title: Cytomegalovirus infection in immunocompetent wheezy infants: the diagnostic value of CMV PCR in bronchoalveolar lavage fluid.
abstract: OBJECTIVE
  Cytomegalovirus (CMV) pneumonitis in immunocompetent hosts is uncommon but is being recognized more frequently, particularly when presenting as severe viral pneumonia. The objective of this study was to examine lower respiratory tract CMV infection in immunocompetent wheezy infants, based on polymerase chain reaction (PCR) in bronchoalveolar lavage (BAL) fluid, to compare CMV PCR results in BAL and in blood samples and to evaluate the benefits of antiviral ganciclovir therapy in these patients.
  
  
  METHODS
  Retrospective review of the records of patients referred to our tertiary care hospital between January 2000 and July 2010 who had unexplained persistent wheezing and underwent fibreoptic flexible bronchoscopy (FFB).
  
  
  CONCLUSIONS
  Fibreoptic flexible bronchoscopy was applied to 102 infants with persistent wheezing and diffuse interstitial infiltration on radiological investigations; so CMV PCR in BAL fluid was performed. CMV PCR in BAL fluid was positive in 51 patients. Retrospectively, we had access to the files of 25 of these patients. The mean CMV PCR in BAL fluid was 334 840 copies/mL. Only eight patients had CMV PCR positivity in their blood samples (mean: 2026·3 copies/mL). There was not a relationship between BAL and blood CMV PCR values based on Spearman's correlation analysis (r = -0·008). Fourteen patients had severe respiratory symptoms and received ganciclovir therapy. Twelve of them fully recovered.
  
  
  CONCLUSIONS
  Bronchoalveolar lavage fluid CMV PCR was superior to blood CMV PCR in diagnosing lower respiratory tract infections caused by CMV in immunocompetent infants. Ganciclovir therapy may be effective in selected immunocompetent wheezy infants with CMV PCR positivity in BAL fluid.
authors.affiliation: Pediatric Pulmonology Department, Faculty of Medicine, Hacettepe University, İhsan Doğramacı Children's Hospital, Ankara, Turkey.
authors.forename: G
authors.initials: G
authors.lastname: Cinel
authors.forename: S
authors.initials: S
authors.lastname: Pekcan
authors.forename: U
authors.initials: U
authors.lastname: Ozçelik
authors.forename: A
authors.initials: A
authors.lastname: Alp
authors.forename: E
authors.initials: E
authors.lastname: Yalçın
authors.forename: D
authors.initials: D
authors.lastname: Doğru Ersöz
authors.forename: N
authors.initials: N
authors.lastname: Kiper
mesh_terms: D000998:Antiviral Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001992:Bronchoalveolar Lavage Fluid / Q000821:virology*; D001999:Bronchoscopy / Q000379:methods; D002675:Child, Preschool; D003587:Cytomegalovirus / Q000302:isolation & purification*; D003586:Cytomegalovirus Infections / Q000175:diagnosis* / Q000188:drug therapy; D005260:Female; D005336:Fiber Optic Technology; D015774:Ganciclovir / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007121:Immunocompetence; D007223:Infant; D008297:Male; D016133:Polymerase Chain Reaction / Q000379:methods; D012135:Respiratory Sounds / Q000175:diagnosis / Q000209:etiology; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D015774:Ganciclovir
keywords: antibiotics; infants; paediatrics; treatment strategies