The value of CMV and fungal PCR for monitoring for acute leukaemia and autologous stem cell transplant patients.

Both CMV and fungal infections have been suggested to be causes of fever of unknown origin (FUO) in neutropenic patients. The aim of this prospective, blinded study was to use nucleic acid techniques for monitoring of 20 acute leukemia and 15 autologous stem cell transplant (SCT) patients. Blood samples were taken weekly and examined for fungal and CMV DNA by PCR and CMV mRNA by NASBA. 387 samples were analysed. Fungal DNA was detected in 9 samples. Four samples were positive for Aspergillus and 6 for Candida DNA (1 sample positive for both). Candida PCR was positive in 2 patients with FUO, 1 patient with a bacterial infection, 1 patient with fungaemia, and in 1 afebrile patient. Three patients had verified Candida infections. One was PCR positive and 2 were negative. Three patients with positive Aspergillus PCR had pneumonias and 1 patient had a FUO. CMV DNA was found in 19 samples from 15 CMV seropositive patients. CMV mRNA was detected in 1 sample. Two patients had infections possibly caused by CMV. No antiviral therapy was give and both recovered. PCR for Aspergillus might be helpful for the diagnosis of pneumonia while neither CMV nor Candida PCR conferred diagnostic benefits in this study.