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World J Virol. Mar 25, 2024; 13(1): 89135
Published online Mar 25, 2024. doi: 10.5501/wjv.v13.i1.89135
Cytomegalovirus infection in non-immunocompromised critically ill patients: A management perspective
Madhura Bhide, Omender Singh, Prashant Nasa, Deven Juneja
Madhura Bhide, Omender Singh, Deven Juneja, Institute of Critical Care Medicine, Max Super Speciality Hospital, Saket, New Delhi 110017, India
Prashant Nasa, Department of Critical Care Medicine, NMC Specialty Hospital, Dubai 7832, United Arab Emirates
Author contributions: Bhide M, and Nasa P researched the subject, performed data acquisition and performed the majority of the writing; Singh O and Juneja D provided inputs writing the paper and reviewed the final draft.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Deven Juneja, DNB, MBBS, Director, Institute of Critical Care Medicine, Max Super Speciality Hospital, Saket, 1 Press Enclave Road, New Delhi 110017, India. devenjuneja@gmail.com
Received: October 21, 2023
Peer-review started: October 21, 2023
First decision: December 17, 2023
Revised: December 18, 2023
Accepted: December 26, 2023
Article in press: December 26, 2023
Published online: March 25, 2024
Processing time: 142 Days and 0.7 Hours
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.