Cytomegalovirus reactivation in a general, nonimmunosuppressed intensive care unit population: Incidence, risk factors, associations with organ dysfunction, and inflammatory biomarkers

Cytomegalovirus infection in immunocompetent critically ill adults: literature review

“…On the other hand, a prospective observational study of 80 mechanically ventilated patients that were seropositive for CMV found no association between CMV disease and 28-day mortality, ICU mortality, ICU length of stay, or duration of mechanical ventilation, although the SOFA score was significantly higher in CMV-infected group [12]. Similar findings were also reported in a study that used CMV pp65 antigenemia as evidence of CMV disease [28].…”

“…A study by Venet showed that septic patients display immune system paralysis, manifesting as reduced Th1 B cell function, increased IL-10 production (anti-inflammatory), and global lymphopenia affecting natural killer cells (NK) specifically quantitatively and most importantly qualitatively related to their interferon production, which is pivotal in attacking CMV-infected cells [10, 11]. CMV disease has also been linked to the cytokine storm associated with critical illness, specifically tumor necrosis factor alpha that activates nuclear factor κB, which enhances the replication of the dormant CMV DNA inside leukocytes, while enhancing the production of cytokines and other proteins [12]. In animal models with bacterial sepsis, Toll-like receptor 4 signaling and secreted inflammatory cytokines all have been found to be potential triggers for reactivation of latent CMV in immunocompetent mice lungs [13].…”

Cytomegalovirus Disease of the Upper Gastrointestinal Tract: An Emerging Infection in Immunocompetent Hosts

“…However, in the last decades, CMV disease in immunocompetent patients has been increasing, with more involvement of the upper gastrointestinal tract [2,7,8,10,12] . Critically ill patients, particularly those with sepsis and under mechanical ventilation, have been proposed as being at risk for this increasing incidence because of a transiently suppressed immunity [5,13] . Further, some cases in healthy individuals have also been reported [2,11,12,14,15] .…”

“…Despite uncertainties about the burden of CMV disease in these patients due to few reported cases, morbidity and mortality seem to be lower than in immunocompromised patients. However, lifethreating situations have been described, especially in elderly patients and those with associated critical illnesses/ comorbidities [3,5,[12][13][14]16] .…”

“…Several studies demonstrated that advanced age is a risk factor for CMV disease in immunocompetent patients, in line with immune senescence [2,3,8,18] . In addition, critical conditions or comorbidities can play a role in patients without immunodeficiency or immunosuppression, causing significant impairment of host immune response [2,3,5,8,13,18] . Marques et al [17] also reported advanced age and those conditions in all immunocompetent patients.…”