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

Autores de IIS La Fe

• José Luis Piñana Sánchez

  Autor

• María Dolores Gómez Ruiz

  Autor

• Eva María González Barberá

  Autor

• Juan Bautista Montoro Gómez

  Autor

• Miguel Salavert Lletí

  Autor

• Paula Moles Poveda

  Autor

• Carlos Carretero Marquez

  Autor

• Aitana Balaguer Roselló

  Autor

• Jaime Sanz Caballer

  Autor

• Guillermo Sanz Santillana

  Autor

Participantes ajenos a IIS La Fe

• Gimenez, E
• Perez, A
• Vinuesa, V
• Hernandez-Boluda, JC
• Tormo, M
• Amat, P
• Solano, C
• Navarro, D

Grupos

• Hematología y Hemoterapia

• Infección Grave

Abstract

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. (C) 2019 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

Keywords

• Cytomegalovirus; CMV DNA in BAL; CMV pneumonia; CMV DNAemia; Pre-emptive antiviral therapy