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Abstract
BACKGROUND Data about cytomegalovirus (CMV) colitis in children are scarce. We aimed to describe the characteristics of childhood CMV colitis in terms of risk factors, clinical symptoms, diagnosis, therapeutic approaches, and outcomes. METHODS Inflammatory bowel disease (IBD) and non-IBD patients with CMV colitis diagnosed by histology and tissue CMV PCR at 2 tertiary centers between January 2017 and November 2019 were studied. Clinical and laboratory data were retrieved from medical records. Underlying conditions, immune status, response to therapy and outcomes were described and followed up to 6 months after diagnosis. RESULTS A total of 16 children (8 non-IBD, 7 ulcerative colitis and 1 Crohn's disease) with CMV colitis were included. All patients had persistent diarrhea (bloody in 13 cases). There was a significant age difference between IBD and non-IBD children (P < 0.05). The final diagnosis in 1 patient was immunodeficiency with a mutation in JAK1 gene. Three children were categorized as apparently immunocompromised and 4 children as apparently immunocompetent. Ulcer was not visible in 2 children from the non-IBD group. The mean fecal calprotectin level of IBD children was significantly higher than that of non-IBD children (376.12 ± 231.21 µg/g vs. 160.96 ± 69.94 µg/g, P < 0.05). After follow-up, 1 patient died because of another reason. Ganciclovir was used in 14 of 16 children for 3 weeks and the treatment was continued with valganciclovir in selected 6 children. CONCLUSIONS CMV colitis is a rare but overlooked cause of prolonged diarrhea in immunocompetent and immunocompromised children. CMV colitis might present without any ulcer formation at colonoscopy in infants.
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Malik MN, Rafae A, Durer C, Durer S, Anwer F. Fecal Calprotectin as a Diagnostic and Prognostic Biomarker for Gastrointestinal Graft Versus Host Disease: A Systematic Review of Literature. Cureus 2019; 11:e4143. [PMID: 31058026 PMCID: PMC6488450 DOI: 10.7759/cureus.4143] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
The current practice for diagnosing graft versus host disease (GVHD) includes clinical or endoscopic evaluation of the patient. Clinical diagnosis is limited by an overlapping symptomatic spectrum with infectious causes, a common scenario in the post-transplant setting where an invasive procedure, such as endoscopy, is often impractical. We, therefore, evaluated the role of fecal calprotectin as a diagnostic as well as a prognostic biomarker for gastrointestinal GVHD (GI-GVHD) occurrence and severity in the post-hematopoietic transplant population. Following Prisma guidelines, we performed a systematic search of articles published after 2004 using the PubMed, Embase, Cochrane Library, and Web of Science databases. After a detailed screening, 10 studies involving a total of 494 patients were included. In the cohorts comparing median fecal calprotectin (mFC) level in GI-GVHD vs. non-GI-GVHD patients, the results indicated an increase in the mFC level in patients with GI-GVHD when compared to non-GI-GVHD patients. Similarly, an increase in the mFC level was seen in accordance with the severity of the disease. Moreover, corticosteroid-resistant patients had a higher mFC level as compared to corticosteroid-sensitive patients. Our study indicates that the mFC level can be used for diagnosing as well as predicting the treatment response to GI-GVHD. However, future randomized prospective trials involving larger populations are needed to further explore its significance.
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Affiliation(s)
| | - Abdul Rafae
- Internal Medicine, McLaren Flint - Michigan State University, Flint, USA
| | - Ceren Durer
- Hemtology and Oncology, The University of Arizona, Tucson, USA
| | - Seren Durer
- Internal Medicine, Florida Hospital, Orlando, USA
| | - Faiz Anwer
- Hematology and Oncology, Cleveland Clinic, Cleveland, USA
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5
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Aron-Wisnewsky J, Prifti E, Belda E, Ichou F, Kayser BD, Dao MC, Verger EO, Hedjazi L, Bouillot JL, Chevallier JM, Pons N, Le Chatelier E, Levenez F, Ehrlich SD, Doré J, Zucker JD, Clément K. Major microbiota dysbiosis in severe obesity: fate after bariatric surgery. Gut 2019; 68:70-82. [PMID: 29899081 PMCID: PMC7143256 DOI: 10.1136/gutjnl-2018-316103] [Citation(s) in RCA: 260] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 05/09/2018] [Accepted: 05/15/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Decreased gut microbial gene richness (MGR) and compositional changes are associated with adverse metabolism in overweight or moderate obesity, but lack characterisation in severe obesity. Bariatric surgery (BS) improves metabolism and inflammation in severe obesity and is associated with gut microbiota modifications. Here, we characterised severe obesity-associated dysbiosis (ie, MGR, microbiota composition and functional characteristics) and assessed whether BS would rescue these changes. DESIGN Sixty-one severely obese subjects, candidates for adjustable gastric banding (AGB, n=20) or Roux-en-Y-gastric bypass (RYGB, n=41), were enrolled. Twenty-four subjects were followed at 1, 3 and 12 months post-BS. Gut microbiota and serum metabolome were analysed using shotgun metagenomics and liquid chromatography mass spectrometry (LC-MS). Confirmation groups were included. RESULTS Low gene richness (LGC) was present in 75% of patients and correlated with increased trunk-fat mass and comorbidities (type 2 diabetes, hypertension and severity). Seventy-eight metagenomic species were altered with LGC, among which 50% were associated with adverse body composition and metabolic phenotypes. Nine serum metabolites (including glutarate, 3-methoxyphenylacetic acid and L-histidine) and functional modules containing protein families involved in their metabolism were strongly associated with low MGR. BS increased MGR 1 year postsurgery, but most RYGB patients remained with low MGR 1 year post-BS, despite greater metabolic improvement than AGB patients. CONCLUSIONS We identified major gut microbiota alterations in severe obesity, which include decreased MGR and related functional pathways linked with metabolic deteriorations. The lack of full rescue post-BS calls for additional strategies to improve the gut microbiota ecosystem and microbiome-host interactions in severe obesity. TRIAL REGISTRATION NUMBER NCT01454232.
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Affiliation(s)
- Judith Aron-Wisnewsky
- Sorbonne Université, INSERM, NutriOmics team, ICAN, F-75013, Paris, France,Assistance Publique Hôpitaux de Paris, APHP, Nutrition department, CRNH Ile de France, Pitié-Salpêtrière Hospital, Paris France
| | - Edi Prifti
- Institute of Cardiometabolism and Nutrition, ICAN, Integromics and metabolomics platform, Paris, France,IRD, Sorbonne Université, UMMISCO, Unité de modélisation Mathématique et Informatique des Systèmes Complexes, 32 Avenue Henri Varagnat, 93143 Bondy Cedex, France
| | - Eugeni Belda
- Institute of Cardiometabolism and Nutrition, ICAN, Integromics and metabolomics platform, Paris, France
| | - Farid Ichou
- Institute of Cardiometabolism and Nutrition, ICAN, Integromics and metabolomics platform, Paris, France
| | - Brandon D Kayser
- Sorbonne Université, INSERM, NutriOmics team, ICAN, F-75013, Paris, France
| | - Maria Carlota Dao
- Sorbonne Université, INSERM, NutriOmics team, ICAN, F-75013, Paris, France
| | - Eric O Verger
- Sorbonne Université, INSERM, NutriOmics team, ICAN, F-75013, Paris, France
| | - Lyamine Hedjazi
- Institute of Cardiometabolism and Nutrition, ICAN, Integromics and metabolomics platform, Paris, France
| | - Jean-Luc Bouillot
- Assistance Publique Hôpitaux de Paris, APHP, Visceral surgery department of Ambroise Paré, Paris, France
| | - Jean-Marc Chevallier
- Assistance Publique Hôpitaux de Paris, APHP, Visceral surgery department of HEGP; Paris, France
| | - Nicolas Pons
- MGP MetaGénoPolis, INRA, Université Paris-Saclay, 78350 Jouy en Josas, France
| | | | - Florence Levenez
- MGP MetaGénoPolis, INRA, Université Paris-Saclay, 78350 Jouy en Josas, France
| | - Stanislav Dusko Ehrlich
- MGP MetaGénoPolis, INRA, Université Paris-Saclay, 78350 Jouy en Josas, France,AgroParisTech, UMR1319 MICALIS, Jouy-en-Josas, France
| | - Joel Doré
- MGP MetaGénoPolis, INRA, Université Paris-Saclay, 78350 Jouy en Josas, France,AgroParisTech, UMR1319 MICALIS, Jouy-en-Josas, France
| | - Jean-Daniel Zucker
- Institute of Cardiometabolism and Nutrition, ICAN, Integromics and metabolomics platform, Paris, France,IRD, Sorbonne Université, UMMISCO, Unité de modélisation Mathématique et Informatique des Systèmes Complexes, 32 Avenue Henri Varagnat, 93143 Bondy Cedex, France
| | - Karine Clément
- Sorbonne Université, INSERM, NutriOmics team, ICAN, F-75013, Paris, France,Assistance Publique Hôpitaux de Paris, APHP, Nutrition department, CRNH Ile de France, Pitié-Salpêtrière Hospital, Paris France
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6
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Naymagon S, Naymagon L, Wong SY, Ko HM, Renteria A, Levine J, Colombel JF, Ferrara J. Acute graft-versus-host disease of the gut: considerations for the gastroenterologist. Nat Rev Gastroenterol Hepatol 2017; 14:711-726. [PMID: 28951581 PMCID: PMC6240460 DOI: 10.1038/nrgastro.2017.126] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Haematopoietic stem cell transplantation (HSCT) is central to the management of many haematological disorders. A frequent complication of HSCT is acute graft-versus-host disease (GVHD), a condition in which immune cells from the donor attack healthy recipient tissues. The gastrointestinal system is among the most common sites affected by acute GVHD, and severe manifestations of acute GVHD of the gut portends a poor prognosis in patients after HSCT. Acute GVHD of the gastrointestinal tract presents both diagnostic and therapeutic challenges. Although the clinical manifestations are nonspecific and overlap with those of infection and drug toxicity, diagnosis is ultimately based on clinical criteria. As reliable serum biomarkers have not yet been validated outside of clinical trials, endoscopic and histopathological evaluation continue to be utilized in diagnosis. Once a diagnosis of gastrointestinal acute GVHD is established, therapy with systemic corticosteroids is typically initiated, and non-responders can be treated with a wide range of second-line therapies. In addition to treating the underlying disease, the management of complications including profuse diarrhoea, severe malnutrition and gastrointestinal bleeding is paramount. In this Review, we discuss strategies for the diagnosis and management of acute GVHD of the gastrointestinal tract as they pertain to the practising gastroenterologist.
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Affiliation(s)
- Steven Naymagon
- Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai
| | - Leonard Naymagon
- Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai
| | - Serre-Yu Wong
- Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai
| | - Huaibin Mabel Ko
- Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai.,Lillian and Henry M. Stratton-Hans Popper Department of Pathology and Laboratory Medicine, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, New York 10029, USA
| | - Anne Renteria
- Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai
| | - John Levine
- Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai
| | | | - James Ferrara
- Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai
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Metafuni E, Giammarco S, De Ritis DG, Rossi M, De Michele T, Zuppi C, Bacigalupo AP, Sica S, Chiusolo P. Fecal but not serum calprotectin is a potential marker of GVHD after stem cell transplantation. Ann Hematol 2017; 96:929-933. [PMID: 28293713 DOI: 10.1007/s00277-017-2974-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 03/06/2017] [Indexed: 01/27/2023]
Abstract
Gastrointestinal graft-versus-host disease (GvHD) represents a life-threatening complication after stem cell transplantation. Differential diagnosis between gut GvHD and other causes of diarrhea after HSCT is still subjected to endoscopy and histological findings. The research for a reliable biomarker for gut GvHD might allow an early diagnosis of this condition and a consequent prompt treatment that could reduce unfavorable outcomes. Recently, fecal calprotectin was reported as reliable marker of gut involvement. We would evaluate if serum instead of fecal calprotectin could be considered a possible biomarker of gut GvHD. Serum calprotectin was measured in a cohort of 54 patients submitted to allogeneic stem cell transplantation using ELISA assay. For a subset of 21 patients, calprotectin serum levels were compared with fecal calprotectin detection. Contrary to fecal calprotectin, we found only a trend to high level of serum calprotectin for GvHD development and gut involvement, but statistical difference was not reached. Fecal but not serum calprotectin could be considered as possible biomarker for gut GvHD.
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Affiliation(s)
- Elisabetta Metafuni
- Hematology Department, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy.,Università Cattolica del Sacro Cuore, Largo Gemelli 8, 00168, Rome, Italy
| | - Sabrina Giammarco
- Hematology Department, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy.,Università Cattolica del Sacro Cuore, Largo Gemelli 8, 00168, Rome, Italy
| | - Daniela Giovanna De Ritis
- Hematology Department, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy.,Università Cattolica del Sacro Cuore, Largo Gemelli 8, 00168, Rome, Italy
| | - Monica Rossi
- Hematology Department, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy.,Università Cattolica del Sacro Cuore, Largo Gemelli 8, 00168, Rome, Italy
| | - Teresa De Michele
- Biochemistry Department, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy.,Università Cattolica del Sacro Cuore, Largo Gemelli 8, 00168, Rome, Italy
| | - Cecilia Zuppi
- Biochemistry Department, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy.,Università Cattolica del Sacro Cuore, Largo Gemelli 8, 00168, Rome, Italy
| | - Andrea P Bacigalupo
- Hematology Department, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy.,Università Cattolica del Sacro Cuore, Largo Gemelli 8, 00168, Rome, Italy
| | - Simona Sica
- Hematology Department, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy. .,Università Cattolica del Sacro Cuore, Largo Gemelli 8, 00168, Rome, Italy.
| | - Patrizia Chiusolo
- Hematology Department, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy.,Università Cattolica del Sacro Cuore, Largo Gemelli 8, 00168, Rome, Italy
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