Cytomegalovirus Infections in Patients Diagnosed with Inflammatory Bowel Disease

Overview

Journal Infect Dis Clin Microbiol

Date 2025 Jan 2

PMID 39744664

Authors

Melike Inan-Hekimoglu

Elif Mukime Saricaoglu

Gule Cinar

Irem Akdemir

Ezgi Gulten

Murat Toruner

Arzu Ensari

Berna Savas

Kemal Osman Memikoglu

Affiliations

Soon will be listed here.

Abstract

Objective: The impact of cytomegalovirus (CMV) on inflammatory bowel disease (IBD) flares remains a matter of debate. This study aimed to evaluate patients with CMV infection who presented with IBD exacerbation in terms of diagnosis and treatment and investigate the importance of CMV DNA levels in colitis development.

Materials And Methods: Patients who were followed up with IBD and examined with clinical suspicion of CMV colitis at a university hospital between January 2016 and December 2021 were retrospectively scanned. This study included all patients who underwent colonoscopic biopsy with a preliminary diagnosis of CMV colitis and compared those with colitis detected histopathologically with those without colitis.

Results: Thirty-nine patients with IBD were included in the study. No statistically significant difference was observed regarding the two groups' demographic data, clinical findings, and outcomes. The median serum CMV DNA level in patients with CMV colitis was 104 copies/mL, which was lower than in patients without colitis (1216 copies/mL) (=0.008). Among patients with CMV colitis, CMV DNA levels were negative or low in 16 (61.5%).

Conclusion: In patients with IBD, CMV colitis may not always be accompanied by CMV viremia. Therefore, negative or low serum CMV DNA levels are not sufficient to exclude CMV colitis. In case of high clinical suspicion, further examinations should be planned.

References

Domenech E, Vega R, Ojanguren I, Hernandez A, Garcia-Planella E, Bernal I . Cytomegalovirus infection in ulcerative colitis: a prospective, comparative study on prevalence and diagnostic strategy. Inflamm Bowel Dis. 2008; 14(10):1373-9. DOI: 10.1002/ibd.20498. View

Kochan K, Biberci Keskin E, Seven G, Bas S, Kiremitci S, Gecer M . Effects of tissue cytomegalovirus quantitative polymerase chain reaction in the management of ulcerative colitis flare-ups: Should we wave aside?. Arab J Gastroenterol. 2021; 22(4):297-304. DOI: 10.1016/j.ajg.2021.11.005. View

Lawlor G, Moss A . Cytomegalovirus in inflammatory bowel disease: pathogen or innocent bystander?. Inflamm Bowel Dis. 2010; 16(9):1620-7. DOI: 10.1002/ibd.21275. View

Kim J, Boo S, Ye B, Kim C, Yang S, Kim J . Clinical utility of cytomegalovirus antigenemia assay and blood cytomegalovirus DNA PCR for cytomegaloviral colitis patients with moderate to severe ulcerative colitis. J Crohns Colitis. 2014; 8(7):693-701. DOI: 10.1016/j.crohns.2013.12.014. View

Sager K, Alam S, Bond A, Chinnappan L, Probert C . Review article: cytomegalovirus and inflammatory bowel disease. Aliment Pharmacol Ther. 2015; 41(8):725-33. DOI: 10.1111/apt.13124. View

Ormeci A, Akyuz F, Baran B, Soyer O, Gokturk S, Onel M . Steroid-refractory inflammatory bowel disease is a risk factor for CMV infection. Eur Rev Med Pharmacol Sci. 2016; 20(5):858-65. View

Kandiel A, Lashner B . Cytomegalovirus colitis complicating inflammatory bowel disease. Am J Gastroenterol. 2006; 101(12):2857-65. DOI: 10.1111/j.1572-0241.2006.00869.x. View

Ljungman P, Boeckh M, Hirsch H, Josephson F, Lundgren J, Nichols G . Definitions of Cytomegalovirus Infection and Disease in Transplant Patients for Use in Clinical Trials. Clin Infect Dis. 2016; 64(1):87-91. DOI: 10.1093/cid/ciw668. View

Powell R, WARNER N, Levine R, Kirsner J . Cytomegalic inclusion disease and ulcerative colitis; report of a case in a young adult. Am J Med. 1961; 30:334-40. DOI: 10.1016/0002-9343(61)90105-x. View

10.

Garrido E, Carrera E, Manzano R, Lopez-Sanroman A . Clinical significance of cytomegalovirus infection in patients with inflammatory bowel disease. World J Gastroenterol. 2013; 19(1):17-25. PMC: 3545225. DOI: 10.3748/wjg.v19.i1.17. View

11.

McCurdy J, Enders F, Jones A, Killian J, Loftus Jr E, Bruining D . Detection of Cytomegalovirus in Patients with Inflammatory Bowel Disease: Where to Biopsy and How Many Biopsies?. Inflamm Bowel Dis. 2015; 21(12):2833-8. DOI: 10.1097/MIB.0000000000000556. View

12.

Roblin X, Pillet S, Oussalah A, Berthelot P, Del Tedesco E, Phelip J . Cytomegalovirus load in inflamed intestinal tissue is predictive of resistance to immunosuppressive therapy in ulcerative colitis. Am J Gastroenterol. 2011; 106(11):2001-8. DOI: 10.1038/ajg.2011.202. View

13.

Sattayalertyanyong O, Limsrivilai J, Phaophu P, Subdee N, Horthongkham N, Pongpaibul A . Performance of Cytomegalovirus Real-Time Polymerase Chain Reaction Assays of Fecal and Plasma Specimens for Diagnosing Cytomegalovirus Colitis. Clin Transl Gastroenterol. 2023; 14(5):e00574. PMC: 10208703. DOI: 10.14309/ctg.0000000000000574. View

14.

Kotton C, Kumar D, Caliendo A, Huprikar S, Chou S, Danziger-Isakov L . The Third International Consensus Guidelines on the Management of Cytomegalovirus in Solid-organ Transplantation. Transplantation. 2018; 102(6):900-931. DOI: 10.1097/TP.0000000000002191. View

15.

Hizel S, Parker S, Onde U . Seroprevalence of cytomegalovirus infection among children and females in Ankara, Turkey, 1995. Pediatr Int. 1999; 41(5):506-9. DOI: 10.1046/j.1442-200x.1999.01118.x. View

16.

Yang H, Zhou W, Lv H, Wu D, Feng Y, Shu H . The Association Between CMV Viremia or Endoscopic Features and Histopathological Characteristics of CMV Colitis in Patients with Underlying Ulcerative Colitis. Inflamm Bowel Dis. 2017; 23(5):814-821. DOI: 10.1097/MIB.0000000000001095. View

17.

Eyre-Brook I, Dundas S . Incidence and clinical significance of colonic cytomegalovirus infection in idiopathic inflammatory bowel disease requiring colectomy. Gut. 1986; 27(12):1419-25. PMC: 1433966. DOI: 10.1136/gut.27.12.1419. View

18.

Jentzer A, Veyrard P, Roblin X, Saint-Sardos P, Rochereau N, Paul S . Cytomegalovirus and Inflammatory Bowel Diseases (IBD) with a Special Focus on the Link with Ulcerative Colitis (UC). Microorganisms. 2020; 8(7). PMC: 7409252. DOI: 10.3390/microorganisms8071078. View

19.

Coban S, Ensari A, Kuzu M, Yalcin S, Palabiyikoglu M, Ormeci N . Cytomegalovirus infection in a patient with Crohn's ileocolitis. Can J Gastroenterol. 2005; 19(2):109-11. DOI: 10.1155/2005/804139. View

20.

Rahier J, Magro F, Abreu C, Armuzzi A, Ben-Horin S, Chowers Y . Second European evidence-based consensus on the prevention, diagnosis and management of opportunistic infections in inflammatory bowel disease. J Crohns Colitis. 2014; 8(6):443-68. DOI: 10.1016/j.crohns.2013.12.013. View