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Abstract
BackgroundGastrointestinal (GI) cytomegaloviral (CMV) infection is common among patients with immunocompromised status; however, data specific to GI-CMV infection in immunocompetent patients are comparatively limited.MethodsThis retrospective study included patients diagnosed with GI-CMV infection at Siriraj Hospital (Bangkok, Thailand) during 2008–2017. Baseline characteristics, presentations, comorbid conditions, endoscopic findings, treatments, and outcomes were compared between immunocompetent and immunocompromised.ResultsOne hundred and seventy-three patients (56 immunocompetent, 117 immunocompromised) were included. Immunocompetent patients were significantly older than immunocompromised patients (73 vs. 48.6 years, p < 0.0001). Significantly more immunocompetent patients were in the ICU at the time of diagnosis (21.0% vs. 8.6%, p = 0.024). GI bleeding was the leading presentation in immunocompetent, while diarrhea and abdominal pain were more common in immunocompromised. Blood CMV viral load was negative in significantly more immunocompetent than immunocompromised (40.7% vs. 12.9%, p = 0.002). Ganciclovir was the main treatment in both groups. Significantly more immunocompetent than immunocompromised did not receive any specific therapy (25.5% vs. 4.4%, p ≤ 0.01). Six-month mortality was significantly higher among immunocompetent patients (39.0% vs. 22.0%, p = 0.047). Independent predictors of death were old age and inpatient or ICU clinical setting. Treatment with antiviral agents was the only independent protective factor.ConclusionGI-CMV infection was frequently observed among immunocompetent elderly patients with comorbidities or severe concomitant illnesses. GI bleeding was the most common presentation. Blood CMV viral load was not diagnostically helpful. Significantly higher mortality was observed in immunocompetent than in immunocompromised patients, but this could be due to more severe concomitant illnesses in the immunocompetent group.
Highlights
Cytomegalovirus (CMV) is a double-stranded DNA virus in the herpes virus family [1]
The aim of this study was to investigate patient characteristics, clinical manifestations, outcomes and prognoses, and factors associated with GI-CMV infection in immunocompetent patients by comparing those parameters with those of GI-CMV infection patients with immunocompromised status
This retrospective review of 173 patients diagnosed with GI-CMV during the last ten years at our center revealed that CMV gastrointestinal disease in immunocompetent patients is not rare
Summary
Cytomegalovirus (CMV) is a double-stranded DNA virus in the herpes virus family [1]. CMV is considered an important opportunistic virus among immunocompromised individuals. Data specific to GI-CMV infection in immunocompetent patients are still quite limited. Three cohorts comprehensively described risk factors, clinical manifestations, and clinical course [7, 27, 28], and one of those studies included patients taking corticosteroids [27]. This could lead to disease underrecognition, which could result in diagnostic delay and poorer outcomes. Gastrointestinal (GI) cytomegaloviral (CMV) infection is common among patients with immunocompromised status; data specific to GI-CMV infection in immunocompetent patients are comparatively limited
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