Diagnostic significance of cytomegalovirus DNA quantitation in gastrointestinal biopsies: comparison with histopathological data and blood cytomegalovirus DNA

Abstract

Objectives This study aims to improve the diagnosis of gastrointestinal (GI) cytomegalovirus (CMV) disease. It presents the results of a novel study in which CMV blood viral load (BVL), tissue viral load (TVL) determined by PCR and hematoxylin-eosin (HE)/immunohistochemistry (IHC) results of GI biopsies are examined comparatively. Methods CMV DNA was investigated by quantitative real-time PCR in blood and GI biopsy specimens of 76 patients suspected of CMV disease. Biopsies were also performed HE/IHC stainings in the pathology laboratory. Results This study included 76 patients whose median age was 34.5 years and 58% (44) were male. Tissue CMV PCR positivity was detected in the highest colon (40/53;75.5%) samples. HE, IHC, blood and tissue CMV PCR positivity rates of all samples were 15.8, 25, 50 and 71.1%, respectively. When IHC was used as the gold standard test for ROC analysis, the optimal cutoff values for the maximum sensitivity and specificity for BVL and TVL were 1.91 log10 copies/ml and 3.82 log10 copies/mg, respectively. Sensitivity and specificity for the cutoff value of tissue CMV DNA were 78.9 and 74.3%, respectively (P < 0.001). Conclusion In this study, CMV DNA was detected in 71.1% of the tissue samples of the cases by PCR. Since the sensitivity of the histopathological examinations accepted as the gold standard is low, simultaneous with the histopathological examinations, determination of BVL, TVL and the identification of optimal cutoff values have been shown to support the diagnosis of GI CMV disease.

Tissue quantitative RT–PCR test for diagnostic significance of cytomegalovirus infection in patients with inflammatory bowel disease and treatment response: Cytomegalovirus infection in patients with inflammatory bowel disease

“…[21] In a similar study, the blood CMV-DNA PCR results were negative in 33.3% of cases with positive tissue CMV-DNA PCR results. [22] We suggest that all IBD patients who are hospitalized for exacerbations be evaluated using tissue CMV-DNA PCR in colonic biopsy specimens for the diagnosis of CMV colitis. CMV-DNA PCR positivity can be detected in tissue, although CMV-DNA PCR is negative in the blood.…”

“…[15,26] In the present study, the IHC test was positive in only 5 (21.7%) of the 23 patients positive for CMV-DNA PCR in the colonic mucosa. Alacam et al [22] reported that 35.1% of cases with CMV-DNA PCR-positive tissue were found to be IHC positive. Although IHC is the gold standard, it alone may not be sufficient for diagnosis.…”

Human cytomegalovirus‐related gastrointestinal disease after kidney transplantation: A systematic review

“…The details on the techniques used for specimens’ analysis were omitted in most studies. hCMV‐specific immunohistochemistry and in situ hybridization procedures are probably more reliable than direct microscopy and hematoxylin‐eosin staining, 108 but the cost‐effectiveness of these methods and the theoretical advantage of combining multiple diagnostic modalities have yet to be assessed 87 …”

“…The details on the techniques used for specimens' analysis were omitted in most studies. hCMV-specific immunohistochemistry and in situ hybridization procedures are probably more reliable than direct microscopy and hematoxylin-eosin staining, 108 but the costeffectiveness of these methods and the theoretical advantage of combining multiple diagnostic modalities have yet to be assessed. 87 The first-line treatment in the majority of post-transplant hCMV-GID episodes consisted of intravenous ganciclovir administration, eventually followed by valganciclovir as secondary prophylaxis in some cases.…”

Involvement of HHV-4 (Epstein–Barr Virus) and HHV-5 (Cytomegalovirus) in Inflammatory Bowel Disease and Colorectal Cancer: A Meta-Analysis

“…The following supporting information can be downloaded at: , Table S1: Studies included in the present meta-analysis, including quantitative and qualitative assessment. References [ 38 , 48 , 49 , 51 , 52 , 53 , 54 , 55 , 73 , 75 , 93 , 99 , 100 , 121 , 122 , 123 , 124 , 125 , 126 , 127 , 128 , 129 , 130 , 131 , 132 , 133 , 134 , 135 , 136 , 137 , 138 , 139 , 140 , 141 , 142 , 143 , 144 , 145 , 146 , 147 , 148 , 149 , 150 , 151 , 152 , 153 , 154 , 155 , 156 , 157 , 158 , 159 ,…”