Abstract
BackgroundCytomegalovirus is highly prevalent virus and usually occurs in immunocompromised patients. The pathophysiology and treatment of inflammatory bowel disease often induce a state of immunosuppression. Because this, there are still doubts and controversies about the relationship between inflammatory bowel disease and cytomegalovirus.AimEvaluate the frequency of cytomegalovirus in patients with inflammatory bowel disease and identify correlations.MethodsPatients with inflammatory bowel disease underwent an interview, review of records and collection of blood and fecal samples. The search for cytomegalovirus was performed by IgG and IgM blood serology, by real-time PCR in the blood and by qualitative PCR in feces. Results were correlated with red blood cell levels, C-reactive protein levels, erythrocyte sedimentation rates and fecal calprotectin levels for each patient.ResultsAmong the 400 eligible patients, 249 had Crohn's disease, and 151 had ulcerative colitis. In the group of Crohn's disease, 67 of the patients had moderate or severe disease, but 126 patients presented with active disease, based on the evaluation of the fecal calprotectin. In patients with ulcerative colitis, only 21 patients had moderate disease, but 76 patients presented with active disease, based on the evaluation of the fecal calprotectin. A large majority of patients had positive CMV IgG. Overall, 10 patients had positive CMV IgM, and 9 patients had a positive qualitative detection of CMV DNA by PCR in the feces. All 400 patients returned negative results after the quantitative detection of CMV DNA in blood by real-time PCR. Analyzing the 19 patients with active infections, we only found that such an association occurred with the use of combined therapy (anti-TNF-alpha + azathioprine)ConclusionThe findings show that latent cytomegalovirus infections are frequent and active cytomegalovirus infection is rare. We did not find any association between an active infection of CMV and inflammatory bowel disease activity.
Highlights
Cytomegalovirus (CMV) is a ß herpes-virus with doublestranded DNA and represents a common viral infection in humans, with infection levels ranging from 40% in developed countries to 100% in developing countries [1]
In the group of Crohn’s disease, 67 of the patients had moderate or severe disease, but 126 patients presented with active disease, based on the evaluation of the fecal calprotectin
In patients with ulcerative colitis, only 21 patients had moderate disease, but 76 patients presented with active disease, based on the evaluation of the fecal calprotectin
Summary
Cytomegalovirus (CMV) is a ß herpes-virus with doublestranded DNA and represents a common viral infection in humans, with infection levels ranging from 40% in developed countries to 100% in developing countries [1]. Primary CMV infection is subclinical in most patients and is often followed by CMV disease or latent CMV infection. CMV disease is rare in immunocompetent patients but not among the immunocompromised population. The organs affected by CMV disease include the eyes, lungs, liver, urinary tract, pancreas, central nervous system, heart and gastrointestinal tract [2]. The different grades of CMV infection can be defined as not infected, latent infection, active infection and disease [3] (Table 1). Cytomegalovirus is highly prevalent virus and usually occurs in immunocompromised patients. The pathophysiology and treatment of inflammatory bowel disease often induce a state of immunosuppression. There are still doubts and controversies about the relationship between inflammatory bowel disease and cytomegalovirus
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