title: Diagnosis of cytomegalovirus pneumonia by quantitative polymerase chain reaction using bronchial washing fluid from patients with hematologic malignancies.
abstract: BACKGROUND
  The incidence of cytomegalovirus (CMV) pneumonia is increasing in patients diagnosed with hematologic malignancies. The utility of CMV-DNA viral load measurement has not been standardized, and viral cut-off values have not been established. This study was designed to investigate the utility of CMV quantitative real-time PCR (qRT-PCR) using bronchial washing fluid.
  
  
  METHODS
  We retrospectively reviewed the microbiologic and pathologic results of bronchial washing fluid and biopsy specimens in addition to the patients' clinical characteristics.
  
  
  RESULTS
  A total of 565 CMV qRT-PCR assays were performed using bronchial washing fluid from patients with hematologic malignancies. Among them, 101 were positive for CMV by qRT-PCR; of these, 24 were diagnosed with CMV pneumonia and 70 with CMV infection, and 7 were excluded due to a diagnosis of invasive pulmonary aspergillosis rather than viral pneumonia. The median CMV load determined by qPCR was 1.8 × 105 copies/mL (3.6 103-1.5 × 108) in CMV pneumonia patients and 3.0 × 103 copies/mL (5.0 × 102-1.1 × 105) in those diagnosed with CMV infection (P < 0.01). Using the ROC curve, the optimal inflection points were 18,900 copies/mL (137,970 IU/mL) in post-bone marrow transplantation (BMT) patients, 316,415 copies/mL (2,309,825 IU/mL) in no-BMT patients and 28,774 copies/mL (210,054 IU/mL) in all patients.
  
  
  CONCLUSIONS
  The CMV titers in bronchial washing fluid determined by qRT-PCR differed significantly between patients diagnosed with CMV pneumonia and those with CMV infection. The viral cut-off values in bronchial washing fluid were suggested for the diagnosis of CMV pneumonia, which were different depending on the BMT status.
authors.affiliation: Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Hwa Young
authors.initials: HY
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Chin Kook
authors.initials: CK
authors.lastname: Rhee
authors.affiliation: Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Joon Young
authors.initials: JY
authors.lastname: Choi
authors.affiliation: Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Hea Yon
authors.initials: HY
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Division of Hematology, The Catholic University of Korea, Seoul, Korea.|The Catholic Blood and Marrow Transplantation Center, The Catholic University of Korea, Seoul, Korea.
authors.forename: Jong Wook
authors.initials: JW
authors.lastname: Lee
authors.affiliation: The Catholic Blood and Marrow Transplantation Center, The Catholic University of Korea, Seoul, Korea.|Department of Internal Medicine, Division of Infectious Diseases, The Catholic University of Korea, Seoul, Korea.|Vaccine Bio Research Institute, The Catholic University of Korea, Seoul, Korea.
authors.forename: Dong Gun
authors.initials: DG
authors.lastname: Lee
mesh_terms: D001992:Bronchoalveolar Lavage Fluid / Q000737:chemistry*; D003587:Cytomegalovirus / Q000235:genetics* / Q000302:isolation & purification; D003586:Cytomegalovirus Infections / Q000175:diagnosis* / Q000235:genetics / Q000821:virology; D004279:DNA, Viral / Q000235:genetics; D005260:Female; D005500:Follow-Up Studies; D019337:Hematologic Neoplasms / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000175:diagnosis* / Q000235:genetics / Q000821:virology; D011379:Prognosis; D012372:ROC Curve; D060888:Real-Time Polymerase Chain Reaction / Q000379:methods*; D012189:Retrospective Studies; D019562:Viral Load
chemical_list: D004279:DNA, Viral
keywords: cytomegalovirus; hematologic neoplasms; pneumonia; real-time polymerase chain reaction