Viral infections in inflammatory bowel disease: Tips and tricks for correct management

Abstract

Over the past decades, the treatment of inflammatory bowel diseases (IBD) has become more targeted, anticipating the use of immune-modifying therapies at an earlier stage. This top-down approach has been correlated with favorable short and long-term outcomes, but it has also brought with it concerns regarding potential infectious complications. This large IBD population treated with immune-modifying therapies, especially if combined, has an increased risk of severe infections, including opportunistic infections that are sustained by viral, bacterial, parasitic, and fungal agents. Viral infections have emerged as a focal safety concern in patients with IBD, representing a challenge for the clinician: they are often difficult to diagnose and are associated with significant morbidity and mortality. The first step is to improve effective preventive strategies, such as applying vaccination protocols, adopt adequate prophylaxis and educate patients about potential risk factors. Since viral infections in immunosuppressed patients may present atypical signs and symptoms, the challenges for the gastroenterologist are to suspect, recognize and diagnose such complications. Appropriate treatment of common viral infections allows us to minimize their impact on disease outcomes and patients’ lives. This practical review supports this standard of care to improve knowledge in this subject area.

Keywords: Inflammatory bowel diseases; Viral infections; Opportunistic infections; Standard of care; Crohn’s disease; Ulcerative colitis

Core Tip: The inflammatory bowel disease population treated with immune-modifying therapies is at increased risk of severe infections, including opportunistic infections sustained by viral agents. Of these opportunistic infections, 40% are due to viral pathogens, including hepatitis A virus, hepatitis C virus, hepatitis B virus, human papillomavirus, influenza virus, human immunodeficiency virus, herpes simplex virus, cytomegalovirus, varicella zoster virus, Epstein-Barr virus, and severe acute respiratory syndrome coronavirus 2 (causing coronavirus disease 19). A challenge for the gastroenterologist is to adopt preventive measures, recognize and treat common viral infections to minimize their impact on disease outcomes and patients' lives. This practical review supports this standard of care, aiming to bridge the gap of knowledge in this subject area.