Abstract
Objective
The study was undertaken to determine if critically ill patients under mechanical ventilation could reactivate latent cytomegalovirus (CMV) in either lung or blood.
Design
Prospective study in critically ill patients.
Setting
The study was performed in a multidisciplinary intensive care unit in a university hospital.
Patients
23 non-immunocompromised, mechanically ventilated patients who were anti-CMV immunoglobulin G-positive. Ten immunocompromised patients with active CMV infection and 16 asymptomatic CMV seropositive non-immunocompromised patients constituted the positive and negative control groups.
Measurements and results
The presence of CMV in blood and bronchoalveolar lavage (BAL) was evaluated by both viral cultures and polymerase chain reaction (PCR). Thirty-seven blood and 22 BAL samples were investigated. Sequential samples were evaluated in 8 patients. For PCR, a 290 bp fragment in the first exon of the immediate early 1 gene was amplified. In order to exclude inhibitors of PCR amplification, a 268 bp fragment of the β-globin gene was concurrently amplified in all samples. Viral cultures of blood and BAL were negative in all 23 non-immunocompromised, mechanically ventilated patients. Moreover, no CMV DNA could be amplified in blood or BAL samples, whereas a β-globin amplification was observed in all samples.
Conclusion
In a series of 23 critically ill patients under mechanical ventilation who were seropositive for CMV, no reactivation of CMV in blood or lung was demonstrated.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Smith CB (1989) Cytomegalovirus pneumonia: state of the art. Chest 95:182–187
Alford CA, Britt WJ (1990) Cytomegalovirus. In: Fields BN, Knipe DM, Chanock RM, Hirsch MS, Melnick JL, Monath TP, Roizman B (eds) Virology, 2nd edn. Raven Press, New York, pp 1981–2010
Domart Y, Trouillet J-L, Fagon J-Y, Chastre J, Brun-Vezinet F, Gibert C (1990) Incidence and morbidity of cytomegaloviral infection in patients with mediastinitis following cardiac surgery. Chest 97:18–22
Döcke WD, Prösch S, Fietze E, Kimel V, Zuckermann H, Klug C, Syrbe U, Krüger DH, Von Baehr R, Volk HD (1994) Cytomegalovirus reactivation and tumour necrosis factor. Lancet 343:268–269
Schrier RD, Nelson JA, Oldstone MBA (1985) Detection of human cytomegalovirus in peripheral blood lymphocytes in a natural infection. Science 230:1048–1051
Taylor-Wiederman J, Sissons JGP, Borysiewicz LK, Sinclair JH (1991) Monocytes are a major site of persistence of human cytomegalovirus in peripheral blood mononuclear cells. J Gen Virol 72: 2059–2064
Adler SP (1983) Transfusion-associated cytomegalovirus infections. Rev Infect Dis 5:977–993
Toorkey CB, Carrigan DR (1989) Immunohistochemical detection of an immediate early antigen of human cytomegalovirus in normal tissues. J Infect Dis 160: 741–750
Griffiths PD, Grundy JE (1987) Molecular biology and immunology of cytomegalovirus. Biochem J 241:313–324
Michelson S, Plotkin SA (eds) (1993) Multidisciplinary approach to understanding cytomegalovirus disease. In: Proceedings of the fourth international cytomegalovirus workshop: multidisciplinary approaches to understanding CMV disease. Elsevier, Amsterdam
Abraham E (1989) Cellular and humoral immunity in the critically ill patient. In: Shoemaker WC, Ayres S, Grenvik A, Holbrook PR, Thompson WL (eds) Textbook of critical care, 2nd edn. Saunders, Philadelphia, pp 1024–1028
Shibata D, Martin WJ, Appleman MD, Causey DM, Leedom JM, Arnheim N (1988) Detection of cytomegalovirus DNA in peripheral blood of patients infected with human immunodeficiency virus. J Infect Dis 158:1185–1192
Cassol SA, Poon MC, Pal R, Naylor MJ, Culver-James J, Bowen TJ, Russel JA, Krawetz SA, Pon RT, Hoar DI (1989) Primer-mediated enzymatic amplification of cytomegalovirus (CMV) DNA. Application to the early diagnosis of CMV infection in marrow transplant recipients. J Clin Invest 83:1109–1115
Einsele H, Steidle M, Vallbracht T, Saal JG, Ehninger G, Muller CA (1991) Early occurrence of human cytomegalovirus infection after bone marrow transplantation as demonstrated by the polymerase chain reaction technique. Blood 77:104–1110
Zipeto D, Revello GR, Silini E, Parea M, Percivalle E, Zavattoni M, Milanesi G, Gerna G (1992) Development and clinical significance of a diagnostic assay based on the polymerase chain reaction for detection of human cytomegalovirus DNA in blood samples from immunocompromised patients. J Clin Microbiol 30:527–530
Xu W, Sundqvist V-A, Brytting M, Linde A (1993) Diagnosis of cytomegalovirus infections using polymerase chain reaction, virus isolation and serology. Scand J Infect Dis 25:311–316
Buffone GJ, Frost A, Samo T, Demmler GJ, Cagle PT, Lawrence EC (1993) The diagnosis of CMV pneumonitis in lung and heart/lung transplant patients by PCR compared with traditional laboratory criteria. Transplantation 56:342–347
Eriksson B-M, Brytting M, Zweygberg-Wirgart B, Hillerdal G, Olding-Stenkvist E, Linde A (1993) Diagnosis of cytomegalovirus in bronchoalveolar lavage by polymerase chain reaction, in comparison with virus isolation and detection of viral antigen. Scand J Infect Dis 25:421–427
Fajac A, Vidaud M, Lebargy F, Stephan F, Ricci S, Geslin P, Goossens M, Bernaudin J-F (1994) Evaluation of human cytomegalovirus latency in alveolar macrophages. Am J Respir Crit Care Med 149:495–499
Hennighausen L, Fleckhenstein B (1986) Nuclear factor 1 interacts with five DNA elements in the promoter region of the human cytomegalovirus major immediate early gene. EMBO J 5:1367–1371
Paya CV, Wold AD, Smith TF (1987) Detection of cytomegalovirus infections in specimens other than urine by shell vial assay and conventional tube cell cultures. J Clin Microbiol 25:755–757
McCabe WR, Jackson GG (1962) Gramnegative bacteria I. Etiology and ecology. Arch Intern Med 110:847–864
Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) APACHE II: a severity of disease classification system. Crit Care Med 18:818–829
Murray JF, Matthay A, Luce JM, Flick MR (1988) An expanded definition of the adult respiratory distress syndrome. Am J Respir Crit Care Med 138:720–723
Bone RC, Fisher CJ, Clemmer TP, Slotman GJ, Metz CA, Balk RA (1989) Sepsis syndrome: a valid clinical entity. Crit Care Med 17:389–393
Higuchi R (1989) Simple and rapid preparation of samples for PCR. In: Erlich HA (ed) PCR technology: principles and applications for DNA amplification. Stockton Press, New York, pp 31–38
Pritchett RF (1980) DNA nucleotide sequence heterogeneity between the Towne and AD 169 strains of cytomegalovirus. J Virol 36:162–171
Saiki RK, Sharf S, Faloona F, Mullis KB, Horn GT, Erlich HA, Arnheim N (1985) Enzymatic amplification of β-globin genomic sequences and restriction site analysis for diagnosis of sickle cell anemia. Science 230:1350–1354
Sun X, Iles M, Weissman C (1993) Physiologic variables and fluid resuscitation in the postoperative intensive care unit patient. Crit Care Med 21:555–561
Casey LC, Balk RA, Bone RC (1993) Plasma cytokine and endotoxin levels correlate with survival in patients with the sepsis syndrome. Ann Intern Med 119:771–778
Adler SP, Baggett J, Mc Voy M (1985). Transfusion-associated cytomegalovirus infections in seropositive cardiac surgery patients. Lancet II:743–746
Grundy JE, Super M, Sweny P, Moorhead J, Lui SF, Berry NJ, Fernando ON, Griffiths PD (1988) Symptomatic cytomegalovirus infection in seropositive kidney recipients: reinfection with donor virus rather than reactivation of recipient virus. Lancet II:132–135
Van der Salm TJ (1990) Cytomegalovirus: more dangerous to the cardiac surgical patient than we thought? Chest 97:3–4
Gilbert GL, Hudson IL, Hayes K, James J, and the neonatal cytomegalovirus infection study group (1989) Prevention of transfusion-acquired cytomegalovirus infection in infants by blood filtration to remove leucocytes. Lancet I:1228–1231
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Stéphan, F., Clergue, F., Méhari, D. et al. Evaluation by polymerase chain reaction of cytomegalovirus reactivation in intensive care patients under mechanical ventilation. Intensive Care Med 22, 1244–1249 (1996). https://doi.org/10.1007/BF01709343
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01709343