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Diseases of the Colon & Rectum

, Volume 41, Issue 5, pp 619–623 | Cite as

Cytomegalovirus enteritis

A highly lethal condition requiring early detection and intervention
  • Michael J. Page
  • James C. Dreese
  • Lisa S. Poritz
  • Walter A. Koltun
Original Contributions

Abstract

Cytomegalovirus infection causing symptomatic enteritis is most usually associated with immunosuppressed transplant patients or patients positive for human immunodeficiency virus. Most reports studying this illness are small and do not clearly define the risk factors or mortality rates. METHODS: The present study retrospectively reviewed the charts of 67 patients with biopsy-proven cytomegalovirus enteritis (esophageal, gastric, small bowel, and colonic) to define and to investigate factors that influence survival. Patients were classified into four groups based on underlying medical condition: 1) patients positive for human immunodeficiency virus; 2) transplant patients receiving immunosuppressive medications; 3) immunosuppressed nontransplant patients; and 4) otherwise healthy individuals. Mortality rates based on underlying medical condition, location of intestinal cytomegalovirus infection, cytomegalovirus therapy, age, and average days to institution of treatment were defined and statistically assessed. RESULTS: Mortality was significantly greater in the normal patient group (80 percent) than in the transplant (21 percent), other immunosuppressed (44 percent), or human immunodeficiency virus-positive (75 percent) groups (P=0.0006, Cochran-Mantel-Haenszel statistics). There was no difference in mortality based on intestinal location of disease or treatment modality (surgery, medical therapy, or both). Cohorts of patients older than 65 years had a statistically higher mortality ratevs. those younger than 65 years old (68vs. 38 percent;P=0.05, Cochran-Mantel-Haenszel statistics). Statistically increased mortality was also associated with increased time from hospital admission to institution of cytomegalovirus treatment, whether therapy was medication alone or medication and surgery (P < 0.05, exact Wilcoxon's test). CONCLUSIONS: 1) Lethal cytomegalovirus enteritis can arise in patient populations not typically identified as being at risk for this disorder, including normal individuals. 2) Mortality in cytomegalovirus enteritis is adversely associated with age older than 65 years and increased time to institution of therapy but is not affected by anatomic site of infection or particular form of treatment. Paradoxically, in this study, normal patients had the highest mortality, which we attribute to a low index of suspicion and relatively late institution of therapy.

Key words

Cytomegalovirus Enteritis Transplant Human immunodeficiency virus Immunosuppression Mortality 

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Copyright information

© the American Society of Colon and Rental Surgeons 1998

Authors and Affiliations

  • Michael J. Page
    • 1
  • James C. Dreese
    • 1
  • Lisa S. Poritz
    • 1
  • Walter A. Koltun
    • 1
  1. 1.From the Department of Surgery, Milton S. Hershey Medical CenterPennsylvania State University College of MedicineHershey

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