title: Cytomegalovirus colitis in immunocompetent critically ill patients.
abstract: OBJECTIVE
  Cytomegalovirus (CMV) is a ubiquitous virus and its reactivation may lead to CMV end-organ disease (CMV EOD) in immunocompromised patients and also in immunocompetent patients when they are critically ill. We aimed to investigate the frequency and the clinical features of proven CMV EOD in previously non-immunosuppressed patients admitted to our institution.
  
  
  METHODS
  From January 2000 to March 2013, the records of all patients with a histopathological diagnosis of CMV EOD at our teaching hospital were reviewed retrospectively. CMV EOD was diagnosed histologically by the identification of true cytomegalic viral inclusion involving endothelial, stromal, and/or epithelial cells on hematoxylin and eosin staining, and was subsequently confirmed by immunohistochemistry using specific antibody against CMV antigens. Immunocompromised patients were excluded.
  
  
  RESULTS
  CMV EOD manifesting as colitis was diagnosed in 14 previously immunocompetent intensive care unit (ICU) patients. The mean age of the patients was 64 years. All had co-morbidities and developed shock before CMV EOD. The major manifestation was gastrointestinal bleeding. The in-hospital mortality rate was 71.4% despite specific treatment with ganciclovir.
  
  
  CONCLUSIONS
  Despite being a rare condition, lower gastrointestinal bleeding in this profile of ICU patients could be the clinical manifestation of CMV colitis, and intensivists should be alert to this condition.
authors.affiliation: Infection Control Unit, Heart Institute (InCor), University of São Paulo Medical School, Dr. Eneas Carvalho de Aguiar avenue, 255, Cerqueira César, São Paulo 05403-000, Brazil.
authors.forename: Rinaldo F
authors.initials: RF
authors.lastname: Siciliano
authors.affiliation: Laboratory of Pathology, Heart Institute (InCor), University of São Paulo Medical School, Brazil.
authors.forename: Jussara B
authors.initials: JB
authors.lastname: Castelli
authors.affiliation: Division of Infectious and Parasitic Diseases, Clinical Hospital, University of São Paulo Medical School, Brazil. Electronic address: bruno_randi@yahoo.com.br.
authors.forename: Bruno A
authors.initials: BA
authors.lastname: Randi
authors.affiliation: Clinical Cardiology Unit, Heart Institute (InCor), University of São Paulo Medical School, Brazil.
authors.forename: Ricardo D
authors.initials: RD
authors.lastname: Vieira
authors.affiliation: Infection Control Unit, Heart Institute (InCor), University of São Paulo Medical School, Dr. Eneas Carvalho de Aguiar avenue, 255, Cerqueira César, São Paulo 05403-000, Brazil.
authors.forename: Tânia M V
authors.initials: TM
authors.lastname: Strabelli
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000998:Antiviral Agents / Q000627:therapeutic use; D015897:Comorbidity; D003422:Critical Care; D016638:Critical Illness / Q000453:epidemiology; D003587:Cytomegalovirus / Q000187:drug effects / Q000302:isolation & purification*; D003586:Cytomegalovirus Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D005260:Female; D015774:Ganciclovir / Q000627:therapeutic use; D017052:Hospital Mortality; D006801:Humans; D007121:Immunocompetence / Q000187:drug effects; D016867:Immunocompromised Host / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D000998:Antiviral Agents; D015774:Ganciclovir
keywords: Colitis; Critically ill; Cytomegalovirus; Intensive care