Short article: Stool cytomegalovirus polymerase chain reaction for the diagnosis of cytomegalovirus-related gastrointestinal disease

Prachasitthisak, Noparat; Tanpowpong, Pornthep; Lertudomphonwanit, Chatmanee; Treepongkaruna, Suporn; Boonsathorn, Sophida; Angkathunyakul, Napat; Sornmayura, Pattana; Chantratita, Wasun

doi:10.1097/meg.0000000000000906

Cited by 10 publications

(8 citation statements)

References 17 publications

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“…We included a broad variety of patients with risk factors for developing CMV colitis, including both immunocompromised and immunocompetent patients. We found an overall sensitivity and specificity of stool CMV-PCR for diagnosing CMV colitis of 70% and 91%, respectively, when using histopathologic findings as the reference standard, and our results are comparable with those from several previous reports ( 36 – 39 ). Most previous studies were conducted in immunocompromised patients.…”

Section: Discussionsupporting

confidence: 89%

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Performance of Cytomegalovirus Real-Time Polymerase Chain Reaction Assays of Fecal and Plasma Specimens for Diagnosing Cytomegalovirus Colitis

Sattayalertyanyong

Limsrivilai

Phaophu

et al. 2023

Clinical and Translational Gastroenterology

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INTRODUCTION: Cytomegalovirus (CMV) viral load detected by real-time polymerase chain reaction (PCR) in plasma or stool may facilitate detection of CMV colitis. METHODS: This prospective study enrolled 117 patients with clinically suspected CMV colitis. Patients presenting with gastrointestinal symptoms and having increased risk of CMV infection were eligible. All participants underwent colonoscopy with tissue biopsy. Five patients underwent colonoscopy twice because of clinical recurrence, resulting in a total of 122 colonoscopies. Stool CMV-PCR and plasma CMV-PCR were performed within 7 days before/after colonoscopy. Twenty asymptomatic volunteers also underwent the same protocol. RESULTS: Twenty-seven (23.1%) of 122 colonoscopies yielded positive for CMV colitis. The sensitivity and specificity was 70.4% and 91.6% for stool CMV-PCR and 66.7% and 94.7% for plasma CMV-PCR, respectively. The sensitivity of either positive plasma or positive stool CMV-PCR was 81.5%, which is significantly higher than that of plasma CMV-PCR alone (P = 0.045). However, positive results from both tests yielded a specificity of 95.8%, which is significantly higher than that of stool CMV-PCR alone (P = 0.045). There was a good and significant correlation between stool CMV-PCR and plasma CMV-PCR (r = 0.71, P < 0.01), and both tests significantly correlated with the cytomegalic cell count (r = 0.62, P < 0.01 for stool and r = 0.64, P < 0.01 for plasma). There were no positive stool or plasma CMV-PCR assays among volunteers. DISCUSSION: The results of this study strongly suggest that the combination of stool CMV-PCR and plasma CMV-PCR can be used to confidently rule in (both positive) or rule out (both negative) a diagnosis of CMV colitis.

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Section: Discussionsupporting

confidence: 89%

“…Most previous studies were conducted in immunocompromised patients. Micheal et al, Ganzenmeuller et al, and Prachasitthisak et al included various types of immunocompromised patients and reported sensitivity of 66%–71%, and specificity of 85%–96% ( 38 , 39 , 41 ). Two studies specifically included only patients with IBD.…”

Section: Discussionmentioning

confidence: 99%

Performance of Cytomegalovirus Real-Time Polymerase Chain Reaction Assays of Fecal and Plasma Specimens for Diagnosing Cytomegalovirus Colitis

Sattayalertyanyong

Limsrivilai

Phaophu

et al. 2023

Clinical and Translational Gastroenterology

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“…Therefore, an isolated positive PCR without macroscopic or microscopic findings does not establish a diagnosis of GI CMV disease. The detection of CMV DNA by PCR in stool specimens has also been employed to diagnose GI CMV disease, but the experience of this tool in SOT remains very limited [66,67].…”

Section: Gastrointestinal Diseasementioning

confidence: 99%

Human cytomegalovirus: a survey of end-organ diseases and diagnostic challenges in solid organ transplant recipients

Contreras

2022

Current Opinion in Organ Transplantation

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Purpose of reviewHuman cytomegalovirus (CMV) infection is one of the most important infectious complications in solid organ transplant (SOT) recipients, leading to significant morbidity and mortality. Therefore, early detection and prompt treatment are imperative to improve transplant outcomes. This article highlights the clinical characteristics of the most common CMV end-organ diseases in SOT recipients and their diagnostic modalities and challenges. Recent findingsCMV can cause a variety of end-organ diseases in SOT recipients. Although CMV nucleic acid amplification by polymerase chain reaction (PCR) is frequently employed to detect CMV reactivation or infection, its predictive value for various CMV end-organ diseases remains uncertain. Given the limitation of PCR or other noninvasive tests, confirmation of CMV end-organ disease may require tissue biopsy, which may not be feasible or available, or may cause untoward complications.

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“…Cases are classified as probable when upper and/or lower GI symptoms are present with CMV identified in tissue specimens, but macroscopic mucosal lesions are not seen [8]. The detection of CMV by PCR in blood or on tissue biopsy is not sufficient to diagnose tissue-invasive disease; the use of quantitative PCR on biopsies from the gut or stool has been considered [8][9][10].…”

Section: Viral Enteritis 21 Cytomegalovirusmentioning

confidence: 99%

Viral Enteritis in Solid-Organ Transplantation

Abbas

Zimmer

Florescu

2021

Viruses

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Solid organ transplant recipients are at increased risk for infections due to chronic immunosuppression. Diarrhea is a commonly encountered problem post transplantation, with infectious causes of diarrhea being a frequent complication. Viral infections/enteritides in solid organ transplant recipients often result from frequently encountered pathogens in this population such as cytomegalovirus, adenovirus, and norovirus. However, several emerging viral pathogens are increasingly being recognized as more sensitive diagnostic techniques become available. Treatment is often limited to supportive care and reduction in immunosuppression, though antiviral therapies mayplay a role in the treatment in certain diseases. Viral enteritis is an important entity that contributes to morbidity and mortality in transplant recipients.

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Short article: Stool cytomegalovirus polymerase chain reaction for the diagnosis of cytomegalovirus-related gastrointestinal disease

Abstract: Stool CMV real-time PCR may be used as a noninvasive tool in the diagnosis of CMV-GI disease. Plasma CMV real-time PCR shows a significant correlation with stool CMV real-time PCR and also represents high diagnostic values.

Cited by 10 publications

References 17 publications

Performance of Cytomegalovirus Real-Time Polymerase Chain Reaction Assays of Fecal and Plasma Specimens for Diagnosing Cytomegalovirus Colitis

Performance of Cytomegalovirus Real-Time Polymerase Chain Reaction Assays of Fecal and Plasma Specimens for Diagnosing Cytomegalovirus Colitis

Human cytomegalovirus: a survey of end-organ diseases and diagnostic challenges in solid organ transplant recipients

Viral Enteritis in Solid-Organ Transplantation

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