Clinical Research Papers:
Diagnosis of cytomegalovirus pneumonia by quantitative polymerase chain reaction using bronchial washing fluid from patients with hematologic malignancies
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Hwa Young Lee1,*, Chin Kook Rhee1,*, Joon Young Choi1, Hea Yon Lee1, Jong Wook Lee2,3 and Dong Gun Lee3,4,5
1 Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, The Catholic University of Korea, Seoul, Korea
2 Department of Internal Medicine, Division of Hematology, The Catholic University of Korea, Seoul, Korea
3 The Catholic Blood and Marrow Transplantation Center, The Catholic University of Korea, Seoul, Korea
4 Department of Internal Medicine, Division of Infectious Diseases, The Catholic University of Korea, Seoul, Korea
5 Vaccine Bio Research Institute, The Catholic University of Korea, Seoul, Korea
* These authors have contributed equally to this work
Dong Gun Lee, email:
Keywords: cytomegalovirus, pneumonia, real-time polymerase chain reaction, hematologic neoplasms
Received: August 04, 2016 Accepted: December 27, 2016 Published: January 04, 2017
Background: The incidence of cytomegalovirus (CMV) pneumonia is increasing in patients diagnosed with hematologic malignancies. The utility of CMV-DNA viral load measurement has not been standardized, and viral cut-off values have not been established. This study was designed to investigate the utility of CMV quantitative real-time PCR (qRT-PCR) using bronchial washing fluid.
Methods: We retrospectively reviewed the microbiologic and pathologic results of bronchial washing fluid and biopsy specimens in addition to the patients’ clinical characteristics.
Results: A total of 565 CMV qRT-PCR assays were performed using bronchial washing fluid from patients with hematologic malignancies. Among them, 101 were positive for CMV by qRT-PCR; of these, 24 were diagnosed with CMV pneumonia and 70 with CMV infection, and 7 were excluded due to a diagnosis of invasive pulmonary aspergillosis rather than viral pneumonia. The median CMV load determined by qPCR was 1.8 × 105 copies/mL (3.6 103-1.5 × 108) in CMV pneumonia patients and 3.0 × 103 copies/mL (5.0 × 102-1.1 × 105) in those diagnosed with CMV infection (P < 0.01). Using the ROC curve, the optimal inflection points were 18,900 copies/mL (137,970 IU/mL) in post-bone marrow transplantation (BMT) patients, 316,415 copies/mL (2,309,825 IU/mL) in no-BMT patients and 28,774 copies/mL (210,054 IU/mL) in all patients.
Conclusions: The CMV titers in bronchial washing fluid determined by qRT-PCR differed significantly between patients diagnosed with CMV pneumonia and those with CMV infection. The viral cut-off values in bronchial washing fluid were suggested for the diagnosis of CMV pneumonia, which were different depending on the BMT status.
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