Evaluation of three assays on alveolar lavage fluid in the diagnosis of cytomegalovirus pneumonitis after bone marrow transplantation.

Cytologic examination, immunofluorescence assays, and cultures for virus were compared prospectively in the detection of cytomegalovirus (CMV) in cells obtained by 41 bronchoalveolar lavages (BALs) from 30 bone marrow transplant recipients with pneumonia. No evidence of CMV was found in 21 BALs. Viral inclusions, positive immunologic assays, and positive cultures were found in 14, 15, and 18 BALs, respectively. Cytological and immunologic results were closely related except in one BAL. In five BALs, a positive culture for virus was the sole criterion noted for diagnosis of CMV. The patients with both cytologically and immunologically positive results were more likely to die with or from respiratory failure (P less than .05), diffuse interstitial patterns (P less than .01), and severe acute graft-vs.-host disease (P less than .02) than were the patients without any criterion for diagnosis of CMV. The discrepancies with the previously reported data, the interpretation of the three diagnostic procedures, and the ability of BAL to diagnose CMV pneumonia are discussed.