Cytomegalovirus (CMV) affects all ages. Once it gains entry, it remains latent in the body, but can emerge or reactivate to cause illness when the immune system weakens. This is why the infection is mainly seen in patients with solid organ transplants, blood cancer, HIV/AIDS and those undergoing chemotherapy or administered a long course of high-dose steroids.
Doctors have said that Covid-19, and the drugs being used to treat it, also suppress immunity of patients, making them susceptible to opportunistic fungal and viral infections such as mucormycosis and CMV. Patients with CMV are currently far fewer than those with mucormycosis. Delhi‘s Sir Ganga Ram Hospital reported five patients with CMV last week.
Doctors in Pune said CMV cases are trickling in. “I have diagnosed two post-Covid patients with the CMV in the last few days. They had complications like pneumonitis (inflammation of lung tissue), colitis (inflammation of the colon), hepatitis (inflammation of the liver), viremia (presence of viruses in the blood),” said infectious disease expert Mahesh Lakhe of Columbia Asia Hospital.
Lakhe said both were Covid patients who had increased requirement of supplemental oxygen, bloody diarrhoea and fever whose imaging studies were suggestive of interstitial patterns. “That’s the reason why we tested them for the CMV,” he said.
Experts at Jehangir Hospital also detected three patients with the Covid-associated or post-Covid CMV last week. All of them were in the age bracket of 35-50 years.
Jehangir’s infectious diseases expert Piyush Chaudhari said, “Prior to contracting Covid, they were healthy and immunocompetent individuals. Two of them had an ulcer of the food pipe and intestines and had suffered gastrointestinal bleeding. The third patient with lung nodules had worsening hypoxia (breathlessness) and it was difficult to wean him off ventilatory support. He ultimately succumbed. Two are still undergoing treatment.”
Covid-associated CMV, perhaps, is linked to Covid-19’s impact on T cell immunity, ranging from absolute lymphopenia (decreased white blood cells) to dysregulation of T cell immunity.
“Also, excess activation of innate immunity in Covid, as is observed in severe sepsis patients, predisposes them to CMV reactivation,” Chaudhari said.
Both SARS-CoV-2 and CMV can affect the inner lining of blood vessels and blood platelets to aggravate coagulopathy (bleeding disorder) and thrombosis (clot formation in blood vessels). Thus, Covid with CMV increases mortality by at least two to three fold.
“Before the pandemic, we used to have approximately eight to 10 CMV patients a year, mainly solid organ transplant recipients and few HIV- positive patients,” Chaudhary said.
Deenanath Mangeshkar Hospital (DMH) treated a 60-year-old woman diagnosed with CMV post-Covid recovery. She had other comorbid conditions. “After Covid recovery, she had abdominal pain and fever. She underwent a colonoscopy and was found to have CMV colitis. We treated her with ganciclovir, an anti-CMV drug for about four weeks. She recovered fully,” said the hospital’s infectious disease expert Parikshit Prayag.