June 30, 2021 5:00:51 pm
At a time when Covid-19 continues to manifest in various types of rare, unheard of diseases and conditions, five Covid patients at Delhi’s Ganga Ram Hospital were reported to have suffered rectal bleeding due to CMV infection or cytomegalovirus, with one person dead, reported PTI. Though cytomegalovirus or CMV is a common virus, it is the first time that it was reported in Covid patients 20-30 days after testing positive in April-May 2021 amid the second wave, said the report.
What is cytomegalovirus?
According to Mayo Clinic, once the body gets infected with this virus, it retains it for life. The virus rarely causes problems in healthy people but can severely impact people with a weakened immune system. The virus spreads easily through an infected person’s blood, saliva, urine or other body fluids and is related to the herpes virus.
CMV is a double-stranded DNA virus and a member of the human herpesvirus family. It is a common viral infection in 50 per cent to 100 per cent of humans worldwide, depending on the age and race of the population tested, said Dr Vipulroy Rathod, senior gastroenterologist, Bhatia Hospital Mumbai.
“Since the virus rarely spells trouble in healthy people, most people who get it don’t even know. The symptoms of primary CMV are mild such as sore throat, muscle aches, fatigue, swollen glands and fever,” Dr Praveen Gupta, director neurology, Fortis Memorial Research Institute, Gurugram told indianexpress.com.
Dr Rathod mentioned that patients with CMV colitis present with non-specific symptoms, including diarrhea, abdominal pain, fever, rectal bleeding, and weight loss.
Hematochezia and diarrhea are the most frequently observed symptoms in these patients. “Therefore, a high index of suspicion is necessary, and laboratory investigations are essential in diagnosing CMV colitis. There are certain specific blood tests and colonoscopic evaluations that can diagnose CMV-related colitis which leads to blood in stools. Colonic mucosal biopsies stained with hematoxylin and eosin (H & E) may reveal the typical inclusion associated with CMV colitis, “owl eye appearance” inclusion bodies, which are highly specific for CMV,” Dr Rathod told indianexpress.com.
How is it related to Covid-19?
‘If you’re pregnant or if your immune system is weakened, CMV is cause for concern. Women who develop an active CMV infection during pregnancy can pass the virus to their babies, who might then experience symptoms. For people who have weakened immune systems, especially people who have had an organ, stem cell or bone marrow transplant, CMV infection can be fatal’, warned Mayo Clinic.
Cytomegalovirus colitis occurs most commonly in immunocompromised hosts, including patients with acquired immunodeficiency syndrome (AIDS), organ transplantation, hematological malignancy, cancer therapy, and corticosteroid therapy, mentioned Dr Rathod.
“It is observed in few instances of Covid-19 infected patients, and the reason could be that these patients are on steroid therapy or are immunocompromised. Underlying chronic inflammatory bowel disease such as ulcerative colitis too can be a predisposing factor,” he said.
As per Mayo Clinic, there is no cure, but there are medications that can help treat the symptoms. The majority of patients with CMV colitis who are immunocompetent may need no treatment with antiviral medications; because of the severity of side-effects of antiviral drugs such as ganciclovir, there is no evidence that treatment with antiviral medications in these patients will make significant differences in patient outcomes, Dr Rathod told indianexpress.com.
“Hence it is important to have high suspicious index if they develop blood in stools which could be secondary to CMV-related bleeding. Timely diagnosis and treatment can prevent further complications,” he advised.