Skip to main content

Advertisement

Log in

Gastrointestinal cytomegalovirus disease in the immunocompromised patient

  • Published:
Current Gastroenterology Reports Aims and scope Submit manuscript

Abstract

Cytomegalovirus (CMV) has emerged as a significant opportunistic pathogen in the era of immunosuppression. CMV was a common cause of gastrointestinal disease in AIDS patients, but the introduction of highly active antiretroviral therapy has led to a dramatic decline in AIDS-related disease. Among patients with solid organ transplants, CMV has become an increasingly important cause of gastrointestinal disease as more routine use of early CMV prophylaxis has increased delayed-onset disease, which is often tissue invasive at presentation. The role of CMV in inflammatory bowel disease is controversial; treatment may be indicated in selected cases of steroid-refractory disease with evidence of CMV. Diagnosis of gastrointestinal CMV disease generally requires endoscopic biopsy with histologic confirmation. CMV culture of biopsy material may be falsely positive because of contamination from latently infected cells. The standard induction treatment of gastrointestinal CMV disease uses intravenous ganciclovir, though the use of oral valganciclovir is increasing, especially for long-term maintenance or suppression therapy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References and Recommended Reading

  1. Centers for Disease Control and Prevention: About CMV. Available at http://www.cdc.gov/cmv/facts.htm. Accessed March 2008.

  2. Crumpacker CS: Cytomegalovirus. In Principles and Practice of Infectious Diseases, edn 6. Edited by Mandell GL, Bennett JR, Dolin R. Philadelphia: Churchill Livingstone; 2005:1786–1801.

    Google Scholar 

  3. Palella FJ, Delaney KM, Moorman AC: Declining morbidity and mortality among patients with advanced human immuno-deficiency virus infection. HIV Outpatient Study Investigators. N Engl J Med 1998, 338:853–860.

    Article  PubMed  Google Scholar 

  4. Kim S, Snider JJ, Gill MJ: Cytomegalovirus disease in HIV infection: twenty years of a regional population’s experience. Clin Infect Dis 2006, 42:1808–1809.

    Article  PubMed  Google Scholar 

  5. Yust I, Fox Z, Burke M: Retinal and extraocular cytomegalovirus end-organ disease in HIV-infected patients in Europe: a EuroSIDA study, 1994–2001. Eur J Clin Microbiol Infect Dis 2004, 7:550–559.

    Google Scholar 

  6. Knox TA, Spiegelman D, Skinner SC: Diarrhea and abnormalities of gastrointestinal function in a cohort of men and women with HIV infection. Am J Gastroenterol 2000, 95:3482–3489.

    Article  PubMed  CAS  Google Scholar 

  7. Benson CA, Kaplan JE, Masur H, et al.: Treating opportunistic infections among HIV-infected adults and adolescents. MMWR Recomm Rep 2004, 53:1–112.

    PubMed  Google Scholar 

  8. Mönkemüller KE, Lazenby AJ, Lee DH, et al.: Occurrence of gastrointestinal opportunistic disorders in AIDS despite the use of highly active antiretroviral therapy. Dig Dis Sci 2005, 50:230–234.

    Article  PubMed  Google Scholar 

  9. Kirk O, Reiss P, Uberti-Foppa C, et al.: Safe interruption of maintenance therapy against previous infection with four common HIV-associated opportunistic pathogens during potent antiretroviral therapy. Ann Intern Med 2002, 137:239–250.

    PubMed  Google Scholar 

  10. Wilcox CM, Chalasani N, Lazenby A, et al.: Cytomegalovirus colitis in acquired immunodeficiency syndrome: a clinical and endoscopic study. Gastrointest Endosc 1998, 48:39–43.

    Article  PubMed  CAS  Google Scholar 

  11. Dieterich DT, Rahmin M: Cytomegalovirus colitis in AIDS: presentation in 44 patients and a review of the literature. J Acquir Immune Defic Syndr 1991, 4(Suppl 1):S29–S35.

    PubMed  Google Scholar 

  12. DeRodriguez CV, Fuhrer J, Lake-Bakaar G: Cytomegalovirus colitis in patients with acquired immunodeficiency syndrome. J R Soc Med 1994, 87:203–205.

    PubMed  CAS  Google Scholar 

  13. Goodgame RW: Gastrointestinal cytomegalovirus disease. Ann Intern Med 1993, 119:924–935.

    PubMed  CAS  Google Scholar 

  14. Oldfield EC: Evaluation of chronic diarrhea in patients with human immunodeficiency virus infection. Rev Gastroenterol Disord 2002, 2:176–188.

    PubMed  Google Scholar 

  15. Kearney DJ, Steuerwald M, Koch J, et al.: A prospective study of endoscopy in HIV-associated diarrhea. Am J Gastroenterol 1999, 95:596–602.

    Article  Google Scholar 

  16. Bini EJ, Weinshel EH: Endoscopic evaluation of chronic human immunodeficiency virus-related diarrhea: Is colonos-copy superior to flexible sigmoidoscopy? Am J Gastroenterol 1998, 93:56–60.

    Article  PubMed  CAS  Google Scholar 

  17. Chamberlain RS, Atkins S, Saini N, et al.: Ileal perforation caused by cytomegalovirus infection in a critically ill adult. J Clin Gastroenterol 2000, 30:432–435.

    Article  PubMed  CAS  Google Scholar 

  18. Connolly GM, Forbes A, Gleason JA, et al.: Investigation of upper gastrointestinal symptoms in patients with AIDS. AIDS 1989, 3:453–456.

    Article  PubMed  CAS  Google Scholar 

  19. Bonacini M, Young T, Laine L: The causes of esophageal symptoms in human immunodeficiency virus infection. Arch Intern Med 1991, 1567–1572.

  20. Enns R: AIDS cholangiopathy: “an endangered disease” [editorial]. Am J Gastroenterol 2003, 98:2111–2112.

    PubMed  Google Scholar 

  21. Jacobson MA, Cello JP, Sande MA: Cholestasis and disseminated cytomegalovirus disease in patients with the acquired immunodeficiency syndrome. Am J Med 1988, 84:218–224.

    Article  PubMed  CAS  Google Scholar 

  22. Ko WF, Cello JP, Rogers SJ, et al.: Prognostic factors for the survival of patients with AIDS cholangiopathy. Am J Gastroenterol 2003, 98:2176–2181.

    Article  PubMed  Google Scholar 

  23. Mönkemüller KE, Bussian AH, Lazenby AJ, et al.: Special histologic stains are rarely beneficial for the evaluation of HIV-related gastrointestinal infections. Am J Clin Pathol 2000, 387–394.

  24. Beaugerie L, Cywiner-Golenzer C, Monfort L, et al.: Definition and diagnosis of cytomegalovirus colitis in patients infected by HIV. J Acquir Immune Defic Syndr Hum Retrovirol 1997, 14:423–429.

    PubMed  CAS  Google Scholar 

  25. Paya CV, Razonable RR: Cytomegalovirus infection after solid organ transplantation. In Transplant Infectious Diseases, edn 2. Edited by Bowden RA, Ljungman P, Paya CV. Philadelphia: Lippincott Williams & Wilkins; 2003:298–325.

    Google Scholar 

  26. Kalil AC, Levitsky J, Lyden E, et al.: Meta-analysis: the efficacy of strategies to prevent organ disease by cytomegalovirus in solid organ transplant recipients. Ann Intern Med 2005, 143:870–880.

    PubMed  Google Scholar 

  27. Arthurs SK, Eid AJ, Pederson RA, et al.: Delayed-onset primary cytomegalovirus disease and the risk of allograft failure and mortality after kidney transplantation. Clin Infect Dis 2008, 46:840–846.

    Article  PubMed  Google Scholar 

  28. Arthurs SK, Eid AJ, Pedersen RA, et al.: Delayed-onset primary cytomegalovirus disease after liver transplantation. Liver Transpl 2007, 13:1703–1709.

    Article  PubMed  Google Scholar 

  29. Kijpittayarit-Arthurs S, Eid AJ, Kremers WK, et al.: Clinical features and outcomes of delayed-onset primary cytomegalovirus disease in cardiac transplant recipients. J Heart Lung Transplant 2007, 26:1019–1024.

    Article  PubMed  Google Scholar 

  30. Limaye AP, Bakthavatsalam R, Kim HR: Late-onset cytomegalovirus disease in liver transplant recipients despite antiviral prophylaxis. Transplantation 2004, 78:1390–1396.

    Article  PubMed  Google Scholar 

  31. Potena L, Holweg CT, Chin C, et al.: Acute rejection and cardiac allograft vascular disease is reduced by suppression of subclinical cytomegalovirus infection. Transplantation 2006, 82:398–405.

    Article  PubMed  CAS  Google Scholar 

  32. Stripolli GF, Hodson EM, Jones C, et al.: Preemptive treatment for cytomegalovirus viremia to prevent cytomegalovirus disease in solid organ transplant recipients. Transplantation 2006, 81:139–145.

    Article  Google Scholar 

  33. Fica A, Cervera C, Perez N, et al.: Immunohistochemically proven cytomegalovirus end-organ disease in solid organ transplant patients: clinical features and usefulness of conventional diagnostic tests. Transpl Infect Dis 2007, 9:203–210.

    Article  PubMed  CAS  Google Scholar 

  34. Dummer JS: Cytomegalovirus infection after liver transplantation: clinical manifestations and strategies for prevention. Rev Infect Dis 1990, 12(Suppl 7):S767–S775.

    PubMed  Google Scholar 

  35. Torres HA, Kontoyiannis DP, Bodey GP, et al.: Gastrointestinal cytomegalovirus disease in patients with cancer: a two decade experience in a tertiary care cancer center. Eur J Cancer 2005, 41:2268–2279.

    Article  PubMed  Google Scholar 

  36. Van Burik JA, Lawatsch EJ, DeFor TE, et al.: Cytomegalovirus enteritis among hematopoietic stem cell transplant recipients. Biol Blood Marrow Transplant 2001, 7:674–679.

    Article  PubMed  Google Scholar 

  37. Ljungeman P, Griffiths P, Paya C: Definitions of cytomegalovirus infection and disease in transplant recipients. Clin Infect Dis 2002, 34:1094–1097.

    Article  Google Scholar 

  38. Peter A, Telkes G, Varga M, et al.: Endoscopic diagnosis of cytomegalovirus infection of upper gastrointestinal tract in solid organ transplant recipients: Hungarian single-center experience. Clin Transplant 2004, 18:580–584.

    Article  PubMed  Google Scholar 

  39. Pereyra F, Rubin R: Prevention and treatment of cytomegalovirus infection in solid organ transplant recipients. Curr Opin Infect Dis 2004, 17:357–371.

    Article  PubMed  CAS  Google Scholar 

  40. Humar A, Mazzuli T, Moussa G, et al.: Clinical utility of cytomegalovirus (CMV) serology testing in high-risk D+/R-transplant recipients. Am J Transplant 2005, 5:1065–1070.

    Article  PubMed  Google Scholar 

  41. Rowshani AT, Bemelman FJ, van Leeuwen EM, et al.: Clinical and immunologic aspects of cytomegalovirus infection in solid organ transplant recipients. Transplantation 2005, 79:381–386.

    Article  PubMed  Google Scholar 

  42. Koskinen PK, Nieminen MS, Mattila SP, et al.: The correlation between symptomatic CMV infection and CMV antigenemia in heart allograft recipients. Transplantation 1993, 55:547–551.

    Article  PubMed  CAS  Google Scholar 

  43. Abecassis MM, Koffron AJ, Kaplan B, et al.: The role of PCR in the diagnosis and management of CMV in solid organ recipients: What is the predictive value for the development of disease and should PCR be used to guide antiviral therapy? Transplantation 1997, 63:275–279.

    Article  PubMed  CAS  Google Scholar 

  44. Geddes CC, Church CC, Collidge T, et al.: Management of cytomegalovirus infection by weekly surveillance after renal transplant: analysis of cost, rejection and renal function. Nephrol Dial Transplant 2003, 18:1891–1898.

    Article  PubMed  Google Scholar 

  45. Humar A, Paya P, Pescovitz MD, et al.: Clinical utility of cytomegalovirus viral load testing for predicting CMV disease in D+/R− solid organ transplant recipients. Am J Transplant 2004, 4:644–649.

    Article  PubMed  Google Scholar 

  46. Gottschalk S, Rooney CM, Heslop HE: Post-transplant lymphoproliferative disorders. Annu Rev Med 2005, 56:29–44.

    Article  PubMed  CAS  Google Scholar 

  47. Adani GL, Baccarani U, Lorenzin D, et al.: De novo gastro-intestinal tumours after renal transplantation: role of CMV and EBV viruses. Clin Transplant 2006, 20:457–460.

    Article  PubMed  Google Scholar 

  48. Powell RD, Warner NE, Levine RS, et al.: Cytomegalic inclusion disease and ulcerative colitis; report of a case in a young adult. Am J Med 1961, 30:334–340.

    Article  PubMed  CAS  Google Scholar 

  49. Hommes DW, Sterringa G, van Deventer SJ, et al.: The pathogenicity of cytomegalovirus in inflammatory bowel disease: a systematic review and evidence-based recommendations for future research. Inflamm Bowel Dis 2004, 10:245–250.

    Article  PubMed  Google Scholar 

  50. Cottone M, Pietrosi G, Martorana A, et al.: Prevalence of cytomegalovirus infection in severe refractory ulcerative and Crohn’s colitis. Am J Gastroenterol 2001, 96:773–775.

    Article  PubMed  CAS  Google Scholar 

  51. Kambham N, Vij K, Cartwright CA, et al.: Cytomegalovirus infection in steroid refractory ulcerative colitis: a case control study. Am J Surg Pathol 2004, 28:365–373.

    Article  PubMed  Google Scholar 

  52. Dimitroulia E, Spanakis N, Konstantinidou A: Frequent detection of cytomegalovirus in the intestine of patients with inflammatory bowel disease. Inflamm Bowel Dis 2006, 12:879–884.

    Article  PubMed  Google Scholar 

  53. Kandiel A, Lashner B: Cytomegalovirus colitis complicating inflammatory bowel disease. Am J Gastroenterol 2006, 101:2857–2865.

    Article  PubMed  CAS  Google Scholar 

  54. Criscuoli V, Casa A, Orlando A, et al.: Severe acute colitis associated with CMV: a prevalence study. Dig Liver Dis 2004, 36:818–820.

    Article  PubMed  CAS  Google Scholar 

  55. Pescovitz MD, Rabkin J, Merion RM, et al.: Valganciclovir results in improved oral absorption of ganciclovir in liver transplant recipients. Antimicrob Agents Chemother 2000, 44:2811–2815.

    Article  PubMed  CAS  Google Scholar 

  56. Martin D, Sierra-Madero J, Walmsley S, et al.: A controlled trial of valganciclovir as induction therapy for cytomegalovirus retinitis. N Engl J Med 2002, 346:1119–1126.

    Article  PubMed  CAS  Google Scholar 

  57. Len O, Gavaldà J, Aguado JM, et al.: Valganciclovir as treatment for cytomegalovirus disease in solid organ transplant recipients. Clin Infect Dis 2008, 46:20–27.

    Article  PubMed  CAS  Google Scholar 

  58. Asberg A, Humar A, Rollag H, et al.: Oral valganciclovir is noninferior to intravenous ganciclovir for the treatment of cytomegalovirus disease in solid organ transplant recipients. Am J Transplant 2007, 7:2106–2113.

    Article  PubMed  CAS  Google Scholar 

  59. Boivin G, Goyette N, Gilbert C, et al.: Clinical impact of ganciclovir-resistant cytomegalovirus infections in solid-organ transplant patients. Transpl Infect Dis 2005, 7:166–170.

    Article  PubMed  CAS  Google Scholar 

  60. Razonable RR, Paya CV: Valganciclovir for the prevention and treatment of cytomegalovirus disease in immunocompromised hosts. Expert Rev Anti Infect Ther 2004, 2:27–41.

    Article  PubMed  CAS  Google Scholar 

  61. Berenguer J, Mallolas J: Intravenous cidofovir for compassionate use in AIDS patients with cytomegalovirus retinitis. Spanish Cidofovir Study Group. Clin Infect Dis 2000, 30:182–184.

    Article  PubMed  CAS  Google Scholar 

  62. Hodson EM, Jones CA, Strippoli GF, et al.: Immunoglobulins, vaccines, or interferon for preventing cytomegalovirus disease in solid-organ transplants. Cochrane Database Syst Rev 2007, CD 005129.

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Allison L. Baroco.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Baroco, A.L., Oldfield, E.C. Gastrointestinal cytomegalovirus disease in the immunocompromised patient. Curr Gastroenterol Rep 10, 409–416 (2008). https://doi.org/10.1007/s11894-008-0077-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11894-008-0077-9

Keywords

Navigation