After a primary infection, human cytomegalovirus (HCMV) remains latent in certain human cells. Different stimuli, including immune deficiency and severe infection, can trigger the reactivation of latent HCMV infection. In the last decade, the role of the reactivation in immunocompetent patients with serious illness has been intensely studied; however, the knowledge of the potential role of moderately severe infections on HCMV dynamics is limited. In the prospective study, 80 HCMV-seropositive, immunocompetent adult patients with community-acquired pneumonia (CAP), treated outside the intensive care unit (ICU), were monitored with real-time polymerase chain reaction (PCR) for the presence of HCMV DNA. Detection of HCMV DNA in whole blood and/or plasma was interpreted as reactivation of latent HCMV infection. HCMV DNA was detected in 6 of 80 (7.5%) patients. All HCMV DNA-positive patients were classified according to the pneumonia severity index (PSI) as high-risk classes IV or V; thus, HCMV DNAaemia rate within these two PSI classes was 16.7%. All of the patients had positive whole blood samples, whereas plasma samples were positive in a single patient. We did not detect any significant differences comparing six patients with proven HCMV DNAaemia and 74 patients in whom HCMV DNAaemia was not demonstrated regarding the levels of inflammatory parameters on admission, length of treatment with supplemental oxygen, and length of hospital stay. In conclusion, the finding of HCMV DNAaemia in patients with CAP treated outside the ICU is a rare event and occurs only in patients with PSI classes designating more severe pneumonia.

Background The efficacy and optimal duration of post-exposure influenza prophylaxis with oseltamivir is undetermined in hospital settings where immediate separation from index cases is not feasible. Methods In an open-label non-inferiority randomized clinical trial in a single-center university hospital, the efficacy of 5-day versus 10-day post-exposure prophylaxis with oseltamivir was compared in adult patients exposed to influenza who could not be immediately separated from index influenza cases. Influenza incidence was assessed for 10 days after discontinuing prophylaxis. Results Among 222 exposed patients (median age 75 years; male 119; median Charlson comorbidity index 5), 110 patients were assigned to 5-day group of post-exposure prophylaxis with oseltamivir, and 112 patients to the 10-day group. The median duration of exposure to influenza was 2 days (IQR 1–3 days). In the intention to treat analysis, incidence of influenza was 2/110 (1.8%) in the 5-day group and 0/112 (0%) in the 10-day group (difference, 1.8 percentage points [1-sided 95% CI, –1 to 4.9 p.p.]; P=.77). Conclusions For patients exposed to influenza in a hospital setting, and who were not immediately separated from index cases, post-exposure prophylaxis with oseltamivir resulted in low incidence of nosocomial influenza transmission. Five-day post-exposure prophylaxis was non-inferior to 10-day regimen.

Background: The aim of the current study was to assess the patients with COVID-19 and the impact of vitamin D supplementation on the course of COVID-19.  Methods: This prospective cohort study included patients hospitalized due to COVID-19 between December 2020 and December 2021. Patients' demographic, clinical, and laboratory parameters were analysed.   Results: 301 participants were enrolled in the study. 46 (15,3%) had moderate, and 162 (53,8%) had severe COVID-19. 14 (4,7%) patients died, and 30 (10,0%) were admitted to the ICU due to disease worsening. The majority needed oxygen therapy (n=224; 74,4%). Average vitamin 25(OH)D3 levels were below optimal at the admittance, and vitamin D deficiency was detected in 205 individuals. More male patients were suffering from vitamin D deficiency. Patients with the more severe disease showed lower levels of vitamin 25(OH)D3 in their blood. The most severe group of patients had more symptoms that lasted significantly longer with progressing disease severity. This group of patients also suffered from more deaths, ICU admissions, and treatments with dexamethasone, remdesivir, and oxygen.  Conclusion: Patients with the severe course of COVID-19 were shown to have increased inflammatory parameters, increased mortality, and higher incidence of vitamin D deficiency. The results suggest that the vitamin D deficiency might represent a significant risk factor for a severe course of COVID-19.