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India Reports First Five Cases Of Cytomegalovirus Related Rectal Bleeding In COVID-19 Patients

COVID-19 has caused many post-treatment complications. Many people with acute COVID-19 illness have recovered well while others continue to face a range of long-term complications after recovery leading to severe health problems.

According to a press release shared today on Tuesday, June 29, 2021, by Sri Ganga Ram Hospital (Delhi), five cases of Cytomegalovirus (CMV) related rectal bleeding in the immunocompetent (people with a healthy immune system) COVID-19 patients were found. This is the first case in India in which COVID-19 patients have complained of rectal bleeding.

Let's get to its details.

About The Report

According to Prof Anil Arora, Chairman of Institute of Liver Gastroenterology and Pancreaticobiliary Sciences, Sir Ganga Ram Hospital, "During the second wave of the COVID-19, in April-May 2021, we have seen five cases of CMV infection in otherwise immunocompetent patients with COVID-19. These patients presented with pain in the abdomen and bleeding in stools. These patients presented with a mean of 20 to 30 days after the diagnosis of COVID-19".

Prof Arora added that none of these patients had other predisposing immunosuppressed states (conditions that had caused their immune system to suppress) or any accounting for the viral infection. The patients were in the age group 30-70 years.

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The diagnosis of these patients was confirmed by PCR testing for cytomegalovirus virions and biopsy of the large intestine that had shown CMV infection.

"In such cases of high index of suspicion and timely intervention in the form of an early diagnosis and effective antiviral therapy can save many precious lives," said Dr Praveen Sharma of Sir Ganga Ram Hospital.

What Is Cytomegalovirus Infection?

Cytomegalovirus is a widespread virus or say, a common virus that belongs to the family Herpesviridae or Herpes. It is found in people of all age groups and its manifestations can range from no symptoms to severe organ dysfunction.

In healthy adults, the CMV infection may not cause any symptoms, but in immunocompromised individuals, the symptoms could be life-threatening and need immediate medical attention. This is the reason why CMV infection is commonly reported in the latter group of patients such as those receiving immunosuppressive therapy after a disease or have an immunodeficiency syndrome. [1]

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Once a person is infected with CMV, the infection lives in the body for life in a dormant state and may get reactive during pregnancy or when the immune system weakens.

Which Is The Target Organ Of Cytomegalovirus Infection?

According to a study, the target organ for CMV infection is the alimentary tract or gastrointestinal tract anywhere from the mouth to the anus. The commonly affected site of CMV is the colon, followed by the duodenum, stomach, oesophagus and small intestine. [2]

As CMV infection mainly infects the gastrointestinal system, it is known to cause related conditions like ulcers, colitis and mass lesions, that lead to symptoms like gastrointestinal bleeding, diarrhoea, fever and abdominal pain.

Symptoms of Cytomegalovirus Infection

In healthy adults, symptoms due to CMV infection are none or mild. They include: [3]

  • Fever
  • Fatigue
  • Sore throat
  • Swollen glands
  • Muscle aches

In immunocompromised individuals, the symptoms may severely affect almost all organs of the gastrointestinal system like intestines, stomach, oesophagus and liver, along with organs like eyes and brain.

Babies born with CMV infection (congenital CMV infection) often face long-term health issues like hearing loss, liver disorders and growth problems.

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Out of these five patients who have complained of Cytomegalovirus infection after recovery from COVID-19, four had complained of lower gastrointestinal bleeding that includes bleeding from the rectum, anus and both large and small intestines. The remaining one patient had complained of intestinal obstruction, a gastrointestinal condition in which digested material is unable to pass normally through the bowel.

How Is Cytomegalovirus Infection Transmitted?

A study says that CMV infection finds its way into the body through mucous membrane contacts like saliva, blood, tears, vaginal fluid, semen and urine. [4]

It is also transmitted through blood components containing cells like infected needles, organ transplants, blood transfusion or stem cells.

In foetus or newborns, the CMV infection can be transplacental (from infected mother to baby through the placenta) or through vaginal secretions during the delivery or via breast milk.

COVID-19 And Cytomegalovirus Infection

Though this is the first case of COVID-related Cytomegalovirus infection in India, it is not the first case of herpes simplex virus, a family to which CMV belongs.

Earlier this month, probably around the second week of June, a hospital in Ghaziabad had reported the first case of herpes simplex virus in a recovered COVID-19 patient.

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Studies say that cytomegalovirus mainly tends to infect people with compromised immune systems, however, the case report of five patients which is reported today, says that those patients were immunocompetent, meaning they were having healthy immune systems.

This indicates that COVID-related Cytomegalovirus infection can also infect healthy individuals and may cause them severe complications

"Two of them had a massive bleed, one requiring emergency lifesaving surgery in the form of removal of the right side of the colon and one of them has succumbed due to massive bleeding and severe COVID chest disease. The other three patients were successfully treated with antiviral therapy with ganciclovir," added Dr Arora.

Diagnosis Of Cytomegalovirus Infection

Some of the diagnostic methods for CMV infection include:

  • PCR: For viral detection and identification.
  • Blood tests: For patients with symptoms of CMV infection.
  • Saliva and urine test: This test is recommended for newborns.

Treatments Of Cytomegalovirus Infection

The primary treatment methods for CMV infection include the use of approved antiviral medicines like ganciclovir, cidofovir, foscarnet and valganciclovir. In immunocompetent individuals, no specific therapy is required apart from the management of symptoms. [5]