Recio Raúl, Lalueza Antonio, Moral Noelia, Pascual Consuelo, Muñoz Marina, Camacho Javier, Caso José María, Folgueira Lola
Department of Microbiology, University Hospital 12 de Octubre, Madrid, Spain.
Biomedical Research Institute imas12, University Hospital 12 de Octubre, Madrid, Spain.
J Med Virol. 2021 Aug;93(8):4693-4703. doi: 10.1002/jmv.26843. Epub 2021 Feb 9.
The clinical significance of molecular detection of respiratory viruses in bronchoalveolar lavage (BAL) samples is poorly defined. We performed an observational retrospective study including all patients who underwent a BAL procedure in our institution, regardless of the reason for bronchoscopy, from January 2015 to December 2018. Respiratory viruses were detected by real-time polymerase chain reaction with a commercial multiplex panel, and a cell culture was performed to detect cytomegalovirus and herpes simplex virus. Positive results were correlated with clinical symptoms and patients' characteristics. Of 540 BAL samples analyzed, 113 (20.9%) were positive for any respiratory virus. Viral detection was significantly associated with respiratory symptoms (83.2% vs. 68.9%, p = .004) and radiological infiltrates (67.3% vs. 52.2%, p = .006). The most frequent viruses detected were rhinovirus (42/113, 37.2%), influenza virus (20/113, 17.7%), and parainfluenza virus (PIV) (16/113, 14.2%). Respiratory pathogens codetections were found in 51/113 (45.1%) BAL samples, including more than one virus (16/51, 31.4%), fungi (8/51, 15.7%), and bacteria (9/51, 17.6%). Viral detection was significantly higher in immunocompromised patients (26.5% vs. 16.9%; p = .022). PIV and human metapneumovirus were mostly observed in lung (50.0%, 8/16) and hemopoietic transplant recipients (25%, 2/8), respectively, with clinical repercussions. Our data underline that molecular diagnosis allows identification of viral agents as the etiology of respiratory infections; however, the high frequency of codetections hinders identification of the agent responsible for the current respiratory symptomatology. Immunocompromised patients are the target population in whom to investigate the presence of respiratory viruses in their BAL samples.
支气管肺泡灌洗（BAL）样本中呼吸道病毒分子检测的临床意义尚不明确。我们进行了一项观察性回顾性研究，纳入了2015年1月至2018年12月期间在我院接受BAL操作的所有患者，无论支气管镜检查的原因是什么。采用商用多重检测试剂盒通过实时聚合酶链反应检测呼吸道病毒，并进行细胞培养以检测巨细胞病毒和单纯疱疹病毒。阳性结果与临床症状和患者特征相关。在分析的540份BAL样本中，113份（20.9%）检测出任何呼吸道病毒呈阳性。病毒检测与呼吸道症状（83.2%对68.9%，p = 0.004）和影像学浸润（67.3%对52.2%，p = 0.006）显著相关。检测到的最常见病毒是鼻病毒（42/113，37.2%）、流感病毒（20/113，17.7%）和副流感病毒（PIV）（16/113，14.2%）。在51/113（45.1%）的BAL样本中发现了呼吸道病原体共检测，包括多种病毒（16/51，31.4%）、真菌（8/51，15.7%）和细菌（9/51，17.6%）。免疫功能低下患者的病毒检测率显著更高（26.5%对16.9%；p = 0.022）。PIV和人偏肺病毒分别主要在肺部（50.0%，8/16）和造血干细胞移植受者（25%，2/8）中观察到，并产生了临床影响。我们的数据强调，分子诊断能够识别作为呼吸道感染病因的病毒病原体；然而，共检测的高频率阻碍了对当前呼吸道症状负责病原体的识别。免疫功能低下患者是在其BAL样本中调查呼吸道病毒存在情况的目标人群。
