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Published on: July 6, 2013
Cytomegalovirus in pediatric inflammatory bowel disease patients with acute severe colitis
Tsega Temtem1, John Whitworth2, Jie Zhang3
1Le Bonheur Children's Hospital, USA; Department of Pediatrics, Division of Gastroenterology, University of Tennessee Health Sciences Center, USA; University of Louisville, School of Medicine, USA.
Insights
Cytomegalovirus (CMV) colitis is more common in children with severe refractory colitis. CMV infection in these pediatric patients does not predict treatment response or the need for surgery.
Area of Science:
- Pediatric Gastroenterology
- Infectious Diseases
- Gastrointestinal Pathology
Background:
- The role of cytomegalovirus (CMV) in pediatric acute severe colitis remains unclear.
- This study investigated the prevalence and impact of CMV in pediatric patients with severe refractory colitis.
Purpose of the Study:
- To determine the prevalence of CMV in the colonic mucosa of children experiencing acute severe refractory colitis.
- To compare clinical characteristics and outcomes between CMV-positive and CMV-negative pediatric patients.
Main Methods:
- A case-control study involving 96 pediatric patients (48 with severe refractory colitis, 48 controls).
- Colonic biopsy specimens were tested for CMV; CMV-positive patients were assessed for laboratory values, medications, and surgical outcomes.
Main Results:
- CMV prevalence was significantly higher in severe refractory colitis patients (14.6%) compared to controls.
- Viral DNA burden did not predict response to antiviral therapy or need for surgery at 12 months.
- Lymphopenia was observed in all CMV-positive patients, but without statistical significance.
Conclusions:
- Pediatric patients with severe refractory colitis exhibit an increased prevalence of CMV.
- CMV viral burden in colonic biopsies does not predict clinical outcomes or the need for colectomy.
Background:
The prevalence and significance of cytomegalovirus (CMV) colitis in pediatric acute severe colitis is unknown. The aim of this study was to determine the prevalence of CMV in colonic mucosa of children with acute severe refractory colitis and compare the clinical characteristics and outcomes of CMV positive and negative patients.
Methods:
In a case-control study, colonic biopsy specimens from children with severe refractory colitis were tested for CMV, and matched with non-refractory IBD controls. We characterized CMV positive patients by assessing laboratory values, concurrent medications, and need for surgery as compared with CMV negative refractory colitis patients.
Results:
Colonic biopsies from 96 patients were evaluated for CMV; 48 with severe refractory colitis, and 48 non-refractory controls. There was an increased prevalence of CMV in severe refractory colitis [7/48 (14.6%), P < 0.0001]; all were previously CMV negative. Viral DNA burden on immunohistochemistry was not predictive of response to antiviral therapy or need for surgery at 12 months. Lymphopenia was seen in all CMV positive patients, but this did not demonstrate statistical significance (P = 0.09). We did not see an association between azathioprine or infliximab use and the need for surgery at 12 months.
Conclusions:
There is an increased prevalence of CMV in colonic biopsies of pediatric patients with severe refractory colitis. Viral burden does not predict clinical outcomes or subsequent need for colectomy.
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