233. Qualitative Cytomegalovirus PCR from Gastrointestinal Specimens for Diagnosis of Tissue Invasive Disease
Session: Poster Abstract Session: Diagnostics: Virology
Thursday, October 8, 2015
Room: Poster Hall
Posters
  • IDWeek Poster.pdf (116.8 kB)
  • Background: Gastrointestinal infections from Cytomegalovirus (CMV) are frequently seen in immunocompromised patients. Following clinical suspicion, diagnosis of CMV gastrointestinal infection is confirmed by histopathology. CMV qualitative PCR from gastrointestinal tissue (GIT) biopsy specimens is being used by some institutions as an adjunct to histopathology to aid in diagnosis. Limited data are available on the usefulness of this test. Our objective was to identify a) number of patients who had CMV Qualitative PCR from GIT, b) number of patients with positive CMV PCR who had evidence of tissue invasive disease on histopathology and c) number of patients who received treatment based on positive CMV PCR assay.

    Methods: Retrospective chart review of all patients from a single medical center who had qualitative CMV PCR on fresh GIT specimens from August 2011 to July 2014 was performed.   All patients with a positive CMV PCR were included in this study. For patients with multiple positive specimens, only the first specimen was included in this evaluation.

    Results: A total of 337 GIT specimens were submitted for CMV PCR.  31 specimens were positive from a total of 28 patients.  Of the 28 patients analyzed, 9 were solid organ transplant recipients, 6 had inflammatory bowel disease, 5 were hematopoietic stem cell recipients, and 4 had HIV.  Histopathology was performed on all 28 patients and positive for CMV tissue invasive disease in 8 patients (29%).  Twenty five patients had quantitative whole blood CMV PCR sent: 18 (72%) were positive.  Twenty seven of the 28 patients received treatment for CMV tissue invasive disease (96%).  Among 8 patients whose histopathology was positive for tissue invasive disease, 3 patients had whole blood CMV PCR <1000 copies/ml, and 4 patients had a whole blood CMV PCR with a mean of 112,940 copies/ ml (17,855 – 285,364).

    Conclusion: A positive CMV qualitative PCR assay from freshly obtained GIT led to initiation of antiviral therapy in more than 95 percent of patients despite negative histopathology data in majority of them. Both qualitative CMV PCR from GIT and whole blood quantitative CMV PCR were infrequently associated with histopathalogic evidence of CMV tissue invasive disease. Further studies should be done to help define parameters for initiation of antiviral therapy in these patients.

    Kartikey Acharya, MD, MPH, Medical College of Wisconsin, Wauwatosa, WI, Mary Beth Graham, MD, FIDSA, Medical College of Wisconsin, Milwaukee, WI and Nathan Ledeboer, PhD, D(ABMM), Microbiology, Medical College of Wisconsin, Milwaukee, WI

    Disclosures:

    K. Acharya, None

    M. B. Graham, None

    N. Ledeboer, None

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