What is cytomegalovirus?: Delhi hospital sees cases of infection after Covid-19 test

These patients had pneumonia in the preceding month, received high doses of steroids and had turned Covid negative at the time of detection of CMV disease

Six persons have been diagnosed with cytomegalovirus (CMV) infection at Indraprastha Apollo Hospitals in Delhi within 20 to 30 days of testing positive for coronavirus, officials said on Thursday.

All these patients admitted at Apollo had severe Covid-19 pneumonia in the preceding month, received high doses of steroids and had turned Covid negative at the time of detection of CMV disease, they said.

Cytomegalovirus infection is a common herpesvirus infection with a wide range of symptoms: from no symptoms to fever and fatigue (resembling infectious mononucleosis) to severe symptoms involving the eyes, brain, or other internal organs.

The cytomegalovirus (CMV) disease is usually found in patients with immunocompromised status like those who suffer from HIV, low CD4 counts, or are cancer post-transplant patients on immunosuppressive medicines etc.

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Suppression of immunity due to Covid-19 and steroids gives CMV a chance to attack patients. The virus otherwise exists in 80-90 percent of the Indian population in asymptomatic form due to inherent immunity.

Dr Athar Ansari, Consultant (Department of Respiratory, Critical Care and Sleep medicine), Indraprastha Apollo Hospitals, said, “In the past month, we have detected CMV disease in six patients with post Covid-19 syndrome that came with varied manifestations. Symptoms of CMV depend on which part of the body it is affecting. If it has direct involvement of lungs, the patient will have a fever, difficulty in breathing, chest pain or cough.”

The patients that were admitted to Apollo after 20-30 days of testing Covid-19 positive were detected with conditions like hypoxia, inflammation in the lungs and liver, and one of them was a known case of acute myeloid leukemia, he said.

CMV colitis is a known entity. Although more common in immunocompromised, it has been reported in immunocompetent patients earlier as well. CMV is an opportunistic infection that preys on low immunity, and Covid-19 is capable of severe immune suppression, the doctor added.

The reason of the activation of the CMV virus in these patients could be the Covid 19-induced immunosuppression and high dose steroid therapy, said Dr Avdhesh Bansal, Senior Consultant, Department of Respiratory, Critical Care and Sleep Medicine, Indraprastha Apollo Hospitals.

CMV disease can have varied presentations and a high index of suspicion is required to make the diagnosis among Covid-19 patients with persistent symptoms not responding to treatment, he said.