Emergence of multiple cytomegalovirus strains in blood and lung of lung transplant recipients.
BACKGROUND
Cytomegalovirus (CMV) is a major pathogen in lung transplant recipients (LTRs). The emergence of different CMV strains in lung and blood after transplantation has not yet been analyzed.


METHODS
In total, 75 serum and 91 broncheoalveolar lavage (BAL) samples obtained from 25 LTRs in the follow-up after transplantation were tested for the presence of different CMV strains. The gB, gN, and gO genes of the CMV isolates were analyzed by subtype-specific PCR, restriction fragment length polymorphism (RFLP), sequencing, and phylogenetic analysis.


RESULTS
Mixed CMV-strain populations were detected after cessation of antiviral prophylaxis in up to 80% and 90% of the patients' BAL and serum, respectively, and this was independent of the CMV serostatus of donor and recipient. In five patients, the same single CMV strain was consistently detectable over at least 1 year in lung and blood, although in two of these cases donor and recipient had both been CMV-seropositive. Most CMV strains were distributed in the lung and blood compartment. Symptomatic CMV infection within the first year after transplantation was observed only in patients with mixed CMV-strain populations (P<0.05).


CONCLUSIONS
Most LTRs harbor more than one CMV strain in their lung and blood compartment after cessation of prophylaxis, but the CMV strain distribution within and between the compartments varies between individuals and is not associated with the donor/recipient serostatus. The data further show that compartmentalization of CMV strains in lung versus blood seems to be a rare event and that the presence of mixed CMV-strain infections within the first year after transplantation may be disadvantageous for LTRs.
Puchhammer-Stöckl
Elisabeth
E
Institute of Virology, Medical University of Vienna, Austria. elisabeth.puchhammer@meduniwien.ac.at
Görzer
Irene
I
Zoufaly
Alexander
A
Jaksch
Peter
P
Bauer
Claudia C
CC
Klepetko
Walter
W
Popow-Kraupp
Therese
T
D000293:Adolescent; D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use; D001483:Base Sequence; D001992:Bronchoalveolar Lavage Fluid / Q000821:virology; D003587:Cytomegalovirus / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D003586:Cytomegalovirus Infections / Q000188:drug therapy / Q000209:etiology* / Q000821:virology*; D004279:DNA, Viral / Q000235:genetics; D005260:Female; D006801:Humans; D008168:Lung / Q000821:virology; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections / Q000188:drug therapy / Q000209:etiology* / Q000821:virology*; D010802:Phylogeny; D016133:Polymerase Chain Reaction; D012150:Polymorphism, Restriction Fragment Length; D013997:Time Factors; D014766:Viremia / Q000188:drug therapy / Q000209:etiology / Q000821:virology
D000998:Antiviral Agents; D004279:DNA, Viral