International Journal of
Medicine and Medical Sciences

  • Abbreviation: Int. J. Med. Med. Sci.
  • Language: English
  • ISSN: 2006-9723
  • DOI: 10.5897/IJMMS
  • Start Year: 2009
  • Published Articles: 531

Full Length Research Paper

Histopathologically documented gastrointestinal cytomegalovirus infection in immunosuppressed patients: Clinicopathologic analysis with serum quantitative PCR correlation

Roger Klein Moreira
  • Roger Klein Moreira
  • Department of Pathology and Cell Biology, Columbia University College of Physicians and Surgeons, New York, USA.
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Christine Norton
  • Christine Norton
  • Department of Pathology, University of New Mexico, Albuquerque, New Mexico, USA.
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Flavia Nunes Rosado
  • Flavia Nunes Rosado
  • Department of Pathology, Vanderbilt University, Nashville, Tennessee, USA.
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Cynthia Cohen
  • Cynthia Cohen
  • Department of Pathology, Emory University School of Medicine, Atlanta, Georgia, USA.
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Frederick Nolte
  • Frederick Nolte
  • Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, South Carolina, USA.
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  •  Accepted: 02 February 2010
  •  Published: 31 March 2010

Abstract

Cytomegalovirus (CMV) infection of the gastrointestinal (GI) tract is associated with high mortality in immunosuppressed patients. Few studies have correlated serum viral load with histopathological findings in this setting. Gastrointestinal biopsies from 28 immunosuppressed patients showing CMV cytopathic effect were studied by immunohistochemistry (IHC) and in situ hybridization (ISH). Quantitative evaluation of CMV-infected cells was correlated with clinicopathologic data, including plasma PCR. 85.7% (24/28) of our patients had detectable viremia. Viral load did not correlate with concentration of CMV-infected cells in tissue, type of infected cell (endothelial, epithelial, smooth muscle, or stromal), microscopic mucosal ulceration, CMV inclusions in multiple sites within the GI tract, endoscopic findings, or presence of systemic symptoms. All PCR-negative cases (4/28) occurred in late onset CMV infection or disease. Most cases of biopsy-proven GI CMV infection and disease are associated with positive viremia by plasma PCR. We found no correlation between viral load and any of the clinicopathologic parameters analyzed in our study. Some cases of late-onset CMV infection and disease may have no detectable CMV viremia by PCR.

Key words: Cytomegalovirus (CMV), immunohistochemistry, in situ hybridization, gastrointestinal.