The Potential Harm of Cytomegalovirus Infection in Immunocompetent Critically Ill Children

Abstract

Cytomegalovirus (CMV) is a ubiquitous infection that causes disease in congenitally infected children and immunocompromised patients. Although nearly all CMV infections remain latent and asymptomatic in immunologically normal individuals, numerous studies have found that systemic viral reactivation is common in immunocompetent critically ill adults, as measured by detection of CMV in the blood (viremia). Furthermore, CMV viremia is strongly correlated with adverse outcomes in the adult intensive care unit (ICU), including prolonged stay, duration of mechanical ventilation, and death. Increasing evidence, including from a randomized clinical trial of antiviral treatment, suggests that these effects of CMV may be causal. Therefore, interventions targeting CMV might improve outcomes in adult ICU patients. CMV may have an even greater impact on critically ill children, particularly in low and middle income countries (LMIC), where CMV is regularly acquired in early childhood, and where inpatient morbidity and mortality are inordinately high. However, to date, there are few data regarding the clinical relevance of CMV infection or viremia in immunocompetent critically ill children. We propose that CMV infection should be studied as a potential modifiable cause of disease in critically ill children, and that these studies be conducted in LMIC. Below, we briefly review the role of CMV in immunologically normal critically ill adults and children, outline age-dependent differences in CMV infection that may influence ICU outcomes, and describe an agenda for future research.

Molecular pathogenesis of secondary bacterial infection associated to viral infections including SARS-CoV-2

“…CMV infection is also connected with immune system paralysis that is characterized by enhanced IL-10 and NFkβ production, lymphopenia, reduction of IFN-γ producing T cells, and increase tissue damage by dysregulated cytokine production. Immune response during CMV infection is generated a favorable environment for secondary bacterial infections [ [27] , [28] , [29] ]. MeV infection is another example of immunosuppressive characteristics that are associated with a secondary bacterial infection.…”

Population Pharmacokinetics and Dose Optimization of Ganciclovir in Critically Ill Children

“…Furthermore, more studies found that CMV reactivation was prevalent in immunocompetent critically ill patients with a high incidence of 15–20%. Worse still, CMV reactivation was also considered to be correlated with clinical adverse outcomes and the increase of inpatient mortality ( Limaye et al, 2008 ; Papazian et al, 2016 ; Alyazidi et al, 2018 ).…”

Cytomegalovirus-Mediated T Cell Receptor Repertoire Perturbation Is Present in Early Life

“…Presently, CMV remains a burden to human health. This is particularly true for vulnerable groups such as children with congenital CMV infection (12), and "frail" patients suffering from autoimmune disease-even if they are otherwise immunocompetent (12,13).…”