Original Article | Published:

Identification of clinically relevant cytomegalovirus infections in patients with inflammatory bowel disease

Modern Pathology volume 31, pages 527538 (2018) | Download Citation


Several lines of evidence indicate that cytomegalovirus infection can be substantially associated with onset of inflammatory bowel disease, especially in patients refractory to immunosuppressive treatment. As cytomegalovirus is widely spread in the population, here we present a quantitative detection system suitable to differentiate clinically relevant cytomegalovirus infection from common latent cytomegalovirus. Using a quantitative real-time PCR approach, cytomegalovirus viral load was evaluated in 917 formalin-fixed and paraffin-embedded colon biopsy samples of 136 patients diagnosed with inflammatory bowel disease. Besides initial cytomegalovirus testing, the PCR system was also used to monitor therapy response after antiviral treatment. Cytomegalovirus DNA was detected in 37 patients (27%) with varying viral loads ranging from 5 to 8.7 × 105 copies/105 cells. Thereof, 13 patients (35%) received an antiviral treatment with 12 of them going into remission (92%). Later, five patients displayed a relapse and three patients who agreed to restart antiviral treatment again showed positive therapy response. A retrospective comparison of viral loads with antiviral therapy response revealed a threshold of 600 cytomegalovirus copies/105 cells as indicative for clinically relevant infection. Of note, sensitivity of cytomegalovirus detection by immunohistochemistry was found to be insufficient to reliably identify antiviral therapy responders. In conclusion, quantitative real-time PCR using formalin-fixed biopsy samples is suitable for detection of cytomegalovirus infection in tissue samples of patients with inflammatory bowel disease. Moreover, it allows the definition of a viral load threshold, predictive for clinical relevance concerning antiviral therapy response.

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We thank Marion Menke for performing immunohistochemistry experiments and for technical assistance.

Author information

Author notes

    • Ulf Helwig
    •  & Michael Respondek

    U Helwig and M Respondek shared senior authorship.


  1. Molecular Diagnostics, Practice of Pathology, Vechta, Germany

    • Nils Wethkamp
    •  & Michael Respondek
  2. Gastroenterology, Medical Department, St Marien-Hospital, Vechta, Germany

    • Eva-Maria Nordlohne
    •  & Volker Meister
  3. Shared Practice for Internal Medicine, Oldenburg, Germany

    • Ulf Helwig


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Competing interests

The authors declare no conflict of interest.

Corresponding author

Correspondence to Nils Wethkamp.

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Supplementary Information accompanies the paper on Modern Pathology website (http://www.nature.com/modpathol)