Cytomegalovirus infection in inflammatory bowel disease is not associated with worsening of intestinal inflammatory activity.
BACKGROUND
Cytomegalovirus is highly prevalent virus and usually occurs in immunocompromised patients. The pathophysiology and treatment of inflammatory bowel disease often induce a state of immunosuppression. Because this, there are still doubts and controversies about the relationship between inflammatory bowel disease and cytomegalovirus.


OBJECTIVE
Evaluate the frequency of cytomegalovirus in patients with inflammatory bowel disease and identify correlations.


METHODS
Patients with inflammatory bowel disease underwent an interview, review of records and collection of blood and fecal samples. The search for cytomegalovirus was performed by IgG and IgM blood serology, by real-time PCR in the blood and by qualitative PCR in feces. Results were correlated with red blood cell levels, C-reactive protein levels, erythrocyte sedimentation rates and fecal calprotectin levels for each patient.


RESULTS
Among the 400 eligible patients, 249 had Crohn's disease, and 151 had ulcerative colitis. In the group of Crohn's disease, 67 of the patients had moderate or severe disease, but 126 patients presented with active disease, based on the evaluation of the fecal calprotectin. In patients with ulcerative colitis, only 21 patients had moderate disease, but 76 patients presented with active disease, based on the evaluation of the fecal calprotectin. A large majority of patients had positive CMV IgG. Overall, 10 patients had positive CMV IgM, and 9 patients had a positive qualitative detection of CMV DNA by PCR in the feces. All 400 patients returned negative results after the quantitative detection of CMV DNA in blood by real-time PCR. Analyzing the 19 patients with active infections, we only found that such an association occurred with the use of combined therapy (anti-TNF-alpha + azathioprine).


CONCLUSIONS
The findings show that latent cytomegalovirus infections are frequent and active cytomegalovirus infection is rare. We did not find any association between an active infection of CMV and inflammatory bowel disease activity.
Departamento de Gastroenterologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - LIM 07, São Paulo, São Paulo, Brazil.
Alexandre Medeiros
AM
do Carmo
Departamento de Gastroenterologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - LIM 07, São Paulo, São Paulo, Brazil.
Fabiana Maria
FM
Santos
Departamento de Gastroenterologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - LIM 07, São Paulo, São Paulo, Brazil.
Carmen Lucia
CL
Ortiz-Agostinho
Departamento de Gastroenterologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - LIM 07, São Paulo, São Paulo, Brazil.
Iêda
I
Nishitokukado
Departamento de Gastroenterologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - LIM 07, São Paulo, São Paulo, Brazil.
Cintia S
CS
Frota
Departamento de Gastroenterologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - LIM 07, São Paulo, São Paulo, Brazil.
Flavia Ubeda
FU
Gomes
Departamento de Gastroenterologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - LIM 07, São Paulo, São Paulo, Brazil.
André Zonetti de Arruda
AZ
Leite
Instituto de Medicina Tropical e Departamento de Doenças Infecciosas e Parasitarias (LIM-HC) da Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil.
Claudio Sérgio
CS
Pannuti
Instituto de Medicina Tropical e Hospital das Clínicas da Faculdade de Medicina (LIM-HC), Universidade de São Paulo, São Paulo, São Paulo, Brazil.
Lucy Santos Vilas
LS
Boas
Departamento de Cirurgia do Serviço de Cirurgia do Cólon Reto e Ânus, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil.
Magaly Gemio
MG
Teixeira
Departamento de Gastroenterologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - LIM 07, São Paulo, São Paulo, Brazil.
Aytan Miranda
AM
Sipahi
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003587:Cytomegalovirus / Q000302:isolation & purification; D003586:Cytomegalovirus Infections / Q000150:complications / Q000473:pathology*; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D007249:Inflammation / Q000150:complications / Q000473:pathology* / Q000821:virology; D015212:Inflammatory Bowel Diseases / Q000150:complications / Q000473:pathology* / Q000821:virology; D007422:Intestines / Q000473:pathology* / Q000821:virology; D008297:Male; D008875:Middle Aged; D055815:Young Adult