Detection of CMV pneumonitis after lung transplantation using PCR of DNA from bronchoalveolar lavage cells.
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.
Bewig
B
B
First Department of Internal Medicine, Christian Albrechts University of Kiel, Germany. bbewig@lmed.uni-kiel.de
Haacke
T C
TC
Tiroke
A
A
Bastian
A
A
Böttcher
H
H
Hirt
S W
SW
Rautenberg
P
P
Haverich
A
A
D000293:Adolescent; D000328:Adult; D000956:Antigens, Viral / Q000032:analysis; D018893:Bronchoalveolar Lavage / Q000379:methods; D001992:Bronchoalveolar Lavage Fluid / Q000166:cytology / Q000821:virology; D003587:Cytomegalovirus / Q000302:isolation & purification*; D003586:Cytomegalovirus Infections / Q000175:diagnosis* / Q000276:immunology; D004279:DNA, Viral / Q000032:analysis; D006801:Humans; D007962:Leukocytes / Q000276:immunology / Q000821:virology; D016040:Lung Transplantation / Q000009:adverse effects*; D010750:Phosphoproteins / Q000032:analysis; D011014:Pneumonia / Q000175:diagnosis* / Q000276:immunology / Q000821:virology*; D016133:Polymerase Chain Reaction; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014763:Viral Matrix Proteins / Q000032:analysis
D000956:Antigens, Viral; D004279:DNA, Viral; D010750:Phosphoproteins; D014763:Viral Matrix Proteins; C065418:cytomegalovirus matrix protein 65kDa