Cytomegalovirus, the forgotten cause of diarrhea?

This is an automatically translated article.


Article written by Doctor Le Xuan Luat - Vinmec Times City International General Hospital

Diarrhea can be caused by bacteria, viruses, the orientation of diarrhea can depend on age, immune status. Diarrhea in immunocompromised people such as old age, underlying medical conditions (kidney failure, hypertension, diabetes, cancer ...) can be caused by many causes. Among them, Cytomegalovirus is usually of little interest.

Cytomegalovirus (CMV) is a virus of the Herpesviridae group, in the same group as Epstein-Barr, Herpes simplex, and Varicella zoster viruses. CMV is a common virus in the world. An estimated 50-100% of people worldwide are infected with CMV, depending on age, gender, race, and economic status. CMV usually resides in the salivary glands, gastrointestinal tract. CMV is also found in urine, blood, milk, and feces.

1. Transmission route of CMV . virus


CMV can be transmitted by:
Sex, especially in people with many partners Blood transfusion Organ transplantation Occupational exposure: contact with other people's CMV-containing fluids such as saliva, blood , urine, milk Transmitted from mother to child during pregnancy and delivery

CMV có thể lây truyền từ mẹ sang con
CMV có thể lây truyền từ mẹ sang con

2. Diseases caused by CMV


CMV often has no clinical manifestations in healthy people. In immunocompromised people, CMV can cause diseases such as:
Hepatitis, which can cause fulminant liver failure Retinitis, which can lead to blindness Pneumonia, Encephalitis, Transverse myelitis, Colitis, Colitis because CMV is rare. Therefore, when a patient has diarrhea, CMV is an often overlooked cause.

3. Manifestations of CMV . colitis


CMV colitis accounts for 21-34% of acute colitis cases. However, the symptoms of colitis caused by CMV are not specific such as:
Fever Fatigue Weight loss Diarrhea, possibly bloody stools Lower abdominal pain or left abdominal pain If only based on clinical symptoms Clinically, it can be difficult to distinguish CMV colitis from other etiologies.

Viêm đại tràng do CMV có thể gây ra tình trạng sụt cân
Viêm đại tràng do CMV có thể gây ra tình trạng sụt cân

4. Tests to diagnose CMV . colitis


CMV IgM : identify acute CMV infection or CMV reactivation. Not significant in the diagnosis of CMV colitis Real-time PCR CMV: Positive only in 50% of patients with CMV infection, confirmed by biopsy Colonoscopy: Endoscopic images are often nonspecific Biopsy of lesions CMV immunohistochemical staining is the gold standard in lesional tissue biopsies.
Therefore, when endoscopic lesions are found, specimens should be taken for pathology.

Nội soi đại tràng giúp chẩn đoán viêm đại tràng do CMV
Nội soi đại tràng giúp chẩn đoán viêm đại tràng do CMV

5. Treatment of diarrhea caused by CMV


The specific treatment for CMV is ganciclovir. However, ganciclovir has side effects such as bone marrow suppression, hepatotoxicity, kidney toxicity, or central nervous system disorders. Therefore, the use of ganciclovir should be carefully considered.
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