hybridization and the polymerase chain reaction.
The purpose of this study was to determine the occurrence and histologic correlates of viral infections in immunocompromised patients with pneumonia. Of the 44 immunocompromised patients studied, 37 had AIDS. Lung tissue from these patients, including 34 with pneumocystis pneumonia, was evaluated by in situ hybridization for the presence of cytomegalovirus (CMV), adenovirus, Epstein-Barr virus, and herpes simplex virus. Fifteen of the 44 patients were positive for at least one virus (34%); CMV (13 cases) was the most common. In an additional seven cases, CMV DNA was detected using the polymerase chain reaction (PCR), for an overall viral detection rate of 22 of 44 (50%). Histologic features were diagnostic of a viral infection in nine of 15 cases (60%) of the in situ positive cases and in nine of 22 (41%) of the tissues where viral DNA was detected by PCR. Mortality rate was significantly correlated with viral detection: 77% for the viral-positive cases and 27% for the viral-negative cases (p < 0.05). We concluded that in immunocompromised patients with pneumonitis, the detection of viral DNA is strongly correlated with survival and that histologic features of the inflamed lung tissue are a specific but insensitive means of diagnosing viral presence.
Nuovo
M A
MA
Department of Pathology, State University of New York (SUNY) at Stony Brook 11794-8691.
Nuovo
G J
GJ
Becker
J
J
Gallery
F
F
Delvenne
P
P
Kane
P B
PB
D017088:AIDS-Related Opportunistic Infections / Q000276:immunology / Q000473:pathology; D001419:Bacteria / Q000302:isolation & purification; D005658:Fungi / Q000302:isolation & purification; D006801:Humans; D016867:Immunocompromised Host; D017403:In Situ Hybridization; D008168:Lung / Q000382:microbiology; D011014:Pneumonia / Q000150:complications* / Q000276:immunology / Q000401:mortality / Q000473:pathology; D016133:Polymerase Chain Reaction; D011237:Predictive Value of Tests; D016019:Survival Analysis; D014777:Virus Diseases / Q000150:complications* / Q000276:immunology / Q000401:mortality / Q000473:pathology; D014780:Viruses / Q000302:isolation & purification