Cytomegalovirus infection in non-immunocompromised critically ill patients: A management perspective

Abstract

Critically ill patients are a vulnerable group at high risk of developing secondary infections. High disease severity, prolonged intensive care unit (ICU) stay, sepsis, and multiple drugs with immunosuppressive activity make these patients prone to immuneparesis and increase the risk of various opportunistic infections, including cytomegalovirus (CMV). CMV seroconversion has been reported in up to 33% of ICU patients, but its impact on patient outcomes remains a matter of debate. Even though there are guidelines regarding the management of CMV infection in immunosuppressive patients with human immunodeficiency virus/ acquired immuno deficiency syndrome, the need for treatment and therapeutic approaches in immunocompetent critically ill patients is still ambiguous. Even the diagnosis of CMV infection may be challenging in such patients due to non-specific symptoms and multiorgan involvement. Hence, a better understanding of the symptomatology, diagnostics, and treatment options may aid intensive care physicians in ensuring accurate diagnoses and instituting therapeutic interventions.

Keywords: Cytomegalovirus; Critically ill; Immunocompetent; Intensive care unit; Virus

Core Tip: Cytomegalovirus (CMV) reactivation in critically ill immunocompetent patients may lead to increased intensive care unit (ICU) and hospital mortality, prolonged mechanical ventilation, longer ICU stay and increased risk of secondary bacterial and fungal infections. Nevertheless, whether it is the cause of clinical deterioration or is just a marker of disease severity remains debatable. Hence, the need for any therapeutic intervention is a management conundrum. The data extrapolated from studies on immunocompromised patients may not apply to these otherwise immunocompetent patients. This warrants future large-scale prospective studies on CMV reactivation in immunocompetent critically ill patients.