Digestive Diseases and Sciences

, Volume 50, Issue 4, pp 609–616 | Cite as

Meta-analysis of Outcome of Cytomegalovirus Colitis in Immunocompetent Hosts

  • Polymnia Galiatsatos
  • Ian Shrier
  • Esther Lamoureux
  • Andrew Szilagyi
Review Article

Abstract

There are only a few anecdotal reports of cytomegalovirus (CMV) colitis in immunocompetent hosts. The impact of the disease in this patient population remains poorly understood. The aim of this study was to perform a meta-analysis using individual patient data to determine outcomes of CMV colitis in immunocompetent patients and identify risk factors that might influence prognosis. A literature search was performed from 1980 to 2003 looking for immunocompetent patients with CMV colitis. Immunocompetence was defined as absence of congenital or acquired immune deficiency, transplant, or immunosuppressive medication. Patients were divided by age (< 55 versus ≥55) and grouped according to coexisting illnesses. Kaplan–Meier curves were plotted to assess survival. Variables included age, sex, site of acquisition of infection, extent of disease, coexisting illnesses, and treatment modality. A total of 44 patients were identified, with an average age of 61.1. Only 10 were free of any comorbidity. The mean follow-up was 13.4 months. Spontaneous remission occurred in 31.8%, mostly individuals < 55 years old. Fourteen deaths occurred, all of which were in patients ≥55. There was a higher mortality rate among male patients ≥55 (56.9%; P = 0.08), patients with immune-modulating diseases (75.2%; P = 0.10), and those having a colectomy (68.9%; P = 0.09). This analysis underlines the rarity of CMV colitis in patients with an intact immune system. Advanced age, male gender, presence of immune-modulating comorbidities, and need for surgical intervention are factors negatively influencing survival. Conversely, young healthy patients have a good prognosis with no intervention.

Keywords

meta-analysis cytomegalovirus colitis 

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References

  1. 1.
    De la Hoz RE, Stephens G, Sherlock C: Diagnosis and treatment approaches to CMV infections in adult patients. J Clin Virol 25:S1–S12, 2002PubMedGoogle Scholar
  2. 2.
    Taylor GH: Cytomegalovirus. Am Fam Phys 67(3):519–524, 2003Google Scholar
  3. 3.
    Sissions JGP, Carmichael AJ: Clinical aspects and management of cytomegalovirus infection. J Infect 44:78–83, 2002Google Scholar
  4. 4.
    Kaufman HS, Kahn AC, Iacobuzio-Donahue C, et al.: Cytomegaloviral enterocolitis. Dis Colon Rectum 42(1):24–30, 1999PubMedGoogle Scholar
  5. 5.
    Rene E, Marche C, Chevalier T, et al.: Cytomegalovirus colitis in patients with acquired immunodeficiency syndrome. Dig Dis Sci 33:741–750, 1988PubMedGoogle Scholar
  6. 6.
    Guttman D, Raymond A, Gelb A, et al.: Virus-associated colitis in homosexual men: two case reports. Am J Gastroenterol 78(3):167–169, 1983PubMedGoogle Scholar
  7. 7.
    Spiegel JS, Schwabe AD: Disseminated cytomegalovirus infection with gastrointestinal involvement. Am J Gastroenterol 73:37–44, 1980PubMedGoogle Scholar
  8. 8.
    Sridama V, Pacini F, Yang SL, et al.: Decreased levels of helper T cells. N Engl J Med 307:352–356, 1980CrossRefGoogle Scholar
  9. 9.
    Diepersloot RJA, Kroes ACM, Visser W, et al.: Acute ulcerative proctocolitis associated with primary Cytomegalovirus infection. Arch Intern Med 150:1749–1751, 1990PubMedGoogle Scholar
  10. 10.
    Consten ECJ, Brummelkamp WH, Henny CP: Cytomegalovirus infection in the pregnant woman. Eur J Obstet Gynecol 52:139–142, 1993Google Scholar
  11. 11.
    Pfau P, Kochman M, Furth E, et al.: Cytomegalovirus colitis complicating ulcerative colitis in the steroid-naïve patient. Am J Gastroenterol 96(3):895–899, 2001PubMedGoogle Scholar
  12. 12.
    Lortholary O, Perronne C, Leport J, et al.: Primary cytomegalovirus infection associated with the onset of ulcerative colitis. Eur J Clin Microbiol Infect Dis 12:570–572, 1993PubMedGoogle Scholar
  13. 13.
    Orvar K, Murray J, Carmen G, et al.: Cytomegalovirus infection associated with onset of inflammatory bowel disease. Dig Dis Sci 38(12):2307–2310, 1993PubMedGoogle Scholar
  14. 14.
    Surawicz C, Myerson D: Self-limited Cytomegalovirus colitis in immunocompetent individuals. Gastroenterology 94:194–199, 1988PubMedGoogle Scholar
  15. 15.
    Maignan M, Whal D, Thiaucourt D, et al.: Self-limited primary cytomegalovirus colitis in an immunocompetent individual. J Intern Med 232:357–359, 1992PubMedCrossRefGoogle Scholar
  16. 16.
    Blair SD, Forbes A, Parkins RA: CMV colitis in an immunocompetent adult. J R Soc Med 85:238–239, 1992PubMedGoogle Scholar
  17. 17.
    Rabinowitz M, Bassan I, Robinson MJ: Sexually transmitted cytomegalovirus proctitis in a woman. Am J Gastroenterol 83(8):885–887, 1988PubMedGoogle Scholar
  18. 18.
    Falagas ME, Griffiths J, Prekezes J, et al.: Cytomegalovirus colitis mimicking colon carcinoma in an HIV-negative patient with chronic renal failure. Am J Gastroenterol 91(1):168–169, 1996PubMedGoogle Scholar
  19. 19.
    Ng FH, Chau TN, Cheung TC, et al.: Cytomegalovirus colitis in individuals without apparent cause of immunodeficiency. Dig Dis Sci 44(5):945–952, 1999PubMedGoogle Scholar
  20. 20.
    Bennett MR, Fine AP, Hanlon JT: Cytomegalovirus hemorrhagic colitis in a nontransplant patient. Postgrad Med 77(8):227–232, 1985PubMedGoogle Scholar
  21. 21.
    Esforzado N, Poch E, Almirall J, et al.: Clin Nephrol 39(5):275–278, 1993PubMedGoogle Scholar
  22. 22.
    Buckner FS, Pomeroy C: Cytomegalovirus disease of the gastrointestinal tract in patients without AIDS. Clin Infect Dis 17:644–656, 1993PubMedGoogle Scholar
  23. 23.
    Page MJ, Dreese JC, Poritz LS, et al.: Cytomegalovirus enteritis. Dis Colon Rectum 41(5):619–623, 1998PubMedGoogle Scholar
  24. 24.
    Klauber E, Briski LE, Khatib R: Cytomegalovirus colitis in the immunocompetent host: an overview. Scand J Infect Dis 30:559–564, 1998PubMedGoogle Scholar
  25. 25.
    Jawad SH: Cytomegalovirus in an elderly patient. Postgrad Med J 68:484, 1992CrossRefPubMedGoogle Scholar
  26. 26.
    Machens A, Bloechle C, Achilles EG, et al.: Toxic megacolon caused by Cytomegalovirus colitis in a multiply injured patient. J Trauma Injury Infect Crit Care 40(4):644–646, 1996Google Scholar
  27. 27.
    Coll PP, Pacala JT, Hamilton CW: Cytomegalovirus colitis in an older woman, successfully treated with ganciclovir. J R Soc Med 92:80–81, 1999Google Scholar
  28. 28.
    Banerjee AK: Cytomegalovirus (CMV) enterocolitis. J R Soc Med 82:446, 1989PubMedGoogle Scholar
  29. 29.
    Chau TN, Lau LK, Lee KC, et al.: Association of self-limited Cytomegalovirus colitis and shigellosis in an immunocompetent patient. Eur J Gastroenterol Hepatol 8(8):819–822, 1996PubMedGoogle Scholar
  30. 30.
    Grimsehl K, Seaton RA, Checketts MR: Fulminant cytomegalovirus colitis complicating Staphylococcus aureus septicaemia and multiorgan failure in a previously immunocompetent patient. J R Soc Med 92:80–81, 1999PubMedGoogle Scholar
  31. 31.
    Karakozis S, Gongora E, Caceres M, et al.: Life-threatening cytomegalovirus colitis in the immunocompetent patient. Dis Colon Rectum 44(11):1716–1720, 2001PubMedGoogle Scholar
  32. 32.
    Rachima C, Maoz E, Apter S, et al.: Cytomegalovirus infection associated with ulcerative colitis in immunocompetent individuals. Postgrad Med J 4:480–491, 1998Google Scholar
  33. 33.
    Cunningham M, Cantoni L, Humair L: Cytomegalovirus primo-infection in a patient with idiopathic proctitis. Am J Gastroenterol 81(7):586–588, 1986PubMedGoogle Scholar
  34. 34.
    Schmucker DL, Heyworth MF, Owen RL, et al.: Impact of aging on gastrointestinal mucosal immunity. Dig Dis Sci 41(6):1183–1193, 1996PubMedGoogle Scholar
  35. 35.
    Goodgame RW: Gastrointestinal cytomegalovirus disease. Ann Intern Med 119:924–935, 1993PubMedGoogle Scholar
  36. 36.
    Papadakis KA, Tung JK, Binder SW, et al.: Outcome of cytomegalovirus infections in patients with inflammatory bowel disease. Am J Gastroenterol 96(7):2137–2142, 2001PubMedGoogle Scholar
  37. 37.
    Vega R, Bertran X, Menacho M, et al.: Cytomegalovirus infection in patients with inflammatory bowel disease. Am J Gastroenterol 94(4):1053–1056, 1999PubMedGoogle Scholar
  38. 38.
    Cottone M, Pietrosi G, Martorana G, et al.: Prevalence of cytomegalovirus infection in severe refractory ulcerative and Crohn’s colitis. Am J Gastroenterol 96(3):77–75, 2001Google Scholar
  39. 39.
    Moonka D, Furth EE, MacDermott RP, et al.: Pouchitis associated with primary Cytomegalovirus infection. Am J Gastroenterol 93(2): 264–266, 1998PubMedGoogle Scholar
  40. 40.
    Munoz-Juarez M, Pemberton JH, Sandborn WJ, et al.: Misdiagnosis of specific Cytomegalovirus infection of the ileoanal pouch as refractory idiopathic chronic pouchitis. Dis Colon Rectum 42(1):117–120, 1999PubMedGoogle Scholar
  41. 41.
    Pfau PR, Lichtenstein GR: Cytomegalovirus infection as a cause of ileoanal pouchitis. Dis Colon Rectum 43(1):113–114, 2000PubMedGoogle Scholar

Copyright information

© Springer Science + Business Media, Inc. 2005

Authors and Affiliations

  • Polymnia Galiatsatos
    • 1
  • Ian Shrier
    • 2
  • Esther Lamoureux
    • 3
  • Andrew Szilagyi
    • 1
    • 4
  1. 1.Division of Gastroenterology, Department of MedicineMcGill UniversityMontrealCanada
  2. 2.Center for Clinical Epidemiology and Community Studies, Lady Davis Institute for Medical ResearchMcGill UniversityMontrealCanada
  3. 3.Department of Pathology, Sir Mortimer B. Davis Jewish General HospitalMcGill UniversityMontrealCanada
  4. 4.Division of GastroenterologyDepartment of MedicineMontrealCanada

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