title: Clinical utility of bronchoalveolar lavage cytomegalovirus viral loads in the diagnosis of cytomegalovirus pneumonitis in infants.
abstract: Cytomegalovirus (CMV) pneumonitis is a significant cause of morbidity and mortality of children in Africa. The current practice for diagnosing CMV pneumonitis in this setting is based on interpretation of clinical, laboratory, and radiological findings. There is a need for a sensitive and specific laboratory test to objectively distinguish between patients with CMV pneumonitis and those with CMV infection, and non-CMV pneumonia. In this study, we compared plasma and non-bronchoscopic bronchoalveolar lavage (NBBAL) CMV viral loads in patients with CMV pneumonitis and those with CMV infection and non-CMV pneumonia. Receiver operator characteristic curve analysis was used to establish a threshold and assess utility of viral loads in the diagnosis of CMV pneumonitis. We assessed the urea dilution method, and expression of viral loads relative to the total amount of extracted nucleic acids in correcting for NBBAL dilution. CMV quantification in NBBAL specimens was more predictive of CMV pneumonitis than blood CMV quantification. The threshold of 4.03 log IU/ml in NBBAL specimens has good predictive value and can be used to guide management of infants with suspected CMV pneumonitis. Adjusting for dilution of NBBAL specimens by using the urea dilution method or by expressing the viral load relative to the total nucleic acids extracted did not provide additional analytical benefits. J. Med. Virol. 89:1080-1087, 2017. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Department of Virology, National Health Laboratory Service, Durban, KwaZulu Natal, South Africa.|Virology, College of Health Sciences, University of KwaZulu-Natal, Durban, KwaZulu Natal, South Africa.
authors.forename: Kerusha
authors.initials: K
authors.lastname: Govender
authors.affiliation: Paediatrics and Child Health, College of Health Sciences, University of KwaZulu-Natal, Durban, KwaZulu Natal, South Africa.
authors.forename: Prakash
authors.initials: P
authors.lastname: Jeena
authors.affiliation: Department of Virology, National Health Laboratory Service, Durban, KwaZulu Natal, South Africa.|Virology, College of Health Sciences, University of KwaZulu-Natal, Durban, KwaZulu Natal, South Africa.
authors.forename: Raveen
authors.initials: R
authors.lastname: Parboosing
mesh_terms: D001769:Blood / Q000821:virology; D001992:Bronchoalveolar Lavage Fluid / Q000821:virology*; D003587:Cytomegalovirus / Q000302:isolation & purification*; D003586:Cytomegalovirus Infections / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011014:Pneumonia / Q000175:diagnosis*; D011237:Predictive Value of Tests; D012372:ROC Curve; D019562:Viral Load
keywords: CMV diagnosis; CMV pneumonia; CMV quantification; paediatric CMV; urea dilution method