Diagnosis of Cytomegalovirus Infection during Exacerbation of Ulcerative Colitis

Abstract

Background/Aims: The role of cytomegalovirus (CMV) reactivation during exacerbations of ulcerative colitis (UC) is yet a matter of debate, and assessment of CMV infection in UC patients remains an ongoing challenge. We aimed to identify associated parameters and compare detection methods for CMV infection during UC exacerbation. Methods: Clinical, pathological and virological parameters were retrospectively analyzed in all patients hospitalized in our institution for UC exacerbation between January 2009 and April 2015, who underwent full evaluation for CMV infection in colonic tissue by histopathology, immunohistochemistry (IHC) and CMV-PCR. Results: Of 28 patients who underwent full examination for tissue CMV-infection, 13 (46.4%) were found to be positive for CMV. Tissue CMV-PCR was more sensitive for the detection of CMV infection than histopathology and IHC. CMV-positive patients had a statistically higher frequency of recent steroid treatment and fever, with higher mean partial Mayo scores and lower mean albumin levels. There were no significant differences between CMV-positive and CMV-negative patients in terms of age, severity of colitis and disease duration. In a multivariable model, only recent steroid treatment and fever were independently associated with colonic CMV infection. Conclusions: This study provides a clinical model to detect the presence of CMV infection in patients hospitalized with UC exacerbation, which could direct proper investigation and facilitate timely empirical therapy

Acute abdomen in the immunocompromised patient: WSES, SIS-E, WSIS, AAST, and GAIS guidelines

“…The CMV seroprevalence analysis in adults showed at least 70% of seropositivity [ 28 , 29 ]. At the endoscopy, the only factor that may suggest the diagnosis is the presence of ulcerations with a well-defined, punched-out appearance present in up to 80% of patients [ 30 – 32 ]. Some studies proposed a typical cecum ulcer involving the ileocecal valve as a specific finding in CMV colitis in patients with graft-versus-host disease [ 33 ].…”

Risk factors of cytomegalovirus infection or reactivation in ulcerative colitis patients

“…Another 22 articles were further excluded by reading the full text. Ultimately, 20 [9,[15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] articles were eligible for data extraction and meta-analysis. The searching process is shown in Fig.…”

IgA, albumin, and eosinopenia as early indicators of cytomegalovirus infection in patients with acute ulcerative colitis

“…Furthermore, patients with CMV infection showed lower serum albumin levels, which was probably due to sever inflammatory process (present as high hsCRP levels) and insufficient intake. A few studies [31,33,34] have indicated that albumin is a nutritional and inflammatory marker that reflects the potential for infection or disease activity. However, the effect of treatment targeting at increasing albumin in CMV infection has not been fully illustrate.…”