Pulmonary cytomegalovirus (CMV) DNA shedding in allogeneic hematopoietic stem cell transplant recipients: Implications for the diagnosis of CMV pneumonia

Autor: Juan Montoro, Aitana Balaguer-Roselló, Paula Moles, Miguel Salavert, Estela Giménez, Víctor Vinuesa, David Navarro, Paula Amat, Carlos Carretero, María Dolores Gómez, Carlos Solano, Jaime Sanz, Ariadna Pérez, José Luis Piñana, Guillermo Sanz, Juan Carlos Hernández-Boluda, Eva Gonzalez, Mar Tormo
Rok vydání: 2019
Předmět:
Male
0301 basic medicine
Dna load
CMV pneumonia
Cytomegalovirus
medicine.disease_cause
chemistry.chemical_compound
0302 clinical medicine
Pre-emptive antiviral therapy
Medicine
030212 general & internal medicine
CMV DNA in BAL
Aged
80 and over
medicine.diagnostic_test
Hematopoietic Stem Cell Transplantation
virus diseases
respiratory system
Middle Aged
Viral Load
Virus Shedding
Infectious Diseases
Cytomegalovirus Infections
Female
Allogeneic hematopoietic stem cell transplant
Bronchoalveolar Lavage Fluid
Adult
Microbiology (medical)
Pneumonia
Viral
030106 microbiology
CMV DNAemia
Article
03 medical and health sciences
Humans
Transplantation
Homologous
Aged
Retrospective Studies
business.industry
CMV Pneumonia
Retrospective cohort study
medicine.disease
Transplant Recipients
respiratory tract diseases
Pneumonia
Bronchoalveolar lavage
chemistry
DNA
Viral
Immunology
business
DNA
Zdroj: The Journal of Infection
JOURNAL OF INFECTION
r-IIS La Fe. Repositorio Institucional de Producción Científica del Instituto de Investigación Sanitaria La Fe
instname
The Journal of infection
r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA
ISSN: 0163-4453
1532-2742
DOI: 10.1016/j.jinf.2019.02.009
Popis: Highlights • CMV DNA is frequently detected in BAL fluid specimens from allo-HSCT. • CMV DNA detection in BAL fluids is comparable across pneumonia etiologies. • CMV DNA loads in BAL fluids are comparable across pneumonia etiologies. • CMV DNA load in BAL may predict attributable-pneumonia mortality.
Summary Objectives To date no definitive cut-off value for cytomegalovirus (CMV) DNA load in bronchoalveolar lavage (BAL) fluid specimens has been established to discriminate between CMV pneumonia and pulmonary CMV DNA shedding in allogeneic hematopoietic stem cell transplant (allo-HSCT) recipients. Methods The current retrospective study is aimed at assessing the range of CMV DNA loads quantified in BAL fluid specimens from allo-HSCT patients with pneumonia in which different microorganisms were causally involved. Results A total of 144 BAL specimens from 123 patients were included. CMV DNA was detected in 56 out of 144 BAL fluid specimens and the median CMV DNA load from patients in whom CMV pneumonia was unlikely or could be tentatively ruled out was 1210 (31–68, 920) IU/ml. The frequency of CMV DNA detection and median CMV DNA loads were comparable, irrespective of the attributable cause of pneumonia. Detection of CMV DNA loads in BAL fluid specimens >500 IU/ml was independently associated with pneumonia-attributable mortality. Conclusions The current study highlights the difficulty in establishing universal CMV DNA load thresholds in BAL fluid specimens for distinguishing between CMV pneumonia and pulmonary CMV DNA shedding, and suggests that the presence of CMV DNA in BAL fluid specimens beyond a certain level may have a deleterious impact on patient outcome.
Databáze: OpenAIRE
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