Medication Summary

The goals of pharmacotherapy are to reduce morbidity and to prevent complications.

Class Summary

Inhibit replication of target virus.

Ganciclovir (Cytovene)

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Acyclic nucleoside analogue of 2'deoxyguanasine. Phosphorylates first to monophosphate form by CMV-encoded protein kinase homologue, then to diphosphate and triphosphate forms by cellular kinases, allowing for a 100-fold greater concentration in CMV-infected cells. Thought to inhibit CMV replication by competitive inhibition of viral DNA polymerases and by incorporating itself into viral DNA, causing termination of viral DNA elongation. Like acyclovir, ganciclovir is virostatic and only exerts its effect on the replicating virus.

Foscarnet (Foscavir)

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Organic analogue of inorganic pyrophosphate that inhibits the replication of herpes simplex viruses, including CMV. Selectively inhibits at pyrophosphate binding site on virus-specific DNA polymerases at concentrations that do not affect cellular polymerases. Unlike ganciclovir, foscarnet does not require activation by a kinase and is active in vitro.

Questions

Maconi G, Colombo E, Zerbi P, et al. Prevalence, detection rate and outcome of cytomegalovirus infection in ulcerative colitis patients requiring colonic resection. Dig Liver Dis. 2005 Jun. 37(6):418-23. [QxMD MEDLINE Link].
Kim YS, Kim YH, Kim JS, et al, for the IBD Study Group of the Korean Association for the Study of Intestinal Diseases(KASID), Korea. Cytomegalovirus infection in patients with new onset ulcerative colitis: a prospective study. Hepatogastroenterology. 2012 Jun. 59(116):1098-101. [QxMD MEDLINE Link].
Gronborg HL, Jespersen S, Honge BL, Jensen-Fangel S, Wejse C. Review of cytomegalovirus coinfection in HIV-infected individuals in Africa. Rev Med Virol. 2017 Jan. 27(1):[QxMD MEDLINE Link].
Sager K, Alam S, Bond A, Chinnappan L, Probert CS. Review article: cytomegalovirus and inflammatory bowel disease. Aliment Pharmacol Ther. 2015 Apr. 41(8):725-33. [QxMD MEDLINE Link].
Beswick L, Ye B, van Langenberg DR. Toward an algorithm for the diagnosis and management of CMV in ptients with colitis. Inflamm Bowel Dis. 2016 Dec. 22(12):2966-76. [QxMD MEDLINE Link].
Onyeagocha C, Hossain MS, Kumar A, et al. Latent cytomegalovirus infection exacerbates experimental colitis. Am J Pathol. 2009 Nov. 175(5):2034-42. [QxMD MEDLINE Link]. [Full Text].
Al-Zafiri R, Gologan A, Galiatsatos P, Szilagyi A. Cytomegalovirus complicating inflammatory bowel disease: a 10-year experience in a community-based, university-affiliated hospital. Gastroenterol Hepatol (N Y). 2012 Apr. 8(4):230-9. [QxMD MEDLINE Link]. [Full Text].
Pillet S, Pozzetto B, Jarlot C, Paul S, Roblin X. Management of cytomegalovirus infection in inflammatory bowel diseases. Dig Liver Dis. 2012 Jul. 44(7):541-8. [QxMD MEDLINE Link].
Hendler SA, Barber GE, Okafor PN, Chang MS, Limsui D, Limketkai BN. Cytomegalovirus infection is associated with worse outcomes in inflammatory bowel disease hospitalizations nationwide. Int J Colorectal Dis. 2020 May. 35(5):897-903. [QxMD MEDLINE Link].
Chan KS, Lee WY, Yu WL. Coexisting cytomegalovirus infection in immunocompetent patients with Clostridium difficile colitis. J Microbiol Immunol Infect. 2016 Dec. 49(6):829-36. [QxMD MEDLINE Link].
Lancini D, Faddy HM, Flower R, Hogan C. Cytomegalovirus disease in immunocompetent adults. Med J Aust. 2014 Nov 17. 201(10):578-80. [QxMD MEDLINE Link].
Goodman AL, Murray CD, Watkins J, Griffiths PD, Webster DP. CMV in the gut: a critical review of CMV detection in the immunocompetent host with colitis. Eur J Clin Microbiol Infect Dis. 2015 Jan. 34(1):13-8. [QxMD MEDLINE Link].
Yokoyama Y, Yamakawa T, Hirano T, et al. Current diagnostic and therapeutic approaches to cytomegalovirus infections in ulcerative colitis patients based on clinical and basic research data. Int J Mol Sci. 2020 Mar 31. 21(7):[QxMD MEDLINE Link]. [Full Text].
Kim JW, Boo SJ, Ye BD, et al. Clinical utility of cytomegalovirus antigenemia assay and blood cytomegalovirus DNA PCR for cytomegaloviral colitis patients with moderate to severe ulcerative colitis. J Crohns Colitis. 2014 Jul. 8(7):693-701. [QxMD MEDLINE Link].
Jones A, McCurdy JD, Loftus EV Jr, et al. Effects of antiviral therapy for patients with inflammatory bowel disease and a positive intestinal biopsy for cytomegalovirus. Clin Gastroenterol Hepatol. 2015 May. 13(5):949-55. [QxMD MEDLINE Link].
Shukla T, Singh S, Loftus EV Jr, Bruining DH, McCurdy JD. Antiviral therapy in steroid-refractory ulcerative colitis with cytomegalovirus: systematic review and meta-analysis. Inflamm Bowel Dis. 2015 Nov. 21(11):2718-25. [QxMD MEDLINE Link].
Maconi G, Lombardini M, Furfaro F, et al. Long-term outcome of inflammatory bowel diseases with cytomegalovirus colitis: effect of antiviral treatment. Eur J Gastroenterol Hepatol. 2014 Oct. 26(10):1146-51. [QxMD MEDLINE Link].
Chan KS, Yang CC, Chen CM, et al. Cytomegalovirus colitis in intensive care unit patients: difficulties in clinical diagnosis. J Crit Care. 2014 Jun. 29(3):474.e1-6. [QxMD MEDLINE Link].
Yadegarynia D, Tehrani S, Roohi M, et al. Prevalence of cytomegalovirus infection in patients with ulcerative colitis: a prospective cross-sectional study in Tehran, Iran. Iran J Microbiol. 2018 Oct. 10(5):342-7. [QxMD MEDLINE Link]. [Full Text].
Carpani G, Foresti S, Dell'Oro R, Grassi G, Bombelli M. Severe systemic cytomegalovirus infection in an immunocompetent patient outside the intensive care unit: a case report. BMC Infect Dis. 2019 Jan 9. 19(1):34. [QxMD MEDLINE Link]. [Full Text].

Media Gallery

Gross specimen of bowel showing ulceration secondary to cytomegalovirus colitis.
Giant cell with inclusion body characteristic of cytomegalovirus colitis.

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Author

Douglas M Heuman, MD, FACP, FACG, AGAF Chief of Hepatology, Hunter Holmes McGuire Department of Veterans Affairs Medical Center; Professor, Department of Internal Medicine, Division of Gastroenterology, Virginia Commonwealth University School of Medicine

Douglas M Heuman, MD, FACP, FACG, AGAF is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Physicians, American Gastroenterological Association

Disclosure: Received grant/research funds from Novartis for other; Received grant/research funds from Bayer for other; Received grant/research funds from Otsuka for none; Received grant/research funds from Bristol Myers Squibb for other; Received none from Scynexis for none; Received grant/research funds from Salix for other; Received grant/research funds from MannKind for other.

Coauthor(s)

Jasmohan S Bajaj, MD, MSc Assistant Professor of Medicine, Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University Medical Center

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

BS Anand, MD Professor, Department of Internal Medicine, Division of Gastroenterology, Baylor College of Medicine

BS Anand, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Additional Contributors

Vivek V Gumaste, MD Associate Professor of Medicine, Mount Sinai School of Medicine of New York University; Adjunct Clinical Assistant, Mount Sinai Hospital; Director, Division of Gastroenterology, City Hospital Center at Elmhurst; Program Director of GI Fellowship (Independent Program); Regional Director of Gastroenterology, Queens Health Network

Vivek V Gumaste, MD is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Drugs & Diseases gratefully acknowledge the contributions of previous authors Deron J. Tessier, MD, and Russell A. Williams, MBBS, to the development and writing of this article.