Coexisting cytomegalovirus infection in immunocompetent patients with Clostridium difficile colitis.

November 29, 2016 at 7:54 am

J Microbiol Immunol Infect. 2016 Jan 12.

Chan KS1, Lee WY2, Yu WL3.

Author information

1Department of Intensive Care Medicine, Chi Mei Medical Center, Tainan City, Taiwan.

2Department of Pathology, Chi Mei Medical Center, Tainan City, Taiwan; Department of Pathology, Taipei Medical University, Taipei City, Taiwan.

3Department of Intensive Care Medicine, Chi Mei Medical Center, Tainan City, Taiwan; Department of Medicine, Taipei Medical University, Taipei City, Taiwan. Electronic address: yuleon_md@yahoo.com.tw

Abstract

Cytomegalovirus (CMV) colitis usually occurs in immunocompromised patients with human immunodeficiency virus infection, organ transplantation, and malignancy receiving chemotherapy or ulcerative colitis receiving immunosuppressive agents.

However, CMV colitis is increasingly recognized in immunocompetent hosts.

Notably, CMV colitis coexisting with Clostridium difficile infection (CDI) in apparently healthy individuals has been published in recent years, which could result in high morbidity and mortality.

CMV colitis is a rare but possible differential diagnosis in immunocompetent patients with abdominal pain, watery, or especially bloody diarrhea, which could be refractory to standard treatment for CDI. As a characteristic of CDI, however, pseudomembranous colitis may be only caused by CMV infection.

Real-time CMV-polymerase chain reaction (PCR) for blood and stool samples may be a useful and noninvasive diagnostic strategy to identify CMV infection when treatment of CDI eventually fails to show significant benefits. Quantitative CMV-PCR in mucosal biopsies may increase the diagnostic yield of traditional histopathology.

CMV colitis is potentially life-threatening if severe complications occur, such as sepsis secondary to colitis, massive colorectal bleeding, toxic megacolon, and colonic perforation, so that may necessitate pre-emptive antiviral treatment for those who are positive for CMV-PCR in blood and/or stool samples while pending histological diagnosis

PDF

http://www.e-jmii.com/article/S1684-1182(16)00008-6/pdf

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Entry filed under: Antimicrobianos, Bacterias, Biología Molecular, Epidemiología, Health Care-Associated Infections, Infecciones gastrointestinales, Infecciones intraabdominales, Infecciones nosocomiales, Infecciones virales, Metodos diagnosticos, Sepsis, Update.

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