Definition and Diagnosis of Cytomegalovirus Colitis in Patients Infected by Human Immunodeficiency Virus

Abstract

The definition and routine diagnosis of cytomegalovirus (CMV) colitis in patients infected by human immunodeficiency virus (HIV) are controversial. In 100 consecutive HIV-infected patients who underwent colonoscopy for the investigation of diarrhea, we compared the yields of routine diagnostic tools for CMV infection and assessed the risk of further CMV organ disease in subgroups of patients with the following features: full evidence of CMV colitis (group 1), colonic CMV infection but no endoscopic lesions (group 2), and no evidence of colonic CMV infection (group 3). All biopsies taken during colonoscopy were examined immediately by routine hematoxylin and eosin (H&E) staining and viral culture and then pooled for second-line H&E staining and immunohistology. Among the 15 diagnoses of CMV colitis (group 1), two were missed during initial H&E examination, and both patients developed further CMV organ disease during follow-up. Of the 12 group 2 patients 11 were not receiving anti-CMV drugs at the time of initial colonoscopy. CMV organ disease was not significantly more common in these patients than in group 3 during follow-up. We conclude that routine H&E staining of colonic biopsy specimens for CMV inclusions is not 100% sensitive for CMV colitis. The favorable outcome of colonic CMV infection without endoscopic lesions suggests that only patients with full evidence of CMV colitis warrant specific antiviral therapy.

Acute Cytomegalovirus Infection Is a Risk Factor in Refractory and Complicated Inflammatory Bowel Disease

“…Histologic examination of colonic biopsies had the lowest sensitivity, probably because the characteristic inclusion bodies are not readily visible in routinely performed H & E stain and because CMV-infected cells are not always cytomegalic [13]. In our study CMV was detected in only one histologic specimen stained with conventional haematoxylin and eosin.…”

“…These sections were evaluated under a microscope for characteristic cytomegalic cells that are often two-to four-fold larger than surrounding cells, usually with large eosinophilic intranuclear inclusions, sometimes surrounded by a clear halo and smaller cytoplasmic inclusions [2,4,12]. Immunohistochemistry (IHC) with monoclonal antibodies directed against CMV immediate early antigen increases diagnostic yield of CMV compared to routine H & E staining [13,14].…”

Cytomegalovirus cholangitis and pancreatitis in an immunocompetent patient

“…25 The efficacy of papillotomy in CMV cholangitis was insufficient. 17 If a diagnosis is made preoperatively, stenting may be effective.…”

Self-limited Colitis during the Course of Rubella and Cytomegalovirus Infection in an Immunocompetent Adult

“…Crohn disease-like linear ulcers are also reported in some cases of cytomegalic colitis (28). Although the detection of inclusion bodies from affected lesions is a useful diagnostic marker for cytomegalic colitis, Beaugerie et al reported that routine hematoxylin-eosin staining of colonic biopsy specimens for CMV inclusion bodies is not 100% sensitive for CMV colitis (29). The detection of CMV DNA is the most sensitive diagnostic tool for cytomegalic colitis, although this examination is difficult in a general hospital that is not specially equipped.…”