Approach to cytomegalovirus infections in patients with ulcerative colitis

Abstract

Cytomegalovirus (CMV) reactivation is common in patients with severe ulcerative colitis (UC), and may ref lect exacerbation of mucosal inf lammation and/or administration of immunosuppressants. The question of whether CMV is an active pathogen or ‘an innocent bystander’ in the exacerbation of UC remains controversial. Patients with UC exacerbated by reactivated CMV experience worse prognoses than those without CMV reactivation and antiviral therapy significantly reduces the need for colectomy in patients with severe UC and high-grade CMV infection, indicating that CMV plays a role in UC prognosis. Therefore, the CMV status of patients on immunosuppressants, particularly those with steroid-refractory or -dependent UC, should be tested. When CMV is detected, be performed based on should adequate treatment the extent of the viral load and the presence of certain clinical features including a large ulcer. Anti-tumor necrosis factor agents may be useful for treating CMV colitis complicating UC.

Cytotoxicity of Human Hepatic Intrasinusoidal CD56bright Natural Killer Cells against Hepatocellular Carcinoma Cells

“…The known ligands for BTLA are Herpesvirus entry mediator (HVEM) and UL144 protein encoded by human CMV [35]. CMV infection rate is relatively high in Korea [36]. It might affect the activation and/or inhibitory status of HI NK cells in this study.…”

Cytomegalovirus and Inflammatory Bowel Diseases (IBD) with a Special Focus on the Link with Ulcerative Colitis (UC)

“…The observation of ulcers that represent particularly inflammatory areas of the digestive mucosa is correlated with CMV tissue infection [ 74 , 91 ]. These sites, when present, must be preferred to detect markers of CMV colitis [ 11 , 46 , 74 , 92 ].…”

“…Several authors propose measuring viral load by IHC or qPCR to adjust anti-inflammatory treatment and to consider antiviral therapy [ 11 , 46 , 152 , 153 , 154 ]. Currently, the heterogeneity of methods and thresholds that are used for identifying CMV reactivation does not make possible the establishment of consensual values for therapeutic adjustment ( Table 1 ).…”

“…Human cytomegalovirus (CMV), also termed human betaherpesvirus 5, is an opportunistic pathogen involved in many inflammatory processes [ 10 ]. The diagnosis of CMV colitis in IBD patients is difficult due to the absence of clinical or endoscopic symptoms that differentiate CMV colitis from colitis associated with the inflammatory disease itself; it is based exclusively on the detection of histological or viral markers in the intestinal mucosa [ 11 , 12 ]. The aim of this review was to highlight the place of colonic CMV infection during IBD by emphasizing the relationships between CMV infection of the colonic mucosa and inflammatory flare-up of UC, the virus and the inflammation interacting with each other, which results in perpetuating and worsening colonic lesions.…”

Cytomegalovirus reactivation in inflammatory bowel disease: an uncommon occurrence related to corticosteroid dependence

“…Overall, the odds of developing an infection while receiving biologic agents are increased (19%), but numerous placebo-controlled trials have failed to consistently demonstrate a risk of serious infection [55]. Cytomegalovirus reactivation is less commonly associated with newer agents than corticosteroid therapy [56][57][58][59][60]. McCurdy et al performed a retrospective case-control study and found that medically refractory inflammatory bowel disease (OR 3.69), corticosteroid therapy (OR 2.95), and immunomodulatory drug therapy (OR 1.86) were significantly associated with cytomegalovirusrelated colitis whereas TNF-α antagonists did not cause cytomegalovirus-related morbidity [20].…”