Cytomegalovirus (CMV) DNA quantification in bronchoalveolar lavage fluid of immunocompromised patients with CMV pneumonia

Elena Beam, Jeffrey J. Germer, Brian Lahr, Joseph D.C. Yao, Andrew Harold Limper, Matthew J. Binnicker, Raymund R Razonable

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Cytomegalovirus (CMV) pneumonia causes major morbidity and mortality. Its diagnosis requires demonstration of viral cytopathic changes in tissue, entailing risks of lung biopsy. This study aimed to determine CMV viral load (VL) thresholds in bronchoalveolar lavage fluid (BALF) for diagnosis of CMV pneumonia in immunocompromised patients. CMV VL in BALF was studied in 17 patients (83% transplant recipients) and 21 control subjects with and without CMV pneumonia, respectively, using an FDA-approved PCR assay (Cobas® AmpliPrep/Cobas TaqMan® CMV Test, Roche Molecular Systems, Inc.) calibrated to the WHO International Standard for CMV DNA (NIBSC: 09/162). Receiver operating characteristic curve analysis produced a BALF CMV VL threshold of 34 800, IU/mL with 91.7% sensitivity and 100.0% specificity for diagnosis of possible, probable, and proven CMV pneumonia in transplant patients, while a threshold of 656 000 IU/mL yielded 100% sensitivity and specificity among biopsy-proven cases. For all immunocompromised patients, a VL threshold of 274 IU/mL was selected. VL thresholds also were normalized to BALF cell count yielding a threshold of 0.32 IU/106 cells with 91.7% sensitivity and 90.5% specificity for possible, probable, and proven CMV pneumonia in transplant recipients. Monitoring CMV VL in BALF may be a less invasive method for diagnosing CMV pneumonia in immunocompromised patients.

Original languageEnglish (US)
Article numbere13149
JournalClinical Transplantation
Volume32
Issue number1
DOIs
StatePublished - Jan 1 2018

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Bronchoalveolar Lavage Fluid
Immunocompromised Host
Cytomegalovirus
Pneumonia
DNA
Viral Load
Sensitivity and Specificity
Biopsy
ROC Curve
Cell Count
Morbidity
Transplants

Keywords

  • bronchoalveolar lavage
  • cytomegalovirus
  • nucleic acid test
  • viral load

ASJC Scopus subject areas

  • Transplantation

Cite this

Cytomegalovirus (CMV) DNA quantification in bronchoalveolar lavage fluid of immunocompromised patients with CMV pneumonia. / Beam, Elena; Germer, Jeffrey J.; Lahr, Brian; Yao, Joseph D.C.; Limper, Andrew Harold; Binnicker, Matthew J.; Razonable, Raymund R.

In: Clinical Transplantation, Vol. 32, No. 1, e13149, 01.01.2018.

Research output: Contribution to journalArticle

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abstract = "Cytomegalovirus (CMV) pneumonia causes major morbidity and mortality. Its diagnosis requires demonstration of viral cytopathic changes in tissue, entailing risks of lung biopsy. This study aimed to determine CMV viral load (VL) thresholds in bronchoalveolar lavage fluid (BALF) for diagnosis of CMV pneumonia in immunocompromised patients. CMV VL in BALF was studied in 17 patients (83{\%} transplant recipients) and 21 control subjects with and without CMV pneumonia, respectively, using an FDA-approved PCR assay (Cobas{\circledR} AmpliPrep/Cobas TaqMan{\circledR} CMV Test, Roche Molecular Systems, Inc.) calibrated to the WHO International Standard for CMV DNA (NIBSC: 09/162). Receiver operating characteristic curve analysis produced a BALF CMV VL threshold of 34 800, IU/mL with 91.7{\%} sensitivity and 100.0{\%} specificity for diagnosis of possible, probable, and proven CMV pneumonia in transplant patients, while a threshold of 656 000 IU/mL yielded 100{\%} sensitivity and specificity among biopsy-proven cases. For all immunocompromised patients, a VL threshold of 274 IU/mL was selected. VL thresholds also were normalized to BALF cell count yielding a threshold of 0.32 IU/106 cells with 91.7{\%} sensitivity and 90.5{\%} specificity for possible, probable, and proven CMV pneumonia in transplant recipients. Monitoring CMV VL in BALF may be a less invasive method for diagnosing CMV pneumonia in immunocompromised patients.",
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