Life-threatening cytomegalovirus colitis in the immunocompetent patient

Karakozis, Stavros; Góngora, Enrique; Caceres, Manuel; Brun, Erwin A.; Cook, J. W.

doi:10.1007/bf02234398

Cited by 46 publications

(37 citation statements)

References 31 publications

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“…Symptomatic CMV infections are typically manifested as a non-specific febrile disease or a mild self-limiting mononucleosis-like syndrome [4]. However, there are many reports of severe or prolonged symptomatic CMV infection in immunocompetent patients [5][6][7]. After primary infection, CMV establishes a lifelong latent infection that can periodically reactivate [3].…”

Section: Introductionmentioning

confidence: 99%

Seroepidemiology of cytomegalovirus infections in Croatia

Vilibić-Čavlek

Kolarić

Beader

et al. 2016

Wien Klin Wochenschr

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Objectives: Cytomegalovirus (CMV) is endemic worldwide, with marked differences in the seroprevalence rates between countries. The aim of this study was to analyze the seroprevalence of CMV infection in Croatia. Methods:During a three year period (2013)(2014)(2015), 2438 consecutive serum samples collected from Croatian residents were tested for the presence of CMV IgM and IgG antibodies using enzyme-linked immunoassay. IgM/IgG positive samples were further tested for IgG avidity. Results:The overall seroprevalence rates for CMV IgG and IgM antibodies were 74.4% and 4.3%, respectively. The IgG seroprevalence differed significantly between population groups: children/adolescents 54.6%, adult general population 77.2%, hemodialysis patients 91.4% (p<0.001). CMV seropositivity was strongly age-dependent with prevalence ranging from 53.0% in children less than 10 years to 93.8% in persons above 60 years (p<0.001). There was no difference in the prevalence between women with normal pregnancy and women with bad obstetric history. Gender and place of residence was not associated with CMV seropositivity.Using IgG avidity, current/recent primary CMV infection was confirmed by low/borderline avidity index (AI) in 46.7% participants, while in 53.3% high AI indicated CMV reactivation or reinfection. Primary infections were detected mainly in children and adolescents (83.2% and 70.5%), while reactivations/reinfections were common in persons older than 40 (77.0-100%). Reactivations/reinfections were most commonly detected in hemodialysis patients (92.3%). Logistic regression showed that older age and being on hemodialysis were significant predictors of CMV seropositivity.Conclusions: CMV is widespread in the Croatian population. Older age and being on hemodialysis appeared to be main risk factors for CMV infection.

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Section: Introductionmentioning

confidence: 99%

Seroepidemiology of cytomegalovirus infections in Croatia

Vilibić-Čavlek

Kolarić

Beader

et al. 2016

Wien Klin Wochenschr

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“…In this group, 47% of them presented conditions that induced alterations of the immune system, such as pregnancy, renal failure, diabetes mellitus or untreated cancer (non-hematologic) (9). Another review with 44 patients with CMV colitis showed an average age of 63 years (11).…”

Section: Discussionmentioning

confidence: 97%

Cytomegalovirus ileitis in an immunocompetent patient

Cerdeña¹,

Guardado

Prodomingo

et al. 2011

Rev. esp. enferm. dig.

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Cytomegalovirus (CMV) is a virus that belongs to the family of Herpesviridae. Infection can cause a serious disease in immunocompromised patients, but it can also affect immunocompetent patients, creating generally self limiting symptoms. However, in some cases it can be fatal. We present a case of CMV ileitis with serious clinical symptoms that led to an operation in an immunocompetent patient.Key words: Ileitis. Cytomegalovirus. Immunocompetent. INTRODUCTIONCytomegalovirus (CMV) is a form of Herpes virus. In humans, it is known as human herpesvirus 5 (HHV-5). It belongs to the Betaherpesvirinae subfamily of Herpesviridae. The source of the virus name is the size increase observed in the infected cells as a result of the weakening of the cytoskeleton. It can cause serious diseases in immunocompromised patients, either due to the reactivation of a latent infection or to a primo-infection. The CMV infection mainly affects immunocompromised patients. However, it is not rare in immunocompetent patients, and its symptoms are compatible with a non-specific viral syndrome or they simulate a mononucleosis (1,2).CMV infection can affect any system of the body, which, in decreasing order of incidence are: gastrointestinal tract (mainly in the form of colitis), central nervous system (meningitis, encephalitis,…), hematological manifestations (hemolytic anemia, thrombocytopenia), eyes (retinitis, uveitis), liver (hepatitis), lung (pneumonitis) and circulatory system (venous and arterial thrombosis) (3).In the case of gastrointestinal tract, the most common affected areas are the colon and the rectum, and other locations such as the small intestine are rarer. Clinical symptoms include: fever, abdominal pain, anorexia, nausea, vomiting, diffuse abdominal pain, lower abdominal pain, weight loss, diarrhea, hematochezia or melena. Complementary tests for diagnosis include: abdominal ultrasound or CT scan, gastroscopy and colonoscopy with ileoscopy with biopsies and fecal culture. Endoscopic findings include friable or edematous mucosa, fold thickening and, more characteristically, well-delimited medium-or bigsized ulcers with protruding edges separated by normal mucosa. The diagnosis is based on histological analysis, fecal culture, C-reactive protein and serology (4,5). The pathogenesis of these lesions is still unclear, but it seems to be the consequence of ischemic damage to the mucosa secondary to an infection of the vascular endothelial cells and local autoimmune alterations (6).Although this infection is considered to be self-limiting in immunocompetent patients, some cases with serious clinical manifestations that can lead to death have been published (3). Cytomegalovirus ileitis in an immunocompetent patient CLINICAL NOTETejedor-Cerdeña María Auxiliadora, Velasco-Guardado Antonio, Fernández-Prodomingo Ana, Piñero-Pérez María Concepción, Calderón Renzo, Prieto-Bermejo Ana Beatriz, Sánchez-Garrido Ana, Martínez-Moreno Juan, Geijo-Martínez Fernando, BlancoMúñez Óscar Javier, Rodríguez-Pérez Antonio. Cytomegalov...

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“…Em artigo recente de metanálise, no período de 1980 a 2003, somente 44 casos foram identificados. Entre estes, 16 pacientes tiveram co-morbidades com alterações imunes, o que significa somente 28 casos CMV em pacientes com sistemas imunes íntegros (13) .…”

Section: Discussionunclassified

“…A maioria dos pacientes identificados tinha mais que 55 anos de idade, com uma idade média de 61,1 anos, isto poderia ser conseqüência de um enfraquecimento do sistema imune, decorrente do envelhecimento (13) . Com respeito à infecção pelo CMV, habitualmente a infecção ocorre durante a infância ou em adultos jovens.…”

Section: Discussionunclassified

Colite por citomegalovirus em paciente transplantada renal: relato de caso e revisão da literatura

Hossne¹,

Prado²,

Neto³

2007

Rev bras. colo-proctol.

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RESUMO: A infecção do citomegalovírus ocorre geralmente em pacientes imunocomprometidos sejam pós-transplantados ou pelas doenças que comprometem o sistema imune (AIDS); apresentamos um caso de um paciente do sexo feminino de 49 anos de idade, que se encontrava em pós-operatório tardio de transplante renal (14 anos), fazendo uso de medicações imunossupressoras. Evolui com quadro de dor abdominal, perda do peso e diarréia não sanguinolenta na fase inicial, necessitando de hospitalização, durante a qual desenvolveu severos quadros de hematoquezia e hipotensão. Submetida a colonoscopia que revelou mucosa de aspecto friável, com úlceras do tipo aftóides, fibrina e formação de pseudopólipos; a biopsia revelou tratar-se de citomegalovírus. Evolui sem melhora com o uso do foscarnet r , necessitando de tratamento cirúrgico, indo a óbito após 5 dias.Descritores: enterocolite, infecções por citomegalovírus. INTRODUÇÃOA infecção do citomegalovírus (CMV) ocorre geralmente em pacientes imunocomprometidos, seja por doença infecciosa (HIV) ou após o transplante de ór-gãos (1) . Tipicamente, quando o CMV afeta o sistema gastrintestinal, ele causa intensa inflamação levando à formações de ulcerações na mucosa e sangramento, que pode ocorrer em todo o trato digestório (1,2) . O ví-rus prolifera-se na camada endotelial, acarretando vasculite e trombose dos segmentos envolvidos, este processo inflamatório tem como resultado a indução de quadros isquêmicos. Este fato tem sido relatado mais usualmente em pacientes pós-transplantados, porém observa-se um aumento da incidência nos pacientes com infecção por HIV estabelecida, tipicamente em estágios avançados (3,4) . RELATO DO CASOPaciente do sexo feminino, 49 anos de idade, acompanhado pelo serviço há 15 anos devido a glomérulo nefrite rapidamente progressiva, diabetes melittus e hipertensão arterial. Submetida a transplante renal há 14 anos, período em que fez uso crô-nico de imunossupressores (prednisona, ciclosporina, imuram).Durante este período apresentou diversas complicações clínicas, entre elas infecções urinárias de repetição, diarréias crônicas, esofagite, duodenite, hipertensão arterial, dislipidemia e depressão.Apresentou boa evolução quanto ao transplante, com níveis de uréia e creatinina próximos a valores normais, porém com necessidade do uso de altas doses de imunossupressores.

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Life-threatening cytomegalovirus colitis in the immunocompetent patient

Abstract: Cytomegalovirus colitis in the immunocompetent patient is an unusual clinical entity. We describe a patient with life-threatening cytomegalovirus colitis in the absence of immune deficiency and review the medical literature available on this topic.

Cited by 46 publications

References 31 publications

Seroepidemiology of cytomegalovirus infections in Croatia

Seroepidemiology of cytomegalovirus infections in Croatia

Cytomegalovirus ileitis in an immunocompetent patient

Colite por citomegalovirus em paciente transplantada renal: relato de caso e revisão da literatura

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