Cytomegalovirus‐associated pseudomembranous colitis in a kidney transplant recipient

Chua, Yi Yi; Ho, Quan Yao; Ngo, Nye Thane; Krishnamoorthy, Thinesh Lee; Thangaraju, Sobhana; Kee, Terence; Wong, Hei Man

doi:10.1111/tid.13694

Cited by 5 publications

(3 citation statements)

References 28 publications

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“…Nervous system infections are common NCs after KT, and cytomegalovirus (CMV) infection is dominantly responsible for infection after KT. CMV infection, with a strong association with the use of immunosuppressive agents, is a major predisposing factor for acute rejection and is a key influencing element of the survival of recipients [ 6 ]. In order to further clarify the incidence and types of NCs after KT, this study conducted a meta-analysis of the published literature on NCs after KT, with the aim of enhancing the understanding of NCs after KT and improving the benefits for KT patients.…”

Section: Introductionmentioning

confidence: 99%

The Prevalence of Neurological Complication after Renal Transplantation

Zhu

Shen

et al. 2022

Evidence-Based Complementary and Alternative Medicine

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Objective. To evaluate the incidence of neurological complications (NCs) after renal transplantation by meta-analysis. Methods. A broad literature search in PubMed, Embase, and Cochrane-Library was performed from inception to December 31, 2021, to collect published studies on the incidence of NCs after kidney transplantation. The R language meta-package was used to organize and analyze the data. Results. 17 articles including 1,1119 participants were considered eligible. There were 3 studies that recorded unclassified NCs (249 participants), 6 that recorded nervous system CMV infection (1489 participants), 3 that recorded headache (243 participants), and 5 that recorded cerebrovascular events (9138 participants). There was significant heterogeneity (all I2 ≥ 75%) in all analyses, and random-effects models were selected. Meta-analysis results showed that the incidence of unclassified NCs was 0.29 (95% CI (0.16–0.48)), the incidence of nervous system CMV infection was 0.38 (95% CI (0.26–0.52)), the incidence of headache was 0.55 (95% CI (0.44–0.66)), and the incidence of stroke was 0.05 (95% CI (0.02–0.09)). Egger’s test showed that there was no conspicuous publication bias in the included literature in each group. Conclusions. Headache had the highest incidence (55%) in the nervous system after KT, followed by nervous system CMV infection (38%) and stroke (5%). Nevertheless, due to the inconsistencies in the types of NCs included and the follow-up time, our results might only serve as an epidemiological reference for the specific incidence differences.

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Section: Introductionmentioning

confidence: 99%

The Prevalence of Neurological Complication after Renal Transplantation

Zhu

Shen

et al. 2022

Evidence-Based Complementary and Alternative Medicine

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“…Additionally, a rare case of ectopic pregnancy rupture after simultaneous pancreas and kidney transplantation has been reported[ 20 ]. In addition, specific intraperitoneal infections, such as neutropenic enterocolitis, CMV colitis[ 8 , 21 , 22 ] and Clostridium difficile ( C. difficile ) colitis, have been reported[ 3 ].…”

Section: Diagnosismentioning

confidence: 99%

Critical considerations for the management of acute abdomen in transplant patients

Pavlidis,

Katsanos,

Kofinas

et al. 2024

World J Transplant

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The number of solid organ transplantations performed annually is increasing and are increasing in the following order: Kidney, liver, heart, lung, pancreas, small bowel, and uterine transplants. However, the outcomes of transplants are improving (organ survival > 90% after the 1st year). Therefore, there is a high probability that a general surgeon will be faced with the management of a transplant patient with acute abdomen. Surgical problems in immunocompromised patients may not only include graft-related problems but also nongraft-related problems. The perioperative regulation of immunosuppression, the treatment of accompanying problems of immunosuppression, the administration of cortisol and, above all, the realization of a rapidly deteriorating situation and the accurate evaluation and interpretation of clinical manifestations are particularly important in these patients. The perioperative assessment and preparation includes evaluation of the patient’s cardiovascular system and determining if the patient has hypertension or suppression of the hypothalamic-pituitary-adrenal axis, or if the patient has had any coagulation mechanism abnormalities or thromboembolic episodes. Immunosuppression in transplant patients is associated with the use of calcineurin inhibitors, corticosteroids, and antiproliferation agents. Many times, the clinical picture is atypical, resulting in delays in diagnosis and treatment and leading to increased morbidity and mortality. Multidetector computed tomography is of utmost importance for early diagnosis and management. Transplant recipients are prone to infections, especially specific infections caused by cytomegalovirus and Clostridium difficile , and they are predisposed to intraoperative or postoperative complications that require great care and vigilance. It is necessary to follow evidence-based therapeutic protocols. Thus, it is required that the clinician choose the correct therapeutic plan for the patient (conservative, emergency open surgery or minimally invasive surgery, including laparoscopic or even robotic surgery).

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“…Multiple cases of pseudomembranous colitis from CMV have been described in the literature[ 21 , 22 - 24 ]. Colitis refractory to CDI treatment leads to the authors testing for other causes of pseudomembranous colitis.…”

Section: Virusesmentioning

confidence: 99%

Non-clostridium difficile induced pseudomembranous colitis

Jagirdhar¹,

Surani²

2023

World J Clin Cases

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Pseudomembranous colitis is severe inflammation of the inner lining of the colon due to anoxia, ischemia, endothelial damage, and toxin production. The majority of cases of pseudomembranous colitis are due to Clostridium difficile. However, other causative pathogens and agents have been responsible for causing a similar pattern of injury to the bowel with the endoscopic appearance of yellow-white plaques and membranes on the mucosal surface of the colon. Common presenting symptoms and signs include crampy abdominal pain, nausea, watery diarrhea that can progress to bloody diarrhea, fever, leukocytosis, and dehydration. Negative testing for Clostridium difficile or failure to improve on treatment should prompt evaluation for other causes of pseudomembranous colitis. Bacterial infections other than Clostridium difficile, Viruses such as cytomegalovirus, parasitic infections, medications, drugs, chemicals, inflammatory diseases, and ischemia are other differential diagnoses to look out for in pseudomembranous colitis. Complications of pseudomembranous colitis include toxic megacolon, hypotension, colonic perforation with peritonitis, and septic shock with organ failure. Early diagnosis and treatment to prevent progression are important. The central perspective of this paper is to provide a concise review of the various etiologies for pseudomembranous colitis and management per prior literature.

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Cytomegalovirus‐associated pseudomembranous colitis in a kidney transplant recipient

Cited by 5 publications

References 28 publications

The Prevalence of Neurological Complication after Renal Transplantation

The Prevalence of Neurological Complication after Renal Transplantation

Critical considerations for the management of acute abdomen in transplant patients

Non-clostridium difficile induced pseudomembranous colitis

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