Buckner F S, Pomeroy C
Infectious Disease Section (111F), Minneapolis VA Medical Center, Minnesota 55417.
Clin Infect Dis. 1993 Oct;17(4):644-56. doi: 10.1093/clinids/17.4.644.
Cytomegalovirus (CMV) infection of the gastrointestinal (GI) tract can cause serious disease in immunocompromised patients. Recipients of solid organ and bone marrow transplants, persons with malignancies, and those receiving immunosuppressive medications are at risk. When CMV infection of the GI tract causes disease, symptoms include pain, ulceration, bleeding, diarrhea, and perforation. All levels of the GI tract, from the oropharynx to the anus, may be involved. Pathological examination of involved gut typically reveals diffuse ulcerations and necrosis with scattered CMV inclusions, although a variety of other abnormalities have been described. Before the introduction of antiviral therapy effective against CMV, mortality was high. However, the use of ganciclovir or foscarnet has improved the prognosis of CMV disease of the GI tract dramatically. CMV infection should be included in the differential diagnosis of GI disease in immunocompromised patients, and the clinician should pursue appropriate diagnostic and therapeutic interventions aggressively.
胃肠道巨细胞病毒（CMV）感染可在免疫功能低下的患者中引发严重疾病。实体器官和骨髓移植受者、恶性肿瘤患者以及接受免疫抑制药物治疗的患者均有感染风险。当胃肠道CMV感染引发疾病时，症状包括疼痛、溃疡、出血、腹泻和穿孔。胃肠道从口咽到肛门的各个部位都可能受累。受累肠道的病理检查通常显示弥漫性溃疡和坏死，并伴有散在的CMV包涵体，不过也有其他多种异常情况的描述。在有效抗CMV抗病毒治疗出现之前，死亡率很高。然而，更昔洛韦或膦甲酸钠的使用显著改善了胃肠道CMV疾病的预后。免疫功能低下患者的胃肠道疾病鉴别诊断应包括CMV感染，临床医生应积极采取适当的诊断和治疗干预措施。
