Histologically proved cytomegalovirus as a terrible and neglect disease: a 13-year report of gastrointestinal and hepatobiliary manifestations from single referral center
Tóm tắt
The aim of the present study was to evaluate the gastrointestinal and hepatobiliary manifestation of cytomegalovirus. In a retrospective study, demographic and clinical information of patients with gastrointestinal or hepatobiliary manifestations and histologically confirmed cytomegalovirus infection was investigated among pathological records. The association between serum cytomegalovirus pp65 and blood positivity of cytomegalovirus polymerase chain reaction with histological findings was also evaluated. Of the 74 included patients, 27 cases (36.5%) were female. The most common symptoms were diarrhea (24.3%). Unusual presentations of cytomegalovirus diseases were gastrointestinal obstruction, refractory peptic ulcer, and corticosteroid-refractory inflammatory bowel disease. In total, 54 cases (75.0%) were transplanted, with the most frequency of kidney transplantation in 32 patients (59.2%). These patients had also more mortality rate. The most prescribed medicine in transplanted patients was CellCept and cyclosporine (40.6%). Mortality rate was more in blood polymerase chain reaction-negative patients. Cytomegalovirus diseases in transplanted patients were more primary infection compared with reactivation infection. No significant difference in mortality rate was seen between ganciclovir and non-ganciclovir recipients. The majority of the patients were negative for antigen or polymerase chain reaction. Early detection of cytomegalovirus could be lifesaving, and negative results of antigen and polymerase chain reaction cannot rule out cytomegalovirus diseases. Early endoscopic evaluation for unusual presentations of cytomegalovirus disease and also liver donor evaluation should be done more carefully. Ganciclovir has no significant effect on mortality of the patients, and then, it should be started at appropriate time.
Tài liệu tham khảo
Arora N, Novak Z, Fowler KB, Boppana SB, Ross SA (2010) Cytomegalovirus viruria and DNAemia in healthy seropositive women. J Infect Dis 202:1800–1803
Azevedo LS et al (2015) Cytomegalovirus infection in transplant recipients. Clinics 70:515–523. doi:10.6061/clinics/2015(07)09
Bhat V, Joshi A, Sarode R, Chavan P (2015) Cytomegalovirus infection in the bone marrow transplant patient. World J Transplant 5:287–291. doi:10.5500/wjt.v5.i4.287
Bobak DA (2003) Gastrointestinal infections caused by cytomegalovirus. Curr Infect Dis Rep 5:101–107
Cohen JI, Corey GR (1985) Cytomegalovirus infection in the normal host. Medicine 64:100–114
Cook CH, Trgovcich J, Zimmerman PD, Zhang Y, Sedmak DD (2006) Lipopolysaccharide, tumor necrosis factor alpha, or interleukin-1β triggers reactivation of latent cytomegalovirus in immunocompetent mice. J Virol 80:9151–9158
Crespo P, Dias N, Marques N, Saraiva da Cunha J (2015) Gastritis as a manifestation of primary CMV infection in an immunocompetent host. BMJ Case Rep:2015. doi:10.1136/bcr-2014-206991
de la Torre-Cisneros J et al (2011) GESITRA-SEIMC/REIPI recommendations for the management of cytomegalovirus infection in solid-organ transplant patients. Enferm Infecc y Microbiologia Clinica 29:735–758. doi:10.1016/j.eimc.2011.05.022
Emery VC (2001) Investigation of CMV disease in immunocompromised patients. J Clin Pathol 54:84–88
Horwitz CA et al (1986) Clinical and laboratory evaluation of cytomegalovirus-induced mononucleosis in previously healthy individuals: report of 82 cases. Medicine 65:124
Hummel M, Abecassis MM (2002) A model for reactivation of CMV from latency. J Clin Virol 25:123–136
Jain M, Duggal S, Chugh TD (2011) Cytomegalovirus infection in non-immunosuppressed critically ill patients. J Infect Dev Ctries 5:571–579
Kotton CN, Kumar D, Caliendo AM, Asberg A, Chou S, Danziger-Isakov L, Humar A (2013) Updated international consensus guidelines on the management of cytomegalovirus in solid-organ transplantation. Transplantation 96:333–360. doi:10.1097/TP.0b013e31829df29d
Ljungman P, Griffiths P, Paya C (2002) Definitions of cytomegalovirus infection and disease in transplant recipients. Clin Infect Dis 34:1094–1097. doi:10.1086/339329
Luscalov S, Loga L, Dican L, Junie LM (2016) Cytomegalovirus infection in immunosuppressed patients after kidney transplantation. Clujul Medical 89:343–346. doi:10.15386/cjmed-587
Martin SH (2012) Harrison’s principles of internal medicine. Vol 2, 18th edn. McGraw-Hill, USA
McCarty TP, Lee RA, Herfel BM, Pappas PG (2015) Cytomegalovirus appendicitis in solid organ transplant patients, two cases and a review. J Clin Virol 66:48–50. doi:10.1016/j.jcv.2015.03.004
Mocarski ES Jr (2004) Immune escape and exploitation strategies of cytomegaloviruses: impact on and imitation of the major histocompatibility system. Cell Microbiol 6:707–717. doi:10.1111/j.1462-5822.2004.00425.x
Penfold MET, Mocarski ES (1997) Formation of cytomegalovirus DNA replication compartments defined by localization of viral proteins and DNA synthesis. Virology 239:46–61. doi:10.1006/viro.1997.8848
Pillet S, Pozzetto B, Jarlot C, Paul S, Roblin X (2012) Management of cytomegalovirus infection in inflammatory bowel diseases. Dig Liver Dis 44:541–548. doi:10.1016/j.dld.2012.03.018
Singh N et al (1988) Infections with cytomegalovirus and other herpesviruses in 121 liver transplant recipients: transmission by donated organ and the effect of OKT3 antibodies. J Infect Dis 158:124–131
Tiwary IK, Das A, Goenka MK (2016) Cytomegalovirus related hepatitis and meningoencephalitis in an immunocompetent individual. Int J Clin Case Rep 6:1–3. doi:10.5376/ijccr.2016.06.0004
van Burik JA, Lawatsch EJ, DeFor TE, Weisdorf DJ (2001) Cytomegalovirus enteritis among hematopoietic stem cell transplant recipients. Biol Blood Marrow Transplant 7:674–679. doi:10.1053/bbmt.2001.v7.pm11787530
Walker A, Petheram SJ, Ballard L, Murph JR, Demmler GJ, Bale JF (2001) Characterization of human cytomegalovirus strains by analysis of short tandem repeat polymorphisms. J Clin Microbiol 39:2219–2226
Wang HW et al (2015) The clinical characteristics and manifestations of cytomegalovirus esophagitis. Dis Esophagus. doi:10.1111/dote.12340
Yan Z, Wang L, Dennis J, Doern C, Baker J, Park JY (2014) Clinical significance of isolated cytomegalovirus-infected gastrointestinal cells. Int J Surg Pathol 22:492–498. doi:10.1177/1066896914537681
Yoshihara S, Fukuma N, Masago R (1999) Cytomegalovirus infection associated with immunosuppressive therapy in collagen vascular diseases. Rheumatism 39:740–748