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Current Gastroenterology Reports

Erschienen in:

01.08.2012 | Gastrointestinal Infections (W Coyle, Section Editor)

Cytomegalovirus Infection and the Gastrointestinal Tract

verfasst von: David M. You, Mark D. Johnson

Erschienen in: Current Gastroenterology Reports | Ausgabe 4/2012

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Abstract

Cytomegalovirus (CMV) infection is common worldwide, but the majority are asymptomatic. However, during initial infection or reactivation, CMV can cause tissue-invasive end-organ damage including in the gastrointestinal tract, especially in immunocompromised individuals. Gastrointestinal CMV disease can present with myriad of symptoms and be highly variable endoscopically. In this article we review the manifestations of CMV infection within the luminal gastrointestinal tract and discuss the options for diagnosis and management.

Staras SA, Dollard SC, Radford KW, et al. Seroprevalence of cytomegalovirus infection in the United States, 1988–1994. Clin Infect Dis. 2006;43:1143–51.PubMedCrossRef

Drew WL, Mintz L, Miner RC, et al. Prevalence of cytomegalovirus infection in homosexual men. J Infect Dis. 1981;143:188–92.PubMedCrossRef

Klemola E, Von Essen R, Henle G, Henle W. Infectious-mononucleosis-like disease with negative heterophil agglutination test. Clinical features in relation to Epstein-Barr virus and cytomegalovirus antibodies. J Infect Dis. 1970;121:608–14.PubMedCrossRef

Adler B, Sinzger C. Endothelial cells in human cytomegalovirus infection: one host cell out of many or a crucial target for virus spread? Thromb Haemost. 2009;102:1057–63.PubMed

Eddleston M, Peacock S, Juniper M, Warrell DA. Severe cytomegalovirus infection in immunocompetent patients. Clin Infect Dis. 1997;24:52–6.PubMedCrossRef

Rafailidis PI, Mourtzoukou EG, Varbobitis IC, Falagas ME. Severe cytomegalovirus infection in apparently immunocompetent patients: a systematic review. Virol J. 2008;5:47.PubMedCrossRef

Oku T, Maeda M, Waga E, et al. Cytomegalovirus cholangitis and pancreatitis in an immunocompetent patient. J Gastroenterol. 2005;40:987–92.PubMedCrossRef

Cook CH, Trgovcich J, Zimmerman PD, et al. Lipopolysaccharide, tumor necrosis factor alpha, or interleukin-1beta triggers reactivation of latent cytomegalovirus in immunocompetent mice. J Virol. 2006;80:9151–8.PubMedCrossRef

Squizzato A, Ageno W, Cattaneo A, Brumana N. A case report and literature review of portal vein thrombosis associated with cytomegalovirus infection in immunocompetent patients. Clin Infect Dis. 2007;44:e13–6.PubMedCrossRef

10.

Hommes DW, Sterringa G, van Deventer SJ, et al. The pathogenicity of cytomegalovirus in inflammatory bowel disease: a systematic review and evidence-based recommendations for future research. Inflamm Bowel Dis. 2004;10:245–50.PubMedCrossRef

11.

Britt W. Manifestations of human cytomegalovirus infection: proposed mechanisms of acute and chronic disease. Curr Top Microbiol Immunol. 2008;325:417–70.PubMedCrossRef

12.

Baehr PH, McDonald GB. Esophageal infections: risk factors, presentation, diagnosis, and treatment. Gastroenterology. 1994;106:509–32.PubMed

13.

Wilcox CM, Straub RF, Schwartz DA. Prospective endoscopic characterization of cytomegalovirus esophagitis in AIDS. Gastrointest Endosc. 1994;40:481–4.PubMedCrossRef

14.

Kanda K, Kume K, Yoshikawa I, et al. Cytomegalovirus esophagitis with massive upper-GI hemorrhage. Gastrointest Endosc. 2004;59:741–3.PubMedCrossRef

15.

Wilcox CM, Straub RF, Schwartz DA. Cytomegalovirus esophagitis in AIDS: a prospective evaluation of clinical response to ganciclovir therapy, relapse rate, and long-term outcome. Am J Med. 1995;98:169–76.PubMedCrossRef

16.

Altman C, Bedossa P, Dussaix E, Buffet C. Cytomegalovirus infection of esophagus in immunocompetent adult. Dig Dis Sci. 1995;40:606–8.PubMedCrossRef

17.

Weile J, Streeck B, Muck J, et al. Severe cytomegalovirus-associated esophagitis in an immunocompetent patient after short-term steroid therapy. J Clin Microbiol. 2009;47:3031–3.PubMedCrossRef

18.

Laguna F, Garcia-Samaniego J, Alonso MJ, et al. Pseudotumoral appearance of cytomegalovirus esophagitis and gastritis in AIDS patients. Am J Gastroenterol. 1993;88:1108–11.PubMed

19.

Wilcox CM, Straub RF, Schwartz DA. Prospective evaluation of biopsy number for the diagnosis of viral esophagitis in patients with HIV infection and esophageal ulcer. Gastrointest Endosc. 1996;44:587–93.PubMedCrossRef

20.

Moustafellos P, Hadjianastasiou V, Gray D. Postural epigastric pain as a sign of CMV gastritis: a case report. Transplant Proc. 2006;38:1357–8.PubMedCrossRef

21.

Giladi M, Lembo A, Johnson Jr BL. Postural epigastric pain: a unique symptom of primary cytomegalovirus gastritis? Infection. 1998;26:234–5.PubMedCrossRef

22.

Van Thiel DH, Gavaler JS, Schade RR, et al. Cytomegalovirus infection and gastric emptying. Transplantation. 1992;54:70–3.PubMedCrossRef

23.

• Reggiani Bonetti L, Losi L, Di Gregorio C, et al. Cytomegalovirus infection of the upper gastrointestinal tract: a clinical and pathological study of 30 cases. Scand J Gastroenterol 2011,46:1228–35. One of the larger case series of upper tract disease, describes the most common endoscopic findings.

24.

Kaplan CS, Petersen EA, Icenogle TB, et al. Gastrointestinal cytomegalovirus infection in heart and heart-lung transplant recipients. Arch Intern Med. 1989;149:2095–100.PubMedCrossRef

25.

Mong A, Levine MS, Furth EE, Laufer I. Cytomegalovirus duodenitis in an AIDS patient. AJR Am J Roentgenol. 1999;172:939–40.PubMed

26.

Kelesidis T, Tozzi S, Mitty R, et al. Cytomegalovirus pseudotumor of the duodenum in a patient with AIDS: an unrecognized and potentially treatable clinical entity. Int J Infect Dis. 2010;14:e274–82.PubMedCrossRef

27.

Mohan H, Bal A, Garg S, Dalal U. Cytomegalovirus-associated pseudotumor simulating gastric malignancy in acquired immunodeficiency syndrome: a case report with review of literature. Jpn J Infect Dis. 2007;60:134–6.PubMed

28.

Kram HB, Shoemaker WC. Intestinal perforation due to cytomegalovirus infection in patients with AIDS. Dis Colon Rectum. 1990;33:1037–40.PubMedCrossRef

29.

DeRiso 2nd AJ, Kemeny MM, Torres RA, Oliver JM. Multiple jejunal perforations secondary to cytomegalovirus in a patient with acquired immune deficiency syndrome. Case report and review. Dig Dis Sci. 1989;34:623–9.PubMedCrossRef

30.

• Martinez C, Rosales M, Calvo X, et al. Serial intestinal endoscopic examinations of patients with persistent diarrhea after allo-SCT. Bone Marrow Transplant 2011, epub ahead of print. Describes the impact of treatment decisions that repeated biopsies can have on differentiation between GVHD and GI CMV disease.

31.

Ng FH, Chau TN, Cheung TC, et al. Cytomegalovirus colitis in individuals without apparent cause of immunodeficiency. Dig Dis Sci. 1999;44:945–52.PubMedCrossRef

32.

Dieterich DT, Rahmin M. Cytomegalovirus colitis in AIDS: presentation in 44 patients and a review of the literature. J Acquir Immune Defic Syndr. 1991;4 Suppl 1:S29–35.PubMed

33.

Cheung TW, Teich SA. Cytomegalovirus infection in patients with HIV infection. Mt Sinai J Med. 1999;66:113–24.PubMed

34.

Lin YH, Yeh CJ, Chen YJ, et al. Recurrent cytomegalovirus colitis with megacolon in an immunocompetent elderly man. J Med Virol. 2010;82:638–41.PubMedCrossRef

35.

Studemeister A. Cytomegalovirus proctitis: a rare and disregarded sexually transmitted disease. Sex Transm Dis. 2011;38:876–8.PubMedCrossRef

36.

Bhaijee F, Subramony C, Tang SJ, Pepper DJ. Human immunodeficiency virus-associated gastrointestinal disease: common endoscopic biopsy diagnoses. Patholog Res Int. 2011;2011:247923.PubMed

37.

Imam SZ, Khan A, Jaso JM, Foringer JR. Quiz page. CMV colitis presenting as a colonic mass. Am J Kidney Dis. 2010;55:A35–7.PubMedCrossRef

38.

Galiatsatos P, Shrier I, Lamoureux E, Szilagyi A. Meta-analysis of outcome of cytomegalovirus colitis in immunocompetent hosts. Dig Dis Sci. 2005;50:609–16.PubMedCrossRef

39.

Revello MG, Gerna G. Diagnosis and management of human cytomegalovirus infection in the mother, fetus, and newborn infant. Clin Microbiol Rev. 2002;15:680–715.PubMedCrossRef

40.

Weber B, Fall EM, Berger A, Doerr HW. Screening of blood donors for human cytomegalovirus (HCMV) IgG antibody with an enzyme immunoassay using recombinant antigens. J Clin Virol. 1999;14:173–81.PubMedCrossRef

41.

Jang EY, Park SY, Lee EJ, et al. Diagnostic performance of the cytomegalovirus (CMV) antigenemia assay in patients with CMV gastrointestinal disease. Clin Infect Dis. 2009;48:e121–4.PubMedCrossRef

42.

Nagata N, Kobayakawa M, Shimbo T, et al. Diagnostic value of antigenemia assay for cytomegalovirus gastrointestinal disease in immunocompromised patients. World J Gastroenterol. 2011;17:1185–91.PubMedCrossRef

43.

Kandiel A, Lashner B. Cytomegalovirus colitis complicating inflammatory bowel disease. Am J Gastroenterol. 2006;101:2857–65.PubMedCrossRef

44.

Kalpoe JS, Kroes AC, de Jong MD, et al. Validation of clinical application of cytomegalovirus plasma DNA load measurement and definition of treatment criteria by analysis of correlation to antigen detection. J Clin Microbiol. 2004;42:1498–504.PubMedCrossRef

45.

Martin-Davila P, Fortun J, Gutierrez C, et al. Analysis of a quantitative PCR assay for CMV infection in liver transplant recipients: an intent to find the optimal cut-off value. J Clin Virol. 2005;33:138–44.PubMedCrossRef

46.

Caliendo AM, Schuurman R, Yen-Lieberman B, et al. Comparison of quantitative and qualitative PCR assays for cytomegalovirus DNA in plasma. J Clin Microbiol. 2001;39:1334–8.PubMedCrossRef

47.

Humar A, Gregson D, Caliendo AM, et al. Clinical utility of quantitative cytomegalovirus viral load determination for predicting cytomegalovirus disease in liver transplant recipients. Transplantation. 1999;68:1305–11.PubMedCrossRef

48.

Boeckh M, Gooley TA, Myerson D, et al. Cytomegalovirus pp 65 antigenemia-guided early treatment with ganciclovir versus ganciclovir at engraftment after allogeneic marrow transplantation: a randomized double-blind study. Blood. 1996;88:4063–71.PubMed

49.

• Lawlor G, Moss AC. Cytomegalovirus in inflammatory bowel disease: pathogen or innocent bystander? Inflamm Bowel Dis 2010,16:1620–7. Thoughtful discussion of the clinical importance of CMV identified in the setting of IBD.

50.

• Reddy N, Wilcox CM. Diagnosis & management of cytomegalovirus infections in the GI tract. Expert Rev Gastroenterol Hepatol 2007,1:287–94. Although it doesn’t discuss the range of clinical manifestations of GI CMV disease in any detail, it provides a thorough review of currently available lab diagnostics and fairly updated review of available antiviral therapy.

51.

de la Hoz RE, Stephens G, Sherlock C. Diagnosis and treatment approaches of CMV infections in adult patients. J Clin Virol. 2002;25 Suppl 2:S1–12.PubMed

52.

Domenech E, Vega R, Ojanguren I, et al. Cytomegalovirus infection in ulcerative colitis: a prospective, comparative study on prevalence and diagnostic strategy. Inflamm Bowel Dis. 2008;14:1373–9.PubMedCrossRef

53.

Cottone M, Pietrosi G, Martorana G, et al. Prevalence of cytomegalovirus infection in severe refractory ulcerative and Crohn’s colitis. Am J Gastroenterol. 2001;96:773–5.PubMedCrossRef

54.

Kaufman HS, Kahn AC, Iacobuzio-Donahue C, et al. Cytomegaloviral enterocolitis: clinical associations and outcome. Dis Colon Rectum. 1999;42:24–30.PubMedCrossRef

55.

• Kornbluth A, Sachar DB. Ulcerative colitis practice guidelines in adults: American College Of Gastroenterology, Practice Parameters Committee. Am J Gastroenterol 2010,105:501–23. Most up to date American College of Gastroenterology Ulcerative Colitis Practice Guidelines, in which the recommendations for management of severe colitis include discussion of diagnosis and management of CMV superinfection.

56.

Roblin X, Pillet S, Oussalah A, et al. Cytomegalovirus load in inflamed intestinal tissue is predictive of resistance to immunosuppressive therapy in ulcerative colitis. Am J Gastroenterol. 2011;106:2001–8.PubMedCrossRef

57.

Fica A, Cervera C, Perez N, et al. Immunohistochemically proven cytomegalovirus end-organ disease in solid organ transplant patients: clinical features and usefulness of conventional diagnostic tests. Transpl Infect Dis. 2007;9:203–10.PubMedCrossRef

58.

• Lemonovich TL, Watkins RR. Update on cytomegalovirus infections of the gastrointestinal system in solid organ transplant recipients. Curr Infect Dis Rep 2012,14:33–40. Somewhat narrower scope, focuses on CMV in GI in SOT. Because of this narrower scope, is able to discuss in depth prevention strategies, which were not discussed in any length in by our review.

59.

Linares L, Sanclemente G, Cervera C, et al. Influence of cytomegalovirus disease in outcome of solid organ transplant patients. Transplant Proc. 2011;43:2145–8.PubMedCrossRef

60.

• Eid AJ, Razonable RR. New developments in the management of cytomegalovirus infection after solid organ transplantation. Drugs 2010,70:965–81. Thorough review of newest available therapies for CMV treatment.

61.

Arthurs SK, Eid AJ, Pedersen RA, et al. Delayed-onset primary cytomegalovirus disease after liver transplantation. Liver Transpl. 2007;13:1703–9.PubMedCrossRef

62.

Eid AJ, Arthurs SK, Deziel PJ, et al. Clinical predictors of relapse after treatment of primary gastrointestinal cytomegalovirus disease in solid organ transplant recipients. Am J Transplant. 2010;10:157–61.PubMedCrossRef

63.

Jacobson MA, Mills J. Serious cytomegalovirus disease in the acquired immunodeficiency syndrome (AIDS). Clinical findings, diagnosis, and treatment. Ann Intern Med. 1988;108:585–94.PubMed

64.

Chui DW, Owen RL. AIDS and the gut. J Gastroenterol Hepatol. 1994;9:291–303.PubMedCrossRef

65.

Salzberger B, Hartmann P, Hanses F, et al. Incidence and prognosis of CMV disease in HIV-infected patients before and after introduction of combination antiretroviral therapy. Infection. 2005;33:345–9.PubMedCrossRef

66.

El Amari EB, Combescure C, Yerly S, et al. Clinical relevance of cytomegalovirus viraemia. HIV Med 2011,12:394–402.

67.

Feasey NA, Healey P, Gordon MA. Review article: the aetiology, investigation and management of diarrhoea in the HIV-positive patient. Aliment Pharmacol Ther. 2011;34:587–603.PubMedCrossRef

68.

Bini EJ, Weinshel EH. Endoscopic evaluation of chronic human immunodeficiency virus-related diarrhea: is colonoscopy superior to flexible sigmoidoscopy? Am J Gastroenterol. 1998;93:56–60.PubMedCrossRef

69.

Khater FJ, Myers JW, Moorman JP. A 45-year-old woman with fever and splenic infarcts. Clin Infect Dis. 2003;37(1093):125–6.

70.

Serna-Higuera C, Gonzalez-Garcia M, Milicua JM, Munoz V. Acute cholestatic hepatitis by cytomegalovirus in an immunocompetent patient resolved with ganciclovir. J Clin Gastroenterol. 1999;29:276–7.PubMedCrossRef

71.

Laing RB, Dykhuizen RS, Smith CC, Molyneaux PJ. Parenteral ganciclovir treatment of acute CMV infection in the immunocompetent host. Infection. 1997;25:44–6.PubMedCrossRef

72.

Cvetkovic RS, Wellington K. Valganciclovir: a review of its use in the management of CMV infection and disease in immunocompromised patients. Drugs. 2005;65:859–78.PubMedCrossRef

73.

Dieterich DT, Poles MA, Lew EA, et al. Treatment of gastrointestinal cytomegalovirus infection with twice-daily foscarnet: a pilot study of safety, efficacy, and pharmacokinetics in patients with AIDS. Antimicrob Agents Chemother. 1997;41:1226–30.PubMed

74.

Kim YS, Kim YH, Kim JS, et al. The prevalence and efficacy of ganciclovir on steroid-refractory ulcerative colitis with cytomegalovirus infection: a prospective multicenter study. J Clin Gastroenterol. 2012;46:51–6.PubMedCrossRef

75.

• Andrews PA, Emery VC, Newstead C. Summary of the British Transplantation Society Guidelines for the Prevention and Management of CMV Disease After Solid Organ Transplantation. Transplantation 2011,92:1181–7. An update to be compared to Kotton CN et al. International Consensus Guidelines on the Management of Cytomegalovirus in Solid Organ Transplant. Transplantation 2010,89:779–95.

76.

• Asberg A, Humar A, Rollag H, et al. Oral valganciclovir is noninferior to intravenous ganciclovir for the treatment of cytomegalovirus disease in solid organ transplant recipients. Am J Transplant 2007,7:2106–13. Randomized prospective trial of 321 SOT recipients demonstrating non inferiority of oral valganciclovir compared to standard of care intravenous ganciclovir. This is the first publication of its kind supporting use of a simpler oral antiviral.

77.

Len O, Gavalda J, Aguado JM, et al. Valganciclovir as treatment for cytomegalovirus disease in solid organ transplant recipients. Clin Infect Dis. 2008;46:20–7.PubMedCrossRef

78.

• Whitley RJ, Jacobson MA, Friedberg DN, et al. Guidelines for the treatment of cytomegalovirus diseases in patients with AIDS in the era of potent antiretroviral therapy: recommendations of an international panel. International AIDS Society-USA. Arch Intern Med 1998,158:957–69. Seminal consensus statement from IAS-USA for management of CMV in AIDS, which includes a discussion about GI disease in particular.

79.

Blanshard C. Treatment of HIV-related cytomegalovirus disease of the gastrointestinal tract with foscarnet. J Acquir Immune Defic Syndr. 1992;5 Suppl 1:S25–8.PubMed

80.

Blanshard C, Benhamou Y, Dohin E, et al. Treatment of AIDS-associated gastrointestinal cytomegalovirus infection with foscarnet and ganciclovir: a randomized comparison. J Infect Dis. 1995;172:622–8.PubMedCrossRef

81.

Limaye AP, Raghu G, Koelle DM, et al. High incidence of ganciclovir-resistant cytomegalovirus infection among lung transplant recipients receiving preemptive therapy. J Infect Dis. 2002;185:20–7.PubMedCrossRef

82.

Limaye AP. Ganciclovir-resistant cytomegalovirus in organ transplant recipients. Clin Infect Dis. 2002;35:866–72.PubMedCrossRef

83.

Kaul DR, Stoelben S, Cober E, et al. First report of successful treatment of multidrug-resistant cytomegalovirus disease with the novel anti-CMV compound AIC246. Am J Transplant. 2011;11:1079–84.PubMedCrossRef

84.

Arav-Boger R, He R, Chiou CJ, et al. Artemisinin-derived dimers have greatly improved anti-cytomegalovirus activity compared to artemisinin monomers. PLoS One. 2010;5:e10370.PubMedCrossRef

85.

Avery RK, Mossad SB, Poggio E, et al. Utility of leflunomide in the treatment of complex cytomegalovirus syndromes. Transplantation. 2010;90:419–26.PubMedCrossRef

86.

Avery RK, Marty FM, Strasfeld L, et al. Oral maribavir for treatment of refractory or resistant cytomegalovirus infections in transplant recipients. Transpl Infect Dis. 2010;12:489–96.PubMedCrossRef

87.

Trofe J, Pote L, Wade E, et al. Maribavir: a novel antiviral agent with activity against cytomegalovirus. Ann Pharmacother. 2008;42:1447–57.PubMedCrossRef

88.

Marty FM, Ljungman P, Papanicolaou GA, et al. Maribavir prophylaxis for prevention of cytomegalovirus disease in recipients of allogeneic stem-cell transplants: a phase 3, double-blind, placebo-controlled, randomised trial. Lancet Infect Dis. 2011;11:284–92.PubMedCrossRef

89.

Bravo FJ, Bernstein DI, Beadle JR, et al. Oral hexadecyloxypropyl-cidofovir therapy in pregnant guinea pigs improves outcome in the congenital model of cytomegalovirus infection. Antimicrob Agents Chemother. 2011;55:35–41.PubMedCrossRef

90.

Quenelle DC, Lampert B, Collins DJ, et al. Efficacy of CMX001 against herpes simplex virus infections in mice and correlations with drug distribution studies. J Infect Dis. 2010;202:1492–9.PubMedCrossRef

91.

• Price NB, Prichard MN. Progress in the Development of New Therapies for Herpesvirus Infections. Curr Opin Virol 2011,1:548–54. Thorough review of newest available therapies for CMV treatment.

Titel: Cytomegalovirus Infection and the Gastrointestinal Tract
verfasst von: David M. You
Mark D. Johnson
Publikationsdatum: 01.08.2012
Verlag: Current Science Inc.
Erschienen in: Current Gastroenterology Reports / Ausgabe 4/2012
Print ISSN: 1522-8037
Elektronische ISSN: 1534-312X
DOI: https://doi.org/10.1007/s11894-012-0266-4

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