eMedicine Specialties > Gastroenterology > Colon

Cytomegalovirus Colitis: Follow-up

Author: Deron J Tessier, MD, Staff Surgeon, Kaiser Permanente Medical Center, Fontana, CA
Coauthor(s): Russell A Williams, MBBS, Program Director, Professor, Department of Surgery, University of California Medical Center at Irvine
Contributor Information and Disclosures

Updated: Oct 10, 2006

Follow-up

Further Inpatient Care

  • Patients with symptomatic disease should undergo induction therapy with intravenous ganciclovir or intravenous foscarnet.
  • Combination therapy with ganciclovir and foscarnet may be effective if monotherapy fails; however, this is associated with significant toxicity.

Further Outpatient Care

  • Patients should receive routine ophthalmologic screening for CMV retinitis (self-screen for visual acuity and floaters).
  • Therapy may need to be discontinued in patients infected with HIV who have clinical resolution and CD4+ lymphocyte counts of higher than 100-150 cells/µL.

Inpatient & Outpatient Medications

  • Maintenance therapy may be considered, especially in patients who require reinduction for relapse.

Transfer

  • Patients may be transferred to a skilled nursing facility or equal care provider during treatment, as long as their clinical situation is controlled.
  • Patients with severe CMV colitis should be monitored closely in either an acute-care setting or a regular hospital floor.

Complications

  • Toxic megacolon and necrotizing colitis
    • Once diagnosed, patients with these complications usually have diffuse disease and a poor prognosis.
    • In these patients, generous resection of all affected colon is indicated to avert perforation and sepsis.
  • Perforation
  • Sepsis
  • Peritonitis
  • Death

Prognosis

  • With rapid diagnosis and proper antiviral therapy, the prognosis of patients with CMV colitis is good if the underlying disease itself is controllable.
  • In patients without immunocompromise, the prognosis appears to be age dependent, with patients older than 55 years having higher mortality. Males and patients who need surgery also have a poorer prognosis.

Patient Education

  • Patients should be educated about the nature of their disease and the possibility of recurrence; in particular, patients with HIV infection or AIDS should be aware of the possibility of recurrence.
  • For excellent patient education resources, visit eMedicine's Immune System Center. Also, see eMedicine's patient education articles HIV/AIDS and HIV Testing.

Miscellaneous

Special Concerns

  • In high-risk patients, only use CMV-seronegative blood.
  • When matching organs, only use organs from seronegative donors.
  • CMV vaccines are being developed.
  • Prophylactic colon screening has not been beneficial.
 


More on Cytomegalovirus Colitis

Overview: Cytomegalovirus Colitis
Differential Diagnoses & Workup: Cytomegalovirus Colitis
Treatment & Medication: Cytomegalovirus Colitis
Follow-up: Cytomegalovirus Colitis
Multimedia: Cytomegalovirus Colitis
References
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References

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  2. Buckner FS, Pomeroy C. Cytomegalovirus disease of the gastrointestinal tract in patients without AIDS. Clin Infect Dis. Oct 1993;17(4):644-56. [Medline].

  3. Dieterich DT, Kotler DP, Busch DF, et al. Ganciclovir treatment of cytomegalovirus colitis in AIDS: a randomized, double-blind, placebo-controlled multicenter study. J Infect Dis. - Busch DF;167(2):278-82. [Medline].

  4. Dieterich DT, Poles MA, Lew EA, et al. Concurrent use of ganciclovir and foscarnet to treat cytomegalovirus infection in AIDS patients. J Infect Dis. May 1993;167(5):1184-8. [Medline].

  5. Drew WL. Cytomegalovirus infection in patients with AIDS. J Infect Dis. Aug 1988;158(2):449-56. [Medline].

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Further Reading

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Keywords

CMV, CMV infection, Herpesviridae, herpesvirus, herpes simplex virus, HSV, Epstein-Barr virus, varicella-zoster virus, HIV, AIDS, CMV colitis, CMV gastrointestinal disease, CMV GI disease, HIV disease complications, bloody diarrhea, watery diarrhea, AIDS complications, CMV ulcerative colitis, cytomegalovirus ulcerative colitis, cytomegalovirus UC, steroid-dependent ulcerative colitis, cytomegalovirus infection, cytomegalovirus

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Contributor Information and Disclosures

Author

Deron J Tessier, MD, Staff Surgeon, Kaiser Permanente Medical Center, Fontana, CA
Deron J Tessier, MD is a member of the following medical societies: American College of Surgeons and American Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Russell A Williams, MBBS, Program Director, Professor, Department of Surgery, University of California Medical Center at Irvine
Russell A Williams, MBBS is a member of the following medical societies: American College of Surgeons, American Pancreatic Association, Association for Surgical Education, Association of VA Surgeons, Society for Surgery of the Alimentary Tract, Southern California Society of Gastroenterology, and Southwestern Surgical Congress
Disclosure: Nothing to disclose.

Medical Editor

Jeffrey D Band, MD, Clinical Professor of Medicine, Wayne State University School of Medicine; Director, Division of Infectious Diseases and International Medicine, William Beaumont Hospital Corporation
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

James L Achord, MD, Professor Emeritus, Department of Medicine, Division of Digestive Diseases, University of Mississippi School of Medicine
James L Achord, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Medical Association, American Society for Gastrointestinal Endoscopy, Mississippi State Medical Association, New York Academy of Sciences, Sigma Xi, and Southern Medical Association
Disclosure: Nothing to disclose.

CME Editor

Alex J Mechaber, MD, FACP, Assistant Dean for Medical Curriculum, Associate Professor of Medicine, Division of General Internal Medicine, University of Miami Miller School of Medicine
Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine
Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD, Clinical Professor of Medicine, Drexel University College of Medicine; Consulting Staff, Department of Medicine, Section of Gastroenterology and Hepatology, Hospital of the Medical College of Pennsylvania
Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law Medicine and Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility
Disclosure: Nothing to disclose.

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