CHEST

CHEST

Volume 119, Issue 3, March 2001, Pages 838-843
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Clinical Investigations
Pulmonary Cytomegalovirus Infection in Immunocompromised Patients

https://doi.org/10.1378/chest.119.3.838Get rights and content

Background:

Cytomegalovirus (CMV) infection and CMVdisease are frequent complications in immunocompromised patients. Inthis study, the incidence of pulmonary CMV infection was analyzed indifferent groups of immunocompromised patients and the diagnostic valueof immunostaining with anti-CMV antibodies in BAL cells wasevaluated in regard to the diagnosis of CMV pneumonitis.

Methods:

Five hundred eighty consecutive BAL procedureswere analyzed prospectively in 442 immunocompromised and 126nonimmunocompromised control subjects. CMV culture in BAL fluid wasperformed by shell vial assay and immunostaining using three monoclonalanti-CMV antibodies.

Results:

The incidence of cultureresults positive for CMV in the BAL fluid varied from 20 to 30% inHIV-positive patients, in patients following stem cell or renaltransplantation, and in patients with autoimmune disease or lungfibrosis treated with immunosuppressive agents. CMV was cultured from4.4% of BALs in patients treated with high-dose chemotherapy and from2.4% of control subjects. CMV disease developed in 37 patients; in 18of these patients, CMV pneumonitis was present. The results of CMVimmunostaining were positive in a total of 22 BALs, all in patientswith CMV disease. The sensitivity, specificity, and positive and negative predictive values of positive CMV immunostaining results forthe diagnosis of CMV pneumonitis were 88.9%, 98.6%, 72.7%, and99.5%, respectively.

Conclusion:

The incidence of pulmonary CMV infection is similar in different groups of immunocompromised patients except for patients following high-dosechemotherapy. CMV immunostaining in the BAL fluid is a very helpfulmethod to diagnose CMV pneumonitis in these patients.

Section snippets

Patient Population

Over a 4-year period, 442 BAL procedures were performed inimmunocompromised patients, and the diagnostic value of differentmethods for CMV detection was prospectively evaluated (ie,CMV culture, cytology, and CMV immunostaining). Similar diagnosticmethods were used in a total of 126 BAL procedures performed inimmunocompetent patients, who were considered to be anonimmunocompromised control group. The immunocompromised BAL groupconsisted of the following patients: HIV-positive patients,

General Microbiological Findings

Microbiological findings are summarized in Table 1. Bacteria were found in 31.9% of immunocompromised patients (141 of442 patients) and in 37.3% of nonimmunocompromised patients (47 of 126patients). Legionella pneumoniae was documented in threepatients. Mycobacterium tuberculosis was found in 5.7% of HIV-positive patients (13 of 227 patients) and in one patient with idiopathic pulmonary fibrosis who had been treated with steroids. Atypical mycobacteria could be cultured in 10.6% of BAL

Discussion

In our study, the incidence of pulmonary CMV infection, defined asa positive CMV culture finding in BAL fluid, was between 24.9% and29% in all immunocompromised patient groups except in patients treatedwith high-dose chemotherapy. High-dose chemotherapy with short-termpancytopenia is only a low-risk factor for the development of CMVdisease, which compares well with the results of a multicenteranalysis3 of CMV pneumonitis following autologous bonemarrow transplantation and a study24 comparing

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    Copyright © 2001 The American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.