Prevalence of Cytomegalovirus infections in ulcerative rettocolitis patients, using PCR in whole blood and biopsies

Background.The relationship between CMV and inflammatory bowel disease (IBD) is not yet fully understood; the viral reactivation could be related to the prolonged steroid treatment of patients with ulcerative colitis (UC). Study Design. Our study was conducted on 25 patients with reactivation of UC, all were screened for CMV research. CMV DNA was carried out by automatic extraction in whole blood and intestinal biopsies and amplified by RealTime PCR. Objectives.We assessed the prevalence of CMV infection and clinical outcome, particularly in CMV positive patients treated with antiviral therapy. Results. CMV DNA was detected in 11/25 patients (44%), 7 positive in both blood and biopsies, 2 positive biopsies, 2 positive in blood, but low charge. 14 CMV DNA negative patients: 8 had remission with conventional therapy, 6 treated with IFX (of which 2 underwent colectomy). 11 CMV DNA positive patients: 7 had remission with conventional therapy, 3 treated with IFX+Ganciclovir, 1 with Ganciclovir, obtaining negative viral load and clinical remission. Conclusion. The literature data available on the association CMV - IBD are partly conflicting. The decision on treatment with antiviral therapy of CMV positive patients is based on course of disease. On the other hand, some patients had remission without antiviral therapy. We considered viral load and resistance to conventional therapy to admit patients into antiviral treatment, getting acute phase remission. There are many unanswered questions regarding management of CMV reactivation in UC patients, which need long-term follow-up studies and larger population.