Acquired overt cytomegalovirus infection in immunocompetent adult patients

AIM: to evaluate the effect of cytomegalovirus (CMV) infection on the course of moderate and severe flare ups of ulcerative colitis (UC).PATIENTS AND METHODS: a prospective cohort single-center study was done in September 2018 — December 2020. The study included patients with moderate and severe flare ups of UC. All patients underwent colonoscopy with biopsy to quantify CMV DNA by polymerase chain reaction (PCR). Subsequently, the patients were divided into subgroups: with the presence of CMV (CMV+) and its absence (CMV–). In the CMV+ subgroup, antiviral therapy was carried out with an assessment of virological, clinical and endoscopic results on the 19th day of therapy, one month after its completion and after 6 months. In the CMV– subgroup these results were evaluated after 6 months only.RESULTS: the study included 126 patients. CMV was detected in 51 (40.5%). At the same time, its presence was not influenced by gender, age, or previous therapy. Laboratory indicators in both subgroups were comparable, as well as the severity of UC. A significant increase in the risk of developing steroid resistance was revealed in CMV+ patients with severe UC attack (OR 1.33, 95% CI: 1.059–19.4). The effectiveness of antiviral therapy was 60.8%. All patients who did not respond to antiviral therapy underwent surgery. At the same time, among patients in whom antiviral therapy was effective (virus eradication was achieved), there was no need for surgery.CONCLUSION: CMV infection significantly increases the likelihood of developing steroid resistance in patients with severe flare up of UC, while all patients who responded to antiviral therapy did not require surgery. Further multicenter randomized trials are needed.

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Effect of cytomegalovirus infection on moderate and severe ulcerative colitis

Alexandrov

Nanaeva

Baranova

et al. 2021

Koloproktologiâ

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Cytomegalovirus Infection in Inflammatory Bowel Diseases

2019

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Cytomegalovirus infection (CMVI) with clinical manifestations is a valuable problem in patients with immunosuppression, particularly in patients with inflammatory bowel disease (IBD) treated with steroids and other immunosuppressive drugs. Clinical activity of cytomegalovirus-associated IBD, natural history and stage of IBD, steroids use and anti TNF-a-agents were identified as risk factors. CMVI diagnostics should clarify not only the presence of CMV but its etiological role in clinical features of the disease. The most significant are the virologic and serological methods. All patients with steroid resistance, loss of effect and severe IBD should undergo CMVI screening. It is likely that joining CMVI to IBD is one of the main causes of resistance to steroids, immunosuppressive and biological treatment. requires further studies.

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Cytomegalovirus Infection in Patients With Moderate and Severe Ulcerative Colitis

et al. 2020

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AIM: to determine the incidence of accompanying cytomegalovirus infection (CMVI) in patients with moderate and severe ulcerative colitis, and also to determine the value of diagnosis and treatment of this infection in that category of patients.PATIENTS AND METHODS: the study included 67 patients with severe or moderate ulcerative colitis. The colonoscopy with biopsy with definition of cytomegalovirus DNA by polymerase chain reaction (PCR) was done in all the patients. The patients without virus (CMV negative group) received therapy according to the current clinical recommendations. The patients with virus (CMV positive group) had antiviral therapy by ganciclovir in addition to the standard therapy. The viral load in colonic biopsy of those patients was evaluated before the treatment and on the 19-21 st therapy days. In case of patient state deterioration and inability to continue the conservative treatment, colectomy was done. The success of therapy in both groups was assessed by the colectomy rate during hospitalization.RESULTS: the incidence of severe and moderate ulcerative colitis combination with cytomegalovirus infection was 43.2%. The previous treatment did not influence on the probability of virus detection. Acute attacks of ulcerative colitis were found significantly more often in the CMV-positive group than in the CMV-negative group (20% vs 2.6%, respectively) (р=0.02). The efficacy of the antiviral therapy was 69%. All the patients who responded to the antiviral therapy did not undergo surgery. Failure of the antiviral therapy in the patients with associated cytomegalovirus infection significantly increased the colectomy rate (0 – in the patients who responded to the antiviral therapy vs. 22.2% of those who did not respond).CONCLUSION: the study showed 43% of cases moderate and ulcerative colitis goes with CMVI persistence. CMVI is the resistance factor for conservative treatment. The specific antiviral therapy in addition to the conservative treatment for this category of patients ameliorates the treatment results and prognosis.

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Acquired overt cytomegalovirus infection in immunocompetent adult patients

Cited by 4 publications

References 3 publications

Effect of cytomegalovirus infection on moderate and severe ulcerative colitis

Effect of cytomegalovirus infection on moderate and severe ulcerative colitis

Cytomegalovirus Infection in Inflammatory Bowel Diseases

Cytomegalovirus Infection in Patients With Moderate and Severe Ulcerative Colitis

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