Prevalence and Predictors of Gastrointestinal Infections Among Patients With Acute Severe Ulcerative Colitis and Those in Remission: A Cross-Sectional Study.

BACKGROUND: Gastrointestinal (GI) infections, common in tropical countries, are likely to precipitate acute exacerbations in patients with ulcerative colitis (UC). However, data are scant. Accordingly, we evaluated GI infections in patients with UC and determined their predictors. METHODS: Consecutive patients with acute severe ulcerative colitis (ASUC) and those in remission were evaluated for GI infections by stool microscopy, modified acid-fast stain, culture, and Clostridioides difficile toxin A/B/GDH, and cytomegalovirus (CMV) was studied using rectal biopsy by real-time polymerase chain reaction (RT-PCR), histology, and serum immunoglobulin M anti-CMV antibody. Demographic, clinical, and laboratory parameters, along with the frequency and predictors of GI infections, were assessed and compared between the two groups. RESULTS: Among 158 patients with UC (mean age 35.2 ± 13.0 years; male-to-female ratio 1.3:1; 108 with ASUC and 50 in remission), 79 (50%) had CMV infection (53 detected by RT-PCR alone, one by inclusion bodies, and 25 by both methods). Overall, 92/158 (58.2%) patients had GI infections, of whom 20/158 (12.6%) had multiple infections. CMV infection (70/108 (64.8%) vs. 9/50 (18%); p < 0.001) and overall GI infections (76/108 (70.3%) vs. 16/50 (32%); p < 0.001) were more common in patients with ASUC than in those in remission. C. difficile infection was observed in 3.7% of patients with ASUC. CMV coinfection was significantly associated with greater than two courses of systemic corticosteroids, extensive colitis, severe endoscopic inflammation, and deep ulcerations. Patients with concomitant parasitic infections were more likely to have prior azathioprine exposure. CONCLUSIONS: GI infections were more common in patients with ASUC than in those in remission, with CMV being the predominant pathogen; C. difficile and parasitic infections were identified in a smaller but clinically relevant proportion of patients. CMV infection was independently associated with prior systemic corticosteroid exposure, severe disease activity, extensive colitis, and deep ulcerations. These findings support routine screening for GI infections, particularly CMV, while considering C. difficile and parasitic infections in the diagnostic evaluation of patients with ASUC.