Severe Symptomatic Primary CMV Infection in Inflammatory Bowel Disease Patients with Low Population Seroprevalence
Background. Cytomegalovirus disease in patients with inflammatory bowel disease is frequently the result of viral reactivation. Conversely, primary CMV infection is believed to be uncommon in immunocompetent adults due to high population seroprevalence. Objectives. The aim of this study was to exami...
Saved in:
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2018-01-01
|
| Series: | Gastroenterology Research and Practice |
| Online Access: | http://dx.doi.org/10.1155/2018/1029401 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832566884830019584 |
|---|---|
| author | Catherine Rowan Ciaran Judge Mary D. Cannon Garret Cullen Hugh E. Mulcahy Elizabeth Ryan Cillian F. De Gascun Glen A. Doherty |
| author_facet | Catherine Rowan Ciaran Judge Mary D. Cannon Garret Cullen Hugh E. Mulcahy Elizabeth Ryan Cillian F. De Gascun Glen A. Doherty |
| author_sort | Catherine Rowan |
| collection | DOAJ |
| description | Background. Cytomegalovirus disease in patients with inflammatory bowel disease is frequently the result of viral reactivation. Conversely, primary CMV infection is believed to be uncommon in immunocompetent adults due to high population seroprevalence. Objectives. The aim of this study was to examine the frequency and severity of primary cytomegalovirus infection in an adult cohort of IBD patients. Study Design. A retrospective review of a prospectively maintained database of 3200 IBD patients attending a single academic centre was performed. Patients with primary CMV infection 2010–13 were identified; clinical, serologic, and virologic parameters were studied in detail. The seroprevalence of CMV in the patient population was also evaluated. Results. Eight patients with IBD (UC = 3, IBD-U = 1, CD = 4) presented with primary CMV infection. Patients presented with both gastrointestinal and extraintestinal symptoms. Mean age was 33 years, and median duration of disease was 72 months. All eight patients were receiving a thiopurine immunomodulator. Median duration of IM use was 144 weeks (range 7–720 weeks). All 8 patients required hospitalisation, with 1 ICU admission; the median length of hospital stay was 11 days (range 6–27). Infection resolved in all cases with withdrawal of immunomodulator and/or antiviral therapy. Seroprevalence of IgG to CMV, indicating prior exposure, in a subgroup of IBD patients (n=80) was 30.5% and increased with age. Conclusion. Primary cytomegalovirus infection can cause a severe illness in IBD patients, particularly those receiving immunosuppression. In areas where adult CMV seroprevalence is low, evidence of CMV should be sought in IBD patients presenting with any febrile systemic illness. |
| format | Article |
| id | doaj-art-3387e3ffd8c94f9285090245c23abaaa |
| institution | Kabale University |
| issn | 1687-6121 1687-630X |
| language | English |
| publishDate | 2018-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Gastroenterology Research and Practice |
| spelling | doaj-art-3387e3ffd8c94f9285090245c23abaaa2025-02-03T01:02:52ZengWileyGastroenterology Research and Practice1687-61211687-630X2018-01-01201810.1155/2018/10294011029401Severe Symptomatic Primary CMV Infection in Inflammatory Bowel Disease Patients with Low Population SeroprevalenceCatherine Rowan0Ciaran Judge1Mary D. Cannon2Garret Cullen3Hugh E. Mulcahy4Elizabeth Ryan5Cillian F. De Gascun6Glen A. Doherty7Centre for Colorectal Disease, St. Vincent’s University Hospital, Dublin, IrelandCentre for Colorectal Disease, St. Vincent’s University Hospital, Dublin, IrelandCentre for Colorectal Disease, St. Vincent’s University Hospital, Dublin, IrelandCentre for Colorectal Disease, St. Vincent’s University Hospital, Dublin, IrelandCentre for Colorectal Disease, St. Vincent’s University Hospital, Dublin, IrelandCentre for Colorectal Disease, St. Vincent’s University Hospital, Dublin, IrelandNational Virus Reference Laboratory, University College Dublin, Dublin, IrelandCentre for Colorectal Disease, St. Vincent’s University Hospital, Dublin, IrelandBackground. Cytomegalovirus disease in patients with inflammatory bowel disease is frequently the result of viral reactivation. Conversely, primary CMV infection is believed to be uncommon in immunocompetent adults due to high population seroprevalence. Objectives. The aim of this study was to examine the frequency and severity of primary cytomegalovirus infection in an adult cohort of IBD patients. Study Design. A retrospective review of a prospectively maintained database of 3200 IBD patients attending a single academic centre was performed. Patients with primary CMV infection 2010–13 were identified; clinical, serologic, and virologic parameters were studied in detail. The seroprevalence of CMV in the patient population was also evaluated. Results. Eight patients with IBD (UC = 3, IBD-U = 1, CD = 4) presented with primary CMV infection. Patients presented with both gastrointestinal and extraintestinal symptoms. Mean age was 33 years, and median duration of disease was 72 months. All eight patients were receiving a thiopurine immunomodulator. Median duration of IM use was 144 weeks (range 7–720 weeks). All 8 patients required hospitalisation, with 1 ICU admission; the median length of hospital stay was 11 days (range 6–27). Infection resolved in all cases with withdrawal of immunomodulator and/or antiviral therapy. Seroprevalence of IgG to CMV, indicating prior exposure, in a subgroup of IBD patients (n=80) was 30.5% and increased with age. Conclusion. Primary cytomegalovirus infection can cause a severe illness in IBD patients, particularly those receiving immunosuppression. In areas where adult CMV seroprevalence is low, evidence of CMV should be sought in IBD patients presenting with any febrile systemic illness.http://dx.doi.org/10.1155/2018/1029401 |
| spellingShingle | Catherine Rowan Ciaran Judge Mary D. Cannon Garret Cullen Hugh E. Mulcahy Elizabeth Ryan Cillian F. De Gascun Glen A. Doherty Severe Symptomatic Primary CMV Infection in Inflammatory Bowel Disease Patients with Low Population Seroprevalence Gastroenterology Research and Practice |
| title | Severe Symptomatic Primary CMV Infection in Inflammatory Bowel Disease Patients with Low Population Seroprevalence |
| title_full | Severe Symptomatic Primary CMV Infection in Inflammatory Bowel Disease Patients with Low Population Seroprevalence |
| title_fullStr | Severe Symptomatic Primary CMV Infection in Inflammatory Bowel Disease Patients with Low Population Seroprevalence |
| title_full_unstemmed | Severe Symptomatic Primary CMV Infection in Inflammatory Bowel Disease Patients with Low Population Seroprevalence |
| title_short | Severe Symptomatic Primary CMV Infection in Inflammatory Bowel Disease Patients with Low Population Seroprevalence |
| title_sort | severe symptomatic primary cmv infection in inflammatory bowel disease patients with low population seroprevalence |
| url | http://dx.doi.org/10.1155/2018/1029401 |
| work_keys_str_mv | AT catherinerowan severesymptomaticprimarycmvinfectionininflammatoryboweldiseasepatientswithlowpopulationseroprevalence AT ciaranjudge severesymptomaticprimarycmvinfectionininflammatoryboweldiseasepatientswithlowpopulationseroprevalence AT marydcannon severesymptomaticprimarycmvinfectionininflammatoryboweldiseasepatientswithlowpopulationseroprevalence AT garretcullen severesymptomaticprimarycmvinfectionininflammatoryboweldiseasepatientswithlowpopulationseroprevalence AT hughemulcahy severesymptomaticprimarycmvinfectionininflammatoryboweldiseasepatientswithlowpopulationseroprevalence AT elizabethryan severesymptomaticprimarycmvinfectionininflammatoryboweldiseasepatientswithlowpopulationseroprevalence AT cillianfdegascun severesymptomaticprimarycmvinfectionininflammatoryboweldiseasepatientswithlowpopulationseroprevalence AT glenadoherty severesymptomaticprimarycmvinfectionininflammatoryboweldiseasepatientswithlowpopulationseroprevalence |