Citomegalovirusna infekcija u bolesnika s upalnim bolestima crijeva

master's thesis

• Title (english): Cytomegalovirus infection in patients with inflammatory bowel disease
• Author: David Dohoczky
• Mentor: Silvija Čuković-Čavka (mentor)
• Committee member: Željko Krznarić (predsjednik povjerenstva)
• Committee member: Jasenka Markeljević (član povjerenstva)
• Committee member: Silvija Čuković-Čavka (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Internal Medicine); Zagreb
• Defense date and country: 2020-07-17, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine

Abstract

Crohnova bolesti i ulcerozni kolitis su kronične upalne bolesti koje primarno zahvaćaju probavnu cijev te su karakterizirane izmjenama razdoblja remisije i relapsa. Globalno, njihova prevalencija raste, a zahtijevaju doživotno i kompleksno liječenje praćeno brojnim nuspojavama i komplikacijama. Bolesnici s upalnim bolestima crijeva skloni su razvoju teških infekcija zbog imunosupresivne terapije i zbog oštećenja sluznice crijeva uslijed kronične upale. Citomegalovirus pripadinik je porodice Herpesvirusa koji u osoba sa suprimiranim imunitetom, kao što su bolesnici s upalnim bolestima crijeva, može izazvati tešku i ponekad fatalnu bolest. U bolesnika s upalnim bolestima crijeva, pogotovo s ulceroznim kolitisom, citomegalovirus je povezan sa značajnim moribiditetom. U ovom radu opisana je uloga citomegalovirusa u egzacerbaciji bolesti, odgovoru na terapiju i potrebi za kiruškim liječenjem. Posebna pozornost posvećena je CMV kolitisu koji diferencijalno-dijagnostički može imitirati teški relaps ulceroznog kolitisa ili Crohnove bolesti, a povezan je s lošijim ishodom. Bolesnici s CMV kolitisom i akutnim relapsom bolesti
pokazuju čestu rezistenciju na terapiju glukokortikoidima. Ovakva refrakternost na terapiju čini se da je povezana s titrom odnosno količinom virusa u tkivu kolona koji je povezan s povećanim rizikom kolektomije. Predmet interesa na ovom području je i terapija upalnih bolesti crijeva za koju je dokazano, osobito u slučaju glukokortikoida i imunomodulatora, da može potencirati reaktivaciju citomegalovirusa. Iako je na ovom području provedeno mnogo istraživanja, još uvijek nije postignut konsenzus po pitanju uloge citomegalovirusa u upalnoj bolesti crijeva. Otvoreno je pitanje da li CMV uzrokuje pogoršanje tijeka bolesti ili je samo „nevini promatrač“ ili „nusprodukt“ teškog oblika osnovne bolesti. U ovom radu prikazan je suvremeni pristup u dijagnostici, liječenju i definiranju klinički relevantne CMV infekcije, poglavito CMV kolitisa, a sve sa svrhom da bi se, korištenjem adekvatnih dijagnostičkih metoda, brže postavila ispravna dijagnoza i pravovremeno uključila antivirusna terapija.

Abstract (english)

Chron's disease (CD) and Ulcerative colitis (UC) are chronic inflammatory diseases (IBDs) that primarily affect the gastrointestinal tract and are characterized by alternating periods of remission and relapse. Their prevalence is increasing globally and they require life-long and complex treatment followed by many side effects and complications. Patients with inflammatory bowel disease are prone to developing severe infections due to immunosuppressive therapy and mucosal
damage caused by chronic inflammation. Cytomegalovirus is a member of the Herpesvirus family that can cause severe and sometimes fatal disease in patients with impaired immunity as seen in IBD patients. Cytomegalovirus is associated with notable morbidity in patients with IBD, especially those with UC. The role of cytomegalovirus is being considered in exacerbations of IBD, response to therapy and the need for surgical treatment. Attention is especially placed on CMV colitis which can mimic a severe flare of UC or CD and is associated with poor outcomes. Patients with CMV colitis and acute exacerbation of IBD are often steroid-resistant. Steroid-resistance seems to be related to colonic tissue CMV viral load which is associated with an increased risk of colectomy. Special interest is also being paid to IBD therapy which was shown to induce viral reactivation, most notably in patients treated with glucocorticoids and immunosuppressive drugs. There are
still many unanswered questions in this field, and consensus has not been reached yet whether CMV actually causes a more severe IBD flare or is it just an “innocent bystander” or “byproduct” of underlying primary disease.The aim of this study is to present current approaches to diagnostics, treatment and the definition of clinically relevant CMV infection, most notably CMV colitis, all in the purpose of reaching the correct diagnosis and to ensure timely antiviral treatment.

• Keywords: upalne bolesti crijeva; Crohnova bolest; ulcerozni kolitis; citomegalovirus; CMV infekcija; CMV kolitis
• Keywords (english): inflammatory bowel disease; Crohn’s disease; ulcerative colitis; cytomegalovirus; CMV infection; CMV colitis
• Language: croatian
• URN:NBN: urn:nbn:hr:105:976966
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2021-04-14 08:13:48