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Cytomegalovirus Infection in Adult Patients with Inflammatory Bowel Disease: A Literature Review
Zahra Momayaz Sanat1, Zeinab Siami2, Sudabeh Alatab1
1Digestive Disease Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
Abstract:
Human cytomegalovirus (HCMV) is classified within the Herpesvirales order and is prevalent in 50%‒80% of the general population. Most carriers experience this infection without noticeable clinical symptoms. HCMV causes a lifelong latent infection that can be reactivated due to immune disorders and inflammation. The reactivation of HCMV becomes particularly significant when it coincides with inflammatory bowel disease (IBD). While cytomegalovirus (CMV) colitis in IBD patients was identified years ago, the role of CMV in triggering flare-ups, acute severe colitis, treatment resistance, and other outcomes in IBD patients experiencing CMV reactivation remains a subject of ongoing debate. In this review, we aim to address an updated insight into aspects related to the CMV colitis in IBD patients including epidemiology, risk factors, clinical features, diagnostic tests, histology, place of immunosuppressants and indications for antiviral treatment. We suggest for personalized and thorough assessment based on the disease phase and colitis severity when prescribing drugs to these patients. Furthermore, we emphasize the importance of regular patient follow-up to monitor drug side effects, ensuring treatment success, and minimizing the risk of colectomy.
Insights
Human cytomegalovirus (HCMV) reactivation can complicate inflammatory bowel disease (IBD). This review details CMV colitis in IBD, covering diagnosis, treatment, and personalized patient management to improve outcomes.
Area of Science:
- Virology
- Gastroenterology
- Immunology
Background:
- Human cytomegalovirus (HCMV), a prevalent herpesvirus, establishes lifelong latent infections.
- Reactivation of HCMV is often associated with immune suppression or inflammation, posing challenges in specific patient populations.
- The interplay between HCMV reactivation and inflammatory bowel disease (IBD) is complex and warrants further investigation.
Purpose of the Study:
- To provide an updated review on cytomegalovirus (CMV) colitis in patients with inflammatory bowel disease (IBD).
- To explore the epidemiology, risk factors, clinical manifestations, diagnostic approaches, and histological findings of CMV colitis in IBD.
- To discuss the role of immunosuppressants and the indications for antiviral therapy in managing CMV colitis within the IBD context.
Main Methods:
- Literature review synthesizing current knowledge on CMV colitis in IBD patients.
- Analysis of epidemiological data, clinical features, and diagnostic modalities.
- Evaluation of treatment strategies, including immunosuppression and antiviral therapy.
Main Results:
- CMV colitis is a significant concern in IBD patients, potentially influencing disease flares, severity, and treatment response.
- Accurate diagnosis requires a combination of clinical suspicion, endoscopic evaluation, histology, and potentially molecular methods.
- The management strategy must be individualized, considering disease activity, severity, and patient-specific factors.
Conclusions:
- Personalized assessment and management are crucial for IBD patients with CMV reactivation, balancing immunosuppressive therapy and antiviral treatment.
- Regular patient follow-up is essential for monitoring treatment efficacy, managing side effects, and reducing the risk of colectomy.
- Further research is needed to fully elucidate the complex relationship between CMV and IBD and optimize therapeutic interventions.
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