A Model for Identifying Cytomegalovirus in Patients With Inflammatory Bowel Disease

McCurdy, Jeffrey D.; Jones, Andrea; Enders, Felicity; Killian, Jill M.; Loftus, Edward V.; Smyrk, Thomas C.; Bruining, David H.

doi:10.1016/j.cgh.2014.05.026

Cited by 71 publications

(53 citation statements)

References 34 publications

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“…The association of CS treatment with the presence of CMV in colonic biopsies is well recognized, though it is still unclear whether CMV is only a surrogate marker of resistance and disease severity or a causative factor [1,2,14,15,16]. In accordance with our findings, there is previous evidence that UC patients whose disease course is complicated by CMV infection, have more severe systemic inflammatory signs, such as high fever, increased C-reactive protein and lower albumin levels [6,15]. On the other hand, one recently published prediction model found no statically significant association between fever and CMV infection risk [6].…”

Section: Discussionsupporting

confidence: 81%

“…In accordance with our findings, there is previous evidence that UC patients whose disease course is complicated by CMV infection, have more severe systemic inflammatory signs, such as high fever, increased C-reactive protein and lower albumin levels [6,15]. On the other hand, one recently published prediction model found no statically significant association between fever and CMV infection risk [6]. This discrepancy might be explained on the basis of the differences that existed in the cohorts that were included in the studies.…”

Section: Discussionsupporting

confidence: 80%

“…In line with the increased inflammation in CMV-infected patients, our study further shows a higher frequency of ulcers on endoscopy in patients with CMV, despite similar severity of colitis. Similar findings have been reported in a recent study that demonstrated a threefold increase in the frequency of endoscopic ulcers in CMV+ patients [6]. …”

Section: Discussionsupporting

confidence: 78%

“…Some studies have found that the presence of CMV in colonic tissue is associated with an increased clinical severity of the disease, as well as with a poor prognosis and steroid refractoriness, while others have found no significant differences between CMV positive and CMV negative UC patients [2,5]. Nonetheless, based on retrospective studies showing some clinical benefit of anti-viral therapy in UC patients with CMV [6,7], guidelines from several societies recommend an evaluation for CMV in patients hospitalized for acute, severe UC [8,9,10]. …”

Section: Introductionmentioning

confidence: 99%

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Diagnosis of Cytomegalovirus Infection during Exacerbation of Ulcerative Colitis

Levin

Yaari²,

Stoff³

et al. 2017

Digestion

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Background/Aims: The role of cytomegalovirus (CMV) reactivation during exacerbations of ulcerative colitis (UC) is yet a matter of debate, and assessment of CMV infection in UC patients remains an ongoing challenge. We aimed to identify associated parameters and compare detection methods for CMV infection during UC exacerbation. Methods: Clinical, pathological and virological parameters were retrospectively analyzed in all patients hospitalized in our institution for UC exacerbation between January 2009 and April 2015, who underwent full evaluation for CMV infection in colonic tissue by histopathology, immunohistochemistry (IHC) and CMV-PCR. Results: Of 28 patients who underwent full examination for tissue CMV-infection, 13 (46.4%) were found to be positive for CMV. Tissue CMV-PCR was more sensitive for the detection of CMV infection than histopathology and IHC. CMV-positive patients had a statistically higher frequency of recent steroid treatment and fever, with higher mean partial Mayo scores and lower mean albumin levels. There were no significant differences between CMV-positive and CMV-negative patients in terms of age, severity of colitis and disease duration. In a multivariable model, only recent steroid treatment and fever were independently associated with colonic CMV infection. Conclusions: This study provides a clinical model to detect the presence of CMV infection in patients hospitalized with UC exacerbation, which could direct proper investigation and facilitate timely empirical therapy

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Section: Discussionsupporting

confidence: 81%

Section: Discussionsupporting

confidence: 80%

Section: Discussionsupporting

confidence: 78%

Section: Introductionmentioning

confidence: 99%

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Diagnosis of Cytomegalovirus Infection during Exacerbation of Ulcerative Colitis

Levin

Yaari²,

Stoff³

et al. 2017

Digestion

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“…However, certain general guidelines and principles are offered here. IBD patients who have a sudden change in their symptoms and signs, develop fulminant colitis, or sudden resistance to medical therapy, should be evaluated thoroughly for the accuracy of the diagnosis (of UC or CD) and for the presence of a secondary disorder, such as CMV infection, C. difficile-induced pseudomembranous colitis, ischemia or a drug reaction (eg, NSAIDs, ipilimumab and mycophenolate), [71][72][73][74][75][76][77][78][79][80] among others ( Figure 6). IBD patients are at increased risk for CMV infection, and should always be considered in suddenly refractory IBD patients.…”

Section: Crohn's Disease With Uc-like Featuresmentioning

confidence: 99%

A contemporary and critical appraisal of ‘indeterminate colitis‘

Odze

2015

Modern Pathology

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Distinguishing ulcerative colitis (UC) from Crohn's disease (CD) is normally based on evaluation of a variety of clinical, radiologic, serologic and pathologic findings, the latter in biopsy and/or resection specimens. Unfortunately, some patients with IBD show overlapping pathologic features of UC and CD, which makes definite distinction between these two disorders difficult or even impossible. In most instances of uncertainty, the patient shows clinical and pathologic features of UC, but in addition, the patient's colon resection specimen reveals one or more CD-like features. In this setting, a diagnosis of indeterminate colitis (IC) is often rendered. IC is not a distinct disease entity, and, thus, it has no diagnostic criteria. The most common causes of uncertainty in IBD pathology that may lead to a diagnosis of IC in a colon resection specimen includes the presence of fulminant (severe and toxic) colitis, insufficient radiologic, endoscopic, or pathologic information (including analysis of prior biopsies) on the patient, failure to utilize major diagnostic criteria as hard evidence in favor of CD, failure to recognize unusual variants of UC and CD that may mimic each other, failure to recognize non-IBD mimics and other superimposed diseases that cause unusual pathologic features in a resection specimen, an attempt to distinguish UC from CD in mucosal biopsies of the colon and ileum, or an attempt to change the patients diagnosis (of UC or CD) based on pouch or diversion-related complications. Details of each of these causes of uncertainty are discussed, in detail, in this review article. A diagnosis of IC should never be made clinically or by pathologists based on evaluation of pre-resection colonic mucosal biopsies. Ultimately, the majority of indeterminate cases represent UC, and, thus, most of these patient can be treated safely with a colectomy combined with an ileal pouch anal anastomosis procedure.

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Management of Hospitalized Patients with Inflammatory Bowel Disease and CMV Infection or Clostridium Difficile Infection

Ouali

Achkar

2021

Management of Inpatient Inflammatory Bowel Disease

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A Model for Identifying Cytomegalovirus in Patients With Inflammatory Bowel Disease

Cited by 71 publications

References 34 publications

Diagnosis of Cytomegalovirus Infection during Exacerbation of Ulcerative Colitis

Diagnosis of Cytomegalovirus Infection during Exacerbation of Ulcerative Colitis

A contemporary and critical appraisal of ‘indeterminate colitis‘

Management of Hospitalized Patients with Inflammatory Bowel Disease and CMV Infection or Clostridium Difficile Infection

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