Cytomegalovirus, the forgotten cause of diarrhea?

Article written by Doctor Le Xuan Luat - Vinmec Times City International General Hospital

Diarrhea can be caused by bacteria, viruses, the orientation of diarrhea can depend on age, immune status. Diarrhea in immunocompromised people such as old age, underlying medical conditions (kidney failure, hypertension, diabetes, cancer ...) can be caused by many causes. Among them, Cytomegalovirus is usually of little interest.

Cytomegalovirus (CMV) is a virus of the Herpesviridae group, in the same group as Epstein-Barr, Herpes simplex, and Varicella zoster viruses. CMV is a common virus in the world. An estimated 50-100% of people worldwide are infected with CMV, depending on age, gender, race, and economic status. CMV usually resides in the salivary glands, gastrointestinal tract. CMV is also found in urine, blood, milk, and feces.

1. Transmission route of CMV . virus

CMV can be transmitted by:
Sex, especially in people with many partners Blood transfusion Organ transplantation Occupational exposure: contact with other people's CMV-containing fluids such as saliva, blood , urine, milk Transmitted from mother to child during pregnancy and delivery

Viêm gan B lây từ mẹ sang con — CMV có thể lây truyền từ mẹ sang con

2. Diseases caused by CMV

CMV often has no clinical manifestations in healthy people. In immunocompromised people, CMV can cause diseases such as:
Hepatitis, which can cause fulminant liver failure Retinitis, which can lead to blindness Pneumonia, Encephalitis, Transverse myelitis, Colitis, Colitis because CMV is rare. Therefore, when a patient has diarrhea, CMV is an often overlooked cause.

3. Manifestations of CMV . colitis

CMV colitis accounts for 21-34% of acute colitis cases. However, the symptoms of colitis caused by CMV are not specific such as:
Fever Fatigue Weight loss Diarrhea, possibly bloody stools Lower abdominal pain or left abdominal pain If only based on clinical symptoms Clinically, it can be difficult to distinguish CMV colitis from other etiologies.

Bệnh nhân sẽ sụt cân khi nuôi ăn qua ống thông — Viêm đại tràng do CMV có thể gây ra tình trạng sụt cân

4. Tests to diagnose CMV . colitis

CMV IgM : identify acute CMV infection or CMV reactivation. Not significant in the diagnosis of CMV colitis Real-time PCR CMV: Positive only in 50% of patients with CMV infection, confirmed by biopsy Colonoscopy: Endoscopic images are often nonspecific Biopsy of lesions CMV immunohistochemical staining is the gold standard in lesional tissue biopsies.
Therefore, when endoscopic lesions are found, specimens should be taken for pathology.

Nội soi đại tràng Sigma — Nội soi đại tràng giúp chẩn đoán viêm đại tràng do CMV

5. Treatment of diarrhea caused by CMV

The specific treatment for CMV is ganciclovir. However, ganciclovir has side effects such as bone marrow suppression, hepatotoxicity, kidney toxicity, or central nervous system disorders. Therefore, the use of ganciclovir should be carefully considered.
Vinmec International General Hospital is one of the hospitals that not only ensures professional quality with a team of leading medical doctors, a system of modern equipment and technology. The hospital provides comprehensive and professional medical examination, consultation and treatment services, with a civilized, polite, safe and sterile medical examination and treatment space. Customers when choosing to perform tests here can be completely assured of the accuracy of test results.

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