title: Steroid-refractory inflammatory bowel disease is a risk factor for CMV infection.
abstract: OBJECTIVE
  Patients with inflammatory bowel disease (IBD) show increased the prevalence of cytomegalovirus (CMV) infection due to the severity of the disease and the immunosuppressive treatments they receive. The aim of this study was to determine the prevalence of CMV infection in IBD patients and identify the risk factors for CMV infection with different demographic characteristics in IBD patients.
  
  
  METHODS
  We enrolled 85 patients diagnosed with IBD (43 with ulcerative colitis (UC) and 42 with Crohn's disease (CD)) in this prospective study. The clinical disease activities of UC and CD were assessed using Truelove-Witts and Crohn's disease activity index (CDAI). CMV infection was assessed by detection of DNA using real-time polymerase chain reaction (PCR) in blood samples and quantitative PCR in colonic biopsy specimens and by detection of inclusion bodies using hematoxylin-eosin staining.
  
  
  RESULTS
  Thirteen patients with IBD exhibited concomitant CMV infection. CMV infection was not detected in any of the patients in remission. Viral loads measured in the colonic mucosa of infected patients ranged from 800-7000 genome copies/mL total extracted DNA. The mean serum CMV DNA level was 1694 ± 910 copies/mL (range: 800-3800). The rate of steroid resistance in CMV-positive cases was significantly higher than that in CMV-negative cases (p = 0.001). CD with acute exacerbation was a risk factor for CMV disease (p = 0.04). All of the CMV-positive patients received immunosuppressive treatments.
  
  
  CONCLUSIONS
  CMV infection should be suspected in steroid-resistant UC and CD. Antiviral treatment improved the clinical outcome in steroid-resistant IBD cases with serum CMV DNA levels above 1000 copies/mL.
authors.affiliation: Department of Internal Medicine, Division of Gastroenterology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey. filiakyuz@hotmail.com.
authors.forename: A C
authors.initials: AC
authors.lastname: Ormeci
authors.forename: F
authors.initials: F
authors.lastname: Akyuz
authors.forename: B
authors.initials: B
authors.lastname: Baran
authors.forename: O M
authors.initials: OM
authors.lastname: Soyer
authors.forename: S
authors.initials: S
authors.lastname: Gokturk
authors.forename: M
authors.initials: M
authors.lastname: Onel
authors.forename: D
authors.initials: D
authors.lastname: Onel
authors.forename: A
authors.initials: A
authors.lastname: Agacfidan
authors.forename: M
authors.initials: M
authors.lastname: Demirci
authors.forename: G
authors.initials: G
authors.lastname: Yegen
authors.forename: M
authors.initials: M
authors.lastname: Gulluoglu
authors.forename: C
authors.initials: C
authors.lastname: Karaca
authors.forename: K
authors.initials: K
authors.lastname: Demir
authors.forename: F
authors.initials: F
authors.lastname: Besisik
authors.forename: S
authors.initials: S
authors.lastname: Kaymakoglu
mesh_terms: D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use; D003586:Cytomegalovirus Infections / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D015212:Inflammatory Bowel Diseases / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D017211:Treatment Failure; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D005938:Glucocorticoids; D007166:Immunosuppressive Agents