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International Journal of Colorectal Disease

, Volume 34, Issue 2, pp 229–237 | Cite as

Accuracy of diagnostic tests and a new algorithm for diagnosing cytomegalovirus colitis in inflammatory bowel diseases: a diagnostic study

  • Lea I. Kredel
  • Pamela Mundt
  • Linda van Riesen
  • Korinna Jöhrens
  • Jörg Hofmann
  • Christoph Loddenkemper
  • Britta Siegmund
  • Jan C. PreißEmail author
Original Article
  • 194 Downloads

Abstract

Purpose

The optimal method for detecting CMV colitis in patients with inflammatory bowel disease (IBD) has not been established. We wanted to investigate which diagnostic test would be most accurate when defining CMV colitis rather by the further clinical course than by using another diagnostic modality.

Methods

All consecutive patients with moderately or severely active IBD who had been tested for CMV by PCR, histology, or antigenemia assay at the two campuses CBF and CCM of the Charité - Universitätsmedizin Berlin between September 2006 and September 2009 were included in this retrospective study. During that time, in patients with a positive CMV test, immunosuppressive treatment of any kind was immediately reduced and antiviral treatment was started. This allowed identifying patients who responded to antiviral treatment and those who only responded to later escalation of immunosuppressive therapy.

Results

One hundred and nine patients were identified, out of whom nine were considered to have clinically relevant CMV colitis. Sensitivity and specificity were 1 and 0.94 for CMV PCR and 0.5 and 1 for pp65 antigen immunofluorescence assay from peripheral blood, 0.67 and 0.98 for immunohistochemistry, and 0.17 and 0.98 for hematoxylin-eosin staining. When using absence of leukocytosis, splenomegaly, and steroid refractory disease as clinical parameters to test for CMV colitis, blood CMV PCR and immunohistochemistry were able to exclude CMV colitis in negative patients with a 75% likelihood of positive patients to have clinically relevant CMV colitis.

Conclusions

Blood-based CMV PCR together with simple clinical parameters can exclude clinically relevant CMV colitis at a high specificity.

Keywords

Inflammatory bowel diseases Ulcerative colitis Crohn’s disease Cytomegalovirus colitis Diagnostic algorithm 

Notes

Compliance with ethical standards

Conflict of interest

BS received a research grant from Pfizer; served as consultant for Falk, Janssen, MSD, Abbvie, Celgene, Lilly, Takeda, Pfizer, and Hospira; and received lecture fees from Abbvie, Falk, Ferring, Janssen, MSD, Merck, and Takeda; all money went to the Charité - Universitätsmedizin Berlin, Germany. JCP served as a consultant for MSD, Pfizer, Takeda, and Biogen and received lecture fees from Vifor, Falk, Janssen, Abbvie, Pfizer, MSD, and Takeda. The other authors declare that they have no conflict of interest.

Informed consent

For this study, formal consent was not required.

Ethical approval

All procedures performed in this study were in accordance with the ethical standards of the institutional research committee (approval number EA4/092/09) and with the 1964 Helsinki declaration and its later amendments.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Lea I. Kredel
    • 1
  • Pamela Mundt
    • 1
    • 2
  • Linda van Riesen
    • 1
    • 3
  • Korinna Jöhrens
    • 4
  • Jörg Hofmann
    • 5
  • Christoph Loddenkemper
    • 6
  • Britta Siegmund
    • 1
  • Jan C. Preiß
    • 1
    • 7
    Email author
  1. 1.Medizinische Klinik mit Schwerpunkt Gastroenterologie, Infektiologie und RheumatologieCharité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of HealthBerlinGermany
  2. 2.Praxis Jessen + Kollegen, Akademische Lehrpraxis der Charité - Universitätsmedizin BerlinBerlinGermany
  3. 3.Klinik für Innere Medizin – Schwerpunkt GastroenterologieDRK Kliniken WestendBerlinGermany
  4. 4.Institut für PathologieCharité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of HealthBerlinGermany
  5. 5.Institut für VirologieCharité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of HealthBerlinGermany
  6. 6.Pathotres Gemeinschaftspraxis für PathologieBerlinGermany
  7. 7.Klinik für Innere Medizin – Gastroenterologie, Diabetologie und HepatologieVivantes Klinikum NeuköllnBerlinGermany

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