Cytomegalovirus infection in immunocompetent wheezy infants: the diagnostic value of CMV PCR in bronchoalveolar lavage fluid

Cinel, Güzin; Pekcan, Sevgi; Alp, Alpaslan; Yalçın, Ebru; Doğru, Deniz; Ki̇per, Nural

doi:10.1111/jcpt.12169

Cited by 12 publications

(11 citation statements)

References 21 publications

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“…This study shows that quantifying CMV in NBBAL specimens is useful in diagnosing CMV pneumonitis in infants and is more predictive than plasma viral load. Other studies have shown similar results in lung transplant recipients [Chemaly et al, ; Westall et al, ], and in wheezy immunocompetent infants [Cinel et al, ], but to our knowledge, respiratory specimen quantification has not previously been evaluated in infants with severe pneumonia admitted to ICU.…”

Section: Discussionsupporting

confidence: 61%

Clinical utility of bronchoalveolar lavage cytomegalovirus viral loads in the diagnosis of cytomegalovirus pneumonitis in infants

Govender

Jeena

Parboosing

2016

Journal of Medical Virology

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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.

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Section: Discussionsupporting

confidence: 61%

Clinical utility of bronchoalveolar lavage cytomegalovirus viral loads in the diagnosis of cytomegalovirus pneumonitis in infants

Govender

Jeena

Parboosing

2016

Journal of Medical Virology

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“…The high prevalence of CMV in PBB and bronchiectasis is also a novel finding and further research is necessary to determine the clinical significance. A high prevalence of airway colonization with CMV (51%) among immunocompetent wheezing children with no underlying disease has been described, but inflammatory markers were not assessed in that study. Although CMV and EBV are well known opportunistic pathogens in immunocompromized children, little is known about their role in the airways of healthy children or children suffering from endobronchial bacterial airway infection.…”

Section: Discussionmentioning

confidence: 90%

Comparison of bronchoscopy and bronchoalveolar lavage findings in three types of suppurative lung disease

Vries

Chang

Marchant

2018

Pediatric Pulmonology

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“…And Peres et al has reported that monitoring the CMV reactivation and preemptive or prophylactic treatment are critical for these patients [25]. The emergence of rapid PCR detection methods has facilitated the accurate, rapid, and quantitative detection of CMV DNA in the patient’s bodily fluids [26]. Furthermore, PCR can be used to detect CMV reactivation, although some researchers have reported that CMV reactivation could simply be an indicator of immunecompromise status and illness severity, and may not require diagnostic procedures and treatment [27].…”

Section: Discussionmentioning

confidence: 99%

Outcomes and prognostic factors of non-HIV patients with pneumocystis jirovecii pneumonia and pulmonary CMV co-infection: A Retrospective Cohort Study

Jia

et al. 2017

BMC Infect Dis

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Background Pneumocystis jirovecii pneumonia (PJP) and pulmonary cytomegalovirus (CMV) infection are common opportunistic infections among immunocompromised patients. However, few studies have evaluated their co-infection, especially among non-HIV patients. Therefore, we aimed to evaluate the outcomes and prognostic factors among non-HIV patients with PJP according to their CMV infection status.MethodsThis retrospective study evaluated non-HIV patients who were diagnosed with PJP between January 2009 and January2016.The patients were classified and compared according to their pulmonary CMV infection status (positive infection: bronchoalveolar lavage fluid [BALF] CMV DNA loads of >500copies/mL).ResultsAmong 70 non-HIV patients with PJP, we identified 38 patients (54.3%) with pulmonary CMV infection. There was no significant difference in the mortality rates for the two groups (p = 0.15). Pulmonary CMV infection was significantly more common among patients who were receiving glucocorticoids and immunosuppressants, compared to corticosteroids only (p = 0.02). Pulmonary CMV infection was also significantly associated with severe dyspnea, a lower PaO2/FiO2, and the presence of centrilobular nodules (p = 0.008). Higher CMV DNA loads in the BALF were positively associated with mortality (p = 0.012).ConclusionsCombined therapy using corticosteroids and other immunosuppressants may be a risk factor for pulmonary CMV co-infection among patients with PJP. In addition, CMV pneumonia should be considered when centrilobular nodules and/or severe hypoxemia are observed in non-HIV patients with PJP. Furthermore, antiviral treatment should be promptly initiated for patients with a high CMV DNA load in BALF, based on their poor prognosis.

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Cytomegalovirus infection in immunocompetent wheezy infants: the diagnostic value of CMV PCR in bronchoalveolar lavage fluid

Abstract: 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.

Cited by 12 publications

References 21 publications

Clinical utility of bronchoalveolar lavage cytomegalovirus viral loads in the diagnosis of cytomegalovirus pneumonitis in infants

Clinical utility of bronchoalveolar lavage cytomegalovirus viral loads in the diagnosis of cytomegalovirus pneumonitis in infants

Comparison of bronchoscopy and bronchoalveolar lavage findings in three types of suppurative lung disease

Outcomes and prognostic factors of non-HIV patients with pneumocystis jirovecii pneumonia and pulmonary CMV co-infection: A Retrospective Cohort Study

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