Department of Intensive Care Medicine, Chi Mei Medical Center, Tainan City, Taiwan.
Department of Pathology, Chi Mei Medical Center, Tainan City, Taiwan; Department of Pathology, Taipei Medical University, Taipei City, Taiwan.
J Microbiol Immunol Infect. 2016 Dec;49(6):829-836. doi: 10.1016/j.jmii.2015.12.007. Epub 2016 Jan 12.
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.
巨细胞病毒（CMV）结肠炎通常发生于人类免疫缺陷病毒感染、器官移植和接受化疗的恶性肿瘤等免疫功能低下的患者，以及接受免疫抑制剂的溃疡性结肠炎患者。然而，越来越多的免疫功能正常的宿主也被发现患有 CMV 结肠炎。值得注意的是，近年来已发表了在无明显健康问题的个体中 CMV 结肠炎与艰难梭菌感染（CDI）共存的病例，这可能导致高发病率和死亡率。CMV 结肠炎是免疫功能正常的腹痛、水样或特别是血性腹泻患者的一种罕见但可能的鉴别诊断，可能对 CDI 的标准治疗有抗药性。然而，作为 CDI 的一个特征，假膜性结肠炎可能仅由 CMV 感染引起。当 CDI 的治疗最终没有明显获益时，对血液和粪便样本进行实时 CMV-聚合酶链反应（PCR）可能是一种有用且非侵入性的诊断策略，有助于识别 CMV 感染。对黏膜活检进行定量 CMV-PCR 可能会增加传统组织病理学的诊断效果。如果发生严重并发症，如结肠炎继发的败血症、大量结直肠出血、中毒性巨结肠和结肠穿孔等，CMV 结肠炎可能具有生命威胁，因此对于血液和/或粪便样本 CMV-PCR 阳性且等待组织学诊断的患者，可能需要进行预防性抗病毒治疗。
