RESUMEN
Herpes simplex virus 1 (HSV-1), a leading cause of genital herpes, infects oral or genital mucosal epithelial cells before infecting the peripheral sensory nervous system. The spread of HSV-1 beyond the sensory nervous system and the resulting broader spectrum of disease are not well understood. Using a mouse model of genital herpes, we found that HSV-1-infection-associated lethality correlated with severe fecal and urinary retention. No inflammation or infection of the brain was evident. Instead, HSV-1 spread via the dorsal root ganglia to the autonomic ganglia of the enteric nervous system (ENS) in the colon. ENS infection led to robust viral gene transcription, pathological inflammatory responses, and neutrophil-mediated destruction of enteric neurons, ultimately resulting in permanent loss of peristalsis and the development of toxic megacolon. Laxative treatment rescued mice from lethality following genital HSV-1 infection. These results reveal an unexpected pathogenesis of HSV associated with ENS infection.
Asunto(s)
Sistema Nervioso Entérico/virología , Herpes Genital/virología , Herpesvirus Humano 1/patogenicidad , Megacolon Tóxico/virología , Neuronas/virología , Enfermedades Vaginales/virología , Animales , Modelos Animales de Enfermedad , Sistema Nervioso Entérico/patología , Femenino , Ganglios/patología , Ganglios/ultraestructura , Ganglios/virología , Ganglios Espinales/patología , Ganglios Espinales/virología , Genoma Viral , Herpes Genital/patología , Herpesvirus Humano 1/genética , Herpesvirus Humano 1/fisiología , Intestinos/virología , Megacolon Tóxico/patología , Ratones , Ratones Endogámicos C57BL , Neuronas/patología , Neutrófilos/virología , Nociceptores/virología , Vagina/virología , Enfermedades Vaginales/patología , Replicación Viral/fisiologíaAsunto(s)
Colitis Ulcerosa/microbiología , Colitis Ulcerosa/virología , Terapia de Inmunosupresión/efectos adversos , Colitis Ulcerosa/complicaciones , Resultado Fatal , Femenino , Humanos , Megacolon Tóxico/complicaciones , Megacolon Tóxico/microbiología , Megacolon Tóxico/cirugía , Megacolon Tóxico/virología , Persona de Mediana Edad , Insuficiencia Multiorgánica/complicaciones , Insuficiencia Multiorgánica/microbiología , Insuficiencia Multiorgánica/virologíaRESUMEN
Cytomegalovirus (CMV) infection is a frequent disease in immunocompromised patients and can affect the gastrointestinal tract in 50% of patients, giving rise to colitis due to CMV. However, a perforated jejunum is not frequent. We present the case of an immunocompromised patient who was diagnosed with colitis due to CMV infection after bowel perforation. Outcome was favorable after surgery and antiviral treatment.
Asunto(s)
Infecciones por Citomegalovirus/complicaciones , Perforación Intestinal/virología , Enfermedades del Yeyuno/virología , Megacolon Tóxico/virología , Humanos , Huésped Inmunocomprometido , Masculino , Megacolon Tóxico/patología , Megacolon Tóxico/cirugía , Persona de Mediana EdadAsunto(s)
Colitis Ulcerosa/complicaciones , Infecciones por Citomegalovirus/complicaciones , Megacolon Tóxico/complicaciones , Anciano , Colitis Ulcerosa/patología , Colitis Ulcerosa/virología , Infecciones por Citomegalovirus/patología , Humanos , Masculino , Megacolon Tóxico/patología , Megacolon Tóxico/virologíaRESUMEN
BACKGROUND: The toxic megacolon is a rare and severe complication of ulcerative colitis. In general it complicates patients with active colitis that are resistant to clinical treatment and, in some cases, the developing factor is unknown. Cytomegalovirus infection in humans in general is a subclinical condition. However, in patients with immunodeficiency the primary infection or the reactivation of latent infection could have enormous clinical effects. One of these effects is the toxic megacolon. AIM: To report a case of fatal toxic megac lon due to cytomegalovirosis in a patient with ulcerative colitis. PATIENT: A male patient, 38 years old, with complaints of diarrhea and weight loss. The diagnosis of ulcerative colitis was made and a vigorous immunossupressive therapy was performed. RESULTS: Due to the evolution to a toxic megacolon the patient was submitted to colectomy. In the post-operatory period there were severe clinical complications and the patient died. The pathological study of the colon revealed active ulcerative colitis, associated with confluent ulcerations and numerous cells with cytomegalic nuclear inclusions. CONCLUSION: The cytomegalovirosis must be considered as one of the causal agent of toxic megacolon in ulcerative colitis.
Asunto(s)
Infecciones por Citomegalovirus/complicaciones , Megacolon Tóxico/virología , Adulto , Infecciones por Citomegalovirus/patología , Resultado Fatal , Humanos , Masculino , Megacolon Tóxico/patologíaRESUMEN
We report a 35-year-old man, a renal allograft recipient, who presented with toxic megacolon. Segmental biopsies from the colon were consistent with cytomegalovirus colitis. Serum polymerase chain reaction for cytomegalovirus DNA confirmed the diagnosis. He was treated with ganciclovir but, though his abdominal condition improved initially, he worsened later and succumbed to his illness.
Asunto(s)
Infecciones por Citomegalovirus/complicaciones , Trasplante de Riñón , Megacolon Tóxico/virología , Adulto , Antivirales/uso terapéutico , Infecciones por Citomegalovirus/tratamiento farmacológico , ADN Viral/sangre , Resultado Fatal , Ganciclovir/uso terapéutico , Humanos , Masculino , Reacción en Cadena de la PolimerasaAsunto(s)
Infecciones por Citomegalovirus/complicaciones , Megacolon Tóxico/virología , Antivirales/uso terapéutico , Infecciones por Citomegalovirus/diagnóstico , Infecciones por Citomegalovirus/tratamiento farmacológico , Diarrea/etiología , Resultado Fatal , Femenino , Ganciclovir/uso terapéutico , Humanos , Linfoma no Hodgkin/complicaciones , Megacolon Tóxico/diagnóstico , Persona de Mediana Edad , Insuficiencia Multiorgánica/etiología , PronósticoRESUMEN
Cytomegalovirus (CMV) colitis is a rare event that has been described mainly in immunocompromised patients with immunosuppressive medication or HIV infection. An association with severe trauma has not been described previously. We report a formerly healthy, multiply injured 75-year-old male who subsequently developed what appeared to be pseudomembranous colitis. By the time the diagnosis of toxic megacolon on the basis of CMV colitis was established, he had succumbed to multiple organ failure. Whenever pseudomembranous colitis is clinically suspected but not confirmed in a critically ill formerly healthy patient, CMV colitis should be excluded. Once the diagnosis is confirmed, generous resection of all affected colon is mandatory in view of the limited benefit of antiviral therapy in CMV-induced toxic megacolon.