Infection with cytomegalovirus in patients with inflammatory bowel disease: prevalence, clinical significance and outcome.
Despite frequent use of immunosuppressive drugs in patients with inflammatory bowel disease (IBD) and reports of cytomegalovirus (CMV) infection following post-transplant immunosuppression, data on the frequency and clinical significance of CMV in patients with IBD are scant. Sixty-three patients with IBD (61 ulcerative colitis and two Crohn's disease) were evaluated for CMV using serology (IgM antibody, mu-capture ELISA), PCR for CMV DNA in colonic biopsy and histological assessment of haematoxylin and eosin-stained colonic biopsy. Positive result in any test was considered as CMV infection. Various parameters associated with CMV infection were analysed using univariate and multivariate analysis. Ten of 63 (15.8 %) patients (age 36.0 +/- 11.2 years, 31 female) were infected with CMV (DNA alone in four, IgM antibody alone in two and both in four, inclusion body in one). Patients with CMV infection were more often female (8/10 vs 23/53, P < 0.05), had pancolitis (10/10 vs 33/53, P < 0.05), histological activity (9/10 vs 17/53, P < 0.005) and used azathioprine (5/10 vs 7/53, P = 0.04; Fisher exact test for all). On multivariate analysis, female gender, pancolitis and histological activity were the independent factors associated with infection. Patients with CMV infection more often required surgical treatment for IBD (4/10 vs 4/53, P = 0.01) and had fatal outcome (3/10 vs 0/53, P = 0.003). CMV infection in patients with IBD may be common and is associated with poor outcome. PCR of rectal biopsy was the most sensitive method of detection followed by IgM antibody for diagnosis.
Kishore
Janak
J
Departments of Microbiology1, Gastroenterology2 and Pathology3, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India.
Ghoshal
Ujjala
U
Departments of Microbiology1, Gastroenterology2 and Pathology3, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India.
Ghoshal
Uday C
UC
Departments of Microbiology1, Gastroenterology2 and Pathology3, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India.
Krishnani
Narendra
N
Departments of Microbiology1, Gastroenterology2 and Pathology3, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India.
Kumar
Sanjay
S
Departments of Microbiology1, Gastroenterology2 and Pathology3, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India.
Singh
Manisha
M
Departments of Microbiology1, Gastroenterology2 and Pathology3, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India.
Ayyagari
Archana
A
Departments of Microbiology1, Gastroenterology2 and Pathology3, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India.
D000293:Adolescent; D000328:Adult; D000914:Antibodies, Viral / Q000097:blood; D001379:Azathioprine / Q000627:therapeutic use; D003106:Colon / Q000473:pathology / Q000821:virology; D003587:Cytomegalovirus / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification*; D003586:Cytomegalovirus Infections / Q000150:complications* / Q000821:virology; D004279:DNA, Viral / Q000032:analysis / Q000235:genetics; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007194:India; D015212:Inflammatory Bowel Diseases / Q000150:complications* / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D012307:Risk Factors
D000914:Antibodies, Viral; D004279:DNA, Viral; D007166:Immunosuppressive Agents; D001379:Azathioprine