Cytomegalovirus disease in nonimmunocompromised, human immunodeficiency virus-negative adults with chronic kidney disease

Yao Ming Chen, Yuan Pin Hung, Chien Fang Huang, Nan-Yao Lee, Chiung-Yu Chen, Junne-Ming Sung, Chia-Ming Chang, Po-Lin Chen, Ching Chi Lee, Yi Hui Wu, Hsiao-Ju Lin, Wen-Chien Ko

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Abstract

Background/Purpose(s): To identify the clinical characteristics of cytomegalovirus (CMV) disease in chronic kidney disease (CKD) patients. Methods: Patients from two sources were reviewed: (1) a retrospective study of hospitalized patients admitted between January 1990 and February 2009 was performed at a tertiary hospital in Taiwan; (2) the English literature from 1990 to 2009 was reviewed for additional cases, and adults with CKD and histopathologically documented cytomegalovirus disease were included. Results: Seven CKD patients from our hospital and seven from the literature were included. Nine (64.3%) patients were males, and the mean age was 66 years. Histopathologically proven CMV disease was present in the gastrointestinal (GI) tract of 13 (92.9%) and in the skin of one (7.1%) patient. GI symptoms included bleeding (78.6%), abdominal pain (35.7%), and diarrhea (28.6%).The most common comorbidities were diabetes mellitus (7, 50%) and hypertension (8,57.1%). Thirteen patients had CMV GI disease. The endoscopic gross features of the GI tract lesions included single or multiple ulcers and a large polypoid or uneven surface mass. Of the seven cases with available data, a low body mass index (22.3±1.3kg/m 2 ) and hypoalbuminemia (25±7.0g/L) were noted. Twelve patients had received ganciclovir or valganciclovir therapy. Five (35.7%) patients died, and the death of two patients was directly related to bowel perforation caused by CMV colitis. Conclusion: CMV disease may occur in CKD patients without the presence of overt immunodeficiency. The gastrointestinal tract is the most common site of involvement. Clinicians should be aware of this possibility in CKD patients who have GI symptoms.

Original languageEnglish
Pages (from-to)345-349
Number of pages5
JournalJournal of Microbiology, Immunology and Infection
Volume47
Issue number4
DOIs
Publication statusPublished - 2014 Jan 1

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Cytomegalovirus
Chronic Renal Insufficiency
HIV
Gastrointestinal Tract
Literature
Hypoalbuminemia
Ganciclovir
Gastrointestinal Diseases
Colitis
Taiwan
Tertiary Care Centers
Abdominal Pain
Ulcer
Comorbidity
Diarrhea
Diabetes Mellitus
Body Mass Index
Retrospective Studies
Hemorrhage
Hypertension

All Science Journal Classification (ASJC) codes

  • Immunology and Allergy
  • Immunology and Microbiology(all)
  • Microbiology (medical)
  • Infectious Diseases

Cite this

@article{3289d5a7c3cd41e09aa6785e0bf83e3c,
title = "Cytomegalovirus disease in nonimmunocompromised, human immunodeficiency virus-negative adults with chronic kidney disease",
abstract = "Background/Purpose(s): To identify the clinical characteristics of cytomegalovirus (CMV) disease in chronic kidney disease (CKD) patients. Methods: Patients from two sources were reviewed: (1) a retrospective study of hospitalized patients admitted between January 1990 and February 2009 was performed at a tertiary hospital in Taiwan; (2) the English literature from 1990 to 2009 was reviewed for additional cases, and adults with CKD and histopathologically documented cytomegalovirus disease were included. Results: Seven CKD patients from our hospital and seven from the literature were included. Nine (64.3{\%}) patients were males, and the mean age was 66 years. Histopathologically proven CMV disease was present in the gastrointestinal (GI) tract of 13 (92.9{\%}) and in the skin of one (7.1{\%}) patient. GI symptoms included bleeding (78.6{\%}), abdominal pain (35.7{\%}), and diarrhea (28.6{\%}).The most common comorbidities were diabetes mellitus (7, 50{\%}) and hypertension (8,57.1{\%}). Thirteen patients had CMV GI disease. The endoscopic gross features of the GI tract lesions included single or multiple ulcers and a large polypoid or uneven surface mass. Of the seven cases with available data, a low body mass index (22.3±1.3kg/m 2 ) and hypoalbuminemia (25±7.0g/L) were noted. Twelve patients had received ganciclovir or valganciclovir therapy. Five (35.7{\%}) patients died, and the death of two patients was directly related to bowel perforation caused by CMV colitis. Conclusion: CMV disease may occur in CKD patients without the presence of overt immunodeficiency. The gastrointestinal tract is the most common site of involvement. Clinicians should be aware of this possibility in CKD patients who have GI symptoms.",
author = "Chen, {Yao Ming} and Hung, {Yuan Pin} and Huang, {Chien Fang} and Nan-Yao Lee and Chiung-Yu Chen and Junne-Ming Sung and Chia-Ming Chang and Po-Lin Chen and Lee, {Ching Chi} and Wu, {Yi Hui} and Hsiao-Ju Lin and Wen-Chien Ko",
year = "2014",
month = "1",
day = "1",
doi = "10.1016/j.jmii.2013.01.011",
language = "English",
volume = "47",
pages = "345--349",
journal = "Journal of Microbiology, Immunology and Infection",
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TY - JOUR

T1 - Cytomegalovirus disease in nonimmunocompromised, human immunodeficiency virus-negative adults with chronic kidney disease

AU - Chen, Yao Ming

AU - Hung, Yuan Pin

AU - Huang, Chien Fang

AU - Lee, Nan-Yao

AU - Chen, Chiung-Yu

AU - Sung, Junne-Ming

AU - Chang, Chia-Ming

AU - Chen, Po-Lin

AU - Lee, Ching Chi

AU - Wu, Yi Hui

AU - Lin, Hsiao-Ju

AU - Ko, Wen-Chien

PY - 2014/1/1

Y1 - 2014/1/1

N2 - Background/Purpose(s): To identify the clinical characteristics of cytomegalovirus (CMV) disease in chronic kidney disease (CKD) patients. Methods: Patients from two sources were reviewed: (1) a retrospective study of hospitalized patients admitted between January 1990 and February 2009 was performed at a tertiary hospital in Taiwan; (2) the English literature from 1990 to 2009 was reviewed for additional cases, and adults with CKD and histopathologically documented cytomegalovirus disease were included. Results: Seven CKD patients from our hospital and seven from the literature were included. Nine (64.3%) patients were males, and the mean age was 66 years. Histopathologically proven CMV disease was present in the gastrointestinal (GI) tract of 13 (92.9%) and in the skin of one (7.1%) patient. GI symptoms included bleeding (78.6%), abdominal pain (35.7%), and diarrhea (28.6%).The most common comorbidities were diabetes mellitus (7, 50%) and hypertension (8,57.1%). Thirteen patients had CMV GI disease. The endoscopic gross features of the GI tract lesions included single or multiple ulcers and a large polypoid or uneven surface mass. Of the seven cases with available data, a low body mass index (22.3±1.3kg/m 2 ) and hypoalbuminemia (25±7.0g/L) were noted. Twelve patients had received ganciclovir or valganciclovir therapy. Five (35.7%) patients died, and the death of two patients was directly related to bowel perforation caused by CMV colitis. Conclusion: CMV disease may occur in CKD patients without the presence of overt immunodeficiency. The gastrointestinal tract is the most common site of involvement. Clinicians should be aware of this possibility in CKD patients who have GI symptoms.

AB - Background/Purpose(s): To identify the clinical characteristics of cytomegalovirus (CMV) disease in chronic kidney disease (CKD) patients. Methods: Patients from two sources were reviewed: (1) a retrospective study of hospitalized patients admitted between January 1990 and February 2009 was performed at a tertiary hospital in Taiwan; (2) the English literature from 1990 to 2009 was reviewed for additional cases, and adults with CKD and histopathologically documented cytomegalovirus disease were included. Results: Seven CKD patients from our hospital and seven from the literature were included. Nine (64.3%) patients were males, and the mean age was 66 years. Histopathologically proven CMV disease was present in the gastrointestinal (GI) tract of 13 (92.9%) and in the skin of one (7.1%) patient. GI symptoms included bleeding (78.6%), abdominal pain (35.7%), and diarrhea (28.6%).The most common comorbidities were diabetes mellitus (7, 50%) and hypertension (8,57.1%). Thirteen patients had CMV GI disease. The endoscopic gross features of the GI tract lesions included single or multiple ulcers and a large polypoid or uneven surface mass. Of the seven cases with available data, a low body mass index (22.3±1.3kg/m 2 ) and hypoalbuminemia (25±7.0g/L) were noted. Twelve patients had received ganciclovir or valganciclovir therapy. Five (35.7%) patients died, and the death of two patients was directly related to bowel perforation caused by CMV colitis. Conclusion: CMV disease may occur in CKD patients without the presence of overt immunodeficiency. The gastrointestinal tract is the most common site of involvement. Clinicians should be aware of this possibility in CKD patients who have GI symptoms.

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