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Цитомегаловирусная инфекция в гастроэнтерологии
Цитомегаловирусная инфекция в гастроэнтерологии
Маев И.В., Великолуг К.А. Цитомегаловирусная инфекция в гастроэнтерологии. Терапевтический архив. 2024;96(8):723–731. DOI: 10.26442/00403660.2024.08.202814
© ООО «КОНСИЛИУМ МЕДИКУМ», 2024 г.
© ООО «КОНСИЛИУМ МЕДИКУМ», 2024 г.
________________________________________________
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Аннотация
Цель. Осветить актуальность гастроинтестинальных проявлений цитомегаловирусной инфекции (ЦМВИ), выделить основные факторы риска ее развития, а также современные тенденции в диагностике и лечении.
Основные положения. ЦМВИ является одним из самых распространенных оппортунистических заболеваний, которое характеризуется многообразием проявлений от бессимптомного течения до тяжелых генерализованных форм с поражением внутренних органов и систем организма. Распространенность ЦМВИ во всем мире составляет 20–95%. Особое внимание уделяется своевременной диагностике, лечению и профилактике ЦМВИ. «Золотым стандартом» в диагностике болезней органов пищеварения, ассоциированных с ЦМВИ, являются иммуногистохимическое исследование и обнаружение ДНК цитомегаловируса в тканях методом полимеразной цепной реакции (ПЦР). Несомненный интерес в диагностике ЦМВИ представляет обнаружение ДНК цитомегаловируса в кале методом цифровой ПЦР. По сравнению с количественной цифровая ПЦР обладает более высокой точностью и чувствительностью. В терапии 1-й линии препаратами выбора являются ганцикловир и валганцикловир. Для лечения пациентов с ЦМВИ, рефрактерной к одной или нескольким предшествующим терапиям, успешно применяют марибавир. Одно из перспективных направлений в лечении цитомегаловирусного колита у пациентов с язвенным колитом – трансплантация фекальной микробиоты.
Заключение. Своевременное выявление факторов риска развития ЦМВИ, внедрение инновационных методов и подходов в диагностике, использование эффективных методов лечения болезней органов пищеварения, ассоциированных с ЦМВИ, позволяют улучшить прогноз основного заболевания и снизить риск развития ургентных состояний в гастроэнтерологии.
Ключевые слова: цитомегаловирусная инфекция, эпидемиология, этиология, патогенез, факторы риска, болезни органов пищеварения, клинические аспекты, диагностика, лечение, профилактика
Key points. CMVI is one of the most common opportunistic diseases, characterized by a variety of manifestations from asymptomatic to severe generalized forms affecting internal organs and body systems. The prevalence of CMVI worldwide ranges from 20 to 95%. Particular attention is paid to timely diagnosis, treatment and prevention of CMVI. The “gold standard” in the diagnosis of digestive diseases associated with CMVI is immunohistochemical examination and detection of cytomegalovirus (CMV) DNA in tissues using the polymerase chain reaction (PCR). Of undoubted interest in the diagnosis of CMV is the detection of CMV DNA in stool using digital PCR. Compared to quantitative PCR, digital PCR has higher accuracy and sensitivity. As first-line therapy, the drugs of choice are ganciclovir and valganciclovir. Maribavir has been successfully used to treat patients with CMV infection refractory to one or more previous therapies. One of the promising directions in the treatment of cytomegalovirus colitis in patients with ulcerative colitis is fecal microbiota transplantation.
Conclusion. Timely identification of risk factors for the development of CMV infection, the introduction of innovative methods and approaches in diagnosis, and the use of effective methods for treating diseases of the digestive system associated with CMV infection can improve the prognosis of the underlying disease and reduce the risk of developing urgent conditions in gastroenterology.
Keywords: cytomegalovirus infection, epidemiology, etiology, pathogenesis, risk factors, diseases of the digestive system, clinical aspects, diagnosis, treatment, prevention
Основные положения. ЦМВИ является одним из самых распространенных оппортунистических заболеваний, которое характеризуется многообразием проявлений от бессимптомного течения до тяжелых генерализованных форм с поражением внутренних органов и систем организма. Распространенность ЦМВИ во всем мире составляет 20–95%. Особое внимание уделяется своевременной диагностике, лечению и профилактике ЦМВИ. «Золотым стандартом» в диагностике болезней органов пищеварения, ассоциированных с ЦМВИ, являются иммуногистохимическое исследование и обнаружение ДНК цитомегаловируса в тканях методом полимеразной цепной реакции (ПЦР). Несомненный интерес в диагностике ЦМВИ представляет обнаружение ДНК цитомегаловируса в кале методом цифровой ПЦР. По сравнению с количественной цифровая ПЦР обладает более высокой точностью и чувствительностью. В терапии 1-й линии препаратами выбора являются ганцикловир и валганцикловир. Для лечения пациентов с ЦМВИ, рефрактерной к одной или нескольким предшествующим терапиям, успешно применяют марибавир. Одно из перспективных направлений в лечении цитомегаловирусного колита у пациентов с язвенным колитом – трансплантация фекальной микробиоты.
Заключение. Своевременное выявление факторов риска развития ЦМВИ, внедрение инновационных методов и подходов в диагностике, использование эффективных методов лечения болезней органов пищеварения, ассоциированных с ЦМВИ, позволяют улучшить прогноз основного заболевания и снизить риск развития ургентных состояний в гастроэнтерологии.
Ключевые слова: цитомегаловирусная инфекция, эпидемиология, этиология, патогенез, факторы риска, болезни органов пищеварения, клинические аспекты, диагностика, лечение, профилактика
________________________________________________
Key points. CMVI is one of the most common opportunistic diseases, characterized by a variety of manifestations from asymptomatic to severe generalized forms affecting internal organs and body systems. The prevalence of CMVI worldwide ranges from 20 to 95%. Particular attention is paid to timely diagnosis, treatment and prevention of CMVI. The “gold standard” in the diagnosis of digestive diseases associated with CMVI is immunohistochemical examination and detection of cytomegalovirus (CMV) DNA in tissues using the polymerase chain reaction (PCR). Of undoubted interest in the diagnosis of CMV is the detection of CMV DNA in stool using digital PCR. Compared to quantitative PCR, digital PCR has higher accuracy and sensitivity. As first-line therapy, the drugs of choice are ganciclovir and valganciclovir. Maribavir has been successfully used to treat patients with CMV infection refractory to one or more previous therapies. One of the promising directions in the treatment of cytomegalovirus colitis in patients with ulcerative colitis is fecal microbiota transplantation.
Conclusion. Timely identification of risk factors for the development of CMV infection, the introduction of innovative methods and approaches in diagnosis, and the use of effective methods for treating diseases of the digestive system associated with CMV infection can improve the prognosis of the underlying disease and reduce the risk of developing urgent conditions in gastroenterology.
Keywords: cytomegalovirus infection, epidemiology, etiology, pathogenesis, risk factors, diseases of the digestive system, clinical aspects, diagnosis, treatment, prevention
Полный текст
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87. Gu J, Ji H, Liu T, et al. Detection of cytomegalovirus (CMV) by digital PCR in stool samples for the non-invasive diagnosis of CMV gastroenteritis. Virol J. 2022;19(1):183. DOI:10.1186/s12985-022-01913-z
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89. Pillet S, Pozzetto B, Jarlot C, et al. Management of cytomegalovirus infection in inflammatory bowel diseases. Dig Liver Dis. 2012;44(7):541-8. DOI:10.1016/j.dld.2012.03.018
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2. Fakhreddine AY, Frenette CT, Konijeti GG. A Practical Review of Cytomegalovirus in Gastroenterology and Hepatology. Gastroenterol Res Pract. 2019;2019:6156581. DOI:10.1155/2019/6156581
3. Das S, Pellett PE. Spatial relationships between markers for secretory and endosomal machinery in human cytomegalovirus-infected cells versus those in uninfected cells. J Virol. 2011;85(12):5864-79. DOI:10.1128/JVI.00155-11
4. Ibanez CE, Schrier R, Ghazal P, et al. Human cytomegalovirus productively infects primary differentiated macrophages. J Virol. 1991;65(12):6581-8.
DOI:10.1128/JVI.65.12.6581-6588.1991
5. Myerson D, Hackman RC, Nelson JA, et al. Widespread presence of histologically occult cytomegalovirus. Hum Pathol. 1984;15(5):430-9. DOI:10.1016/s0046-8177(84)80076-3
6. Sinzger C, Kahl M, Laib K, et al. Tropism of human cytomegalovirus for endothelial cells is determined by a post-entry step dependent on efficient translocation to the nucleus. J Gen Virol. 2000;81(Pt.12):3021-35. DOI:10.1099/0022-1317-81-12-3021
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12. Kamatani K, Kenzaka T, Sugimoto R, et al. Multiple thrombosis associated with Cytomegalovirus enterocolitis in an immunocompetent patient: a case report. BMC Infect Dis. 2021;21(1):530. DOI:10.1186/s12879-021-06230-4
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17. Sun L, Chen JM, Yang K, et al. Cytomegalovirus cell tropism and clinicopathological characteristics in gastrointestinal tract of patients with HIV/AIDS. Diagn Pathol. 2022;17(1):9. DOI:10.1186/s13000-022-01193-9
18. Caplan MR, Wilson EMP, Schechter M, et al. High prevalence of gastrointestinal manifestations among Cytomegalovirus end-organ disease in the combination antiretroviral era. J Virus Erad. 2021;7(3):100052. DOI:10.1016/j.jve.2021.100052
19. Nangle S, Mitra S, Roskos S, Havlichek D. Cytomegalovirus infection in immunocompetent adults: Is observation still the best strategy? IDCases. 2018;14:e00442. DOI:10.1016/j.idcr.2018.e00442
20. Rafailidis PI, Mourtzoukou EG, Varbobitis IC, Falagas ME. Severe cytomegalovirus infection in apparently immunocompetent patients: a systematic review. Virol J. 2008;5:47. DOI:10.1186/1743-422X-5-47
21. Zhang Z, Liu X, Sang L, et al. Cytomegalovirus reactivation in immunocompetent mechanical ventilation patients: a prospective observational study. BMC Infect Dis. 2021;21(1):1026. DOI:10.1186/s12879-021-06698-0
22. Lautenschlager I, Halme L, Höckerstedt K, et al. Cytomegalovirus infection of the liver transplant: virological, histological, immunological, and clinical observations. Transpl Infect Dis. 2006;8(1):21-30. DOI:10.1111/j.1399-3062.2006.00122.x
23. Paya CV, Marin E, Keating M, et al. Solid organ transplantation: results and implications of acyclovir use in liver transplants. J Med Virol. 1993;Suppl. 1:123-7. DOI:10.1002/jmv.1890410524
24. Kathi P, Tama M, Reddy V, et al. Acute Gastrointestinal Bleeding Due to Cytomegalovirus Colitis in a Patient with Common Variable Immunodeficiency. ACG Case Rep J. 2018;5:e40. DOI:10.14309/crj.2018.40
25. Maiorana A, Baccarini P, Foroni M, et al. Human cytomegalovirus infection of the gastrointestinal tract in apparently immunocompetent patients. Hum Pathol. 2003;34(12):1331-6. DOI:10.1016/j.humpath.2003.08.005
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27. Mohanlal RD, Karstaedt A. Cytomegalovirus infection of the gastrointestinal tract in Soweto, South Africa: A look back at the clinical and histological features over 8 years. J Infect Dis Epidemiol. 2017;3:038. DOI:10.23937/2474-3658/1510038
28. Ko JH, Peck KR, Lee WJ, et al. Risk factors for cytomegalovirus gastrointestinal diseases in adult patients with cancer. Eur J Clin Microbiol Infect Dis. 2014;33(10):1847-53. DOI:10.1007/s10096-014-2107-x
29. Marsico C, Kimberlin DW. Congenital Cytomegalovirus infection: advances and challenges in diagnosis, prevention and treatment. Ital J Pediatr. 2017;43(1):38.
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9. Poole EL, Nevels MM. Editorial: Cytomegalovirus Pathogenesis and Host Interactions. Front Cell Infect Microbiol. 2021;11:711551. DOI:10.3389/fcimb.2021.711551
10. Kenneson A, Cannon MJ. Review and meta-analysis of the epidemiology of congenital cytomegalovirus (CMV) infection. Rev Med Virol. 2007;17(4):253-76. DOI:10.1002/rmv.535
11. Rawlinson WD, Boppana SB, Fowler KB, et al. Congenital cytomegalovirus infection in pregnancy and the neonate: consensus recommendations for prevention, diagnosis, and therapy. Lancet Infect Dis. 2017;17(6):e177-88. DOI:10.1016/S1473-3099(17)30143-3
12. Kamatani K, Kenzaka T, Sugimoto R, et al. Multiple thrombosis associated with Cytomegalovirus enterocolitis in an immunocompetent patient: a case report. BMC Infect Dis. 2021;21(1):530. DOI:10.1186/s12879-021-06230-4
13. Gandhi MK, Khanna R. Human cytomegalovirus: clinical aspects, immune regulation, and emerging treatments. Lancet Infect Dis. 2004;4(12):725-38.
DOI:10.1016/S1473-3099(04)01202-2
14. Simmons KE. Early-life Human Cytomegalovirus Infections in Canadians: Implications for a Healthy Development. A Thesis submitted in partial fulfillment of the requirements for the degree of master of science in The Faculty of Graduate and Postdoctoral Studies (Pathology and Laboratory Medicine). Vancouver: University of British Columbia, 2019.
15. Safdar A, Armstrong D. Cytomegalovirus. In: Principles and Practice of Transplant Infectious Diseases. USA. 2019; p. 611-42. DOI:10.1007/978-1-4939-9034-4_37
16. Torre-Cisneros J, Humar A. Prevention and Treatment of CMV Infection (and Other Herpes Viruses). Infectious Diseases in Solid-Organ Transplant. 2019; p. 65-80.
DOI:10.1007/978-3-030-15394-6_6
17. Sun L, Chen JM, Yang K, et al. Cytomegalovirus cell tropism and clinicopathological characteristics in gastrointestinal tract of patients with HIV/AIDS. Diagn Pathol. 2022;17(1):9. DOI:10.1186/s13000-022-01193-9
18. Caplan MR, Wilson EMP, Schechter M, et al. High prevalence of gastrointestinal manifestations among Cytomegalovirus end-organ disease in the combination antiretroviral era. J Virus Erad. 2021;7(3):100052. DOI:10.1016/j.jve.2021.100052
19. Nangle S, Mitra S, Roskos S, Havlichek D. Cytomegalovirus infection in immunocompetent adults: Is observation still the best strategy? IDCases. 2018;14:e00442. DOI:10.1016/j.idcr.2018.e00442
20. Rafailidis PI, Mourtzoukou EG, Varbobitis IC, Falagas ME. Severe cytomegalovirus infection in apparently immunocompetent patients: a systematic review. Virol J. 2008;5:47. DOI:10.1186/1743-422X-5-47
21. Zhang Z, Liu X, Sang L, et al. Cytomegalovirus reactivation in immunocompetent mechanical ventilation patients: a prospective observational study. BMC Infect Dis. 2021;21(1):1026. DOI:10.1186/s12879-021-06698-0
22. Lautenschlager I, Halme L, Höckerstedt K, et al. Cytomegalovirus infection of the liver transplant: virological, histological, immunological, and clinical observations. Transpl Infect Dis. 2006;8(1):21-30. DOI:10.1111/j.1399-3062.2006.00122.x
23. Paya CV, Marin E, Keating M, et al. Solid organ transplantation: results and implications of acyclovir use in liver transplants. J Med Virol. 1993;Suppl. 1:123-7. DOI:10.1002/jmv.1890410524
24. Kathi P, Tama M, Reddy V, et al. Acute Gastrointestinal Bleeding Due to Cytomegalovirus Colitis in a Patient with Common Variable Immunodeficiency. ACG Case Rep J. 2018;5:e40. DOI:10.14309/crj.2018.40
25. Maiorana A, Baccarini P, Foroni M, et al. Human cytomegalovirus infection of the gastrointestinal tract in apparently immunocompetent patients. Hum Pathol. 2003;34(12):1331-6. DOI:10.1016/j.humpath.2003.08.005
26. Marques S, Carmo J, Pinto D, et al. Cytomegalovirus Disease of the Upper Gastrointestinal Tract: A 10-Year Retrospective Study. GE Port J Gastroenterol. 2017;24(6):262-8. DOI:10.1159/000479232
27. Mohanlal RD, Karstaedt A. Cytomegalovirus infection of the gastrointestinal tract in Soweto, South Africa: A look back at the clinical and histological features over 8 years. J Infect Dis Epidemiol. 2017;3:038. DOI:10.23937/2474-3658/1510038
28. Ko JH, Peck KR, Lee WJ, et al. Risk factors for cytomegalovirus gastrointestinal diseases in adult patients with cancer. Eur J Clin Microbiol Infect Dis. 2014;33(10):1847-53. DOI:10.1007/s10096-014-2107-x
29. Marsico C, Kimberlin DW. Congenital Cytomegalovirus infection: advances and challenges in diagnosis, prevention and treatment. Ital J Pediatr. 2017;43(1):38.
DOI:10.1186/s13052-017-0358-8
30. Ahmad S, Mahalik SK, Pati AB, et al. Sigmoid Colonic Stricture Mimicking Hirschsprung Disease in a Cytomegalovirus Positive Immunocompetent Infant. Indian J Pediatr. 2021;88(7):724. DOI:10.1007/s12098-021-03730-8
31. Zadrazil Z. Human Cytomegalovirus as a driving force towards Immunosenescence. Doctoral thesis, Nanyang Technological University. Singapore. 2018. DOI:10.32657/10356/73417
32. Infectious Diseases of the Fetus and Newborn Infant. Ch. 23. Cytomegalovirus. Eds. JS Remington, JO Klein. Elsevier. 2011; p. 708-75.
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Авторы
И.В. Маев1, К.А. Великолуг*2
1ФГБОУ ВО «Российский университет медицины» Минздрава России, Москва, Россия;
2ООО «МедлайН – Сервис», Москва, Россия
*Vel_71@mail.ru
1Russian University of Medicine, Moscow, Russia;
2MedlayN – Service, LLC, Moscow, Russia
*Vel_71@mail.ru
1ФГБОУ ВО «Российский университет медицины» Минздрава России, Москва, Россия;
2ООО «МедлайН – Сервис», Москва, Россия
*Vel_71@mail.ru
________________________________________________
1Russian University of Medicine, Moscow, Russia;
2MedlayN – Service, LLC, Moscow, Russia
*Vel_71@mail.ru
Цель портала OmniDoctor – предоставление профессиональной информации врачам, провизорам и фармацевтам.