Abstract
Background: This study was designed to investigate the utility of CMV quantitative-PCR (qPCR) in bronchial washing fluid and define the viral load cut off values to discriminate CMV pneumonia from infection.
Methods: From Mar 2008 to Jun 2014, a total of 565 CMV qPCR was performed on bronchial washing fluid from patients with hematologic malignancies to isolate the pathogen of pneumonia in Seoul St. Mary's hospital. Retrospective chart review was done.
Results: Among the 565 specimen, 101 of CMV qPCR were positive. Twenty-six were diagnosed CMV pneumonia, 68 were CMV infection and 7 were excluded due to the diagnoses of IPA. Of the 26 patients, 9 (34.6%) had acute leukemia and 18 (69.2%) were post-BMT status including 2 autologous transplantations. CMV pneumonia was occurred mean 175.6 ± 55.43 days after BMT, 6 had histories of preemptive CMV therapy. All of the patiens were treated with antiviral agents and/or CMV IgG. Eleven (42.3%) were improved after the treatment, 28-days mortality was 46.2%. Median CMV qPCR result was 1.2 X 10^5 copies/mL (1.8 X 10^3-1.5 X 10^8) in CMV pneumonia patients and 6.1 X 10^3 copies/ml (548-1.1 X 10^5) in CMV infection (P = 0.27). Using the Receiver operating characteristic (ROC) curve, 1.9 X 10^4 copies/mL showed 73% of sensitivity and 84% of specificity, 2.5 X 10^4 copies/mL showed 69% of sensitivity and 88% of specificity (AUC 0.878, P = 0.000).
Conclusions: Although the titers of CMV qPCR were not statistically different between the patients diagnosed CMV pneumonia and infection, cut off values of 1.9-2.5 X 10^4 copies/mL could suggest the point to correlate CMV qPCR in bronchial washing fluid to CMV pneumonia.
- Copyright ©ERS 2015
