Viral Enteric Infections in Acute Severe Ulcerative Colitis

Area of Science:

• Gastroenterology
• Infectious Diseases
• Internal Medicine

Background:

• Excluding superimposed enteric infections is critical in managing acute severe ulcerative colitis (ASUC).
• While Clostridium difficile and cytomegalovirus infections are known to increase colectomy and mortality rates in ASUC, the impact of common viral enteropathogens remains unclear.
• This study investigates the role of viral enteropathogens in ASUC episodes.

Purpose of the Study:

• To determine if viral enteric infections alter the severity or outcomes of acute severe ulcerative colitis (ASUC) episodes.
• To assess the prevalence of common viral enteropathogens in patients presenting with ASUC.
• To compare clinical outcomes between ASUC patients with and without viral enteropathogen infections.

Main Methods:

• Retrospective review of 147 patients with ASUC treated between October 2015 and January 2021 at a tertiary center.
• Faecal multiplex polymerase chain reaction (PCR) was used to test for adenovirus 40/41, human rotavirus, and norovirus GI.
• Patients testing positive for viral pathogens were compared to those testing negative regarding disease severity markers and treatment outcomes.

Main Results:

• 14.9% (22/147) of ASUC patients tested positive for viral enteropathogens; two patients had dual infections.
• No significant differences were observed between infected and non-infected cohorts in C-reactive protein levels, Mayo endoscopic subscore, or length of hospital admission.
• Rates of rescue therapy requirement and colectomy were similar between the groups (59% vs 56% and 4.5% vs 4.1%, respectively).

Conclusions:

• Viral enteropathogen infections are relatively common in patients with acute severe ulcerative colitis (ASUC).
• These viral infections did not appear to significantly affect disease severity at presentation.
• The presence of viral enteropathogens did not influence the need for rescue therapy or its success rate in ASUC.