CMV gastroenteritis/colitis
Alternative names:
colitis - cytomegalovirus; gastroenteritis - cytomegalovirus;
esophagitis - cytomegalovirus; gastrointestinal CMV disease
Definition:
An inflammation of the stomach or intestine caused by infection
with cytomegalovirus (CMV).
Causes, incidence, and risk factors:
Cytomegalovirus (CMV) is present worldwide, and infections
are very common. In the third world, CMV infection occurs
at or near the time of birth, while in more developed countries,
infection is slightly delayed and occurs throughout infancy,
childhood, and through adolescence. CMV is transmitted in
situations of close interpersonal contact. The virus has been
isolated in nearly all organs and body fluids in the human
body. By adulthood, up to eighty percent have anti-CMV antibodies,
which signifies prior infection.
CMV infection in normal people usually produces no symptoms;
however, a flu-like syndrome can occur. In rare instances,
more severe CMV infection involving the GI tract has been
reported in people with normal immunity. Patients with CMV
colitis manifest symptoms such as fever, bloody diarrhea and
abdominal pain. When CMV colitis occurs in patients with normal
immune systems, they typically have other serious medical
problems such as severe trauma, renal failure, or severe infection.
A special category of patients who have inflammatory bowel
disease, such as Crohn's Disease and ulcerative colitis, can
suffer from gastrointestinal CMV infections. In fact, a small
number of patients who have undergone colectomy for ulcerative
colitis have been found to have symptomatic CMV infections
in their remaining intestine.
Symptomatic CMV infections of the GI tract are more common
in persons with impaired immune systems, and in these patients
serious infections can occur. People at risk include those
with AIDS, recipients
of organ transplants (overall incidence between 2-16%) or
bone marrow transplants (overall incidence between 32-52%),
and people receiving chemotherapy
or other immunosuppressive treatments. Immunocompromised people
who develop CMV gastroenteritis
and colitis can have
severe illness.
Gastrointestinal CMV Infection
Gastrointestinal CMV disease may be localized or widespread.
Ulcers can occur in the
esophagus, stomach, small intestine, or colon. Additionally,
overt gastritis (inflammation of the stomach) and colitis
(inflammation of the colon) can also be seen. Typically, ulcerations
in the upper GI tract (esophagus, stomach) are associated
with symptoms of nausea and vomiting, pain on swallowing (odynophagia),
difficulty swallowing (dysphagia), or abdominal pain. When
the intestines are involved, the ulcerations may cause abdominal
pain, diarrhea, or bloody stools. More severe infections can
result in gastrointestinal
bleeding or perforation (a hole through the wall of the
infected organ).
Update Date: 05/08/00
Ronald J. Lew, MD Hospital of the University of Pennsylvania
Division, Gastroenterology - Fellow
VeriMed Healthcare Network
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