title: Coexisting cytomegalovirus infection in immunocompetent patients with Clostridium difficile colitis.
abstract: Cytomegalovirus (CMV) colitis usually occurs in immunocompromised patients with human immunodeficiency virus infection, organ transplantation, and malignancy receiving chemotherapy or ulcerative colitis receiving immunosuppressive agents. However, CMV colitis is increasingly recognized in immunocompetent hosts. Notably, CMV colitis coexisting with Clostridium difficile infection (CDI) in apparently healthy individuals has been published in recent years, which could result in high morbidity and mortality. CMV colitis is a rare but possible differential diagnosis in immunocompetent patients with abdominal pain, watery, or especially bloody diarrhea, which could be refractory to standard treatment for CDI. As a characteristic of CDI, however, pseudomembranous colitis may be only caused by CMV infection. Real-time CMV-polymerase chain reaction (PCR) for blood and stool samples may be a useful and noninvasive diagnostic strategy to identify CMV infection when treatment of CDI eventually fails to show significant benefits. Quantitative CMV-PCR in mucosal biopsies may increase the diagnostic yield of traditional histopathology. CMV colitis is potentially life-threatening if severe complications occur, such as sepsis secondary to colitis, massive colorectal bleeding, toxic megacolon, and colonic perforation, so that may necessitate pre-emptive antiviral treatment for those who are positive for CMV-PCR in blood and/or stool samples while pending histological diagnosis.
authors: Department of Intensive Care Medicine, Chi Mei Medical Center, Tainan City, Taiwan.
authors: Khee-Siang
authors: KS
authors: Chan
authors: Department of Pathology, Chi Mei Medical Center, Tainan City, Taiwan; Department of Pathology, Taipei Medical University, Taipei City, Taiwan.
authors: Wen-Ying
authors: WY
authors: Lee
authors: Department of Intensive Care Medicine, Chi Mei Medical Center, Tainan City, Taiwan; Department of Medicine, Taipei Medical University, Taipei City, Taiwan. Electronic address: yuleon_md@yahoo.com.tw.
authors: Wen-Liang
authors: WL
authors: Yu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D016360:Clostridioides difficile / Q000302:isolation & purification; D003015:Clostridium Infections / Q000382:microbiology / Q000628:therapy*; D060085:Coinfection; D003092:Colitis / Q000628:therapy* / Q000821:virology*; D003587:Cytomegalovirus / Q000302:isolation & purification; D003586:Cytomegalovirus Infections / Q000628:therapy* / Q000821:virology; D004761:Enterocolitis, Pseudomembranous / Q000382:microbiology / Q000628:therapy*; D000069467:Fecal Microbiota Transplantation; D005260:Female; D015774:Ganciclovir / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction
chemical_list: D000900:Anti-Bacterial Agents; D000998:Antiviral Agents; D015774:Ganciclovir
keywords: C. difficile infection; Clostridium difficile; colitis; cytomegalovirus; immunocompetent