SARS-CoV-2 Infection and CMV Dissemination in Transplant Recipients as a Treatment for Chagas Cardiomyopathy: A Case Report

Abstract

Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). COVID-19 has infected over 90 million people worldwide, therefore it is considered a pandemic. SARS-CoV-2 infection can lead to severe pneumonia, acute respiratory distress syndrome (ARDS), septic shock, and/or organ failure. Individuals receiving a heart transplantation (HT) may be at higher risk of adverse outcomes attributable to COVID-19 due to immunosuppressives, as well as concomitant infections that may also influence the prognoses. Herein, we describe the first report of two cases of HT recipients with concomitant infections by SARS-CoV-2, Trypanosoma cruzi, and cytomegalovirus (CMV) dissemination, from the first day of hospitalization due to COVID-19 in the intensive care unit (ICU) until the death of the patients.

SARS-CoV-2 infection in heart transplant recipients: a systematic literature review of clinical outcomes and immunosuppression strategies

“…In five of the studies, 2-D echocardiography revealed decreased LV ejection fraction (EF) [ 11 , 14 , 24 , 28 , 32 ]. Of the five studies, one did not undergo repeat endomyocardial biopsies due to a recent negative biopsy and the other who had severe biventricular dysfunction that required retransplantation had an endomyocardial biopsy that ruled out acute humoral rejection and no mention was made of viral particles within the myocardium or inflammation [ 21 ].…”

COVID-19-associated opportunistic infections: a snapshot on the current reports

“…However, it seems that future studies are needed for standard diagnosis and new treatment options of these infections in COVID-19 patients (Table 4). [31,88] Candidiasis [43] Mucormycosis [60] Cryptococcosis [24,65,[71][72][73] Pneumocystis jiroveci (carinii) pneumonia [76,81,88,89] Histoplasma capsulatum [95,96,98] Coccidioides immitis [101,102] Strongyloidiasis [175,176] CMV [130,132,135,136] HSV [143] IL-6 blocker (Tocilizumab)…”

“…Ganciclovir is an effective treatment option for CMV infection, especially for immunosuppressed individuals [128,129]. To date, disseminated CMV infection [130], CMV myocarditis [131], CMV proctitis [132], pneumonitis [133,134] as well as CMV viremia [135,136] were reported among COVID-19 patients, in which some of them received corticosteroids [130,[132][133][134][135][136] or tocilizumab [135]. While CMV is latent in most individuals, reactivation of latent infection can lead to severe infections with fatal outcomes following immunosuppression in COVID-19 patients.…”

Immune Response to COVID-19

“…Comorbidities may influence COVID-19 severity via an increase in pro-inflammatory response, coagulatory disorders, or different ACE2 expression [65][66][67]. Investigations confirmed that old age, systemic arterial hypertension, Diabetes Mellitus [68], obesity [16], alcohol consumption [69], smokers and chronic obstructive pulmonary disease (COPD) [70], heart disease, liver disease and kidney disease [71], cancer [72,73], immunodeficiencies, transplanted patients [74], and co-infections [17,74] are in fact risk factor for severe COVID-19 and increase death risk and the presence of two or more comorbidities further increase the death risk [75]. We will review the impact of the most common comorbidities associated with poor COVID-19 prognosis and their influence on the anti-SARS-CoV-2 immune response.…”

“…Co-infections can increase the susceptibility to severe COVID-19, by an increase in the hyper inflammation or hypercoagulation status [74,148]. Few reports have investigated the impact of parasites on COVID-19, such as leishmaniasis, toxoplasmosis, malaria, and Chagas disease [148][149][150][151].…”