Cytomegalovirus pneumonia in patients with severe covid-19 disease
Lung India
; 39(SUPPL 1):S157, 2022.
Article
in English
| EMBASE | ID: covidwho-1857324
ABSTRACT
Background:
70-90 % of the adult population carries latent cytomegalovirus (CMV), which may be reactivated by inflammation and immune suppression. CMV reactivation has been seen in up to one-third of critically ill patients, and is associated with worse clinical outcomes. Here, the authors present two challenging cases, wherein the management of severe COVID-19 disease was complicated by CMV pneumonia. Case Reports Our patients presented with severe COVID-19 pneumonia with acute respiratory distress syndrome and were admitted in the intensive care unit (ICU). The patients received immunosuppressive therapy, either tocilizumab or methylprednisolone pulse therapy. Both the patients had a prolonged hospital stay, and showed an initial improvement followed by clinical deterioration, with recurrence of fever, worsening respiratory failure, and development of consolidations on CT thorax. A thorough work up for opportunistic infections revealed CMV infection. Both patients were treated with intravenous Ganciclovir and showed marked improvement.Discussion:
The use of steroids and other immunomodulatory therapies in the treatment of severe COVID-19 disease, along with immune suppression caused by severe COVID-19 itself, predisposes patients to reactivation of CMV. Furthermore, CMV reactivation is associated with a longer ICU length of stay, prolonged mechanical ventilation, increased risk of secondary infections, and mortality.Conclusion:
These cases highlight the importance of considering CMV disease as a differential diagnosis in critically ill patients with COVID-19 with unexplained worsening, especially in the setting of immunomodulatory therapies, as early treatment may prevent adverse clinical outcomes and mortality.
ganciclovir; methylprednisolone; tocilizumab; adult; adult respiratory distress syndrome; artificial ventilation; case report; clinical article; clinical outcome; complication; conference abstract; coronavirus disease 2019; critically ill patient; Cytomegalovirus; cytomegalovirus infection; deterioration; differential diagnosis; drug therapy; female; fever; hospitalization; human; immunosuppressive treatment; immunotherapy; intensive care unit; intravenous drug administration; length of stay; male; mortality; nonhuman; opportunistic infection; outcome assessment; pneumonia; prevention; respiratory failure; secondary infection; thorax
Search on Google
Collection:
Databases of international organizations
Database:
EMBASE
Language:
English
Journal:
Lung India
Year:
2022
Document Type:
Article
Similar
MEDLINE
...
LILACS
LIS