Alimentary Tract
Severe acute colitis associated with CMV: a prevalence study

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Abstract

Background.

Cytomegalovirus has been identified as a pathogen that contributes to flares of colitis when detected in colonic specimens of patients with inflammatory bowel disease.

Aim.

To determine the overall prevalence and the role of cytomegalovirus infection in a consecutive series of patients with acute severe colitis admitted to our department from 2000 to 2003.

Methods.

Among 42 patients (38 with ulcerative colitis and 4 with Crohn's disease) admitted to our hospital for acute severe colitis, we performed proctoscopy and biopsy together with blood sample for cytomegalovirus determination at the time of admission, regardless of their steroid resistance.

Results.

In the 42 patients, we discovered an overall cytomegalovirus infection prevalence of 21.4% (9/42) in our geographical area. In seven patients (16.6%), cytomegalovirus was detected through biopsy. The presence of cytomegalovirus in biopsies was not always predictive of steroid resistance. Three patients with cytomegalovirus in biopsies responded to conventional treatment without needing any antiviral treatment, which suggests that the virus plays only an incidental role.

Conclusions.

Cytomegalovirus is frequently associated with colitis but it is not always pathogenic. Studies on the genotyping of the virus might explain the diversity of its biological behaviour.

Introduction

Cytomegalovirus (CMV) has been associated with inflammatory bowel disease (IBD) both at the first appearance of disease and in relapse [1], [2], [3], [4], [5]. In a previous series, we reported a prevalence of 36% in the rectal biopsy of patients with acute steroid-resistant severe colitis [6]; our policy had been to perform a rectal biopsy only in cases of severe steroid resistant colitis. Because it is unclear whether CMV is a bystander or has a primary role in the activation or reactivation of acute colitis, we decided to perform rectal biopsy and the detection of CMV pp65 antigenemia in the polymorphonucleates in a new series of consecutive patients with acute severe colitis on their admission to the ward, without waiting for the response to steroids, in order to see if the presence of the virus in the blood or in biopsy predicted steroid resistance.

Section snippets

Patients and methods

From 2000 to 2003 a total of 42 patients with severe colitis (23 males/19 females) according to the Truelove criteria [7] were admitted to the V. Cervello Hospital in Palermo. Thirty-eight patients had ulcerative colitis (UC) and four had Crohn's disease (CD). The diagnosis of IBD was made on the basis of endoscopic and histological evidence. UC was defined as continuous mucosal inflammation without granuloma affecting the rectum as well as all or part of the colon adjoining the rectum. CD was

Results

CMV was detected in 9 out of 42 patients affected with acute severe colitis (21.4%). In three of these patients, CMV was detected both in the histological specimens and in the blood; in four patients, only in the histological specimens; and in two patients, only in the blood (2 PMN cells and 1 PMN cell/2 × 105).

Among these 42 patients, 12 (28.5%) were resistant to steroids. CMV was detected in 4 out of 12 steroid-resistant patients (33%) in biopsies (in two of these four patients antigenemia

Discussion

In a previous paper, we have shown that the prevalence of CMV infection in severe colitis steroid-resistant patients was 36% [6]. As we did not search for the presence of CMV in all the patients, we were unable to establish the overall prevalence of CMV in severe acute colitis. In this new series we have adopted a different approach: we performed proctoscopy and biopsy together with blood sample CMV determination in all the patients admitted to the hospital for severe colitis.

Our main objective

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