| Theme |
Cytomegalovirus enterocolitis and Clostridium difficile infection |
| Title |
Therapy for cytomegalovirus infection in patients with inflammatory bowel disease : from active users of antiviral agents |
| Author |
Takumi Fukuchi |
Department of Gastroenterology and Hepatology, Osakafu Saiseikai Nakatsu Hospital |
| Author |
Satoshi Ubukata |
Department of Gastroenterology and Hepatology, Osakafu Saiseikai Nakatsu Hospital |
| Author |
Taro Iwatsubo |
Department of Gastroenterology and Hepatology, Osakafu Saiseikai Nakatsu Hospital |
| [ Summary ] |
Cytomegalovirus (CMV) is an exacerbating factor in patients with ulcerative colitis (UC). Several previous reports showed that the prognosis of patients with UC refractory to corticosteroids (CS) concomitant with CMV infection is poor. Therefore, an accurate and rapid diagnosis of colonic CMV reactivation is important in the management of patients with UC. Yoshino et al. reported that realtime polymerase chain reaction assay using colonic mucosa (mucosal-polymerase chain reaction [PCR]) was promising for detection of colonic CMV reactivation in the point of its high sensitivity. However, the clinical periods and characteristics of colonic CMV reactivation in UC patients are unclear. In 2013, we reported that 29.4 % of active UC cases without corticosteroids were diagnosed as CMV positive based on mucosal PCR screening results. However, 73.3 % of CMV-positive active UC cases without corticosteroids inducted remission by intensive granulocyte and monocyte adsorptive apheresis without antiviral agents. Thus, antiviral agents are not needed at the early clinical stage of colonic CMV reactivation in patients with active UC without corticosteroids because colonic CMV reactivation may not be an exacerbating factor in these patients. Meanwhile, several previous reports demonstrated the efficacy of antiviral agents for CMV infection in patients with refractory UC. Thus, the use antiviral agents may lead to improvement when CMV infection can become an exacerbating factor in patients with refractory UC. |