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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
G Cathomas, P Morris, K Pekle, I Cunningham and D Emanuel
Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York
10021.
The objective was to compare the use of the polymerase chain reaction
(PCR), virus culture, and immunostaining of alveolar cells used alone and
in combination as diagnostic methods for the rapid diagnosis of
cytomegalovirus (CMV) pneumonia in marrow transplant recipients.
Seventy-five marrow transplant recipients with clinical and radiological
evidence of pneumonitis were used as subjects. Bronchoalveolar lavage was
performed on all patients to obtain material for conventional and/or rapid
CMV culture, immunostaining of alveolar cells with monoclonal antibodies
(MoAbs), and amplification of CMV-DNA by PCR. Assay results were then
prospectively correlated with clinical outcome. Seven of the 75 patients
(9.3%) had CMV pneumonitis and 6 patients (8%) had CMV infection without
pneumonia. PCR is the most sensitive assay for the detection of CMV in
bronchoalveolar lavage fluid. For the diagnosis of CMV pneumonitis, the
sensitivity of alveolar cell immunostaining and PCR were both 100%. The
sensitivity of virus culture was 85.7%. The positive predictive value for
each test, used alone, for the identification of CMV pneumonitis was low.
However, when the result of the PCR assay was assessed in combination with
CMV immunostaining of alveolar cells, the sensitivity, specificity,
positive, and negative predictive value of this strategy was 100%. The
concomitant use of PCR and the rapid immunostaining of alveolar cells for
CMV has facilitated the development of a sensitive and specific diagnostic
algorithm for the detection and early treatment of CMV pneumonitis in
transplant recipients.
Volume 81,
Issue 7,
pp. 1909-1914,
04/01/1993
Copyright © 1993 by The American Society of Hematology
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