RESUMO
Gastrointestinal infection with cytomegalovirus (CMV) is uncommon in immunocompetent hosts. The case of a 70-year-old male with CMV colitis, who has no history of chronic inflammatory bowel disease or immunodeficiency is described. Diagnosis was aided by the identification of inclusion bodies that reacted positively for CMV by immunohistochemical testing in biopsy specimens from the colonic mucosa. His hospital course was characterized by poor improvement of his symptoms after the CMV infection was treated with ganciclovir, and the occurrence of megacolon. A repeat colonoscopy with biopsy revealed a recurrence of the CMV infection. Although CMV colitis is common in immunocompromised patients, we believe this is the first case of CMV colitis with megacolon and recurrent CMV infection in an immunocompetent patient. Colitis caused by CMV colitis should be considered in elderly people with diarrhea.
Assuntos
Colite/complicações , Colite/virologia , Infecções por Citomegalovirus/complicações , Infecções por Citomegalovirus/virologia , Citomegalovirus/isolamento & purificação , Megacolo/complicações , Megacolo/virologia , Idoso , Antivirais/uso terapêutico , Colite/tratamento farmacológico , Infecções por Citomegalovirus/tratamento farmacológico , Ganciclovir/uso terapêutico , Humanos , Imuno-Histoquímica , Corpos de Inclusão Viral , Mucosa Intestinal/patologia , Mucosa Intestinal/virologia , Masculino , Megacolo/cirurgia , Recidiva , Resultado do TratamentoRESUMO
OBJECTIVE: To explore the relationship between human cytomegalovirus (HCMV) UL144 sequence variability and clinical disease. METHODS: HCMV UL144 open reading frame (ORF) was amplified by PCR assay in 72 low-passage isolates [65 congenitally infective children and 7 healthy children who were HCMV-DNA positive by quantitative PCR (qPCR)]. All positive PCR products were analyzed by heteroduplex mobility assay and single-stranded conformation polymorphism (HMA-SSCP) and 32 of them were sequenced. RESULTS: Fifty-five patient isolates and five healthy children isolates were HCMV-UL144 positive by PCR. Sequencing and HMA-SSCP analysis showed that significant strain-specific variability was present in the UL144 ORF. Phylogenetic analysis indicated that the nucleotide sequences could be separated into 3 major genotypes. Comparing between UL144 sequences and the corresponding symptoms showed that genotype 2 did not exist in megacolon isolates. And genotype 1 and 3 were the major types among microcephaly and jaundice isolates respectively. CONCLUSIONS: HCMV-UL144 existed in most of low passage isolates and sequences were hypervariable. The UL144 ORF and its predicted product with the high level of sequence variability in different kinds of isolates suggest that UL144 ORF might play a role in HCMV infectivity and subsequent diseases.
Assuntos
Infecções por Citomegalovirus/genética , Citomegalovirus/genética , Variação Genética , Fases de Leitura Aberta/genética , Sequência de Aminoácidos , Sequência de Bases , Citomegalovirus/isolamento & purificação , Infecções por Citomegalovirus/virologia , DNA Viral/genética , Genótipo , Humanos , Lactente , Recém-Nascido , Icterícia/genética , Icterícia/virologia , Megacolo/genética , Megacolo/virologia , Microcefalia/genética , Microcefalia/virologia , Dados de Sequência Molecular , Filogenia , Reação em Cadeia da Polimerase , Polimorfismo Conformacional de Fita Simples , Homologia de Sequência de AminoácidosRESUMO
PURPOSE: The aetiology of idiopathic megarectum and idiopathic megacolon is unknown. A previous study in patients with chronic idiopathic intestinal pseudo-obstruction, a condition also associated with a dilated gut, identified the possible involvement of herpes viruses. This study therefore aimed to determine whether these viruses may also be implicated in the pathogenesis of these conditions. METHODS: Resected large bowel from three patients with idiopathic megarectum and three patients with idiopathic megacolon were studied. Histology for viral inclusions and nested polymerase chain reaction (PCR) using specific primers for cytomegalovirus, Epstein-Barr virus, herpes simplex virus type 1 and varicella zoster virus was performed. DNA was extracted from paraffin-embedded blocks by proteinase K and phenol chloroform extraction. RESULTS: Viral inclusions were not seen. PCR failed to identify DNA of the four herpes viruses tested. CONCLUSION: Patients with idiopathic megarectum or idiopathic megacolon may have subtle abnormalities of the enteric innervation, but these do not appear to be attributable to the neurotropic effects of the herpes viruses studied.
