Anat Yerushalmy-Feler1,2, Jacqueline Padlipsky2, Shlomi Cohen3,4. 1. Pediatric Gastroenterology Unit, Pediatrics Department, "Dana-Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center, 6 Weizman Street, 6423906, Tel Aviv, Israel. 2. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. 3. Pediatric Gastroenterology Unit, Pediatrics Department, "Dana-Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center, 6 Weizman Street, 6423906, Tel Aviv, Israel. shlomico@tlvmc.gov.il. 4. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. shlomico@tlvmc.gov.il.
Abstract
PURPOSE OF REVIEW: Cytomegalovirus (CMV) colitis is a relatively common end-organ infectious complication in immunocompromised hosts which negatively affects clinical outcomes. This paper presents the contemporary approaches to the diagnosis and management of CMV colitis and discusses some of the controversies of this condition, focusing on methods of diagnosis. RECENT FINDINGS: While certain risk factors for CMV colitis are well recognized, the clinical as well as endoscopic features of this condition are nonspecific. Rapid diagnosis and management are usually needed, especially in critically ill patients, which necessitate invasive diagnostic procedures. Hematoxylin and eosin staining of colonic mucosal tissue may show the typical viral inclusions associated with CMV colitis that are highly specific for this condition. However, the staining has low sensitivity compared to immunohistochemistry, which is considered the gold standard for diagnosis of CMV colitis. Tissue polymerase chain reaction (PCR) is highly sensitive for diagnosis, but is controversial for many reasons, detailed in this paper. A high index of suspicion is needed, and once diagnosis is made, treatment should be highly considered to improve the outcome of these severely ill patients. Noninvasive diagnostic tests will be available in the future and will hopefully improve the diagnosis and care of patients with CMV colitis.
PURPOSE OF REVIEW: Cytomegalovirus (CMV) colitis is a relatively common end-organ infectious complication in immunocompromised hosts which negatively affects clinical outcomes. This paper presents the contemporary approaches to the diagnosis and management of CMV colitis and discusses some of the controversies of this condition, focusing on methods of diagnosis. RECENT FINDINGS: While certain risk factors for CMV colitis are well recognized, the clinical as well as endoscopic features of this condition are nonspecific. Rapid diagnosis and management are usually needed, especially in critically illpatients, which necessitate invasive diagnostic procedures. Hematoxylin and eosin staining of colonic mucosal tissue may show the typical viral inclusions associated with CMV colitis that are highly specific for this condition. However, the staining has low sensitivity compared to immunohistochemistry, which is considered the gold standard for diagnosis of CMV colitis. Tissue polymerase chain reaction (PCR) is highly sensitive for diagnosis, but is controversial for many reasons, detailed in this paper. A high index of suspicion is needed, and once diagnosis is made, treatment should be highly considered to improve the outcome of these severely ill patients. Noninvasive diagnostic tests will be available in the future and will hopefully improve the diagnosis and care of patients with CMV colitis.
Authors: Federico Coccolini; Mario Improta; Massimo Sartelli; Kemal Rasa; Robert Sawyer; Raul Coimbra; Massimo Chiarugi; Andrey Litvin; Timothy Hardcastle; Francesco Forfori; Jean-Louis Vincent; Andreas Hecker; Richard Ten Broek; Luigi Bonavina; Mircea Chirica; Ugo Boggi; Emmanuil Pikoulis; Salomone Di Saverio; Philippe Montravers; Goran Augustin; Dario Tartaglia; Enrico Cicuttin; Camilla Cremonini; Bruno Viaggi; Belinda De Simone; Manu Malbrain; Vishal G Shelat; Paola Fugazzola; Luca Ansaloni; Arda Isik; Ines Rubio; Itani Kamal; Francesco Corradi; Antonio Tarasconi; Stefano Gitto; Mauro Podda; Anastasia Pikoulis; Ari Leppaniemi; Marco Ceresoli; Oreste Romeo; Ernest E Moore; Zaza Demetrashvili; Walter L Biffl; Imitiaz Wani; Matti Tolonen; Therese Duane; Sameer Dhingra; Nicola DeAngelis; Edward Tan; Fikri Abu-Zidan; Carlos Ordonez; Yunfeng Cui; Francesco Labricciosa; Gennaro Perrone; Francesco Di Marzo; Andrew Peitzman; Boris Sakakushev; Michael Sugrue; Marja Boermeester; Ramiro Manzano Nunez; Carlos Augusto Gomes; Miklosh Bala; Yoram Kluger; Fausto Catena Journal: World J Emerg Surg Date: 2021-08-09 Impact factor: 5.469