Archive for June 5, 2016

Cytomegalovirus in inflammatory bowel disease: A systematic review.

World J Gastroenterol. 2016 Jan 21;22(3):1321-30. doi: 10.3748/wjg.v22.i3.1321.

Römkens TE1, Bulte GJ1, Nissen LH1, Drenth JP1.

Author information

1Tessa EH Römkens, Loes HC Nissen, Joost PH Drenth, Department of Gastroenterology and Hepatology, Radboud University Nijmegen Medical Centre, 6500 HB Nijmegen, The Netherlands.

Abstract

AIM:

To identify definitions of cytomegalovirus (CMV) infection and intestinal disease, in inflammatory bowel disease (IBD), to determine the prevalence associated with these definitions.

METHODS:

We conducted a systematic review and interrogated PubMed, EMBASE and Cochrane for literature on prevalence and diagnostics of CMV infection and intestinal disease in IBD patients. As medical headings we used “cytomegalovirus” OR “CMV” OR “cytomegalo virus” AND “inflammatory bowel disease” OR “IBD” OR “ulcerative colitis” OR “colitis ulcerosa” OR “Crohn’s disease”. Both MeSH-terms and free searches were performed. We included all types of English-language (clinical) trials concerning diagnostics and prevalence of CMV in IBD.

RESULTS:

The search strategy identified 924 citations, and 52 articles were eligible for inclusion. We identified 21 different definitions for CMV infection, 8 definitions for CMV intestinal disease and 3 definitions for CMV reactivation. Prevalence numbers depend on used definition, studied population and region. The highest prevalence for CMV infection was found when using positive serum PCR as a definition, whereas for CMV intestinal disease this applies to the use of tissue PCR > 10 copies/mg tissue. Most patients with CMV infection and intestinal disease had steroid refractory disease and came from East Asia.

CONCLUSION:

We detected multiple different definitions used for CMV infection and intestinal disease in IBD patients, which has an effect on prevalence numbers and eventually on outcome in different trials.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4716042/pdf/WJG-22-1321.pdf

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June 5, 2016 at 10:52 am

Steroid-refractory inflammatory bowel disease is a risk factor for CMV infection.

Eur Rev Med Pharmacol Sci. 2016 Mar;20(5):858-65.

Ormeci AC1, Akyuz F, Baran B, Soyer OM, Gokturk S, Onel M, Onel D, Agacfidan A, Demirci M, Yegen G, Gulluoglu M, Karaca C, Demir K, Besisik F, Kaymakoglu S.

1Department of Internal Medicine, Division of Gastroenterology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey. filiakyuz@hotmail.com

Abstract

OBJECTIVE:

Patients with inflammatory bowel disease (IBD) show increased the prevalence of cytomegalovirus (CMV) infection due to the severity of the disease and the immunosuppressive treatments they receive. The aim of this study was to determine the prevalence of CMV infection in IBD patients and identify the risk factors for CMV infection with different demographic characteristics in IBD patients.

PATIENTS AND METHODS:

We enrolled 85 patients diagnosed with IBD (43 with ulcerative colitis (UC) and 42 with Crohn’s disease (CD)) in this prospective study. The clinical disease activities of UC and CD were assessed using Truelove-Witts and Crohn’s disease activity index (CDAI). CMV infection was assessed by detection of DNA using real-time polymerase chain reaction (PCR) in blood samples and quantitative PCR in colonic biopsy specimens and by detection of inclusion bodies using hematoxylin-eosin staining.

RESULTS:

Thirteen patients with IBD exhibited concomitant CMV infection. CMV infection was not detected in any of the patients in remission. Viral loads measured in the colonic mucosa of infected patients ranged from 800-7000 genome copies/mL total extracted DNA. The mean serum CMV DNA level was 1694 ± 910 copies/mL (range: 800-3800). The rate of steroid resistance in CMV-positive cases was significantly higher than that in CMV-negative cases (p = 0.001). CD with acute exacerbation was a risk factor for CMV disease (p = 0.04). All of the CMV-positive patients received immunosuppressive treatments.

CONCLUSIONS:

CMV infection should be suspected in steroid-resistant UC and CD. Antiviral treatment improved the clinical outcome in steroid-resistant IBD cases with serum CMV DNA levels above 1000 copies/mL.

PDF

http://www.europeanreview.org/wp/wp-content/uploads/858-865.pdf

June 5, 2016 at 10:51 am

CMV Colitis in Immunocompetent Patients: 2 Cases of a Diagnostic Challenge.

Case Rep Gastrointest Med. 2016;2016:4035637.

Paparoupa M1, Schmidt V1, Weckauf H2, Ho H1, Schuppert F1.

1Department of Gastroenterology, Endocrinology, Diabetology and General Medicine, Klinikum Kassel, Mönchebergstraße 41-43, 34125 Kassel, Germany.

2Institute of Pathology, Klinikum Kassel, Mönchebergstraße 41-43, 34125 Kassel, Germany.

Abstract

CMV infections are generally thought to be opportunistic by immunosuppression. Many literature cases though indicate that CMV infections can be also observed in immunocompetent patients. We present an unusual case of an extensive concentric benign stenosis due to CMV colitis and a case of coexistence with Crohn’s Disease, both observed in nonimmunosuppressed individuals. The right diagnosis was set after implementation of multiple unsuccessful treatment strategies. Our purpose is therefore to familiarize clinicians involved with the diagnosis and treatment of gastroenterological diseases with this entity.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4844870/pdf/CRIGM2016-4035637.pdf

June 5, 2016 at 10:49 am


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