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      Cytomegalovirus Colitis in Immunocompetent Patients

      case-report
      Author(s): 1 , , 2 , 3 , 4 , 5
      Editor(s): ,
      Publication date (Electronic, pub):
      Publication date (Electronic, collection):
      Journal: Cureus
      Publisher: Cureus
      Keywords: colitis, cytomegalovirus, immunocompetent, diagnosis, management, colonoscopy, histopathology

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          Abstract

          Cytomegalovirus colitis is common in immunocompromised patients, but rare in immunocompetent patients. The present study not only represents the colonoscopy and pathological findings, but also applies the method of diagnosing and treating cytomegalovirus colitis in immunocompetent patients.

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          Severe cytomegalovirus infection in apparently immunocompetent patients: a systematic review

          Petros Rafailidis, Eleni Mourtzoukou, Ioannis C Varbobitis … (2008)
          Background The morbidity and mortality associated with cytomegalovirus (CMV) infection in immunocompromised patients (especially in HIV-infected patients and transplant recipients), as well as with congenital CMV infection are well known. In contrast, relatively little attention has been paid to the morbidity and mortality that CMV infection may cause in immunocompetent patients. Methods We reviewed the evidence associated with severe manifestations of CMV infection in apparently immunocompetent patients and the potential role of antiviral treatment for these infections. We searched in PubMed, Scopus, and the Cochrane Library for the period of 1950–2007 to identify relevant articles. Results We retrieved 89 articles reporting on severe CMV infection in 290 immunocompetent adults. Among these reports, the gastrointestinal tract (colitis) and the central nervous system (meningitis, encephalitis, transverse myelitis) were the most frequent sites of severe CMV infection. Manifestations from other organ-systems included haematological disorders (haemolytic anaemia, thrombocytopenia), thrombosis of the venous or arterial vascular system, ocular involvement (uveitis), and lung disease (pneumonitis). The clinical practice reported in the literature has been to prescribe antiviral treatment for the most severe manifestations of monophasic meningoencephalitis (seizures and coma), ocular involvement, and lung involvement due to CMV. Conclusion Severe life-threatening complications of CMV infection in immunocompetent patients may not be as rare as previously thought.
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            Meta-analysis of outcome of cytomegalovirus colitis in immunocompetent hosts.

            E Lamoureux, Ian Shrier, Polymnia Galiatsatos … (2005)
            There are only a few anecdotal reports of cytomegalovirus (CMV) colitis in immunocompetent hosts. The impact of the disease in this patient population remains poorly understood. The aim of this study was to perform a meta-analysis using individual patient data to determine outcomes of CMV colitis in immunocompetent patients and identify risk factors that might influence prognosis. A literature search was performed from 1980 to 2003 looking for immunocompetent patients with CMV colitis. Immunocompetence was defined as absence of congenital or acquired immune deficiency, transplant, or immunosuppressive medication. Patients were divided by age ( or =55) and grouped according to coexisting illnesses. Kaplan-Meier curves were plotted to assess survival. Variables included age, sex, site of acquisition of infection, extent of disease, coexisting illnesses, and treatment modality. A total of 44 patients were identified, with an average age of 61.1. Only 10 were free of any comorbidity. The mean follow-up was 13.4 months. Spontaneous remission occurred in 31.8%, mostly individuals 55. There was a higher mortality rate among male patients > or =55 (56.9%; P = 0.08), patients with immune-modulating diseases (75.2%; P = 0.10), and those having a colectomy (68.9%; P = 0.09). This analysis underlines the rarity of CMV colitis in patients with an intact immune system. Advanced age, male gender, presence of immune-modulating comorbidities, and need for surgical intervention are factors negatively influencing survival. Conversely, young healthy patients have a good prognosis with no intervention.
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              Risk Factors and Clinical Outcomes Associated with Cytomegalovirus Colitis in Patients with Acute Severe Ulcerative Colitis

              Suk-Kyun Yang, Jin-Ho Kim, Chang Yu … (2016)
              Cytomegalovirus (CMV) colitis can contribute to an unfavorable outcome of acute severe ulcerative colitis (ASUC). The purpose of this study was to evaluate the clinical outcomes of ASUC according to the CMV status and identify risk factors for CMV colitis in patients with ASUC.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Cureus
                Journal ID (iso-abbrev): Cureus
                Journal ID (issn): 2168-8184
                Title: Cureus
                Publisher: Cureus (Palo Alto (CA) )
                ISSN (Electronic): 2168-8184
                Publication date (Electronic, pub): 8 November 2016
                Publication date (Electronic, collection): November 2016
                Volume: 8
                Issue: 11
                Electronic Location Identifier: e869
                Affiliations
                [1 ] Department of Medicine, New York-Presbyterian Hospital, Weill Cornell Medical College, New York City, NY, USA
                [2 ] Department of Medicine, Shifa International Hospital, Shifa College of Medicine, Islamabad, Pakistan
                [3 ] Department of Pathology, SUNY Downstate Medical Center, Brooklyn, NY, USA
                [4 ] Department of Hepatology and Multiorgan Transplant, Beaumont Hospital, Royal Oak, MI, USA
                [5 ] Division of Gastroenterology, Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA
                Author notes
                Article
                DOI: 10.7759/cureus.869
                PMC ID: 5145268
                PubMed ID: 27980888
                SO-VID: a540bb2d-c21e-404d-9563-2fc8ca829dc8
                Copyright © Copyright © 2016, Inayat et al.
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date received : 31 August 2016
                Date accepted : 8 November 2016
                Categories
                Subject: Gastroenterology

                Keywords: colitis,cytomegalovirus,immunocompetent,diagnosis,management,colonoscopy,histopathology
                Data availability:
                Keywords: colitis, cytomegalovirus, immunocompetent, diagnosis, management, colonoscopy, histopathology

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