The Importance of CMV Reactivation in COVID-19-Related ARDS Patients

Objectives: Cytomegalovirus (CMV) reactivation is a significant cause of morbidity and mortality in critically ill patients. Existing or newly developed immunosuppression appears to be the main factor for reactivation. COVID-19 patients with acute respiratory distress syndrome can be affected by a variety of conditions that cause immunosuppression. Clarifying CMV reactivation and notably its predictive features became important during the epidemic. Method(s): This is a retrospective, observational, and cohort study. All COVID-19 patients admitted to the ICU between March 11, 2020 and March 11, 2021 were analyzed. All of the information was gathered from the hospital's electronic records. CMV reactivation was defined as CMV DNA >=1000 copies/ml in tracheal samples. The patient population was analyzed in two groups, namely, patients with CMV reactivation and patients without reactivation. Result(s): During the study period, 99 of all COVID-19 ARDS patients fulfilled the inclusion criteria, and CMV reactivation was detected in 55 (55.6%) of them. Age, BMI, APACHE-II score, hypertension, chronic respiratory disease, the usage of interleukin blockers, the duration of steroid usage, procalcitonin (PCT), and CD-8 T-cell levels differed significantly from the patients without CMV reactivation. Furthermore, the reactivation group had longer ICU stays, longer durations of mechanical ventilation, and higher mortality. Conclusion(s): CMV can be reactivated in critically ill COVID-19 ARDS patients, which appears to correlate with worse outcomes. Obesity, the usage of IL-blockers and steroids >12 days, high PCT, and low CD-8 T-cell levels appear to be risk factors. Critically ill COVID-19 patients should be closely monitored with regard to immunosuppression and CMV status.Copyright © 2022 by The Cardiovascular Thoracic Anaesthesia and Intensive Care.

The usage of the immunosuppressant agents and secondary infections in patients with COVID-19 in intensive care unit: a retrospective study

Introduction: It's known that immunosuppressant agents such as pulse methylprednisolone (PMP), dexamethasone (DXM) and interleukin- blockers (IL-B) are used in COVID-19 [1-3]. The aim of this study is to investigate the effect of these immunosuppressant agents on secondary infections in patients with COVID-19 in intensive care units (ICU). Methods: This study was retrospectively designed and all data between March 2020 and October 2021 of six tertiary ICU was evaluated. All patients were divided by three groups as Group I (GI, no immunosuppressant or MP ≤ 1.0 mg/kg), Group II (GII, PMP and/or DXM) and Group III (GIII, only IL-B and PMP and/or DXM). Demographic data, PaO2/FiO2 (P/F) ratio, C-reactive protein (CRP) and procalcitonin, hemogram parameters, ferritin and d-dimer, culture results and outcomes were recorded. For comparison between GI-GII and GI-GIII, propensity score matching (PSM) was used by matching 14 parameters [age, gender, BMI, CCI, APACHE II, P/F ratio, CRP, procalcitonin, hemogram parameters, ferritin, d-dimer and invasive mechanical ventilation (IMV) requirements]. Results: 412 ICU patients were included in the study (GI = 118, GII = 184, GIII = 110). Mortality rates were 27.1%, 39.7% and 55.5% respectively. After PSM, in GII and GIII, the number of ( +) tracheal cultures, ( +) bloodstream cultures, detected different microorganisms during ICU period, neuropathy, tracheotomized patients, duration of IMV and length of ICU stay were significantly higher than GI. Mortality rate and ( +) CMV-DNA-PCR were similar in GI and GII whereas they were significantly higher in GIII than GI. Conclusions: The usage of immunosuppressant agents in COVID-19 causes increased secondary infections. Moreover, increased secondary infections appear as a reason for prolonged ICU stay and duration of IMV, and also, increased mortality.

Human Metapneumovirus Infection in Adults as the Differential Diagnosis of COVID-19

Human metapneumovirus (HMPV) is a respiratory tract virus identified 18 years prior to severe acute respiratory syndrome coronavirus-2. Both viruses cause acute respiratory failure characterised by a rapid onset of widespread inflammation in the lungs with clinical symptoms similar to those reported for other viral respiratory lung infections. HMPV, more generally known as childhood viral infection, causes mild and self-limiting infections in the majority of adults, but clinical courses can be complicated in risky groups and associated morbidity and mortality are considerable. Moreover, adults are not regularly screened for HMPV and the prevalence of adult HMPV infections in Turkey is unknown, with previous reports in the paediatric population. This should always be kept in mind during the coronavirus disease-2019 pandemic, particularly when neurological complications are added to respiratory findings. In our study, two adult cases of HMPV pneumonia and encephalitis have been recorded.