Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Technical Report
  • Published:

CMV viral load in bronchoalveolar lavage for diagnosis of pneumonia in allogeneic hematopoietic stem cell transplantation

Abstract

The objective of this report is to analyze the value of CMV viral load (VL) in bronchoalveolar lavage (BAL) in recipients of allogeneic hematopoietic stem cell transplantation (AHSCT) and to analyze the concordance between CMV quantification in plasma and BAL samples. Fifty-six patients were included; in 16 (28.6%) patients with symptoms of lung disease a BAL sample was collected, 7 (43.7%) patients had a VL >150 copies/mL (six had probable CMV pneumonia). Patients with CMV pneumonia were female (100%), of median age 53.5 years, and the median time from transplantion to onset of symptoms was 67.5 days. Pneumonia was early in three cases (incidence 5.4%). Median BAL VL was 53 250 copies/mL and plasma VL was 538 copies/mL (in one patient, the plasma VL was negative). Three (50.0%) patients had an improvement in the first week of treatment, and plasma VL became negative; the other 3 (50.0%) patients died with a CMV pneumonia refractory to treatment. Therefore, any value of CMV VL in BAL, especially if it is greater than plasma, with compatible signs or symptoms, should be considered suggestive of CMV pneumonia in recipients of AHSCT and they should receive specific treatment.

This is a preview of subscription content, access via your institution

Access options

Buy this article

USD 39.95

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Erard V, Guthrie KA, Seo S, Smith J, Huang M, Chien J et al. Reduced mortality of cytomegalovirus pneumonia after hematopoietic cell transplantation due to antiviral therapy and changes in transplantation practices. Clin Infect Dis 2015; 61: 31–39.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Ljungman P, Griffiths P, Paya C . Definitions of Cytomegalovirus infection and disease in transplant recipients. Clin Infect Dis 2002; 34: 1094–1097.

    Article  Google Scholar 

  3. Ljungman P, Boeckh M, Hirsch HH, Josephson F, Lundgren J, Nichols G et al. Definitions of CMV infection and disease in transplant patiens for use in clinical trials. Clin Infect Dis 2016; 64: 87–91.

    PubMed  Google Scholar 

  4. Travi G, Pergam SA . Cytomegalovirus pneumonia in hematopoietic stem cell recipients. J Intensive Care Med 2014; 29: 200–212.

    Article  PubMed  Google Scholar 

  5. Chemaly RF, Yen-Lieberman B, Castilla EA, Reilly A, Arrigain S, Farver C et al. Correlation between viral loads of cytomegalovirus in blood and bronchoalveolar lavage specimens from lung transplant recipients determined by histology and immunohistochemistry. J Clin Microbiol 2004; 42: 2168–2172.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Seo S, Renaud C, Kuypers JM, Chiu CY, Huang ML, Samayoa E et al. Idiopathic pneumonia syndrome after hematopoietic cell transplantation: evidence of occult infectious etiologies. Blood 2015; 125: 3789–3797.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Cathomas BG, Morris P, Pekle P, Cunningham I, Emanuel D . Rapid diagnosis of cytomegalovirus pneumonia in marrow transplant recipients by bronchoalveolar lavage using the polymerase chain reaction, virus culture, and the direct immunostaining of alveolar cells. Blood 1993; 81: 1909–1914.

    CAS  PubMed  Google Scholar 

  8. Eriksson BM, Brytting M, Zweygberg-Wirgart B, Hillerdal G, Olding-Stenkvist E, Linde A . Diagnosis of cytomegalovirus in bronchoalveolar lavage by polymerase chain reaction, in comparison with virus isolation and detection of viral antigen. Scand J Infect Dis 1993; 25: 421–427.

    Article  CAS  PubMed  Google Scholar 

  9. Tan SK, Burgener EB, Waggoner JJ, Gajurel K, Gonzalez S, Chen SF et al. Molecular and culture-based bronchoalveolar lavage fluid testing for the diagnosis of cytomegalovirus penumonitis. Open Forum Infect Dis 2016; 3: ofv212.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Emery V, Zuckerman M, Jackson G, Aitken C, Osman H, Pagliuca A et al. Management of cytomegalovirus infection in haemopoietic stem cell transplantation. Br J Haematol 2013; 162: 25–39.

    Article  CAS  PubMed  Google Scholar 

  11. Chemaly RF, Yen-Lieberman B, Chapman J, Reilly A, Bekele BN, Gordon SM et al. Clinical utility of cytomegalovirus viral load in bronchoalveolar lavage in lung transplant recipients. Am J Transplant 2005; 5: 544–548.

    Article  PubMed  Google Scholar 

  12. Henke-Gendo C, Ganzenmueller T, Kluba J, Harste G, Raggub L, Heim A . Improved quantitative PCR protocols for adenovirus and CMV with an internal inhibition control system and automated nucleic acid isolation. J Med Virol 2012; 84: 890–896.

    Article  CAS  PubMed  Google Scholar 

  13. Westall GP, Michaelides A, Williams TJ, Snell GI, Kotsimbos TC . Human cytomegalovirus load in plasma and bronchoalveolar lavage fluid: a longitudinal study of lung transplant recipients. J Infect Dis 2004; 190: 1076–1083.

    Article  PubMed  Google Scholar 

  14. Ruell J, Barnes C, Mutton K, Foulkes B, Chang J, Cavet J et al. Active CMV disease does not always correlate with viral load detection. Bone Marrow Transplant 2007; 40: 55–61.

    Article  CAS  PubMed  Google Scholar 

  15. Liu J, Kong J, Chang YJ, Chen H, Chen YH, Han W et al. Patients with refractory cytomegalovirus (CMV) infection following allogeneic haematopoietic stem cell transplantation are at high risk for CMV disease and non-relapse mortality. Clin Microbiol Infect 2015; 21: 1121, e9–e15.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to L Iglesias.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Iglesias, L., Perera, M., Torres-Miñana, L. et al. CMV viral load in bronchoalveolar lavage for diagnosis of pneumonia in allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant 52, 895–897 (2017). https://doi.org/10.1038/bmt.2017.11

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue date:

  • DOI: https://doi.org/10.1038/bmt.2017.11

This article is cited by

Search

Quick links