Gastrointestinal infections caused by cytomegalovirus

Abstract

Cytomegalovirus (CMV) is an important human pathogen, causing a variety of syndromes ranging from asymptomatic infections to life-threatening end-organ disease. Infections of the gastrointestinal tract are an especially common form of disease caused by CMV and are usually manifest as luminal infections, such as esophagitis or colitis. Solid organ disease caused by CMV is also known to occur, with hepatitis being the most common syndrome. The large majority of cases of tissue-invasive disease caused by CMV have been reported to occur in immunocompromised hosts. Patients at highest risk for serious CMV-mediated disease are commonly HIV infected, recipients of transplants, or are receiving potent immunosuppressive medications. Intriguingly, several recent reports have discussed the previously underappreciated role of serious forms of CMV-mediated disease occurring in immunocompetent patients. This paper reviews several recent reports addressing important aspects related to the diagnosis, treatment, and management of CMV infections of the gastrointestinal tract.

Practical Aspects in the Evaluation of Infectious Esophagitis

“…For the detection of HSV, biopsies should be taken from the edge of an ulcerated lesion. In contrast, CMV and EBV are better detected from the center of the ulcer base [3,5,9]. Since different viruses show variability concerning their best traceability, sampling should include…”

“…or Actinomyces sps. are detected [1][2][3][4][5]. Frequently, there is evidence of several pathogens but simultaneous infection by different viruses is rare [6,7].…”

Severe Distal Cytomegalovirus Esophagitis With Aerodigestive Symptoms in an Immunocompetent Infant

“…CMV can occur anywhere in the gastrointestinal tract, and immunocompetent infants are usually asymptomatic, although severe gastrointestinal disease has been exceptionally described [3][4][5][6][7]. CMV esophagitis is expressed by luminal syndrome with erosive and ulcerative lesions [8], and there are few reports on severe esophagitis in immunocompetent neonate/infants in the literature review. In two case reports, vomiting, feeding intolerance, failure to gain weight, lymphadenopathy and hepatosplenomegaly were the main symptoms [9,10].…”

Cytomegalovirus associated toxic megacolon in an immunocompetent host. A case report

“…CMV has been known to affect patients with a compromised immune system such as HIV, lymphoma, cancers, patients on radiotherapy, and other immunosuppressive therapies, which provide favorable conditions for the reactivation of latent infection. In these patients it causes lethal infections affecting various organ systems, with the gastrointestinal tract being the most commonly affected, and esophagitis and colitis involving the left colon being the most common manifestations [4,5]. In immunocompetent patients CMV infections are mostly asymptomatic, though sometimes they cause a mononucleosis-like syndrome or selflimiting pneumonitis or hepatitis [6].…”