CYTOMEGALOVIRUS ENTERITIS - A HIGHLY LETHAL CONDITION REQUIRING EARLYDETECTION AND INTERVENTION

Cytomegalovirus infection causing symptomatic enteritis is most usuall y associated with immunosuppressed transplant patients or patients pos itive for human immunodeficiency virus. Most reports studying this ill ness are small and do not clearly define the risk factors or mortality rates. METHODS: The present study retrospectively reviewed the charts of 67 patients with biopsy-proven cytomegalovirus enteritis (esophage al, gastric, small bowel, and colonic) to define and to investigate fa ctors that influence survival. Patients were classified into four grou ps based on underlying medical condition: 1) patients positive for hum an immunodeficiency virus; 2) transplant patients receiving immunosupp ressive medications; 3) immunosuppressed nontransplant patients; and 4 ) otherwise healthy individuals. Mortality rates based on underlying m edical condition, location of intestinal cytomegalovirus infection, cy tomegalovirus therapy, age, and average days to institution of treatme nt were defined and statistically assessed. RESULTS: Mortality was sig nificantly greater in the normal patient group (80 percent) than in th e transplant (21 percent), other immunosuppressed (44 percent), or hum an immunodeficiency virus-positive (75 percent) groups (P = 0.0006, Co chran-Mantel-Haenszel statistics). There was no difference in mortalit y based on intestinal location of disease or treatment modality (surge ry, medical therapy, or both). Cohorts of patients order than 65 years had a statistically higher mortality rate vs. those younger than 65 y ears old (68 vs. 38 percent; P = 0.05, Cochran-Mantel-Haenszel statist ics). Statistically increased mortality was also associated with incre ased time from hospital admission to institution of cytomegalovirus tr eatment, whether therapy was medication alone or medication and surger y (P < 0.05, exact Wilcoxon's test). CONCLUSIONS: 1) Lethal cytomegalo virus enteritis can arise in patient populations not typically identif ied as being at risk for this disorder, including normal individuals. 2) Mortality in cytomegalovirus enteritis is adversely associated with age older than 65 years and increased time to institution of therapy but is not affected by anatomic site of infection or particular form o f treatment. Paradoxically, in this study, normal patients had the hig hest mortality, which we attribute to a low index of suspicion acid re latively late institution of therapy.