title: Symptomatic cytomegalovirus gastrointestinal infection with positive quantitative real-time PCR findings in apparently immunocompetent patients: a case series.
abstract: Cytomegalovirus (CMV) gastrointestinal disease rarely occurs in immunocompetent patients, and is mainly diagnosed on the basis of histopathological findings. Real-time PCR for CMV DNA quantification is considered to be a useful diagnostic tool, but its place in the diagnostic strategy is not clearly defined. The goal of the study was to describe the clinical and paraclinical features of apparently immunocompetent patients with CMV gastrointestinal disease diagnosed according to quantitative PCR results. In this retrospective study conducted in a 1500-bed tertiary-care centre, we reviewed the case records of apparently immunocompetent patients with positive findings of CMV DNA in gastrointestinal biopsies with compatible symptoms and endoscopic findings. A total of 13 patients were included between January 2007 and December 2010. The median age was 81 years, and 54% of patients had underlying immune-modulating conditions. Diarrhoea, haematochezia and dysphagia were the main reported symptoms, and ulcers were the main endoscopic findings. The mean value of CMV DNA load in gastrointestinal biopsies was 3845 copies/μg total DNA (range, 15-15 500 copies/μg total DNA). The highest values were found in two patients who were diagnosed with adenocarcinoma in the subsequent course of CMV infection. Clinical features were similar to those in previous series in which diagnosis was based on histopathological analysis. Elderly people are more commonly affected, and a link with immune senescence is possible. Quantification of CMV DNA seems to be a useful tool for diagnosis when combined with clinical and endoscopic findings, but further studies are necessary to interpret quantitative values.
authors.affiliation: Department of Infectious Diseases, Grenoble University Hospital, Grenoble, France. Electronic address: Sbernard@chu-grenoble.fr.
authors.forename: S
authors.initials: S
authors.lastname: Bernard
authors.affiliation: Department of Virology, University Hospital, Grenoble, France; Unit of Virus Cell Interactions, UMI 3265, UJF-EMBL-CNRS Grenoble, France.
authors.forename: R
authors.initials: R
authors.lastname: Germi
authors.affiliation: Department of Virology, University Hospital, Grenoble, France; Unit of Virus Cell Interactions, UMI 3265, UJF-EMBL-CNRS Grenoble, France.
authors.forename: J
authors.initials: J
authors.lastname: Lupo
authors.affiliation: Department of Pathology, Grenoble University Hospital, Grenoble, France.
authors.forename: M-H
authors.initials: MH
authors.lastname: Laverrière
authors.affiliation: Microbiology and Infectious Diseases, Sherbrooke University Hospital, Sherbrooke, Quebec, Canada.
authors.forename: V
authors.initials: V
authors.lastname: Masse
authors.affiliation: Department of Virology, University Hospital, Grenoble, France; Unit of Virus Cell Interactions, UMI 3265, UJF-EMBL-CNRS Grenoble, France.
authors.forename: P
authors.initials: P
authors.lastname: Morand
authors.affiliation: University Clinic of Geriatric Medicine, Grenoble University Hospital, Grenoble, France.
authors.forename: G
authors.initials: G
authors.lastname: Gavazzi
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003587:Cytomegalovirus / Q000235:genetics*; D003586:Cytomegalovirus Infections / Q000175:diagnosis* / Q000276:immunology; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D005767:Gastrointestinal Diseases / Q000175:diagnosis / Q000276:immunology / Q000821:virology*; D006801:Humans; D007121:Immunocompetence; D008297:Male; D008875:Middle Aged; D060888:Real-Time Polymerase Chain Reaction / Q000379:methods*; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D019562:Viral Load
chemical_list: D004279:DNA, Viral
keywords: Colitis; PCR; cytomegalovirus; immunosenescence; oesophagitis