title: Predictive value of cytomegalovirus DNA detection by polymerase chain reaction in blood and bronchoalveolar lavage in lung transplant patients.
abstract: BACKGROUND
  Despite promising results, the efficacy of polymerase chain reaction (PCR) for clinical management of cytomegalovirus (CMV) infection in transplanted patients is still controversial.
  
  
  METHODS
  A prospective study of CMV detection, with concurrent shell vial cultures and PCR in blood and bronchoalveolar lavage (BAL), was conducted in 13 lung transplant recipients, monitored for 15 months (range: 1-42 months). CMV DNA was detected by PCR amplification of a 406-bp fragment in the Us region and a 290-bp fragment in the immediate early region of the viral genome.
  
  
  RESULTS
  When comparing PCR to viral culture, the sensitivity and specificity of CMV DNA detection were 100% and 65.7% in blood (n=122) and 100% and 75% in BAL (n=104). The positive and negative predictive values of PCR for a forthcoming diagnosis of CMV infection were 50% and 97% in blood, and 67% and 85% in BAL. Seventeen CMV infections were evaluated at the end of treatment: when PCR was still positive either in blood or BAL, CMV infection relapsed within 35+/-5 days; when PCR was negative, CMV infection relapsed after 142+/-57 days (P=0.01).
  
  
  CONCLUSIONS
  Negative CMV detection by PCR strongly advocates against a forthcoming CMV infection. PCR assay seems to be a good predictor for early recurrence of CMV infection, and would be useful for monitoring the response to antiviral therapy.
authors.affiliation: Laboratoire d'Histologie-Biologie Tumorale, Hopital Tenon, Paris, France.
authors.forename: F
authors.initials: F
authors.lastname: Stéphan
authors.forename: A
authors.initials: A
authors.lastname: Fajac
authors.forename: D
authors.initials: D
authors.lastname: Grenet
authors.forename: P
authors.initials: P
authors.lastname: Honderlick
authors.forename: S
authors.initials: S
authors.lastname: Ricci
authors.forename: I
authors.initials: I
authors.lastname: Frachon
authors.forename: S
authors.initials: S
authors.lastname: Friard
authors.forename: I
authors.initials: I
authors.lastname: Caubarrere
authors.forename: J F
authors.initials: JF
authors.lastname: Bernaudin
authors.forename: M
authors.initials: M
authors.lastname: Stern
mesh_terms: D000293:Adolescent; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D001992:Bronchoalveolar Lavage Fluid / Q000737:chemistry* / Q000821:virology*; D003587:Cytomegalovirus / Q000235:genetics*; D004279:DNA, Viral / Q000097:blood*; D004341:Drug Evaluation; D005260:Female; D006801:Humans; D016040:Lung Transplantation / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral