title: Cytomegalovirus colitis in intensive care unit patients: difficulties in clinical diagnosis.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Intensive Care Medicine, Chi Mei Medical Center, Tainan City, Taiwan; Department of Health and Nutrition, Chia Nan University of Pharmacy & Science, Tainan, Taiwan.
authors.forename: Khee-Siang
authors.initials: KS
authors.lastname: Chan
authors.affiliation: Department of Intensive Care Medicine, Chi Mei Medical Center, Tainan City, Taiwan.
authors.forename: Chun-Chieh
authors.initials: CC
authors.lastname: Yang
authors.affiliation: Department of Intensive Care Medicine, Chi Mei Medical Center, Tainan City, Taiwan; Chia Nan University of Pharmacy & Science, Tainan, Taiwan.
authors.forename: Chin-Ming
authors.initials: CM
authors.lastname: Chen
authors.affiliation: Department of Intensive Care Medicine, Chi Mei Medical Center, Tainan City, Taiwan; Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan.
authors.forename: His-Hsing
authors.initials: HH
authors.lastname: Yang
authors.affiliation: Department of Clinical Pathology, Chi Mei Medical Center, Tainan, Taiwan.
authors.forename: Ching-Chien
authors.initials: CC
authors.lastname: Lee
authors.affiliation: Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan; Department of Internal Medicine, Chi Mei Medical Center-Liou Ying, Tainan, Taiwan.
authors.forename: Yin-Ching
authors.initials: YC
authors.lastname: Chuang
authors.affiliation: Department of Intensive Care Medicine, Chi Mei Medical Center, Tainan City, Taiwan; Department of Medicine, Taipei Medical University, Taipei, Taiwan. Electronic address: yuleon_md@yahoo.com.tw.
authors.forename: Wen-Liang
authors.initials: WL
authors.lastname: Yu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D003092:Colitis / Q000175:diagnosis / Q000473:pathology / Q000821:virology*; D003106:Colon / Q000473:pathology*; D003113:Colonoscopy; D003587:Cytomegalovirus / Q000235:genetics*; D003586:Cytomegalovirus Infections / Q000175:diagnosis / Q000473:pathology*; D004279:DNA, Viral / Q000097:blood / Q000302:isolation & purification*; D005243:Feces / Q000821:virology; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D012189:Retrospective Studies
chemical_list: D004279:DNA, Viral
keywords: Acute hemorrhagic rectal ulcer; Cytomegalovirus colitis; Immunohistochemical stain; Polymerase chain reaction; Pseudomembranous colitis