CYTOMEGALOVIRUS INFECTION IN PATIENTS WITH MODERATE AND SEVERE ULCERATIVE COLITIS

Abstract

AIM: to determine the incidence of accompanying cytomegalovirus infection (CMVI) in patients with moderate and severe ulcerative colitis, and also to determine the value of diagnosis and treatment of this infection in that category of patients.PATIENTS AND METHODS: the study included 67 patients with severe or moderate ulcerative colitis. The colonoscopy with biopsy with definition of cytomegalovirus DNA by polymerase chain reaction (PCR) was done in all the patients. The patients without virus (CMV negative group) received therapy according to the current clinical recommendations. The patients with virus (CMV positive group) had antiviral therapy by ganciclovir in addition to the standard therapy. The viral load in colonic biopsy of those patients was evaluated before the treatment and on the 19-21 st therapy days. In case of patient state deterioration and inability to continue the conservative treatment, colectomy was done. The success of therapy in both groups was assessed by the colectomy rate during hospitalization.RESULTS: the incidence of severe and moderate ulcerative colitis combination with cytomegalovirus infection was 43.2%. The previous treatment did not influence on the probability of virus detection. Acute attacks of ulcerative colitis were found significantly more often in the CMV-positive group than in the CMV-negative group (20% vs 2.6%, respectively) (р=0.02). The efficacy of the antiviral therapy was 69%. All the patients who responded to the antiviral therapy did not undergo surgery. Failure of the antiviral therapy in the patients with associated cytomegalovirus infection significantly increased the colectomy rate (0 – in the patients who responded to the antiviral therapy vs. 22.2% of those who did not respond).CONCLUSION: the study showed 43% of cases moderate and ulcerative colitis goes with CMVI persistence. CMVI is the resistance factor for conservative treatment. The specific antiviral therapy in addition to the conservative treatment for this category of patients ameliorates the treatment results and prognosis.