IGM investigation of Citomegalovirus (CMV) in severe Covid-19 patients

Cytomageloviruses, whose sole host is human, mostly cause latent infection. It is a very common pathogen and can be seropositive in 80% of the population. Since it can be found in all body fluids, its transmission is very common. The COVID-19 pandemic, caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), spread rapidly among communities due to its rapid transmission ability, leading to high mortality. In COVID-19 infection, mild symptoms may occur after exposure to the virus. As the severity of the disease increases, an increase in inflammatory responses may be observed, which can lead to tissue and organ damage. Corticosteroids have been widely used for the lack of specific treatment for COVID-19 and suppression of the inflammatory response. However, due to the suppression of the immune system by corticosteroids, it provides an environment for opportunistic pathogens. In our study; In this study, it was aimed to investigate the latent CMV reactivation due to corticosteroids given to severe COVID-19 patients. Between January 2022 and January 2023, 202 patients who met the inclusion criteria of Mersin University Faculty of Medicine and Practice Hospital were included in the study. CMV IgM was investigated by ELISA method in the sera of the included patients. The patients' CMV IgG seropositivity, demographic characteristics and certain blood parameters (Lymphocyte Count, Sedimentation, Procalcitonin, C-reactive protein, Lactate-dehydrogenase) were examined. As a result of the statistical analysis of the results obtained, 11/80 (13.7%) of 80/202 (39.6%) patients with a history of steroid/immunosuppressive drug were found to be CMV IgM positive. Considering the CMV IgG avidity results of the positive patient group, only 1 (9.09%) patient with <55 was detected. This result suggests that the patient had undergone CMV infection within a time frame of ≤ 3 months. Considering the data we have, it is thought that steroid use may have a significant effect on CMV IgM positivity (p<0.041). In the blood parameters examined in the patient group using steroids; High C-reactive protein level (p<0.001), low lymphocyte count (p<0.001), sedimentation rate (p<0.001) and high lactate-dehydrogenase enzyme were found to be significant when compared with patients without a history of immunosuppressive therapy (p<0.001). An increase in procalcitonin levels was observed in the patient group included in the study, but this increase was not found to be significant when compared to other groups (p<0.152). It is thought that COVID-19 infection and steroid use may be effective in CMV reactivation. It is important to keep in mind the reactivation of latent infections in the use of corticosteroids and immunosuppressives in terms of diagnosis and treatment.