Introduction:
Cytomegalovirus is a common virus that affects humans in various ways. Once affected by this virus, it remains in the human body for life long. Cytomegalovirus infection is the most common viral infection that occurs in humans. It spreads through bodily fluids. Cytomegalovirus infection can affect many organs, like the stomach, colon, eyes, and esophagus. Cytomegalovirus esophagitis is the second most common gastrointestinal condition of cytomegalovirus disease.
What Is Cytomegalovirus Esophagitis?
Cytomegalovirus esophagitis is a condition that affects individuals with debilitating diseases like human deficiency virus, long-term renal dialysis, and acquired immunodeficiency syndrome. The typical manifestation of this condition is dysphagia and odynophagia, and large ulcers or ulcers in the middle to distal esophagus. Cytomegalovirus esophagitis infection has an increased recurrence rate and poor prognosis.
What Are the Causes of Cytomegalovirus Esophagitis?
Cytomegalovirus is a member of the Herpesviridae family. It is acquired by sexual contact or during the perinatal period in adulthood. The risk of getting the disease occurs in immunocompromised individuals. Acute cytomegalovirus infection is the most common human viral infection. Once the infection is acquired, there is lifelong viral latency along with the risk of intermittent reactivation. Mucosal infections caused by cytomegalovirus lead to tissue necrosis and inflammation that involves vascular endothelium and, ultimately, ischemic mucosal injury (injury to the small intestine lining). This largely contributes to tissue injury and ulcer formation.
What Are the Signs and Symptoms of Cytomegalovirus Esophagitis?
The signs and symptoms of cytomegalovirus esophagitis are :
-
Fever.
-
Nausea and vomiting.
-
Abdominal pain.
-
Chest pain.
-
Weight loss.
-
Hematemesis (blood in vomit).
-
Dysphagia (difficulty in swallowing food).
What Are the Risk Factors and Complications of Cytomegalovirus Esophagitis?
Risk factors that predispose to cytomegalovirus esophagitis are:
-
High or low-dose corticosteroid therapy.
-
History of blood transfusion.
-
AIDS (acquired immunodeficiency syndrome) or HIV (human immunodeficiency virus) infection.
-
Advancing age.
-
The condition that decreases an individual’s immunity.
Complications of cytomegalovirus esophagitis are :
-
Perforation - The condition that develops holes through body organs' walls.
-
Stricture Formation - This can occur due to fibrosis, neoplasia, or inflammation and damage to esophagus mucosa or submucosa.
-
Periesophageal Pseudoaneurysms - A condition where the blood vessels of the organ wall are injured.
What Is the Diagnosis of Cytomegalovirus Esophagitis?
The diagnosis of cytomegalovirus esophagitis is made by doing a test like
-
Antigen Detection Test: Arapid kit test to detect antigens in blood samples.
-
Culture Test: A bacterial culture test is used to detect and confirm a bacterial infection.
-
Esophagogastroduodenoscopy: A diagnostic procedure used to detect duodenal and gastric ulcers.
-
Antibody Test: A test that is used to detect antibodies in the blood.
-
Qualitative or Quantitative Polymerase Chain Reaction: A method widely used that rapidly makes billions of copies of DNA used for DNA analysis.
-
Endoscopy With Biopsy: In this procedure, the endoscopic tube is used to take a tissue sample for biopsy.
-
X-Ray: A painless procedure that images the structures of the body, especially bones.
-
CT (Computed Tomography) Scan: A diagnostic imaging technique that uses a combination of computer technology and X-rays to create images of body tissues.
What Is the Treatment of Cytomegalovirus Esophagitis?
The treatment of cytomegalovirus esophagitis is mainly done by giving Ganciclovir and Valganciclovir. Active diseased condition is treated by giving Ganciclovir intravenously divided into doses daily for three to six weeks. In cases with concurrent retinitis and recurrent gastrointestinal disease maintenance therapy with IV, Ganciclovir is given after discontinuation of induction therapy. Treatment only suppresses the infection but does not eliminate it. Thus persistent immune deficient individuals are more prone to relapse.
In cases of recurrence, repeat induction is done, followed by maintenance therapy. An alternative to Ganciclovir is Foscarnet. In conditions of failures of monotherapy, combination therapy IV Ganciclovir and IV Foscarnet are given.
What Are the Differential Diagnosis of Cytomegalovirus Esophagitis?
Cytomegalovirus esophagitis usually presents as an isolated, single large ulcer in the distal esophagus but can manifest as diffuse esophagitis. This presentation can be tough to distinguish from other disorders like herpes simplex virus, esophagitis, and acid peptic disease. Other differential diagnoses are:
-
Esophageal Cancer - Cancer that occurs in the esophagus; it causes difficulty in swallowing and unintentional weight loss.
-
Gastroesophageal Reflux Disease (GERD) - Gastroesophageal reflux disease is a condition that occurs due to frequent backflow of stomach acids.
-
Tuberculosis - Mycobacterium tuberculosis is the main cause of this condition. The condition mainly attacks the lungs, brain, and spine. It is a serious bacterial infection.
-
Histoplasmosis - An infection that occurs as a result of breathing spores that is often found in bat and bird droppings.
-
Herpes Simplex Esophagitis - A viral infection that affects the esophagus caused by the herpes simplex virus.
-
Drug-induced Dysphagia - A condition that causes difficulty in swallowing and dysfunction swallowing that occurs due to the effect of medications.
-
Achalasia - A condition that makes tough food and liquids pass through the esophagus.
-
Aphthous Ulcer - A most common condition that causes ulcerative ulcers in the gastrointestinal tract.
-
Candidiasis - Fungal infection that affects the mouth, skin, throat, gut, and vagina.
-
Acid Peptic Disease - These diseases include gastroesophageal reflux disorder, duodenal ulcers, and gastric ulcers.
-
Barrett's Esophagus - A condition that affects the light pink lining of the esophagus due to constant acid reflux that results in redness and thickened esophagus.
-
Cryptococcosis - Infectious diseased condition caused by pathogenic encapsulated yeast genus Cryptococcus.
What Is the Prognosis of Cytomegalovirus Esophagitis?
Cytomegalovirus esophagitis carries a poor prognosis and has significant mortality and morbidity, around 25 percent in one year in immunocompromised individuals. Around 28 percent of the non-HIV immunocompromised individuals died within a year of cytomegalovirus esophagitis diagnosis. Other risk factors like acquired immunodeficiency, history of transplant, active malignancy, recent use of steroid therapy, immunosuppressive therapy, or chemotherapy increase the risk of mortality. Supportive therapy will suffice in providing symptomatic relief without poor prognosis in immunocompetent individuals.
Conclusion:
Cytomegalovirus esophagitis remains latent in a large number of individuals, even if they are immunocompromised. Individuals of advanced age receiving chemotherapy or organ transplants are at increased risk. This viral infection can also be acquired by bodily fluids when the individual comes in contact with blood products and sexual contact. An individual should be educated about taking needful precautions when coming into bodily fluids and a good induction treatment along with regular follow-up of the individual.
