New Delhi: At least five cases of Cytomegalovirus (CVM) related rectal bleeding were reported in COVID-19 patients admitted to Delhi’s Sir Ganga Ram Hospital, one of whom succumbed to the infection. These patients with Cytomegalovirus had complained of bleeding in stool and abdominal pain, Prof Anil Arora, chairman, Institute of Liver Gastroenterology and Pancreaticobiliary Sciences at Ganga Ram Hospital said on Tuesday.Also Read - How COVID-19 Complications Can Cause Kidney Damage, Doctor Explains
None of them had other predisposing immunosuppressed states accounting for this viral infection, he added. Also Read - 4th Wave of COVID? Karnataka Govt to Tighten Rules Amid Rising Cases. Deets Inside
“This is the first report from India of five cases of Cytomegalovirus (CMV) related rectal bleeding in Covid immunocompetent patients,” a spokesperson of the Delhi hospital said in a press briefing. Until now it affected only immunocompromised patients, post-transplant, cancer, AIDS, etc, the official said. Also Read - Focus On Testing, Tracking, Treating: Centre Writes to States to Take Measures Amid Surge in COVID Cases
The patients were from Delhi-NCR and belonged to the age group of 30-70. Four of them had presented with lower gastrointestinal bleed, which is bleeding in stools and one of them presented with intestinal obstruction, the hospital stated.
Typically, the problems begin to surface on an average 20-30 days after the diagnosis of Covid-19, doctors at Sir Ganga Ram Hospital said.
“Two of them had massive bleeding, one requiring emergency life-saving surgery in the form of removal of right side of the colon, while one of them succumbed due to massive bleeding and severe Covid-19 chest disease,” the hospital said.
The other three patients were successfully treated with antiviral therapy with ganciclovir, said Arora.
Hospital authorities said that a few CMV cases had emerged during the covid second wave of April-May in otherwise immunocompetent patients diagnosed with coronavirus. This was the same time when a series of fungal infections, starting with Black Fungus, emerged in COVID patients.
“One such opportunistic infection from CMV Cytomegalovirus exists in 80 to 90 per cent 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,” the statement read.
But in these five cases, 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, doctors 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,” said Dr Sunila Jain, senior consultant pathologist, at the hospital.
In such cases, a high index of suspicion and timely intervention in the form of an early diagnosis and effective antiviral therapy can save many a precious lives, opined Dr Praveen Sharma, senior consultant, gastroenterology department at the Sir Ganga Ram Hospital.