Cytomegalovirus in pediatric inflammatory bowel disease patients with acute severe colitis - 11/11/21
, John Whitworth a, b , Jie Zhang a, d , Bindiya Bagga a, c Bienvenue sur EM-consulte, la référence des professionnels de santé.
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Highlights |
• | There is increased prevalence of cytomegalovirus in pediatric inflammatory bowel disease patients with acute severe colitis. |
• | Viral burden on histopathology is not predictive of response to therapy or long-term outcomes. |
• | Lymphopenia is not a reliable marker of cytomegalovirus colitis in pediatric inflammatory bowel disease. |
Abstract |
Background |
The prevalence and significance of cytomegalovirus (CMV) colitis in pediatric acute severe colitis is unknown. The aim of this study was to determine the prevalence of CMV in colonic mucosa of children with acute severe refractory colitis and compare the clinical characteristics and outcomes of CMV positive and negative patients.
Methods |
In a case-control study, colonic biopsy specimens from children with severe refractory colitis were tested for CMV, and matched with non-refractory IBD controls. We characterized CMV positive patients by assessing laboratory values, concurrent medications, and need for surgery as compared with CMV negative refractory colitis patients.
Results |
Colonic biopsies from 96 patients were evaluated for CMV; 48 with severe refractory colitis, and 48 non-refractory controls. There was an increased prevalence of CMV in severe refractory colitis [7/48 (14.6%), P < 0.0001]; all were previously CMV negative. Viral DNA burden on immunohistochemistry was not predictive of response to antiviral therapy or need for surgery at 12 months. Lymphopenia was seen in all CMV positive patients, but this did not demonstrate statistical significance (P = 0.09). We did not see an association between azathioprine or infliximab use and the need for surgery at 12 months.
Conclusions |
There is an increased prevalence of CMV in colonic biopsies of pediatric patients with severe refractory colitis. Viral burden does not predict clinical outcomes or subsequent need for colectomy.
Le texte complet de cet article est disponible en PDF.Keywords : Inflammatory bowel disease, Colitis, Cytomegalovirus
Plan
Vol 45 - N° 6
Article 101625- novembre 2021 Retour au numéro
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