Cytomegalovirus and ulcerative colitis: Place of antiviral therapy

Figure 1 Techniques currently used for the detection of markers of cytomegalovirus infection. Analyses highlighted in orange are very useful, those highlighted in yellow of little use, and those without color of no use, for the diagnosis of CMV reactivation in inflammatory bowel diseases. ELISA: Enzyme-linked immunosorbent assay; IHC: Immunohistochemistry; CMV: Cytomegalovirus; HE staining: Hematoxylin and eosin staining; NAAT: Nucleic acid amplification test.

Figure 2 Therapeutic algorithm for the intake of flare-ups of refractory ulcerative colitis in patients aged > 30 years according to the quantification of cytomegalovirus density in colonic tissue. ¹Defined by steroid resistance or immunosuppressive treatment or anti-TNF drugs; ²Defined by quantification of CMV DNA in intestinal tissue of 10-250 copies/mg of inflamed tissue or low-grade CMV density by IHC in biopsy specimens (4 inclusions or less); ³Defined by quantification of CMV DNA in intestinal tissue of > 250 copies/mg of inflamed tissue or high-grade CMV density by IHC in biopsy specimens (more than 4 inclusions); ⁴Defined by a need for hospitalization and a Lichtiger score > 10. CMV: Cytomegalovirus; IHC: immunohistochemistry; TNF: Tumor necrosis factor.