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Cytomegalovirus pneumonia in patients with inflammatory bowel disease: a systematic review
Antonio Cascio1, Chiara Iaria, Paolo Ruggeri
1Tropical and Parasitological Diseases Unit, Department of Human Pathology, Policlinico G. Martino, Via Consolare Valeria n. 1, 98125 Messina, Italy. acascio@unime.it
Background:
Inflammatory bowel disease (IBD) patients are at increased risk of cytomegalovirus (CMV) reactivation, and although CMV pneumonia may be a fatal disease in IBD patients, little information is available on this issue. The objectives of this study were to identify risk factors for the development of CMV pneumonia in IBD patients and to find useful information to better manage this potentially fatal complication.
Methods:
A computerized search without language restrictions was conducted using PubMed and SCOPUS. An article was considered eligible for inclusion in the systematic review if it reported detailed data on patients with IBD presenting with pneumonia due to CMV.
Results:
Overall, 12 articles describing the history of 13 patients, published between the years 1996 and 2011, were finally considered. All patients were adults with a mean age of 33 years, and 11/13 were females. Fever and dyspnea were the most frequent symptoms. The most frequent radiological signs were bilateral pulmonary infiltrates. Six cases were complicated by hemophagocytic lymphohistiocytosis. Eight of the 13 were transferred to intensive care units and four of them died.
Conclusions:
CMV pneumonia should always be suspected in IBD patients who present with fever and tachypnea, especially if the latter is worsening and/or is associated with dyspnea. Treatment must be early and specific.
Insights
Cytomegalovirus (CMV) pneumonia is a serious risk for inflammatory bowel disease (IBD) patients. Early diagnosis and specific treatment are crucial for managing this potentially fatal complication in IBD.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Pulmonology
Background:
- Inflammatory bowel disease (IBD) patients face an elevated risk of cytomegalovirus (CMV) reactivation.
- CMV pneumonia poses a significant, potentially fatal threat to IBD patients, yet remains under-researched.
- Limited information exists regarding the risk factors and management of CMV pneumonia in this vulnerable population.
Purpose of the Study:
- To identify risk factors associated with the development of CMV pneumonia in IBD patients.
- To gather essential information for improved management strategies of this severe complication.
Main Methods:
- A systematic review was conducted using a comprehensive search of PubMed and SCOPUS databases.
- Inclusion criteria required articles to detail data on IBD patients diagnosed with CMV pneumonia.
Main Results:
- The review analyzed 12 articles detailing 13 adult patients (mean age 33, 11 female) from 1996-2011.
- Common symptoms included fever and dyspnea, with bilateral pulmonary infiltrates on imaging.
- Four of the 13 patients died, and six developed hemophagocytic lymphohistiocytosis; 8 required intensive care.
Conclusions:
- CMV pneumonia must be suspected in IBD patients presenting with fever and tachypnea, particularly with worsening respiratory distress or dyspnea.
- Prompt and targeted treatment is essential for improving outcomes.
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