背景:巨细胞病毒在儿童初次感染后建立了终生潜伏期。巨细胞病毒的再激活已在免疫受损的患者中得到了很好的报道;然而,在过去的几年中,已经观察到巨细胞病毒再激活也发生在没有外源性免疫抑制的危重患者中,这增加了重症监护病房的住院时间和死亡率。
方法:一位63岁的印度男性,没有任何已知的共病,2019年患上了严重的冠状病毒病,住进了重症监护室。他收到了Remdesivir,托珠单抗,类固醇,抗凝剂,和经验性抗生素在接下来的3周。然而,他的临床状况没有多大改善,在疾病的第9周,他的病情开始恶化,常规细菌培养,真菌培养物,而巨细胞病毒实时聚合酶链反应对血液均为阴性。他的临床状况迅速恶化,这导致需要有创机械通气。气管吸出细菌和真菌培养显示无生长,但是巨细胞病毒实时聚合酶链反应显示气管抽吸物中有21,86,000拷贝/mL。更昔洛韦治疗4周后,患者临床好转并出院.目前,他做得很好,能够在不需要氧气的情况下进行日常活动。
结论:更昔洛韦的及时治疗与巨细胞病毒感染的良好预后相关。因此,可以建议,如果2019年冠状病毒病患者气管吸出物中巨细胞病毒载量高,则应使用更昔洛韦开始治疗,以及无法解释和长期的临床和/或放射学特征。
BACKGROUND: Cytomegalovirus establishes life-long latency after primary infection in childhood. Cytomegalovirus
reactivation has been well reported in immune-compromised patients; however, in the last few years it has been observed that cytomegalovirus
reactivation also occurs in critically ill patients without exogenous immunosuppression, which increases length of intensive care unit stay and mortality rate.
METHODS: A 63-year-old Indian male, without any known comorbidity, developed severe coronavirus disease 2019 and was admitted to the intensive care unit. He received remdesivir, tocilizumab, steroids, anticoagulants, and empiric antibiotics over the next 3 weeks. However, his clinical condition did not improve much, and during the 9th week of illness his condition started deteriorating and routine bacterial cultures, fungal cultures, and cytomegalovirus real-time polymerase chain reaction on blood were negative. His clinical condition worsened rapidly, which led to the need for invasive mechanical ventilation. Tracheal aspirate bacterial and fungal culture showed no growth, but cytomegalovirus real-time polymerase chain reaction showed 21,86,000 copies/mL in tracheal aspirates. After 4 weeks of ganciclovir treatment, the patient improved clinically and was discharged. Currently he is doing well and able to do his routine activity without the need of oxygen.
CONCLUSIONS: Timely management with ganciclovir is associated with favorable outcome in cytomegalovirus infection. Thus, it can be suggested that treatment should be initiated with ganciclovir if a patient with coronavirus disease 2019 has high cytomegalovirus load in tracheal aspirates, along with unexplained and prolonged clinical and/or radiological features.