Use of DNA amplification for diagnosis of cytomegalovirus enteritis after intestinal transplantation

被引:32
作者
Kusne, S
Manez, R
Frye, BL
StGeorge, K
AbuElmagd, K
TabascoMenguillon, J
Fung, JJ
Todo, S
Rinaldo, C
Ehrlich, GD
机构
[1] UNIV PITTSBURGH, CTR GENOM SCI, DEPT SURG, PITTSBURGH, PA 15261 USA
[2] UNIV PITTSBURGH, DEPT MED, PITTSBURGH, PA 15261 USA
[3] UNIV PITTSBURGH, DEPT PATHOL, PITTSBURGH, PA 15261 USA
[4] UNIV PITTSBURGH, DEPT OTOLARYNGOL, PITTSBURGH, PA 15261 USA
关键词
D O I
10.1016/S0016-5085(97)70122-7
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Background & Aims: Intestinal transplantation is a feasible therapy for patients with short-bowel syndrome. However, cytomegalovirus (CMV) enteritis can cause complications. The aim of this study was to investigate the value of polymerase chain reaction (PCR)-based detection methods for CMV in the management of patients with small bowel transplants. Methods: Comparative evaluation of PCR with histopathology, shell-vial assay, and tube culture of intestinal biopsy specimens was used for the diagnosis of CMV enteritis in 21 patients. Results: Ten patients experienced 21 episodes of CMV enteritis, diagnosed by histopathology, virology, or both. PCR had a sensitivity and specificity of 96% and 69%, respectively, compared with traditional methods, whereas the positive and negative predictive values were 35% and 99%, respectively. Threes and 4+ signals corresponded to a specificity of 91% and positive predictive value of 59%, respectively. CMV was detected by PCR a median of 11 days (range, 0-32) earlier than other methods and lasted a median of 40 days (range, 21-80) in the 13 episodes, which became PCR-negative and in those patients who developed asymptomatic infection. In 8 episodes, CMV by PCR never became negative and was associated with a relapse of disease confirmed by other methods. Conclusions: PCR is a sensitive method for the early detection of CMV in intestinal biopsy specimens and can be used for preemptive therapy after intestinal transplantation.
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页码:1121 / 1128
页数:8
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