Prevalence of entamoeba histolytic and cytomegalovirus infection in inflammatory bowel di̇sease

Objective: Diagnosis and management of IBD can be difficult, as some infections may mimic IBD and lead to misdiagnosis. Acute ameboic colitis may mimic inflammatory bowel disease or may be added to IBD and cause symptoms to worsen. 1 Several studies have reported that viral infections, particularly cytomegalovirus (CMV) infection, are associated with the onset and aggravation of inflammatory bowel disease, indicating poor prognosis, increasing the prevalence of toxic megacolon and increasing the risk of surgical intervention. The aim of this study was to determine the incidence of Entamoeba histolytica and CMV infection in IBD patients in our center, to show their role in activation and disease progression, and to review our clinical practice approach and contribute to the literature. Materials and methods: Between January 2014 and December 2017, 769 patients diagnosed as IBD in Dokuz Eylül University Faculty of Medicine Hospital, Department of Internal Medicine, Department of Gastroenterology were included in this study. Demographic data of patients, clinical data (Stool number, history of rise in body temperature), laboratory resaults (CRP, leukocyte value, CMV-DNA PCR in plasma), stool examinations (Stool direct examination and culture, stool E.histolytica adhesin antigen), abdomen imaging, colon biopsy specimens (Histopathological examination, presence of CMV by IHC) were evaluated. Results: There were 61 (14.15%) CMV positive patients. Of the 61 patients, 37 (60.7%) were diagnosed with UC and 24 (39.3%) were diagnosed with CD. 70.5% of the patients were followed up with immunosuppressive therapy when CMV positivity was detected. The use of immunosuppressive therapy was significantly higher in patients with CMV-positive Crohn's disease compared to patients with UC. (p = 0.019) (87.5% in patients with Crohn's disease and 59.5% in patients with UC). 16.4% of the patients had a previous surgical history. 30% of these patients are diagnosed with UC and 70% with Crohn's disease. Surg 0.04) It was seen that infliximab use was higher in CMV positive CD patients than UC patients. (p = 0.02) 41% of the patients received azathioprine treatment. E. Histolytica positivity was found in 5.8% of the patients. E. histolytica positive 60.9 UC, 39.1% CD. Conclusion: CMV infection is mostly seen in patients with UC. Most CMV-positive patients are treated with immunosuppressive drugs, and the use of immunosuppressive therapy was significantly higher in patients with CMV-positive CD than patients with UC. Patients were followed up with azathioprine at the highest rate among immunosuppressive therapies, whereas azathioprine was followed by corticosteroid use (p = 0.019). Patients with CMV positive CD had more infliximab use than UC patients. (p = 0.02) Previous surgical history was higher in patients with Crohn's disease than patients with UC. (P = 0.04) It is important to detect infections such as CMV and E. histolytica in IBD, which may mimic the disease and adversely affect the course of the disease. The standards to be determined in terms of diagnosis and treatment are necessary to guide the researches and clinical applications.