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Risk factors for cytomegalovirus gastrointestinal diseases in adult patients with cancer

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Abstract

Cytomegalovirus (CMV) gastrointestinal (GI) disease has been noticed frequently in cancer patients, causing abdominal pain, diarrhea, and GI bleeding. However, little is known about its actual incidence, clinical presentation, and the risk factors for its development among cancer patients. To answer these questions, we analyzed all cases that occurred during an 18-year period at our center. A case–control study was performed to identify risk factors for CMV GI disease. Electronic medical records were reviewed from individuals who were admitted and diagnosed with CMV GI disease during the period of January 1995 through March 2013 at a tertiary care center. Two CMV disease-free cancer patients were matched as controls. A total of 98 episodes of CMV GI disease were included in this study, and the overall incidence rate was 52.5 per 100,000 cancer patients, with an increasing trend throughout the study period. According to multivariate analysis, male sex, low body mass index, lymphopenia, hematological malignancy, and steroid use and red blood cell transfusion within 1 month prior to the CMV disease were identified to be independent risk factors. Among these factors, RBC transfusion showed the highest odds ratio (OR = 5.09). Male sex, low body mass index, lymphopenia, hematological malignancy, steroid use, and red blood cell transfusion within 1 month prior to the CMV disease diagnosis were independent risk factors for the development of CMV GI disease in adult patients with cancer.

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References

  1. McGavran MH, Smith MG (1965) Ultrastructural, cytochemical, and microchemical observations on cytomegalovirus (Salivary Gland Virus) infection of human cells in tissue culture. Exp Mol Pathol 76:1–10

    Article  PubMed  CAS  Google Scholar 

  2. Gandhi MK, Khanna R (2004) Human cytomegalovirus: clinical aspects, immune regulation, and emerging treatments. Lancet Infect Dis 4:725–738. doi:10.1016/S1473-3099(04)01202-2

    Article  PubMed  CAS  Google Scholar 

  3. Gandhi MK, Wills MR, Sissons JG, Carmichael AJ (2003) Human cytomegalovirus-specific immunity following haemopoietic stem cell transplantation. Blood Rev 17:259–264

    Article  PubMed  Google Scholar 

  4. Cope AV, Sweny P, Sabin C, Rees L, Griffiths PD, Emery VC (1997) Quantity of cytomegalovirus viruria is a major risk factor for cytomegalovirus disease after renal transplantation. J Med Virol 52:200–205

    Article  PubMed  CAS  Google Scholar 

  5. Jacobson MA (1997) Treatment of cytomegalovirus retinitis in patients with the acquired immunodeficiency syndrome. N Engl J Med 337:105–114. doi:10.1056/NEJM199707103370207

    Article  PubMed  CAS  Google Scholar 

  6. Saito M, Ishino A, Ito T, Sakuma T, Matsuzaki M, Katagata N, Watanabe F, Takenoshita S, Nomizu T (2013) Hemorrhagic cytomegalovirus colitis in a postoperative colon cancer patient. Case Rep Oncol 6:109–113. doi:10.1159/000348711

    Article  PubMed  PubMed Central  Google Scholar 

  7. Nomura K, Kamitsuji Y, Kono E, Matsumoto Y, Yoshida N, Konishi H, Horiike S, Okanoue T, Taniwaki M (2005) Severe cytomegalovirus enterocolitis after standard chemotherapy for non-Hodgkin’s lymphoma. Scand J Gastroenterol 40:604–606. doi:10.1080/00365520510015395

    Article  PubMed  Google Scholar 

  8. Furukawa Y, Nakamura H, Sakamoto S, Miura Y (1988) Cytomegalovirus gastritis as an initial manifestation of a patient with adult T-cell leukemia. Acta Haematol 80:216–218

    Article  PubMed  CAS  Google Scholar 

  9. Reed EC, Wolford JL, Kopecky KJ, Lilleby KE, Dandliker PS, Todaro JL, McDonald GB, Meyers JD (1990) Ganciclovir for the treatment of cytomegalovirus gastroenteritis in bone marrow transplant patients. A randomized, placebo-controlled trial. Ann Intern Med 112:505–510

    Article  PubMed  CAS  Google Scholar 

  10. Sohn YM, Park KI, Lee C, Han DG, Lee WY (1992) Congenital cytomegalovirus infection in Korean population with very high prevalence of maternal immunity. J Korean Med Sci 7:47–51

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  11. Seo S, Cho Y, Park J (2009) Serologic screening of pregnant Korean women for primary human cytomegalovirus infection using IgG avidity test. Korean J Lab Med 29:557–562. doi:10.3343/kjlm.2009.29.6.557

    Article  PubMed  CAS  Google Scholar 

  12. Kim JM, Kim SJ, Joh JW, Kwon CH, Shin M, Kim EY, Moon JI, Jung GO, Choi GS, Lee SK (2010) Early and delayed onset cytomegalovirus infection of liver transplant recipients in endemic areas. Transplant Proc 42:884–889. doi:10.1016/j.transproceed.2010.02.025

    Article  PubMed  CAS  Google Scholar 

  13. Kim T, Sung H, Park KT, Kim SC, Kim S-H, Choi S-H, Kim YS, Woo JH, Park S-K, Han DJ, Lee S-O (2009) Clinical usefulness of human cytomegalovirus antigenemia assay after kidney transplantation. Infect Chemother 41:72. doi:10.3947/ic.2009.41.2.72

    Article  Google Scholar 

  14. Mori T, Mori S, Kanda Y, Yakushiji K, Mineishi S, Takaue Y, Gondo H, Harada M, Sakamaki H, Yajima T, Iwao Y, Hibi T, Okamoto S (2004) Clinical significance of cytomegalovirus (CMV) antigenemia in the prediction and diagnosis of CMV gastrointestinal disease after allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant 33:431–434. doi:10.1038/sj.bmt.1704369

    Article  PubMed  CAS  Google Scholar 

  15. Galiatsatos P, Shrier I, Lamoureux E, Szilagyi A (2005) Meta-analysis of outcome of cytomegalovirus colitis in immunocompetent hosts. Dig Dis Sci 50:609–616

    Article  PubMed  Google Scholar 

  16. Kotler DP (2000) Cachexia. Ann Intern Med 133:622–634

    Article  PubMed  CAS  Google Scholar 

  17. Teo HK, Price P, Papadimitriou JM (1991) The effects of protein malnutrition on the pathogenesis of murine cytomegalovirus disease. Int J Exp Pathol 72:67–82

    PubMed  CAS  PubMed Central  Google Scholar 

  18. Yi F, Zhao J, Luckheeram RV, Lei Y, Wang C, Huang S, Song L, Wang W, Xia B (2013) The prevalence and risk factors of cytomegalovirus infection in inflammatory bowel disease in Wuhan, Central China. Virol J 10:43. doi:10.1186/1743-422X-10-43

    Article  PubMed  PubMed Central  Google Scholar 

  19. Chen YM, Hung YP, Huang CF, Lee NY, Chen CY, Sung JM, Chang CM, Chen PL, Lee CC, Wu YH, Lin HJ, Ko WC (2013) Cytomegalovirus disease in nonimmunocompromised, human immunodeficiency virus-negative adults with chronic kidney disease. J Microbiol Immunol Infect. doi:10.1016/j.jmii.2013.01.011

    Google Scholar 

  20. Reusser P, Attenhofer R, Hebart H, Helg C, Chapuis B, Einsele H (1997) Cytomegalovirus-specific T-cell immunity in recipients of autologous peripheral blood stem cell or bone marrow transplants. Blood 89:3873–3879

    PubMed  CAS  Google Scholar 

  21. Whitley RJ, Jacobson MA, Friedberg DN, Holland GN, Jabs DA, Dieterich DT, Hardy WD, Polis MA, Deutsch TA, Feinberg J, Spector SA, Walmsley S, Drew WL, Powderly WG, Griffiths PD, Benson CA, Kessler HA (1998) Guidelines for the treatment of cytomegalovirus diseases in patients with AIDS in the era of potent antiretroviral therapy: recommendations of an international panel. International AIDS Society-USA. Arch Intern Med 158:957–969

    Article  PubMed  CAS  Google Scholar 

  22. Lim SH, Pathapati S, Langevin J, Hoot A (2012) Severe CMV reactivation and gastritis during treatment of follicular lymphoma with bendamustine. Ann Hematol 91:643–644. doi:10.1007/s00277-011-1307-z

    Article  PubMed  Google Scholar 

  23. Yeh YM, Chen YP, Wu HC, Su WC, Chen TY (2009) Cytomegalovirus-related neutropenic enterocolitis with negative CMV antigenemia as the initial presentation in an acute myeloid leukemia patient. Ann Hematol 88:279–280. doi:10.1007/s00277-008-0596-3

    Article  PubMed  Google Scholar 

  24. Stuck AE, Minder CE, Frey FJ (1989) Risk of infectious complications in patients taking glucocorticosteroids. Rev Infect Dis 11:954–963

    Article  PubMed  CAS  Google Scholar 

  25. Saag KG, Koehnke R, Caldwell JR, Brasington R, Burmeister LF, Zimmerman B, Kohler JA, Furst DE (1994) Low dose long-term corticosteroid therapy in rheumatoid arthritis: an analysis of serious adverse events. Am J Med 96:115–123

    Article  PubMed  CAS  Google Scholar 

  26. Takizawa Y, Inokuma S, Tanaka Y, Saito K, Atsumi T, Hirakata M, Kameda H, Hirohata S, Kondo H, Kumagai S, Tanaka Y (2008) Clinical characteristics of cytomegalovirus infection in rheumatic diseases: multicentre survey in a large patient population. Rheumatology (Oxford) 47:1373–1378. doi:10.1093/rheumatology/ken231

    Article  CAS  Google Scholar 

  27. Lee HS, Park JY, Shin SH, Kim SB, Lee JS, Lee A, Ye BJ, Kim YS (2012) Herpesviridae viral infections after chemotherapy without antiviral prophylaxis in patients with malignant lymphoma: incidence and risk factors. Am J Clin Oncol 35:146–150. doi:10.1097/COC.0b013e318209aa41

    Article  PubMed  Google Scholar 

  28. Chang H, Tang TC, Hung YS, Lin TL, Kuo MC, Wang PN (2011) Cytomegalovirus infection in non-transplant patients with hematologic neoplasms: a case series. Chang Gung Med J 34:65–74

    PubMed  Google Scholar 

  29. Wadhawan M, Gupta S, Goyal N, Vasudevan KR, Makki K, Dawar R, Sardana R, Lal N, Kumar A (2012) Cytomegalovirus infection: its incidence and management in cytomegalovirus-seropositive living related liver transplant recipients: a single-center experience. Liver Transpl 18:1448–1455. doi:10.1002/lt.23540

    Article  PubMed  Google Scholar 

  30. Al-Hajjar S, Al Seraihi A, Al Muhsen S, Ayas M, Al Jumaah S, Al Jefri A, Shoukri M, El Solh H (2011) Cytomegalovirus infections in unrelated cord blood transplantation in pediatric patients: incidence, risk factors, and outcomes. Hematol Oncol Stem Cell Ther 4:67–72

    Article  PubMed  Google Scholar 

  31. Lang DJ (1972) Cytomegalovirus infections in organ transplantation and post transfusion. An hypothesis. Arch Gesamte Virusforsch 37:365–377

    Article  PubMed  CAS  Google Scholar 

  32. Adler SP, Baggett J, McVoy M (1985) Transfusion-associated cytomegalovirus infections in seropositive cardiac surgery patients. Lancet 2:743–747

    Article  PubMed  CAS  Google Scholar 

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Funding

This work was not financially supported.

Conflict of interest

All authors: no reported conflicts.

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Authors and Affiliations

  1. Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, Republic of Korea

    J.-H. Ko, K. R. Peck, W. J. Lee, K. Huh, J. R. Yoo, K. Kim, S. Y. Cho, Y. E. Ha, C.-I. Kang, D. R. Chung & J.-H. Song

  2. Division of Hematology-Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    C. W. Jung

  3. Division of Gastroenterology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    Y.-H. Kim

  4. Department of Laboratory Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    N. Y. Lee

  5. Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    K.-M. Kim

Authors
  1. J.-H. Ko
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  2. K. R. Peck
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  3. W. J. Lee
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  4. K. Huh
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  5. J. R. Yoo
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  6. K. Kim
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  7. S. Y. Cho
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  8. Y. E. Ha
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  9. C.-I. Kang
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  10. D. R. Chung
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  11. C. W. Jung
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  12. Y.-H. Kim
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  13. N. Y. Lee
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  14. K.-M. Kim
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  15. J.-H. Song
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Correspondence to K. R. Peck.

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Ko, JH., Peck, K.R., Lee, W.J. et al. Risk factors for cytomegalovirus gastrointestinal diseases in adult patients with cancer. Eur J Clin Microbiol Infect Dis 33, 1847–1853 (2014). https://doi.org/10.1007/s10096-014-2107-x

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  • DOI: https://doi.org/10.1007/s10096-014-2107-x

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