Detection of Cytomegalovirus in Colonic Mucosa of Children With Inflammatory Bowel Disease

El‐Matary, Wael; Stefanovici, Camelia; Caeseele, Paul Van; Deora, Vini; McCurdy, Jeffrey D.

doi:10.1097/mpg.0000000000001976

Cited by 9 publications

(10 citation statements)

References 17 publications

(26 reference statements)

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“…In moderate to severe UC adult patients, CMV colitis is observed in 25–30% [ 43 , 44 , 45 ], especially those exhibiting steroid refractory disease [ 46 ]. The detection of CMV in colonic mucosa is less frequent in IBD children than in adults [ 47 ], probably because of lower seroprevalence of CMV infection in the pediatric population [ 48 ] and lower risk of viral reactivation; however, the consequences of CMV colitis on IBD evolution is similar to that observed in adults [ 49 , 50 ]. CMV colitis can reveal the inflammatory disease which was not diagnosed until the viral episode [ 51 ].…”

Section: Controversial Role Of CMV Infection In Ibd Inflammatory Fmentioning

confidence: 99%

Cytomegalovirus and Inflammatory Bowel Diseases (IBD) with a Special Focus on the Link with Ulcerative Colitis (UC)

et al. 2020

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Cytomegalovirus (CMV) infects approximately 40% of adults in France and persists lifelong as a latent agent in different organs, including gut. A close relationship is observed between inflammation that favors viral expression and viral replication that exacerbates inflammation. In this context, CMV colitis may impact the prognosis of patients suffering from inflammatory bowel diseases (IBDs), and notably those with ulcerative colitis (UC). In UC, the mucosal inflammation and T helper cell (TH) 2 cytokines, together with immunomodulatory drugs used for controlling flare-ups, favor viral reactivation within the gut, which, in turn, increases mucosal inflammation, impairs corticoid and immunosuppressor efficacy (the probability of steroid resistance is multiplied by more than 20 in the case of CMV colitis), and enhances the risk for colectomy. This review emphasizes the virological tools that are recommended for exploring CMV colitis during inflammatory bowel diseases (IBD) and underlines the interest of using ganciclovir for treating flare-ups associated to CMV colitis in UC patients.

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Section: Controversial Role Of CMV Infection In Ibd Inflammatory Fmentioning

confidence: 99%

Cytomegalovirus and Inflammatory Bowel Diseases (IBD) with a Special Focus on the Link with Ulcerative Colitis (UC)

et al. 2020

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“…Some authors recommend FFPE tissue CMV PCR as an additional method besides IHC to recognize further patients who will benefit from anti-CMV treatment (38) CMV-PCR on tissue biopsy is claimed in some studies to be a useful marker, especially in early phases of CMV infection with a sensitivity and reliability comparable to that of IHC (19,41,42), while some other studies indicate a poor correlation between results of tissue CMV PCR and CMV IHC. Highly sensitive PCR assays can provide false positive results leading to unnecessary treatment (35,43). In addition, in our follow-up information the majority of tissue CMV PCR-positive cases did not have poor clinical course, but cases with positive IHC, though much less frequent, showed higher adverse outcome rates despite treatment.…”

Section: Discussionmentioning

confidence: 61%

Cytomegalovirus detection by PCR on fresh and formalin fixed tissues in colon biopsies of children with colitis

Movahedinia

Gharalari

Nozarian

et al. 2023

Preprint

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For diagnosis of CMV infection in colon biopsies, immunohistochemistry (IHC) and polymerase chain reaction (PCR) can be helpful besides pathologic examination. We performed CMV IHC and PCR on formalin–fixed paraffin-embedded (FFPE) and fresh tissue (FT) in clinically suspicious children for colitis and compared the results with the patients’ clinical course. In a prospective cohort study, among 153 candidate children for the colonoscopy due to colitis, 50 showed positive CMV PCR on FT. PCR on FFPE tissue was positive in 17/40 (42.5 %) cases, of which 2/40 (5%) had positive IHC. Low titer plasma CMV DNA level was seen in 7/17 FFPE-PCR positive cases. Two patients had a high plasma CMV DNA level, who were the two IHC-positive cases. Fecal calprotectin level showed an association with disease histologic activity, but not with CMV positivity on either of the methods of detection. IHC positivity was more likely to be associated with a high plasma CMV DNA level. There was a high rate of false positivity by CMV PCR test on fresh tissue that was neither associated with histopathology nor with the CMV DNA plasma level. Antiviral treatment was correlated with a poorer outcome in patients with inflammatory bowel disease (P=0.035). Conclusion: The PCR result of FT is correlated neither to histology nor to the serum CMV-DNA level. High fecal calprotectin level is associated with active lesions in histopathology. Large randomized clinical trials are recommended to assess the efficacy of antiviral treatment in acute colitis cases that have a high copy number of CMV in the blood or positive results on IHC.

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“…A systematic review of the adult IBD literature showed the highest rates of CMV colitis when using tissue PCR (9). However, a study of children with moderate-to-severe IBD showed that all "CMV colitis" patients with a qualitative tissue PCR diagnosis improved without antiviral therapy (21), possibly indicating the detection of clinically insignificant viral DNA by PCR. We examined routine histopathology for primary diagnosis of CMV colitis as it is the most accepted method in the literature (12,13,17).…”

Section: Discussionmentioning

confidence: 99%

Routine Histology-Based Diagnosis of CMV Colitis Was Rare in Pediatric Patients

Buck

Cho

Walsh

et al. 2022

Journal of Pediatric Gastroenterology &Amp; Nutrition

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Cytomegalovirus (CMV) induced or complicated colitis is important to identify, yet its incidence is unknown among pediatric patients. We aimed to establish the incidence of routine histology-confirmed CMV colitis among pediatric patients with colitis. Pathology reports at Texas Children's Hospital (TCH) between January 1, 2011 and November 6, 2019 were reviewed. Of 1801 cases of histologic colitis, 11 patients had CMV found by histology (mean age 15.4, 72.7% female), with an incidence of 0.6%. Nine out of these 11 (81.8%) patients were immunocompromised and 4 (36.4%) had inflammatory bowel disease (IBD) as an underlying diagnosis of whom 2 had new-onset ulcerative colitis. At an average follow-up of 3.7 years, none of the CMV colitis cases experienced recurrence or severe complications (such as colectomy). An independent analysis of 54 consecutive IBD-associated colectomy cases at TCH showed no histologic evidence of CMV. We conclude that routine histology proven CMV-associated colitis in pediatric patients and IBD-colon explants was rare.

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Detection of Cytomegalovirus in Colonic Mucosa of Children With Inflammatory Bowel Disease

Cited by 9 publications

References 17 publications

Cytomegalovirus and Inflammatory Bowel Diseases (IBD) with a Special Focus on the Link with Ulcerative Colitis (UC)

Cytomegalovirus and Inflammatory Bowel Diseases (IBD) with a Special Focus on the Link with Ulcerative Colitis (UC)

Cytomegalovirus detection by PCR on fresh and formalin fixed tissues in colon biopsies of children with colitis

Routine Histology-Based Diagnosis of CMV Colitis Was Rare in Pediatric Patients

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