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Howard-Jones AR, Cristerna-Tarrasa GH, Khan R, Stormon M, Arbuckle S, Britton PN. Severe Postnatal Cytomegalovirus Enterocolitis in Immunocompetent Term Infants Requiring Total Parenteral Nutrition. JPGN REPORTS 2021; 2:e110. [PMID: 37205973 PMCID: PMC10191544 DOI: 10.1097/pg9.0000000000000110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 06/10/2021] [Indexed: 05/21/2023]
Abstract
Postnatal cytomegalovirus enterocolitis is uncommon in immunocompetent infants. We report a 10-week-old term boy with severe and prolonged secretory diarrhea, leading to dependence on total parenteral nutrition and a 10-week hospitalization. Cytomegalovirus enterocolitis was diagnosed based on duodenal biopsy in the context of marked viremia, and the child recovered promptly on initiation of ganciclovir. Collated case reports reveal delayed diagnoses as the norm but rapid improvement with antiviral treatment. Cytomegalovirus enterocolitis should be considered early as a differential diagnosis in infants with refractory diarrhea.
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Affiliation(s)
- Annaleise R. Howard-Jones
- From the Department of Infectious Diseases & Microbiology, The Children’s Hospital at Westmead, Westmead, New South Wales, Australia
- Discipline of Child and Adolescent Health, University of Sydney, The Children’s Hospital at Westmead, Westmead, New South Wales, Australia
| | | | - Rabia Khan
- Department of Gastroenterology, The Children’s Hospital at Westmead, Westmead, New South Wales, Australia
| | - Michael Stormon
- Discipline of Child and Adolescent Health, University of Sydney, The Children’s Hospital at Westmead, Westmead, New South Wales, Australia
- Department of Gastroenterology, The Children’s Hospital at Westmead, Westmead, New South Wales, Australia
| | - Susan Arbuckle
- Discipline of Child and Adolescent Health, University of Sydney, The Children’s Hospital at Westmead, Westmead, New South Wales, Australia
- Department of Histopathology, The Children’s Hospital at Westmead, Westmead, New South Wales, Australia
| | - Philip N. Britton
- From the Department of Infectious Diseases & Microbiology, The Children’s Hospital at Westmead, Westmead, New South Wales, Australia
- Discipline of Child and Adolescent Health, University of Sydney, The Children’s Hospital at Westmead, Westmead, New South Wales, Australia
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Wang Y, Huang Z, Ye Z, Zheng C, Jiang Z, Huang Y. Cytomegalovirus enteritis with intractable diarrhea in infants from a tertiary care center in China. Scand J Gastroenterol 2020; 55:55-61. [PMID: 31917930 DOI: 10.1080/00365521.2019.1706763] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background: Cytomegalovirus (CMV) is rarely thought to be the cause of significant gastrointestinal infection in immunocompetent children. CMV colitis is seldom observed in young infants. This study aims to examine the clinical features of CMV colitis in Chinese children.Methods: Patients with infantile onset CMV colitis diagnosed in intestinal tissue at Children's Hospital of Fudan University from 1st January 2017, to 31st January 2019 were enrolled. Clinical data were retrieved from medical records, and the literature on infant CMV colitis was also reviewed.Results: Ten patients were included with a median age of 2.5 months [interquartile range 2.0, 6.3 months]. All 10 patients had diarrhea, 10 patients had anemia, seven patients reported hematochezia, five patients had hypoalbuminemia, five patients had retinitis, two patients had hearing impairment, and one patient had perianal abscess and anal fistula. The patients had punched-out ulcerations, longitudinal ulcerations or irregular ulcerations on the rectum and/or colon. Typical histologic evaluation showed crypt distortion and inflammatory infiltration. CMV inclusion bodies were noted in four patients. Immunohistochemistry on intestinal tissue was performed to diagnose CMV, with all patients positive. After follow-up, all patients are clinically recovered or in remission; six patients received antiviral therapy, and five patients had healed ulcers on endoscopic examination.Conclusions: CMV colitis might be a rare cause of intractable diarrhea in immunocompetent children. Clinicians should be aware of the possibility of CMV colitis in patients with intractable diarrhea.
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Affiliation(s)
- Yuhuan Wang
- Department of Gastroenterology, Children's Hospital of Fudan University, Shanghai, China
| | - Zhiheng Huang
- Department of Gastroenterology, Children's Hospital of Fudan University, Shanghai, China
| | - Ziqing Ye
- Department of Gastroenterology, Children's Hospital of Fudan University, Shanghai, China
| | - Cuifang Zheng
- Department of Gastroenterology, Children's Hospital of Fudan University, Shanghai, China
| | - Zhinong Jiang
- Department of Pathology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ying Huang
- Department of Gastroenterology, Children's Hospital of Fudan University, Shanghai, China
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Intestinal manifestations of postnatal and congenital cytomegalovirus infection in term and preterm infants. J Clin Virol 2016; 83:29-36. [PMID: 27529309 DOI: 10.1016/j.jcv.2016.08.289] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 06/27/2016] [Accepted: 08/10/2016] [Indexed: 12/26/2022]
Abstract
To review the relevant literature on cytomegalovirus-(CMV-)related intestinal problems in neonates, supplemented by two own cases of volvulus, a PubMed search and separate additional searches with characterizing terms were performed. 46 hits were found, 15 of which had to be excluded because they did not report clinical cases, yielding a total of 47 infants. Symptoms in both preterm and term infants with proven postnatal infection (n=16) included abdominal distension, bloody diarrhoea, necrotising enterocolitis (NEC) with perforation and intestinal stricture, with lethal outcome in 3 patients. Manifestations in congenital or unclearly allocated CMV-infections, including volvulus, were similar. We report on 2 additional cases with volvulus in extremely low gestational age neonates (ELGANs) with proven postnatal CMV-infection and concurrent detection of CMV positive cells within the resected intestinal stroma. As a conclusion volvulus should be added to other known intestinal manifestations of breastmilk (BM) related postnatal CMV disease in extremely preterm infants.
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Cytomegalovirus Enterocolitis in Immunocompetent Young Children: A Report of Two Cases and Review of the Literature. Pediatr Infect Dis J 2016; 35:573-6. [PMID: 26862673 PMCID: PMC4829454 DOI: 10.1097/inf.0000000000001080] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Cytomegalovirus (CMV) causes significant morbidity and mortality in congenitally infected children and immunocompromised hosts. Among healthy individuals, CMV is generally thought to cause mild, self-limited illness. CMV enterocolitis, in particular, is rarely considered among immunocompetent children presenting with diarrhea. We describe 2 cases of invasive CMV colitis in immunocompetent infants presenting with diarrhea and review the literature to date on this topic. Although invasive CMV enterocolitis has been sporadically reported among immunocompetent children, it remains an underrecognized cause of infectious diarrhea in this population and indications for antiviral therapy are lacking. We propose that CMV should be included in the differential diagnosis of intractable diarrhea in immunocompetent children.
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Louazon T, Collardeau S, Lachaux A. [Cytomegalovirus colitis in an immunocompetent child]. Arch Pediatr 2014; 21:1016-9. [PMID: 24997060 DOI: 10.1016/j.arcped.2014.05.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Revised: 12/03/2013] [Accepted: 05/12/2014] [Indexed: 11/15/2022]
Abstract
Cytomegalovirus (CMV) colitis is uncommon in young infants. Here we report a case of a 10-week-old breastfed infant admitted to the emergency room for rectal bleeding. He had had stools streaked with red blood for four days, was in good general condition, and was apyretic. Blood count, C-reactive protein, stool bacteriology and virology, abdominal X-ray examination, and abdominal ultrasounds did not reveal any abnormality. Cow's milk protein allergy was suggested despite the negativity of specific immunoglobulins E (IgE) and a diet excluding cow's milk protein was initiated in the mother. In a context of persistent rectal bleeding and good general condition, an endoscopic examination found diffuse hemorrhagic colitis and an erythematous aspect of the fundus. CMV was revealed by histological examination (typical cytopathic effect and immunostaining) and high viral load in the blood. The patient's immune balance was normal and the mother did not have any form of CMV infection. The diagnosis of primary CMV infection was retained in this immunocompetent child. Rectal bleeding disappeared without specific antiviral treatment. This observation points out that with rectal bleeding in an infant, cow's milk protein allergy should not be the only cause considered.
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Affiliation(s)
- T Louazon
- Service de gastroentérologie, hépatologie et nutrition pédiatriques, université de Lyon 1, hospices civils de Lyon, hôpital Femme Mère-Enfant du CHU de Lyon, 59, boulevard Pinel, 69677 Bron cedex, France.
| | - S Collardeau
- Centre de biologie et de pathologie Est, hospices civils de Lyon, 59, boulevard Pinel, 69677 Bron cedex, France
| | - A Lachaux
- Service de gastroentérologie, hépatologie et nutrition pédiatriques, université de Lyon 1, hospices civils de Lyon, hôpital Femme Mère-Enfant du CHU de Lyon, 59, boulevard Pinel, 69677 Bron cedex, France
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Bar-Meir M, Farrow KN, Melin-Aldana H, Chadwick EG. Cytomegalovirus Enterocolitis Mimicking Necrotizing Enterocolitis: Case Reports and Review of the Literature. J Pediatric Infect Dis Soc 2013; 2:71-5. [PMID: 26619446 DOI: 10.1093/jpids/pis060] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Accepted: 05/01/2012] [Indexed: 01/18/2023]
Abstract
A case of necrotizing enterocolitis (NEC) with pathologic evidence of cytomegalovirus (CMV) infection is presented. This preterm infant developed abdominal distention and tachycardia, and a clinical diagnosis of NEC was made. Acute bowel obstruction occurred 20 days later. Biopsy specimens of the ileum obtained during laparotomy showed extensive CMV inclusion bodies and positive immunoperoxidase staining for CMV. Urine culture and polymerase chain reaction from the blood were also positive for CMV. The patient was treated with ganciclovir and recovered. Thirty-two similar cases of CMV enterocolitis and intestinal obstruction in premature and full term babies are reviewed here.
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Affiliation(s)
| | - Kathryn N Farrow
- Neonatology Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Hector Melin-Aldana
- Pathology, Children's Memorial Hospital Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Ellen G Chadwick
- Departments of Infectious Diseases Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Kurtz M, Morgan M. Concomitant Clostridium difficile colitis and cytomegalovirus colitis in an immunocompetent elderly female. BMJ Case Rep 2012; 2012:bcr-2012-007273. [PMID: 23234822 DOI: 10.1136/bcr-2012-007273] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
A 78-year-old Japanese woman with diarrhoea and abdominal pain was admitted for PCR test (PCR)-proven Clostridium difficile colitis. The patient's symptoms persisted despite multiple courses of antibiotics including intravenous metronidazole, oral vancomycin and oral fidaxomicin. She underwent a stool transplant without improvement. Biopsies from a colonoscopy revealed concomitant cytomegalovirus (CMV) infection. The patient was immediately started on intravenous ganciclovir. Unfortunately, she developed sepsis secondary to colitis, and underwent definitive treatment with a total colectomy. Although CMV is a rare colonic pathogen in the immunocompetent patient, it should be considered in patients with severe or refractory C difficile colitis.
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Affiliation(s)
- Maria Kurtz
- Department of Internal Medicine, Madigan Army Medical Center, Tacoma, Washington, USA.
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Cytomegalovirus colitis following azacitidine therapy. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2012; 22:e21-3. [PMID: 22942891 DOI: 10.1155/2011/616725] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The present report describes the first recognized case of cytomegalovirus (CMV) colitis following azacitidine therapy. A 66-year-old woman with myelodysplastic syndrome developed CMV colitis, which responded to treatment with ganciclovir. Currently, patients receiving azacitidine do not undergo CMV testing, or receive prophylaxis or CMV-free blood products; however, this policy needs to be revised.
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Freeman AJ, Bishop PR, Subramony C, Nowicki MJ. Life-threatening cytomegalovirus enteritis and pneumonia in an immunocompetent adolescent: a case report and brief literature review. Clin Pediatr (Phila) 2012; 51:507-11. [PMID: 21339249 DOI: 10.1177/0009922811398962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- A Jay Freeman
- University of Mississippi Health Center, Jackson, MS, USA
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Ramos Boluda E, Molina Arias M, Sarría Osses J, Larrauri Martínez J, Prieto Bozano G. [Cytomegalovirus infection causing protracted diarrhea in an immunocompetent child]. An Pediatr (Barc) 2009; 70:582-5. [PMID: 19423414 DOI: 10.1016/j.anpedi.2009.01.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2008] [Revised: 01/25/2009] [Accepted: 01/27/2009] [Indexed: 11/16/2022] Open
Abstract
Cytomegalovirus infection is a frequent cause of complications in immunodeficient patients. In healthy hosts, cytomegalovirus infection is usually asymptomatic. We describe a case of a 3 month old immunocompetent boy who suffered from protracted diarrhoea that required parenteral nutrition. After treatment with ganciclovir he recovered without any after effects.
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Affiliation(s)
- E Ramos Boluda
- Servicio de Gastroenterología, Departamento de Anatomía Patológica, Hospital Infantil Universitario La Paz, Madrid, Spain.
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