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Predisposition to Cytomegalovirus Infection of the Gastrointestinal Tract
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Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
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IN RESPONSE:
The important work by Dieterich and colleagues on the treatment of gastrointestinal cytomegalovirus infection was not overlooked but was published after submission of my review. Dr. Poles and coworkers have done readers a service by summarizing their results and providing a reference list.
I do believe that corticosteroids predispose patients to gastrointestinal cytomegalovirus infection based on evidence from case reports quoted in my review [1-3] and from personal experience (see Figure 2 of the Annals review). However, many (but by no means all) such patients are elderly or have had cancer or another debilitating illness, making the role of corticosteroids in the activation of cytomegalovirus unclear. I certainly agree with Drs. Kao and Richmond's main point that the more potent immunosuppressive therapies are associated with a higher frequency of cytomegalovirus disease.
I regret that my review did not include the important case report of Drs. Arnar and Gudmundsson showing that the disease can occur in normal hosts. Their 5-year follow-up, along with the quoted articles and more recent case reports [4, 5], will help clinicians to appreciate this.
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
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