WordNet

any of a group of herpes viruses that enlarge epithelial cells and can cause birth defects; can affect humans with impaired immunological systems (同)CMV
inflammation of the colon (同)inflammatory_bowel_disease

PrepTutorEJDIC

結腸炎

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/12/24 20:31:40」(JST)

wiki en

Cytomegalovirus colitis, also known as CMV colitis, is an inflammation of the colon

Causes The infection is spread by saliva, urine, respiratory droplets, sexual contact, and blood transfusions. Most people are exposed to the virus in their lifetime, but it usually produces mild or no symptoms in healthy people.

However, serious CMV infections can occur in people with weakened immune systems. This includes patients receiving chemotherapy for cancer and patients on immune-suppressing medicines following an organ transplant.

In rare instances, more severe CMV infection involving the GI tract has been reported in people with a healthy immune system.

Diagnosis

The diagnosis of CMV colitis is based on serology, CMV antigen testing and colonscopy with biopsy. Clinical suspicion should be aroused in the setting of immunocompromised patient but it is much rarer in immunocompetent patient. Although it is known that CMV colitis is almost always caused by reactivation of latent CMV infection in immunocompromised patients, new infection of CMV or reinfection of different strain of CMV can cause colitis in immunocompetent hosts. Because asymptomatic CMV viremia and viruria is common and about 1/3 of symptomatic CMV infection is caused by reinfection of different strain of CMV, the diagnosis of CMV colitis needs more direct causality. It is practically achieved by colonoscopy or sigmoidoscopy tissue sampling and pathological evidence of CMV infection under microscope. Positive CMV IgG doesn't necessarily mean that it is reactivation of latent infection because of the possibility of reinfection of different strain.

Treatment

The usual treatment is antiretrovirals.^[1] Severe CMV colitis may lead a colectomy.^[2]

Risk factors

The systemic use of corticosteroids in the context of inflammatory bowel disease.^[1]

References

^ ^a ^b Kandiel A, Lashner B (December 2006). "Cytomegalovirus colitis complicating inflammatory bowel disease". Am. J. Gastroenterol. 101 (12): 2857–65. doi:10.1111/j.1572-0241.2006.00869.x. PMID 17026558.
^ Lawlor G, Moss AC (September 2010). "Cytomegalovirus in inflammatory bowel disease: pathogen or innocent bystander?". Inflamm. Bowel Dis. 16 (9): 1620–7. doi:10.1002/ibd.21275. PMID 20232408.

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

1. 成人の免疫正常宿主におけるサイトメガロウイルス感染の疫学、臨床症状、および治療 epidemiology clinical manifestations and treatment of cytomegalovirus infection in immunocompetent adults
2. AIDS関連サイトメガロウイルスによる胃腸疾患 aids related cytomegalovirus gastrointestinal disease
3. 消化器病学における臨床病理学的症例：小腸および結腸 clinical pathological cases in gastroenterology small intestine and colon
4. サイトメガロウイルス感染の診断検査の概要 overview of diagnostic tests for cytomegalovirus infection
5. 成人における潰瘍性大腸炎の臨床症状、診断、および予後 clinical manifestations diagnosis and prognosis of ulcerative colitis in adults

English Journal

Absence of Large Ulcers Indicate That Viral Therapy is Not Necessary in Cytomegalovirus Infection in Ulcerative Colitis.

Matsushita M, Fukata N, Omiya M, Okazaki K.SourceThird Department of Internal Medicine Kansai Medical University Osaka, Japan.
Journal of clinical gastroenterology.J Clin Gastroenterol.2012 Oct 10. [Epub ahead of print]
PMID 23059406

Pointers and pitfalls of mycophenolate-associated colitis.

Lee S, de Boer WB, Subramaniam K, Kumarasinghe MP.SourceDepartment of Anatomical Pathology, PathWest Laboratory Medicine, QE II Medical Centre, Nedlands, Western Australia, Australia.
Journal of clinical pathology.J Clin Pathol.2012 Oct 4. [Epub ahead of print]
AIMS: Mycophenolate-associated colitis has been previously reported to show patterns of colonic mucosal injury mimicking a host of conditions, including graft-versus-host disease, ischaemia and inflammatory bowel disease (IBD). The aim of this study is to characterise, semiquantitatively, pathologic
PMID 23038687

Japanese Journal

ステント留置により閉塞性大腸炎を術前診断した直腸癌イレウスの1例

今西俊介,山崎一馬,児玉多曜,近藤悟,小松原利英
日本臨床外科学会雑誌 75(12), 3326-3331, 2014
症例は77歳，女性．直腸癌イレウスにて当科初診．大腸ステントを留置し減圧後，術前精査を施行．下部消化管内視鏡検査にて下行結腸に閉塞性大腸炎を認め，生検組織よりサイトメガロウイルス腸炎の診断．注腸検査にて同部の狭窄を認めた．ステント留置より27日目に腹腔鏡下低位前方切除術を施行．閉塞性大腸炎をきたした下行結腸を含む十分な腸管切除により術後合併症なく退院した．大腸癌イレウスでは一般的に閉塞部より口側腸 …
NAID 130005085346

Oral Tacrolimus for Megacolon in Patients with Severe Ulcerative Colitis

Narabayashi Ken,Inoue Takuya,Sakanaka Taisuke,Iguchi Munetaka,Fujiwara Kaori,Yorifuji Naoki,Kakimoto Kazuki,Nouda Sadaharu,Okada Toshihiko,Ishida Kumi,Abe Yosuke,Masuda Daisuke,Takeuchi Toshihisa,Fukunishi Shinya,Umegaki Eiji,Higuchi Kazuhide
Internal Medicine 53(16), 1755-1758, 2014
… Toxic megacolon is an infrequent but life-threatening complication that occurs most commonly in patients with severe ulcerative colitis. … Intravenous steroids are often recommended for patients with toxic megacolon secondary to ulcerative colitis. … However, steroid dependency may mask the presence of intra-abdominal sepsis and is associated with refractoriness, during which cytomegalovirus reactivation may occur. …
NAID 130004678422

炎症性腸疾患以外を基礎疾患としたサイトメガロウイルス腸管感染症の内視鏡的検討

新井修
日本大腸肛門病学会雑誌 67(1), 1-7, 2014
【目的】炎症性腸疾患以外を基礎疾患としたサイトメガロウイルス（CMV）腸管感染症の内視鏡像を明らかにする【方法】生検組織でCMV感染症と診断した15例を対象にi）臨床像，ii）内視鏡像，iii）治療反応性について検討した【成績】i）平均年齢64.1歳，男女比8：7，87％に消化器症状を認め，基礎疾患は造血器悪性腫瘍が47％と最多であった．ii）内視鏡像は発赤・アフタ性病変・びらん，潰瘍（不整形，打 …
NAID 130003385079