Cytomegalovirus colitis in intensive care unit patients: Difficulties in clinical diagnosis

Khee Siang Chan, Chun Chieh Yang, Chin Ming Chen, His Hsing Yang, Ching Chien Lee, Yin Ching Chuang, Wen Liang Yu

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Purpose: Cytomegalovirus (CMV) infection occurs increasingly in critically ill patients in intensive care units (ICUs). We reported CMV colitis which has rarely been recognized in the ICU patients. Methods: CMV DNA was detected by polymerase chain reaction (PCR) for blood and/or stool samples. Definite diagnosis of CMV colitis required histopathology or CMV immunohistochemical staining of colorectal biopsies. We reviewed ICU patients characterized by positive blood or stool CMV-PCR with colorectal bleeding or water diarrhea. Results: We identified 18 patients (biopsy-proved, n = 8; probable cases, n = 10). The most common comorbidities were chronic renal disease, diabetes mellitus, and coronary artery disease. Stool CMV-PCR was positive in 7 of 10 patients (2 of 3 biopsy-proved and 5 of 7 probable cases). Colonoscopy was performed for 15 patients, revealing ulcerative or polypoid lesions. The endoscopists obtained colonic biopsies from 9 patients. Yet, the pathologists reported CMV colitis for 4 patients. Additional 4 patients were confirmed using immunohistochemical stain by the request of clinical physicians. Pseudomembranous colitis was found in 4 patients. Conclusion: Diagnosis of CMV colitis seems difficult in clinical practice and need persistent communication between clinicians. The positive stool CMV-PCR result was a useful hint for adding immunohistochemical stain in mucosal biopsies to make a definite diagnosis of CMV colitis.

Original languageEnglish
JournalJournal of Critical Care
Volume29
Issue number3
DOIs
Publication statusPublished - 2014

Fingerprint

Colitis
Cytomegalovirus
Intensive Care Units
Biopsy
Polymerase Chain Reaction
Coloring Agents
Pseudomembranous Enterocolitis
Cytomegalovirus Infections
Colonoscopy
Chronic Renal Insufficiency
Critical Illness
Comorbidity
Coronary Artery Disease
Diarrhea
Diabetes Mellitus
Communication
Staining and Labeling
Hemorrhage
Physicians
Water

Keywords

  • Acute hemorrhagic rectal ulcer
  • Cytomegalovirus colitis
  • Immunohistochemical stain
  • Polymerase chain reaction
  • Pseudomembranous colitis

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Medicine(all)

Cite this

Cytomegalovirus colitis in intensive care unit patients : Difficulties in clinical diagnosis. / Chan, Khee Siang; Yang, Chun Chieh; Chen, Chin Ming; Yang, His Hsing; Lee, Ching Chien; Chuang, Yin Ching; Yu, Wen Liang.

In: Journal of Critical Care, Vol. 29, No. 3, 2014.

Research output: Contribution to journalArticle

Chan, Khee Siang ; Yang, Chun Chieh ; Chen, Chin Ming ; Yang, His Hsing ; Lee, Ching Chien ; Chuang, Yin Ching ; Yu, Wen Liang. / Cytomegalovirus colitis in intensive care unit patients : Difficulties in clinical diagnosis. In: Journal of Critical Care. 2014 ; Vol. 29, No. 3.
@article{5735aba1891c49f49ffb40b7301af7a2,
title = "Cytomegalovirus colitis in intensive care unit patients: Difficulties in clinical diagnosis",
abstract = "Purpose: Cytomegalovirus (CMV) infection occurs increasingly in critically ill patients in intensive care units (ICUs). We reported CMV colitis which has rarely been recognized in the ICU patients. Methods: CMV DNA was detected by polymerase chain reaction (PCR) for blood and/or stool samples. Definite diagnosis of CMV colitis required histopathology or CMV immunohistochemical staining of colorectal biopsies. We reviewed ICU patients characterized by positive blood or stool CMV-PCR with colorectal bleeding or water diarrhea. Results: We identified 18 patients (biopsy-proved, n = 8; probable cases, n = 10). The most common comorbidities were chronic renal disease, diabetes mellitus, and coronary artery disease. Stool CMV-PCR was positive in 7 of 10 patients (2 of 3 biopsy-proved and 5 of 7 probable cases). Colonoscopy was performed for 15 patients, revealing ulcerative or polypoid lesions. The endoscopists obtained colonic biopsies from 9 patients. Yet, the pathologists reported CMV colitis for 4 patients. Additional 4 patients were confirmed using immunohistochemical stain by the request of clinical physicians. Pseudomembranous colitis was found in 4 patients. Conclusion: Diagnosis of CMV colitis seems difficult in clinical practice and need persistent communication between clinicians. The positive stool CMV-PCR result was a useful hint for adding immunohistochemical stain in mucosal biopsies to make a definite diagnosis of CMV colitis.",
keywords = "Acute hemorrhagic rectal ulcer, Cytomegalovirus colitis, Immunohistochemical stain, Polymerase chain reaction, Pseudomembranous colitis",
author = "Chan, {Khee Siang} and Yang, {Chun Chieh} and Chen, {Chin Ming} and Yang, {His Hsing} and Lee, {Ching Chien} and Chuang, {Yin Ching} and Yu, {Wen Liang}",
year = "2014",
doi = "10.1016/j.jcrc.2014.01.003",
language = "English",
volume = "29",
journal = "Journal of Critical Care",
issn = "0883-9441",
publisher = "Elsevier BV",
number = "3",

}

TY - JOUR

T1 - Cytomegalovirus colitis in intensive care unit patients

T2 - Difficulties in clinical diagnosis

AU - Chan, Khee Siang

AU - Yang, Chun Chieh

AU - Chen, Chin Ming

AU - Yang, His Hsing

AU - Lee, Ching Chien

AU - Chuang, Yin Ching

AU - Yu, Wen Liang

PY - 2014

Y1 - 2014

N2 - Purpose: Cytomegalovirus (CMV) infection occurs increasingly in critically ill patients in intensive care units (ICUs). We reported CMV colitis which has rarely been recognized in the ICU patients. Methods: CMV DNA was detected by polymerase chain reaction (PCR) for blood and/or stool samples. Definite diagnosis of CMV colitis required histopathology or CMV immunohistochemical staining of colorectal biopsies. We reviewed ICU patients characterized by positive blood or stool CMV-PCR with colorectal bleeding or water diarrhea. Results: We identified 18 patients (biopsy-proved, n = 8; probable cases, n = 10). The most common comorbidities were chronic renal disease, diabetes mellitus, and coronary artery disease. Stool CMV-PCR was positive in 7 of 10 patients (2 of 3 biopsy-proved and 5 of 7 probable cases). Colonoscopy was performed for 15 patients, revealing ulcerative or polypoid lesions. The endoscopists obtained colonic biopsies from 9 patients. Yet, the pathologists reported CMV colitis for 4 patients. Additional 4 patients were confirmed using immunohistochemical stain by the request of clinical physicians. Pseudomembranous colitis was found in 4 patients. Conclusion: Diagnosis of CMV colitis seems difficult in clinical practice and need persistent communication between clinicians. The positive stool CMV-PCR result was a useful hint for adding immunohistochemical stain in mucosal biopsies to make a definite diagnosis of CMV colitis.

AB - Purpose: Cytomegalovirus (CMV) infection occurs increasingly in critically ill patients in intensive care units (ICUs). We reported CMV colitis which has rarely been recognized in the ICU patients. Methods: CMV DNA was detected by polymerase chain reaction (PCR) for blood and/or stool samples. Definite diagnosis of CMV colitis required histopathology or CMV immunohistochemical staining of colorectal biopsies. We reviewed ICU patients characterized by positive blood or stool CMV-PCR with colorectal bleeding or water diarrhea. Results: We identified 18 patients (biopsy-proved, n = 8; probable cases, n = 10). The most common comorbidities were chronic renal disease, diabetes mellitus, and coronary artery disease. Stool CMV-PCR was positive in 7 of 10 patients (2 of 3 biopsy-proved and 5 of 7 probable cases). Colonoscopy was performed for 15 patients, revealing ulcerative or polypoid lesions. The endoscopists obtained colonic biopsies from 9 patients. Yet, the pathologists reported CMV colitis for 4 patients. Additional 4 patients were confirmed using immunohistochemical stain by the request of clinical physicians. Pseudomembranous colitis was found in 4 patients. Conclusion: Diagnosis of CMV colitis seems difficult in clinical practice and need persistent communication between clinicians. The positive stool CMV-PCR result was a useful hint for adding immunohistochemical stain in mucosal biopsies to make a definite diagnosis of CMV colitis.

KW - Acute hemorrhagic rectal ulcer

KW - Cytomegalovirus colitis

KW - Immunohistochemical stain

KW - Polymerase chain reaction

KW - Pseudomembranous colitis

UR - http://www.scopus.com/inward/record.url?scp=84899984433&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84899984433&partnerID=8YFLogxK

U2 - 10.1016/j.jcrc.2014.01.003

DO - 10.1016/j.jcrc.2014.01.003

M3 - Article

C2 - 24556151

AN - SCOPUS:84899984433

VL - 29

JO - Journal of Critical Care

JF - Journal of Critical Care

SN - 0883-9441

IS - 3

ER -