Cytomegalovirus Infection in Patients With Inflammatory Bowel Disease

Vega, Roser; Bertrán, X; Menacho, Margarita; Domènech, Eugeni; Vega, Vicente Moreno de; Hombrados, M.; Cabré, Eduard; Ojanguren, Isabel; Gassull, Miquel A.

doi:10.1111/j.1572-0241.1999.01013.x

Cited by 122 publications

(98 citation statements)

References 13 publications

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“…Cytomegalovirus (CMV) reactivation is known as an important exacerbating factor (20)(21)(22). However, the clinical significance of CMV reactivation remains controversial.…”

Section: Discussionmentioning

confidence: 99%

Prognostic factors for colectomy in refractory ulcerative colitis treated with calcineurin inhibitors

Bamba

Andoh

Imaeda

et al. 2012

Experimental and Therapeutic Medicine

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Abstract. Calcineurin inhibitors (CNIs) such as cyclosporin A (CSA) and tacrolimus (FK506) are efficacious in patients with steroid-refractory or steroid-dependent ulcerative colitis (UC). We retrospectively investigated patients with refractory UC treated with CNIs to elucidate the prognostic factors for a colectomy. Data from 59 patients (35 men and 24 women) were analyzed. CSA and FK506 were administered by intravenous infusion and peroral administration, respectively. The efficacy of the CNIs was assessed using Seo's complex integrated disease activity index. Categorical data analyses were also conducted. The results revealed that the response rates for CSA and FK506 were similar (CSA, 66.6%; FK506, 63.6%). However, oral FK506 had a slower onset of action than intravenous CSA. The risk factors for CNI non-responsiveness were: i) more than 10,000 mg of prednisolone used prior to CNI treatment; and ii) positivity for cytomegalovirus antigenemia (C7-HRP). The factors affecting the rate of colectomy were: i) CNI non-responsiveness; ii) more than 10,000 mg of prednisolone used prior to the initiation of CNI treatment; and iii) positivity for C7-HRP. The addition of azathioprine (AZA) following CNI treatment significantly reduced the incidence of colectomy. Our results revealed the prognostic factors affecting the efficacy of CNI therapy and the need for colectomy in patients with refractory UC. Importantly, some of these factors may be obtained prior to or shortly following the start of CNI treatment. Furthermore, AZA is an important agent for averting colectomy once a patient responds to CNIs.

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“…Cytomegalovirus (CMV) reactivation is known as an important exacerbating factor (20)(21)(22). However, the clinical significance of CMV reactivation remains controversial.…”

Section: Discussionmentioning

confidence: 99%

Prognostic factors for colectomy in refractory ulcerative colitis treated with calcineurin inhibitors

Bamba

Andoh

Imaeda

et al. 2012

Experimental and Therapeutic Medicine

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“…These factors included female gender, pancolonic disease with active inflammation at histology, and azathioprine treatment. Using antigenemia, Wada [15] reported a prevalence of 34%, while Vega [16] reported a result of 3% in a retrospective study that used HE and ICH results. Severe steroid-resistant colitis: Cottone et al [17] showed that the prevalence of CMV, studied using HE and ICH and antigenemia, was 36%.…”

Section: Patient Selection Methodsmentioning

confidence: 99%

Cytomegalovirus and inflammatory bowel disease: Is there a link?

Criscuoli¹,

Rizzuto²,

Cottone³

2006

WJG

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The objective of this report is to give an overall view of the epidemiological, clinical, diagnostic and therapeutic features of Cytomegalovirus (CMV) infection in inflammatory bowel disease (IBD). A review of published reports on this topic was carried out, with particular attention paid to the selection of patients included in studies and the diagnostic methods employed. CMV is frequently associated with IBD. In some cases, CMV infection is associated with a poor outcome but it is not clear which patients are more likely to be affected and in which stage of the disease. The use of anti-viral therapy in IBD is controversial and an empirical study with controls is needed. The natural history of CMV infection related to the development and treatment of IBD has not been clarified but it is important to take it in consideration because of the possibility of viral persistence in the immunocompromised host and viral interaction with the immune system. family, which includes Epstein -Barr virus (EBV), Herpes Simplex virus tipes1 and 2 (HSV-1,2), Varicella-Zoster virus, and Human Herpes virus types 6 and 7 (HHV-6,7). Similar to infection with other viruses in the family, primary infection with CMV results in the establishment of a persistent or latent infection, due to the ability of the virus to remain integrated in the DNA of host cells. The sign of a viral infection is a cytopathic effect shown by the presence of large nuclear and cytoplasmic inclusions, represented by aggregates of replicating CMV nucleoprotein cores. To avoid recognition and destruction by CD8+T lymphocytes, the virus develops the ability to evade the immune system by several mechanisms. CMV produces some proteins, such as US2, US3 and US11, that inhibit the presentation of viral antigens to T cells, blocking the class I MHC in the endoplasmic reticulum or in the cytosol. It also produces homologues to class I MHC proteins and may compete for binding and presentation of viral antigens. Once the viral DNA remains undisturbed in the infected cells, subsequent reactivation can occur in response to several stimuli, such as immunosuppressant therapy or chemotherapy [1] . The down-regulation of the cell surface markers acts on interferon-alpha/beta dependent responses by affecting several levels of IFN signal transduction and a transcription activation pathway. CMV infection leads to the activation of Nuclear Factor kappa B (NF-kB) and its translocation to the nucleus, promoting the expression of cytokines, chemokines and cellular adhesion molecules. These mechanisms are also present in inflammatory bowel disease (IBD) where there is activation of several pro-inflammatory cytokines (such as IFN-gamma), the transcription of which is regulated through nuclear transcription factors (such as Nuclear Factor kappa B) and through a signal transducer and activator of transcription (STAT family). CMV aND IBDThe role of CMV in IBD is reviewed considering the following issues: diagnostic methods to detect the virus, prevalence of CMV in IBD according to pa...

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“…En la CU, la reactivación local de CMV se manifiesta habitualmente por crisis graves refractarias a corticoides 31,32,[34][35][36][37] . Estudios de cohorte informan una prevalencia de reactivación viral que varía entre 4,6 y 25% [38][39][40][41][42][43][44] .…”

Section: Rol De Citomegalovirus En Crisis Grave De Enfermedad Inflamaunclassified

“…En pacientes con estudio positivo, la medición de carga viral en sangre o antigenemia pueden ayudar a guiar la terapia, aunque los valores de corte no son claros. La terapia antiviral sugerida es ganciclovir endovenoso por 14 días, cuya tasa de respuesta varía entre 60 y 86%; sin embargo, la evidencia está limitada a estudios observacionales de tipo cohorte 35,45,49,[51][52][53] . La respuesta se observa al quinto o séptimo día de tratamiento.…”

Section: Rol De Citomegalovirus En Crisis Grave De Enfermedad Inflamaunclassified

Diagnóstico y manejo de colitis ulcerosa grave: Una mirada actualizada

Hernández-Rocha¹,

Ibáñez²,

Molina³

et al. 2017

Rev. méd. Chile

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Management of severe ulcerative colitis.An up-to-date L a enfermedad inflamatoria intestinal (EII) incluye 2 entidades: Colitis ulcerosa (CU) y la enfermedad de Crohn (EC). Ambas tienen un curso crónico con periodos de remisión y reactivación de variable intensidad. Los episodios de reactivación o crisis se caracterizan por la reaparición o aumento de la diarrea, sangre en deposiciones, dolor abdominal, con o sin sín-tomas sistémicos. En el caso de los pacientes con CU, donde la afectación es exclusivamente del colon y recto, hasta 25% tendrá una crisis grave que requiere hospitalización, pudiendo darse esta situación al debut o en cualquier momento de la evolución 1 . De los pacientes con crisis grave, 20 a 30% no responderá al uso de corticoides intravenosos y de ellos, 80% requerirá colectomía 2 . La mortalidad a corto plazo de la crisis grave es ~ 1% 3 . Por lo tanto, estos pacientes deben ser tratados oportuna y agresivamente, con el fin de evitar complicaciones y reducir la necesidad de colectomía.La incidencia de CU y EC ha aumentado en los últimos años e importantes avances en el diagnós-tico y manejo de estos pacientes han reducido la morbilidad y mortalidad 4 .Lo señalado anteriormente determina que médicos de diversas áreas se vean enfrentados cada vez más frecuentemente a pacientes con CU grave. Por esto, el objetivo de este artículo es revisar y difundir el manejo actual de la crisis grave de CU.

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Cytomegalovirus Infection in Patients With Inflammatory Bowel Disease

Abstract: Cytomegalovirus infection may play a role in the natural history of refractory inflammatory bowel disease and in some of its complications. The clearance of cytomegalovirus in colonic mucosa may lead some of these patients to remission.

Cited by 122 publications

References 13 publications

Prognostic factors for colectomy in refractory ulcerative colitis treated with calcineurin inhibitors

Prognostic factors for colectomy in refractory ulcerative colitis treated with calcineurin inhibitors

Cytomegalovirus and inflammatory bowel disease: Is there a link?

Diagnóstico y manejo de colitis ulcerosa grave: Una mirada actualizada

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