Cytomegalovirus in ulcerative colitis: an evidence-based approach to diagnosis and treatment

Jena, Anuraag; Mishra, Shubhra; Singh, Anupam; Sekar, Aravind; Sharma, Vishal

doi:10.1080/17474124.2022.2032662

Cited by 9 publications

(11 citation statements)

References 87 publications

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“…Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes a severe respiratory disease (Bezzio et al 2020 ; Jena et al 2022 ) and novel variants of concern (VOCs) have emerged, conveying different clinical symptoms (Brodin 2021 ; Kennedy et al 2021 ; Yang and Rao 2021 ). Considering the existence of angiotensin-converting enzyme 2 (ACE-2) receptor onto the respiratory and epithelial cells, the SARS-CoV-2 enters into the enterocytes (Puoti et al 2021 ).…”

Section: Methodsmentioning

confidence: 99%

Protective role of flavonoids quercetin and silymarin in the viral-associated inflammatory bowel disease: an updated review

Zarenezhad

Abdulabbas

Kareem³

et al. 2023

Arch Microbiol

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Inflammatory bowel disease (IBD) is a chronic recurrent inflammation of the gastrointestinal tract (GIT). IBD patients are susceptible to various infections such as viral infections due to the long-term consumption of immunosuppressive drugs and biologics. The antiviral and IBD protective traits of flavonoids have not been entirely investigated. This study objective included an overview of the protective role of flavonoids quercetin and silymarin in viral-associated IBD. Several viral agents such as cytomegalovirus (CMV), Epstein–Barr virus (EBV), varicella zoster virus (VZV) and enteric viruses can be reactivated and thus develop or exacerbate the IBD conditions or eventually facilitate the disease remission. Flavonoids such as quercetin and silymarin are non-toxic and safe bioactive compounds with remarkable anti-oxidant, anti-inflammatory and anti-viral effects. Mechanisms of anti-inflammatory and antiviral effects of silymarin and quercetin mainly include immune modulation and inhibition of caspase enzymes, viral binding and replication, RNA synthesis, viral proteases and viral assembly. In the nutraceutical sector, natural flavonoids low bioavailability and solubility necessitate the application of delivery systems to enhance their efficacy. This review study provided an updated understanding of the protective role of quercetin and silymarin against viral-associated IBD.

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Section: Methodsmentioning

confidence: 99%

Protective role of flavonoids quercetin and silymarin in the viral-associated inflammatory bowel disease: an updated review

Zarenezhad

Abdulabbas

Kareem³

et al. 2023

Arch Microbiol

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“…CMV may be found in the mucosa of the colon; therefore, when deciding the treatment of CMV infection in patients with severe UC, clarification of the presence of CMV is essential [ 6 , 7 ]. Furthermore, the duration of therapy depends on the disease's severity and the patient’s clinical and virologic response to treatment [ 9 ]. In accordance with previous research, we treated the patient until both the symptoms and CMV viremia resolved.…”

Section: Discussionmentioning

confidence: 99%

“…In accordance with previous research, we treated the patient until both the symptoms and CMV viremia resolved. The typical duration of therapy is 21 days; however, it may be longer, particularly in patients with tissue-invasive diseases [ 9 , 10 ]. The treatment of CMV infection should be modified based on the viremia and systemic symptoms.…”

Section: Discussionmentioning

confidence: 99%

Timing of Treatment for Cytomegalovirus Infection in an Immunocompetent Middle-Aged Woman With Fulminant Ulcerative Colitis: A Case Report

Ohta¹,

Mishiro²,

Sano³

2023

Cureus

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Viral infections, such as cytomegalovirus (CMV) infection, may affect the clinical course of ulcerative colitis (UC). CMV can cause chronic inflammation of the intestinal mucosa. In inflammatory bowel disease, chronic inflammation caused by CMV can deter the regeneration of the mucosa of the colon. However, the relationship between CMV and inflammatory bowel disease still needs to be clarified, especially in immunocompetent patients, such as younger patients not treated with immunosuppressants. Herein, we describe our experience with a middle-aged immunocompetent female patient diagnosed with fulminant UC positive for myeloperoxidase antineutrophil cytoplasmic antibody (MPO-ANCA). Her initial response to high-dose prednisolone was favorable; however, remission was not achieved. Immunohistochemical staining revealed the presence of CMV. Subsequently, the patient was successfully treated with prednisolone, adalimumab, and azathioprine, along with the anti-CMV treatment comprising valganciclovir. This case shows that the presence of CMV in the mucosa and blood may make patients with UC refractory to immunosuppression; furthermore, the positivity of MPO-ANCA in patients with UC can necessitate the administration of high-dose immunosuppressants to taper the dose of prednisolone.

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“…CMV infection must be treated in high-grade cases, whereas immunosuppression may be effective in low-grade cases. Generally, the drug for treating CMV disease is ganciclovir [23]. Researchers compared non-overlapping years from 2003 to 2016 from the Kids Inpatient Database (KID) and National Inpatient Sample (NIS).…”

Section: Cytomegalovirus (Cmv)mentioning

confidence: 99%

Association Between Inflammatory Bowel Disease and Viral Infections

et al. 2023

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Chronic inflammatory gastrointestinal diseases such as Crohn's disease (CD) and ulcerative colitis (UC) are known as inflammatory bowel disorders (IBD). Patients with inflammatory bowel illnesses are more susceptible to viral infections. In people with IBD, viral infections have emerged as a significant issue. Viral infections are often difficult to identify and have a high morbidity and fatality rate. We reviewed studies on viral infections and IBD, concentrating on Cytomegalovirus (CMV), SARS-CoV-2, Epstein-Barr virus (EBV), enteric viruses, and hepatitis B virus (HBV). Also, the effect of IBD on these viral infections is discussed. These data suggest that patients with IBD are more likely to get viral infections. As a result, practitioners should be aware of the increased risk of viral infections in inflammatory bowel disease patients.

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Cytomegalovirus in ulcerative colitis: an evidence-based approach to diagnosis and treatment

Cited by 9 publications

References 87 publications

Protective role of flavonoids quercetin and silymarin in the viral-associated inflammatory bowel disease: an updated review

Protective role of flavonoids quercetin and silymarin in the viral-associated inflammatory bowel disease: an updated review

Timing of Treatment for Cytomegalovirus Infection in an Immunocompetent Middle-Aged Woman With Fulminant Ulcerative Colitis: A Case Report

Association Between Inflammatory Bowel Disease and Viral Infections

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