CMV reactivation in COVID-19 patients: pouring fuel on the fire
Keywords:cytomegalovirus (CMV), reactivation, COVID-19, lymphopenia, hyperinflammatory response.
Severe SARS-CoV-2 infection could promote CMV reactivation, that further worsens disease prognosis.
This study included admitted patients with recent COVID-19 for one year period in a tertiary hospital, having clinical criteria of CMV reactivation and positive CMV DNAemia.
Fifteen of 559 COVID-19 patients were diagnosed with CMV reactivation (2.7%). 86.6% were male, with a mean age of 63.6 years. Immunodepression was significantly higher in the CMV positive group (p=0.008). Lymphopenia was significantly more important in patients who reactivated CMV (p=<0.001), whereas ferritin level (p=0.019) and IL-6 level (p=0.035) on admission appeared to be significantly lower in this group. There was no significant difference for COVID-19 treatments. ICU admission (p<0 .001) and bacterial infections (p<0.001) appeared to be significant for CMV reactivation. Also, the mortality was significantly higher in the CMV positive group (p=0.042).
This study raises the possible incrimination of lymphopenia, immunosuppression, critical illness, and bacterial infections in CMV reactivation.
WHO Coronavirus (COVID-19) Dashboard. Available from: https://covid19.who.int accessed December 10, 2021.
Batah SS, Fabro AT. Pulmonary pathology of ARDS in COVID-19: A pathological review for clinicians. Respir Med. 2021 Jan ;176 :106239. doi: 10.1016/j.rmed.2020.106239
Ragab D, Salah Eldin H, Taeimah M, Khattab R, Salem R. The COVID-19 Cytokine Storm; What We Know So Far. Front Immunol. 2020 Jun; 11: 01446 doi:10.3389/fimmu.2020.01446
P, Horby, Lim Ws, Emberson Jr, et al. et al. Dexamethasone in Hospitalized Patients with Covid-19. N Engl J Med. 2021 Nov 27;384(8); doi:10.1056/NEJMoa2021436
C, Zhang, Wu Z, Li Jw, Zhao H, and Wang Gq. Cytokine release syndrome in severe COVID-19: interleukin-6 receptor antagonist tocilizumab may be the key to reduce mortality. Int J Antimicrob Agents 2021 Nov 27;55(5); doi: 10.1016/j.ijantimicag.2020.105954.
Cantini F, Niccoli L, Nannini C, et al. Beneficial impact of Baricitinib in COVID-19 moderate pneumonia; multicentre study. J Infect. 2020;81(4):647-679. doi:10.1016/j.jinf.2020.06.052
Le Balc’h P, Pinceaux K, Pronier C, Seguin P, Tadié J-M, Reizine F. Herpes simplex virus and cytomegalovirus reactivations among severe COVID-19 patients. Crit Care. 2020 Aug 28;24(1):530.
Jh, Naendrup, Borrega Jorge G, Dennis Alexander E, et al. Reactivation of EBV and CMV in Severe COVID-19-Epiphenomena or Trigger of Hyperinflammation in Need of Treatment? A Large Case Series of Critically ill Patients. J Intensive Care Med. 2021 Nov 18; doi:10.1177/08850666211053990
E, Forte, Zhang Z, Thorp Eb, and Hummel M. Cytomegalovirus Latency and Reactivation: An Intricate Interplay With the Host Immune Response. Front Cell Infect Microbiol [Internet]. 2020 Mar 31;10; doi:10.3389/fcimb.2020.00130
Wc, Carll, Rady My, Salomao Ma, et al.. Cytomegalovirus haemorrhagic enterocolitis associated with severe infection with COVID-19. BMJ Open Gastroenterol. 2021 Jan;8(1); doi:10.1136/bmjgast-2020-000556
My, Khatib, Shaik Ks, Ahmed Aa, et al, et al. Tocilizumab-induced cytomegalovirus colitis in a patient with COVID-19. Clin Case Rep 2020;9(1); doi:10.1002/ccr3.3487
Infectious Diseases Society of America Guidelines on the Diagnosis of COVID-19 [Internet]. [cited 2021 Nov 27]. Available from: https://www.idsociety.org/practice-guideline/covid-19-guideline-diagnostics/
Razonable RR, Humar A. Cytomegalovirus in solid organ transplant recipients—Guidelines of the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant. 2019;33(9); doi:10.1111/ctr.13512
Foresta C, Rocca MS, Di Nisio A. Gender susceptibility to COVID-19: a review of the putative role of sex hormones and X chromosome. J Endocrinol Invest. 2021 May 1;44(5):951–6.
Iwatani Y, Amemiya N, Nokiba H, Yamazaki M, Sugiura H, Nitta K. Risk factors for cytomegalovirus reactivation in patients with kidney disease under immunosuppressive therapy. Clin Exp Nephrol 2021 Aug 3; doi:10.1007/s10157-021-02117-5
COVID-19 Guideline, Part 1: Treatment and Management. Available from: https://www.idsociety.org/practice-guideline/covid-19-guideline-treatment-and-management/ accessed November 27, 2021
O, Gundogdu, Demir B, Coskun Co, and Ersan I. Efficacy of pulse steroid therapy in patients critically ill with COVID-19. Bratisl Lek Listy 2021;122(11); doi:10.4149/BLL_2021_126
Má, López Zúñiga, Moreno-Moral A, Ocaña-Granados A, et al. High-dose corticosteroid pulse therapy increases the survival rate in COVID-19 patients at risk of hyper-inflammatory response. PloS One 2021;16(1). doi:10.1371/journal.pone.0243964
Vy, Mareev, Orlova Ya, Pavlikova Ep, et al. Steroid pulse -therapy in patients With coronAvirus Pneumonia (COVID-19), sYstemic inFlammation And Risk of vEnous thRombosis and thromboembolism (WAYFARER Study). Kardiologiia 2020 Jul 7;60(6). doi:10.18087/cardio.2020.6.n1226
Scherlinger M, Alain S, and Richez C Monitoring of Epstein-Barr virus (EBV)/cytomegalovirus (CMV)/varicella-zoster virus (VZV) load in patients receiving tocilizumab for rheumatoid arthritis Joint Bone Spine 2018 Mar;85(2):259-260; doi: 10.1016/j.jbspin.2017.02.010. Epub 2017 Mar 28.
Fg, Frantzeskaki, Karampi Es, Kottaridi C, et al. Cytomegalovirus reactivation in a general, non-immunosuppressed intensive care unit population: incidence, risk factors, associations with organ dysfunction, and inflammatory biomarkers. J Crit Care. 2015 Apr;30(2). doi:10.1016/j.jcrc.2014.10.002
Mansfield S, Grießl M, Gutknecht M, Cook CH. Sepsis and cytomegalovirus: foes or conspirators? Med Microbiol Immunol (Berl). 2015 Jun;204(3):431–7.
Copyright (c) 2022 Racha Ibrahim, Marie-Ange Ghaleb, Eddy Lilly, Rebecca Kassab, Marie Chedid, Zeina Bou Chebl, Christian Haddad, Nabil Chehata, Gebrael Saliba, Jacques Choucair, Elie Haddad
This work is licensed under a Creative Commons Attribution 4.0 International License.
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access and Benefits of Publishing Open Access).
This journal provides immediate open access to its content on the principle that making research freely available to the public supports a greater global exchange of knowledge.
Articles are published Under License of Creative Commons Attribution 3.0 License Â©
Copyright policies & self-archiving
This is our Copyright Policy. We are a RoMEO green journal.
|Author's Pre-print:||author can archive pre-print (ie pre-refereeing)|
|Author's Post-print:||author can archive post-print (ie final draft post-refereeing)|
|Publisher's Version/PDF:||author can archive publisher's version/PDF|