Predictive Value of Cytomegalovirus Dna Detection by Polymerase Chain Reaction in Blood and Bronchoalveolar Lavage in Lung Transplant Patients1

Stéphan, François; Fajac, Anne; Grenet, Dominique; Honderlick, P.; Ricci, Sylvie; Frachon, Irène; Friard, S.; Caubarrere, I.; Jf, Bernaudin; Stern, M.

doi:10.1097/00007890-199705270-00011

Cited by 31 publications

(28 citation statements)

References 32 publications

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“…The detection of CMV in BAL fluid may or may not be indicative of CMV pneumonia (68,73,(141)(142)(143)(144)(145). Shedding of CMV in saliva and respiratory secretions is not uncommon, and the demonstration of CMV DNA in these respiratory samples in the absence of compatible clinical signs and symptoms (or in the absence of biopsy confirmation) is of unclear significance and does not necessarily indicate CMV pneumonia (141).…”

Section: Nucleic Acid-based Methodsmentioning

confidence: 99%

“…To confirm the clinical suspicion of tissue-invasive CMV disease in these nonviremic situations, one may repeat the NAT at a later time point, use another NAT assay with higher sensitivity or a different genetic target, or obtain tissue for histopathologic diagnosis (54). In such cases, one should strongly consider sampling body fluid or tissue from the suspected site of infection, such as the aqueous and vitreous humor fluid for patients suspected to have CMV retinitis (139,194), BAL fluid for patients suspected to have CMV pneumonia (142,143), and CSF for patients suspected to have CMV encephalitis, meningitis, or polyradiculopathy (147,195,196).…”

Section: Rapid Diagnosismentioning

confidence: 99%

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Clinical Utility of Viral Load in Management of Cytomegalovirus Infection after Solid Organ Transplantation

2013

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SUMMARY The negative impact of cytomegalovirus (CMV) infection on transplant outcomes warrants efforts toward improving its prevention, diagnosis, and treatment. During the last 2 decades, significant breakthroughs in diagnostic virology have facilitated remarkable improvements in CMV disease management. During this period, CMV nucleic acid amplification testing (NAT) evolved to become one of the most commonly performed tests in clinical virology laboratories. NAT provides a means for rapid and sensitive diagnosis of CMV infection in transplant recipients. Viral quantification also introduced several principles of CMV disease management. Specifically, viral load has been utilized (i) for prognostication of CMV disease, (ii) to guide preemptive therapy, (iii) to assess the efficacy of antiviral treatment, (iv) to guide the duration of treatment, and (v) to indicate the risk of clinical relapse or antiviral drug resistance. However, there remain important limitations that require further optimization, including the interassay variability in viral load reporting, which has limited the generation of standardized viral load thresholds for various clinical indications. The recent introduction of an international reference standard should advance the major goal of uniform viral load reporting and interpretation. However, it has also become apparent that other aspects of NAT should be standardized, including sample selection, nucleic acid extraction, amplification, detection, and calibration, among others. This review article synthesizes the vast amount of information on CMV NAT and provides a timely review of the clinical utility of viral load testing in the management of CMV in solid organ transplant recipients. Current limitations are highlighted, and avenues for further research are suggested to optimize the clinical application of NAT in the management of CMV after transplantation.

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Section: Nucleic Acid-based Methodsmentioning

confidence: 99%

Section: Rapid Diagnosismentioning

confidence: 99%

Clinical Utility of Viral Load in Management of Cytomegalovirus Infection after Solid Organ Transplantation

2013

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“…Although PCR is extremely sensitive and specific in detecting the presence of CMV DNA, there is the concern that a positive signal resulting from the presence of very few DNA copies may not differentiate between replicating and latent viruses (91,142,157,507). On the other hand, negative CMV detection by PCR strongly advocates against CMV infection (33,278,347,448). Additionally, a positive PCR signal for CMV in a seronegative recipient is significant because it indicates primary infection (278).…”

Section: Pcr Amplificationmentioning

confidence: 99%

“…While plasma PCR may be of clinical utility, further evaluation is needed before firm recommendations can be made on its applicability. PCR can also be of clinical value when analyzing urine (78,121), bronchoalveolar lavage fluid (240,448), cerebrospinal fluid (70,170,491,499), aqueous and vitreous humor samples (133,149,304), tissue biopsy samples (48,54,112,268,501), and other miscellaneous body fluids (259).…”

Section: Pcr Amplificationmentioning

confidence: 99%

“…Significant decreases in viral loads are observed during ganciclovir administration (213,314,470). The discontinuation of treatment when CMV PCR is positive in bronchoalveolar lavage specimens of lung transplant recipients (448) and in blood specimens of kidney/kidney-pancreas transplant recipients (213) has been associated with recurrence of CMV infection. Disappearance of the PCR signal in leukocytes might represent a primary end point to be achieved during antiviral therapy to delay or prevent a relapse of CMV disease (151).…”

Section: Treatmentmentioning

confidence: 99%

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New Strategies for Prevention and Therapy of Cytomegalovirus Infection and Disease in Solid-Organ Transplant Recipients

Sia¹,

Patel²

2000

Clinical Microbiology Reviews

220

181

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Comparison of cytomegalovirus antigenemia and culture assays in patients on and off antiviral therapy

George

Rinaldo

1999

J. Med. Virol.

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We examined 1,869 consecutive blood specimens from 529 patients (>80% organ transplant recipients) for detection of CMV by antigenemia and culture assays, and compared results between patients on and off antiviral therapy. All 1,869 specimens were tested by the shell vial assay and antigenemia, and 503 were also tested by standard tube culture. The overall positivity rate for each test was 17.0% for antigenemia, 1.8% for shell vial culture assay, and 0.7% by tube culture. No specimens were positive by either shell vial or tube culture, while negative by antigenemia. These findings were consistent across all organ transplant and other patient types. Shell vial positivity was associated with higher antigenemia levels in patients either on or off anti-CMV drug therapy. Among the shell vial positive specimens, the antigenemia counts were higher in patients on antiviral drug therapy as compared to those not on therapy. We conclude that the pp65 antigenemia assay is superior to culture methods for detection of CMV in blood, particularly for patients on anti-CMV drug treatment. Additionally, its quantitative nature renders the antigenemia assay an excellent tracking tool for both resolution of asymptomatic, low level CMV reactivations and response of CMV infection to antiviral treatment.

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Predictive Value of Cytomegalovirus Dna Detection by Polymerase Chain Reaction in Blood and Bronchoalveolar Lavage in Lung Transplant Patients1

Abstract: Negative CMV detection by PCR strongly advocates against a forthcoming CMV infection. PCR assay seems to be a good predictor for early recurrence of CMV infection, and would be useful for monitoring the response to antiviral therapy.

Cited by 31 publications

References 32 publications

Clinical Utility of Viral Load in Management of Cytomegalovirus Infection after Solid Organ Transplantation

Clinical Utility of Viral Load in Management of Cytomegalovirus Infection after Solid Organ Transplantation

New Strategies for Prevention and Therapy of Cytomegalovirus Infection and Disease in Solid-Organ Transplant Recipients

Comparison of cytomegalovirus antigenemia and culture assays in patients on and off antiviral therapy

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