Human cytomegalovirus and Epstein-Barr virus infection in inflammatory bowel disease: Need for mucosal viral load measurement

Ciccocioppo, Rachele; Racca, Francesca; Paolucci, Stefania; Campanini, Giulia; Pozzi, L.; Betti, E.; Riboni, Roberta; Vanoli, Alessandro; Baldanti, Fausto; Corazza, Gino Roberto

doi:10.3748/wjg.v21.i6.1915

Cited by 97 publications

(78 citation statements)

References 53 publications

(58 reference statements)

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“…Our study shows that 33.3% patients have EBV infection in colonic mucosa of IBD patients, lower than that reported by other researchers (45.5-81.0%) [7][8][9][10][11]15]. It may be due to the difference in patients enrolled.…”

Section: Discussioncontrasting

confidence: 75%

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The Status of Epstein-Barr Virus Infection in Intestinal Mucosa of Chinese Patients with Inflammatory Bowel Disease

Chen

Peng

et al. 2018

Digestion

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Aims: This cross-sectional study is to investigate the presence of Epstein-Barr virus (EBV) in colonic mucosa of inflammatory bowel disease (IBD) patients and its correlation with the clinical disease activities and therapeutic regimens. Methods: Subjects undergoing colonoscopy for screening of polyps were recruited as control. EBV DNA load was analyzed by means of quantitative real-time polymerase chain reaction and EBV-encoded RNAs were tested by in situ hybridization in intestinal mucosa of IBD patients. EBV infection was defined as positive with either method. Clinical disease activity was assessed using the Mayo Clinic Score for ulcerative colitis and Crohn’s disease activity index for CD. Results: EBV was detectable in 33 out of 99 IBD patients (33.3%). In controls, EBV prevalence was 7.5% (3/40). We found a significant correlation between EBV prevalence and clinical disease activities (mild [10.71%, 3/28] versus moderate [32.73%, 18/55], severe [75.00%, n = 12/16], p < 0.001). However, no significant difference was found in EBV prevalence between patients who received immunosuppressive therapy and those who did not. Conclusions: EBV infection is common in colonic mucosa of IBD patients. There is a significant correlation between EBV infection and clinical disease activities of IBD. However, prospective studies are still needed to explore the exact role of EBV in IBD.

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Section: Discussioncontrasting

confidence: 75%

“…However, only a few studies have been found on this issue. To date, data about EBV positive rate in mucosa of IBD patients vary because of the difference in enrolled subjects, testing approaches, and study design [7][8][9][10][11]. EBV prevalence in colonic mucosa of Chinese IBD patients is not clear so far.…”

Section: Introductionmentioning

confidence: 99%

The Status of Epstein-Barr Virus Infection in Intestinal Mucosa of Chinese Patients with Inflammatory Bowel Disease

Chen

Peng

et al. 2018

Digestion

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“…This high rate of CMV detection reflects the clinical sensitivity of CMV PCR in colonic tissue, and is in agreement with previous studies, demonstrating the high sensitivity and frequency of positive CMV PCR in steroid-refractory colitis [3,14,17,18]. In this regard, it has also been suggested that clinical outcomes correlate with the tissue viral load [19,20,21]. We thus expect that this rapid, sensitive and quantitative assay will be increasingly utilized in the diagnostic workup of patients with UC exacerbation, and further determination of its clinical significance is of high importance.…”

Section: Discussionsupporting

confidence: 90%

“…This patient's course, exemplifying the importance of PCR in diagnosis and therapeutic decisions, is comparable to that described in the case series by Roblin et al [21], which included 7 patients with a positive tissue CMV-PCR and negative IHC staining, who were treated successfully with antiviral therapy. We further found a positive correlation between the tissue CMV viral load and the tissue IHC staining that had not been observed in a previous report [20]. This difference could be attributed to differences in techniques and assay sensitivity.…”

Section: Discussionsupporting

confidence: 60%

Diagnosis of Cytomegalovirus Infection during Exacerbation of Ulcerative Colitis

Levin

Yaari²,

Stoff³

et al. 2017

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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

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“…Finally, it is known that steroid-refractory UC patients have a high incidence of human cytomegalovirus (CMV) [13][14][15][16]. It has also and underwent multiple wash-out surgeries.…”

Section: Case Reportmentioning

confidence: 99%

Successful management of refractory ulcerative colitis with orally administered serum-derived bovine immunoglobulin therapy

2015

Clin Case Rep Rev

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This case describes a female patient with a long history of pan-colitis (>10 years) with a recent flare of disease precipitated by a Clostridium difficile infection (CDI) after experiencing septic arthritis. The CDI was successfully treated with vancomycin confirmed by a negative PCR test. The patient then experienced a flare of ulcerative colitis (UC) with 7-8 watery, bloody stools per day with cramping. Initial treatment with 30 mg oral prednisone daily and rectal mesalamine, 1 g QHS, at bedtime resulted in no change in condition. Increased oral steroid (40 mg q.d.) caused an increase of watery, bloody stools to 10-15 per day. The patient was advised to include oral serum-derived bovine immunoglobulin/protein isolate (SBI), a prescription medical food, in combination with oral steroids. Over two months, this combination effectively resolved gastrointestinal symptoms and a repeat flexible sigmoidoscopy demonstrated mucosal healing (from Mayo UC score grade 2 to grade 0). The steroid dose was tapered from 40 mg to 5 mg in combination with SBI and the patient continues to be maintained on both therapeutics for a year. We discuss the unique complications of managing this particular patient, her refusal of anti-TNF therapies and why SBI was a therapeutic option in this case.

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Human cytomegalovirus and Epstein-Barr virus infection in inflammatory bowel disease: Need for mucosal viral load measurement

Abstract: Viral colitis appeared to contribute to mucosal lesions in refractory IBD, and its correct diagnosis and management require quantitative real-time polymerase chain reaction assay of mucosal specimens.

Cited by 97 publications

References 53 publications

The Status of Epstein-Barr Virus Infection in Intestinal Mucosa of Chinese Patients with Inflammatory Bowel Disease

The Status of Epstein-Barr Virus Infection in Intestinal Mucosa of Chinese Patients with Inflammatory Bowel Disease

Diagnosis of Cytomegalovirus Infection during Exacerbation of Ulcerative Colitis

Successful management of refractory ulcerative colitis with orally administered serum-derived bovine immunoglobulin therapy

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