Covid-induced CMV with rectal bleeding seen, 1 death so far
New Delhi: Delhi has now reported the country's first cases of Cytomegalovirus (CMV) related rectal bleeding in at least five Covid-19 patients — all of whom were otherwise immunocompetent, with one of them succumbing to massive bleeding and severe Covid infection and one other patient needing life-saving surgery.
Sir Ganga Ram Hospital here reported the first five cases, of which three have made a full recovery on a regimen of antiviral therapy. All five cases were reported over the last 45 days.
According to Professor Anil Arora, Chairman of the hospital's Institute of Liver Gastroenterology and Pancreaticobiliary Sciences, "During the second wave of 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. None of them had other predisposing immunosuppressed states accounting for this viral infection."
"A lot of emphasis has been given to black and white fungus, but we did not know until recently that a new virus called Cytomegalovirus (CMV), which is a normal part of the body in about 80 to 90 per cent of the population, may get reactivated due to the immunosuppression caused by the COVID-19 infection," Prof Arora added.
Doctors at the Ganga Ram hospital said that the COVID-19 infection itself and the medicines used for its treatment (steroids) do suppress the immunity of patients and make them susceptible for uncommon infections with varied presentations. One such opportunistic infection is (CMV) virus.
Cytomegalovirus exists in 80 to 90 percent of the Indian population in asymptomatic form as our immunity is strong
enough to make it clinically asymptomatic. Clinical presentation with symptoms secondary to CMV is usually seen in patients whose immunity is compromised.
But in the series all patients presented with low lymphocyte count (6-10 per cent as against a normal of 20 to 40 per cent) indicating Covid-induced suppression of immunity predisposing them to symptomatic reactivation of CMV infection. Out of five cases with age group of 30-70 years were from Delhi NCR, four had presented with lower gastrointestinal bleed (that is bleeding in stools) and one patient presented with intestinal obstruction. Two of them had massive bleeding, one requiring emergency lifesaving surgery in the form of removal of the right side of the colon. The other three patients were successfully treated with antiviral therapy with ganciclovir, Prof Arora said.
"Cytomegalovirus colitis was confirmed by PCR testing for CMV viremia and tissue biopsy from the large intestine which showed intranuclear inclusion bodies which was further confirmed to be due to CMV infection by the specific immunohistochemistry stains," Dr Sunila Jain, Senior Consultant Pathologist, said.
"In such cases, a high index of suspicion and timely intervention in the form of an early diagnosis and effective antiviral therapy can be life-saving", Dr Praveen Sharma, Senior Consultant, Gastroenterology Department, said.