Severe acute colitis associated with CMV: a prevalence study

Criscuoli, Valeria; Casà, Angelo; Orlando, Ambrogio; Pecoraro, G.; Oliva, L; Traina, Mario; Rizzo, Aroldo; Cottone, Mario

doi:10.1016/j.dld.2004.05.013

Cited by 119 publications

(78 citation statements)

References 15 publications

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“…The prevalence of HCMV infection was 21% (9 out of 42 patients) [2]. The prevalence rate of HCMV infection in the steroid-refractory group was 33% (4 out of 12 patients) which approximate the previous estimate in a previous series [3].…”

Section: Introductionsupporting

confidence: 76%

Toxic megacolon and human Cytomegalovirus in a series of severe ulcerative colitis patients

Criscuoli

Rizzuto

Gallo

et al. 2015

Journal of Clinical Virology

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a b s t r a c tBackground: Human Cytomegalovirus (HCMV) infection has been reported to be a cause of refractory ulcerative colitis (UC). Toxic megacolon (TM) is a rare but severe complication of an acute attack of UC. Objectives: Aim of this study is to evaluate in a case-control study the association between HCMV and TM. Study design: All patients who were admitted at Medicine Department of V. Cervello Hospital in Palermo (tertiary referral center) for a severe UC flare-up complicated by the onset of TM (diameter of the transverse colon > 6 cm) between January 1990 and November 2011 were identified through the electronic database. A total of 24 consecutive patients (16 male/8 female) with TM were identified. Each case of TM were individually matched by sex, age, extent of the underlying disease to 24 severe UC controls who did not develop TM. A further non matched control population of 48 severe UC was included.Haematoxilin and eosin stain, immunohistochemical procedure and nested polymerase chain reaction were performed to detect HCMV genes and proteins on rectal biopsies or surgical specimens. Pp65 antigenemia was performed in order to diagnose any possible systemic infection. HCMV frequency was compared between patients with and without TM during follow-up, using Fisher's Exact test. Results and conclusions: HCMV was detected in histological specimens of 11 patients (46%) with TM compared to 2 (9%) severe UC matched controls (P = 0.0078) and 7 (14%) unmatched controls (p = 0,003). In severe colitis the presence of HCMV is more frequently associated with TM.

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Section: Introductionsupporting

confidence: 76%

Toxic megacolon and human Cytomegalovirus in a series of severe ulcerative colitis patients

Criscuoli

Rizzuto

Gallo

et al. 2015

Journal of Clinical Virology

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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].…”

Section: Discussionsupporting

confidence: 75%

Diagnosis of Cytomegalovirus Infection during Exacerbation of Ulcerative Colitis

Levin

Yaari²,

Stoff³

et al. 2017

Digestion

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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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“…Prevalence has been reported to range from 0.5 to 100% (Table 1). Severe colitis: A group in Italy [13] studied the prevalence of CMV using rectal biopsies and HE staining, immunoperoxidase staining for CMV antigens and antigenemia pp65 (a buffy-coat preparation) on the peripheral leukocytes. The study was performed prospectively in a consecutive series of hospital admissions without waiting for a possible response to conventional therapy, in order to determine the prevalence of CMV in severe consecutive episodes of colitis.…”

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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Severe acute colitis associated with CMV: a prevalence study

Cited by 119 publications

References 15 publications

Toxic megacolon and human Cytomegalovirus in a series of severe ulcerative colitis patients

Toxic megacolon and human Cytomegalovirus in a series of severe ulcerative colitis patients

Diagnosis of Cytomegalovirus Infection during Exacerbation of Ulcerative Colitis

Cytomegalovirus and inflammatory bowel disease: Is there a link?

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