Evaluation of diagnostic criteria for mucosal cytomegalic inclusion disease in the acquired immune deficiency syndrome.

Mucosal cytomegalic inclusion disease (CID) is a serious complication in acquired immune deficiency syndrome (AIDS) that usually is associated with disseminated cytomegalovirus (CMV) infection, and leads progressively to death in many patients. Early diagnosis may improve the chances of responding to specific antiviral therapy. We analyzed retrospectively the diagnostic evaluations of 26 AIDS patients with histopathologically confirmed CID infections and 19 AIDS or AIDS-related complex patients without CMV infections. The groups were similar demographically and clinically. Characteristic CMV inclusion bodies were found on antemortem biopsy in 92% of patients, including 80% for rectal biopsy alone. The specificity of the viral inclusions for CMV was established using an immunohistological technique. Rectal culture for virus isolation was much less sensitive (30%) than biopsy. Urine cultures were positive more frequently (39%) than were rectal cultures, but were less specific. Furthermore, the presence of immunoglobulin G anti-CMV was nonspecific and the presence of immunoglobulin anti-CMV was both insensitive and nonspecific. We conclude that mucosal biopsy is a rapid and reliable means of detecting cytomegalovirus infections, and is an indispensible part of the evaluation for this disease.