Oncotarget

Clinical Research Papers:

Diagnosis of cytomegalovirus pneumonia by quantitative polymerase chain reaction using bronchial washing fluid from patients with hematologic malignancies

Hwa Young Lee, Chin Kook Rhee, Joon Young Choi, Hea Yon Lee, Jong Wook Lee and Dong Gun Lee _

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Oncotarget. 2017; 8:39736-39745. https://doi.org/10.18632/oncotarget.14504

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Abstract

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

Correspondence to:

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

Abstract

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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