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Cytomegalovirus Colitis


Presentation

  • If stenotic lesions are present, surgery may be required not only to remove the obstruction but also to rule out malignancy.[ncbi.nlm.nih.gov]
Recurrent Bacterial Infection
  • Although there was amelioration of the colitis and clinical status after treatment with ganciclovir, the patient later deteriorated and died due to recurrent bacterial infections.[ncbi.nlm.nih.gov]
Ascitic Fluid
  • Diagnosis of lupus peritonitis was made by abdominal computed tomography scan, colonoscopy, and ascitic fluid analysis. Steroid and cyclophosphamide therapy resulted in the improvement of severe lupus nephritis and peritonitis.[ncbi.nlm.nih.gov]
Diarrhea
  • An 84-year-old male presented with chronic diarrhea and CMV colitis; he had been experiencing protracted diarrhea since 2006. In October 2009 he failed a 21-day course of valgancyclovir 900 mg orally twice daily.[ncbi.nlm.nih.gov]
Chronic Diarrhea
  • Other pathogens should be considered in patients with chronic diarrhea who are refractory to initial treatments.[ncbi.nlm.nih.gov]
  • The infectious disease team was consulted and it was determined that in the context of the patient's HIV infection, AIDS and resultant immunosuppression, CMV infection was contributing to chronic diarrhea, abdominal pain, and formation of a colovesical[cureus.com]
  • Diagnostic Accuracy of Fecal Calprotectin Assay in Distinguishing Organic Causes of Chronic Diarrhea from Irritable Bowel Syndrome: A Prospective Study in Adults and Children. Clinical Chemistry 49:6 861–867. Available online at . Accessed Sep 2012.[labtestsonline.it]
  • Investigation of chronic diarrhea in acquired immunodeficiency syndrome: a prospective study of 155 patients. Gut. 1996;39:824-32. [ Links ] 9. Chalasani N, Wilcox CM. Etiology and outcome of lower gastrointestinal bleeding in patients with AIDS.[scielo.br]
Chronic Watery Diarrhea
  • Chronic watery diarrhea was present in all the patients with colitis but was also present in 65% of the patients without colitis.[link.springer.com]
Rectal Mass
  • We report a case in which a previously healthy man presented with hematochezia and an obstructing rectal mass thought to be rectal adenocarcinoma.[acgcasereports.gi.org]
Hyperactive Bowel Sounds
  • Physical exam revealed a cachectic male with hyperactive bowel sounds without any abdominal tenderness or organomegaly.[acgcasereports.gi.org]
Vascular Disease
  • A woman with peripheral vascular disease developed cytomegalovirus colitis following repair of abdominal aortic aneurysm.[ncbi.nlm.nih.gov]
  • Coronary Artery Disease or Peripheral Vascular Disease No change in standard management. E. Diabetes or other Endocrine issues No change in standard management. F. Malignancy No change in standard management. G.[clinicaladvisor.com]
  • disease (seems to be related to immunosuppressive therapy) Blood transfusions Malnutrition Epidemiology United States data Cytomegalovirus (CMV) colitis is rare in immunocompetent patients.[emedicine.medscape.com]
Heart Disease
  • He had the underlying end-stage renal disease, ischemic heart disease, cerebrovascular disease, hypertension and gout. Colonoscopy revealed multiple clean base ulcers at rectum and sigmoid colon.[ncbi.nlm.nih.gov]
Hyperactivity
  • Physical exam revealed a cachectic male with hyperactive bowel sounds without any abdominal tenderness or organomegaly.[acgcasereports.gi.org]

Workup

  • Workup for Clostridium difficile and all enteric pathogens were negative. The patient remained febrile with abdominal pain.[ncbi.nlm.nih.gov]
  • Coverage begins with the patient's first visit and proceeds through the diagnostic workup: endoscopy, radiologic testing, and instruments for rating and classifying inflammatory bowel disease.[books.google.de]
  • Workup revealed intussusception with associated pneumatosis. A right hemicolectomy was performed. Pathologic examination revealed cytomegalovirus (CMV) colitis.[austinpublishinggroup.com]
  • "Cytomegalovirus (CMV) Workup." Medscape.com. Dec. 1, 2017.. Azevedo, L.S., et al. "Cytomegalovirus infection in transplant recipients." Clinics (Sao Paulo) 70.7 July 2015: 515-23. doi: 10.6061/clinics/2015(07)09. Epub 2015 Jul 1. Review.[medicinenet.com]
Microcytic Anemia
  • Blood investigations showed normal white cell count (5400/μL) with normal differential, microcytic anemia with hemoglobin 10 g/dL, and hypoalbuminemia with otherwise normal liver enzymes.[acgcasereports.gi.org]
Staphylococcus Aureus
  • CASE PRESENTATION: We are presenting a 72-year-old African-American male transferred to our intensive care unit (ICU) with methicillin-resistant Staphylococcus aureus bacteremia, respiratory failure, and dialysis-dependent acute kidney injury.[ncbi.nlm.nih.gov]
Colitis
  • Our experience suggests that biopsies may be necessary to detect CMV and the prompt management of CMV colitis should be instituted when intractable ischemic colitis is observed.[ncbi.nlm.nih.gov]
Viral Inclusion Body
  • Light microscopy of selected viral diseases (morphology of viral inclusion bodies). Pathol Annu 1976;11:53-75. [ PUBMED ] 34. Schwartz DA, Wilcox CM.[jdeonline.in]

Treatment

  • CONCLUSION: In IBD patients with active CMV colitis, antiviral treatment seems to have a marginal impact in the short term, during the treatment of the acute phase, but it may have some beneficial effect in maintaining remission up to 1 year of follow-up[ncbi.nlm.nih.gov]

Prognosis

  • Despite aggressive clinical manifestations, the prognosis of CMV colitis is good if diagnosed and treated early.[ncbi.nlm.nih.gov]
  • In patients without immunocompromised status, the prognosis appears to be age dependent, with patients older than 55 years having a higher mortality. Males and patients who need surgery also have a poorer prognosis.[emedicine.medscape.com]

Etiology

  • […] the case of a patient who presented with abdominal pain 4 years after heart transplantation; clinical and x-ray findings were suggestive of a neoplastic or ischemic stenosis, and histopathological examination likewise initially suggested an ischemic etiology[ncbi.nlm.nih.gov]
  • Physical exam is often not specific to the diagnosis of CMV colitis; fever in these patients can be indicative of an infectious etiology.[clinicaladvisor.com]
  • (Etiology) Cytomegalovirus Gastroenteritis/Colitis disease is an indication of a frail immune system (which is caused by other medical conditions or viral infections).[dovemed.com]
  • Etiology Pathogen : cytomegalovirus ( CMV, human herpes virus 5, HHV-5 ) Transmission Blood transfusions Sexual transmission Droplet transmission Transplant-transmitted infection (e.g., bone marrow, lungs, kidneys) References: [1] [2] [3] Pathophysiology[amboss.com]

Epidemiology

  • Search for other works by this author on: Ulrich von Both 1Division of Infectious Diseases and Hospital Epidemiology, Zurich, Switzerland Search for other works by this author on: Reto Laffer 1Division of Infectious Diseases and Hospital Epidemiology,[academic.oup.com]
  • Jeffrey D Band, MD, FACP, FIDSA Professor of Medicine, Oakland University William Beaumont School of Medicine; Health System Chair, Healthcare Epidemiology and International Medicine, Beaumont Health System; Former Chief of Infectious Diseases, Beaumont[emedicine.medscape.com]
  • […] antiviral drugs, such as ganciclovir or valganciclovir Terminology CMV infection: refers to presence of detectable CMV levels in the human body CMV disease: CMV disease relates to symptoms due to CMV ICD coding B25.8 : other cytomegaloviral diseases Epidemiology[pathologyoutlines.com]
  • Epidemiology, clinical manifestations, and treatments of cytomegalovirus infection in immunocompetent hosts. In: UpToDate; April, 2015. Available from: .[Last accessed on 2015 Apr 2]. 2. Centers for Disease Control and Prevention.[mjdrdypu.org]
Sex distribution
Age distribution

Pathophysiology

  • […] can be acquired during birth, breast feeding, close contact, sexual contact, transfusion or with organ transplant ( Scand J Gastroenterol 2010;45:1295 ) Sites Most common sites of CMV related gastrointestinal involvement are the esophagus and colon Pathophysiology[pathologyoutlines.com]
  • Pathophysiology Cytomegalovirus (CMV) has 3 major patterns of infection.[emedicine.medscape.com]
  • ., bone marrow, lungs, kidneys) References: [1] [2] [3] Pathophysiology Clinical features CMV infection is usually asymptomatic. Severe manifestations occur in immunocompromised states (e.g., following organ transplantation, AIDS ).[amboss.com]
  • The pathophysiology of a disease may compromise the immune system.[journals.plos.org]

Prevention

  • European evidence-based consensus on the prevention, diagnosis and management of opportunistic infections in inflammatory bowel disease. J Crohns Colitis. 2009;3(2):47-91.[consultant360.com]
  • Seite 170 - Rotavirus vaccine for the prevention of rotavirus gastroenteritis among children. Recommendations of the Advisory Committee on Immunization Practices (ACIP). ‎ Seite 18 - Griffin. 1990.[books.google.de]
  • The anatomopathological study allowed us to make the diagnosis of CMV colitis, and administer appropriate treatment to prevent further immunosuppression.[revistanefrologia.com]

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