Cytomegalovirus Related Gastrointestinal Tract Manifestation of Surgical Significance: Three Cases Presentation and Review

Authors

  • Siriroj Chanthachaiwat Department of Surgery, Samitivej Hospital, Bangkok, Thailand
  • Vibul Jotiskulratana Department of Surgery, Samitivej Hospital, Bangkok, Thailand
  • Pornthep Pramyothin Department of Surgery, Samitivej Hospital, Bangkok, Thailand
  • Vatana Supromajaktr Department of Surgery, Samitivej Hospital, Bangkok, Thailand
  • Chingyiam Panjapiyakul Department of Surgery, Samitivej Hospital, Bangkok, Thailand
  • Jatturong Bhupornwiwat Department of Surgery, Samitivej Hospital, Bangkok, Thailand
  • Wanchai Danvajira Department of Surgery, Samitivej Hospital, Bangkok, Thailand
  • Thongdee Shaipanich Department of Surgery, Samitivej Hospital, Bangkok, Thailand
  • Chinda Suwanraks Department of Surgery, Samitivej Hospital, Bangkok, Thailand

Abstract

                This article presents three surgical cases with cytomegalovirus (CMV) infection of gastrointestinal tract in recent years (1994-1995) at Samitivej Hospital. The first patient had perforation of CMV infected duodenum with defect in cellular mediated immune response. The second patient was a six-week post renal transplanted recipient who developed CMV colitis and renal allograft infection. The third patient, with normal immune response, had massive gastrointestinal hemorrhage from CMV jejunitis. Surgical resection had to be done to control the bleeding. Only the third patient had satisfactory response to antiviral therapy.

                With rising incidence of immune suppressed patients, complicated CMV infection would be more often encountered, especially in this particular group of patients. Preventive measures have been invariably used to reduce rate of CMV infection among organs transplanted patients. High index of suspicion should be the mainstay of early detection and management in the immunosuppressed patients, especially those who harbour HIV.  However, patients with normal immune response but have atypical clinical presentation of CMV infection should be cautiously search for.

References

1. Moanto HO. Cytomegalovirus. In: Mandell, Douglas and Bennett. Principles and practices of infectious diseases, vol 2, 4th ed. New York: Churchill Livingstone Inc, 1995; 1351-62.

2. Chetty R, Roskell DE. Cytomegalovirus infection in the gastrointestinal tract. J Clin Pathol 1994;47:968-72.

3. Cheung ANY, Path MRC, Ng IOL, Path MRC. Cytomegalovirus infection of the gastrointestinal tract in Non-AIDS patients. Am J Gastroenterol 1993; 88:1882-6.

4. "IX Infection, 11 Viral infection", Scientific American Medicine. 1991:17-25.

5. Cerille GJ. Transplantation and organs replacement. Philadelphai: JB Lippincott, 1988:448-453.

6. Krech U. Complement-fixing antibodies against cytomegalovirus in different parts of the world. Bull WHO 1973; 49:103-6.

7. Kantakamalakul W, Puthavathana P, Wasi C, et al. Rubella, cytomegalovirus and herpes simplex virus infections in newborns, 1984-85. J Infect Dis Antimicrob Agents (Thailand) 1986:7-12

8.Chotivitayatharakorn P, Pooworawan Y. Cytomegaloviral infection in perinatal period. Chulalongkorn Med J (Thailand) 1986;30:283-91.

9. Charoen O, Nuchprapyoon C, Chumnijarakij T, Ganpai S. Cytomegalovirus antibody screening program of Thai blood donors for bone-marrow transplant patients. Thai J Hematol Transf Med (Thailand) 1992:23-27.

10. Tanapaichitra D, Siristonpun Y, Srimuang O, Jootar S, et al. The prevalence of antibodies to cytomegalovirus and to epstein barr virus among immunocompromised hosts, patients with AIDS and teenagers with cervical lymphadenopathy. Internal Medicine (Thailand) 1988:129-33.

11. Urwijitaroon Y, Teawpatanataworn S, Kitjaroentharm A. Prevalence of cytomegalovirus antibody in Thai-northeastern blood donors. Sringarind Med J (Thailand) 1992:149.

12. Betts RF, Freeman RB, Douglas RG Jr, et al. Transmission of cytometalovirus infection with renal allograft. Kidney Intl 1975;8:387-94.

13. Kyriazis AP, Mitra SK. Multiple cytomegaalovirus-related intestinal perforations in patients with acquired immunodeficiency syndrome; Report of two cases and review of the literature. Arch Pathol Lab Med 1992; 116:495-9.

14. Kram HB, Shoemaker WC. Intestinal perforation due to cytomegalovirus infection in patients with AIDS. Dis Col & Rect 1990;33:1037-40.

15. Cheung ANY, Ng IOL. Cytomegalovirus infection of the gastrointestinal tract in non-AIDS patients. Am J Gastroenterol 1993;88:1882-6.

16. Balfour HH Jr, Saachs Gw, Welo P, et al. Cytomegalovirus vaccine in renal transplant candidates: progress report of a randomized, placebo-controlled, double-blind trial. Birth Defect 1984;20:289.

17. Snydman DR, Werner BG, Heinze-Lacey B, et al. Use of cytomegalovirus immune globulin or prevent cytomegalovirus disease in renal transplant recipients. N Engl J Med 1987;317;1049.

18. Kasiske BL, Heim-Duthoy KL, Tortorice KL. Polyvalent immune globulin and cytomegalovirus infection after renal transplantation. Arch Intern Med 1989; 149:2733.

19. Balfour HH Jr, Fletcher CV, Dunn D. Prevention of cytomaegalovirus with oral acyclovir. Transplant Proc 1991; 23:1357-60.

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Published

1995-06-30

How to Cite

1.
Chanthachaiwat S, Jotiskulratana V, Pramyothin P, Supromajaktr V, Panjapiyakul C, Bhupornwiwat J, Danvajira W, Shaipanich T, Suwanraks C. Cytomegalovirus Related Gastrointestinal Tract Manifestation of Surgical Significance: Three Cases Presentation and Review. Thai J Surg [Internet]. 1995 Jun. 30 [cited 2024 Dec. 24];16(1):26-32. Available from: https://he02.tci-thaijo.org/index.php/ThaiJSurg/article/view/250196

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Section

Review Articles