CMV in the gut: a critical review of CMV detection in the immunocompetent host with colitis

A L Goodman, C D Murray, J Watkins, P D Griffiths, D P Webster, A L Goodman, C D Murray, J Watkins, P D Griffiths, D P Webster

Abstract

As scientific techniques for the detection of cytomegalovirus (CMV) improve, we are able to detect small amounts of CMV in the mucosal wall. As clinicians, we are unsure how to interpret the results of this novel test. There is controversy in the literature as to the significance of the detection of CMV in the gut. Whilst the importance of CMV and reactivation of the virus is clear in those patients such as allograft recipients with established immune compromise, the role is less clear in patients with less damaged immune systems. We explore whether the detection of CMV in such cases influences outcome and how it should be optimally managed. We discuss the optimal management of such cases, according to current guidelines, with a review of the literature.

Figures

Fig. 1
Fig. 1
a and bshow endoscopic appearances of the proximal ascending colon in our patient. c shows her histology andd shows histology from a patient with cytomegalovirus (CMV) colitis and typical owl’s eye inclusion
Fig. 2
Fig. 2
Proposed cycle of pathology
Fig. 3
Fig. 3
Flow chart of suggested management

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