Rectal bleeding: New complication of Covid-19

The second wave of the pandemic has added some new complications of coronavirus to the list, 'Rectal bleeding' is one of them. The main cause of rectal bleeding was said to be due to cytomegalovirus (CMV) infection. There can be many reasons for rectal bleeding in patients affected with COVID-19. The common reasons are haemorroids, anal fissures and intestinal bleeding due to diverticulosis etc. Although diarrhoea can be a significant symptom of COVID-19 infection, a significant proportion of patients develop constipation. This could be due to poor appetite and intake of food or liquids and reduced mobility. Common causes for rectal bleeding like hemorrhoids are aggravated due to constipation. Blood thinning medications that are used to prevent clots in the lungs can also enhance bleeding.

What is CMV - Cytomegalovirus?

CMV or cytomegalovirus is a common virus. This virus rarely causes a problem in healthy people, but can have severe effects on people with a weak immune system. The body retains this virus for a lifetime once infected. CMV mainly spreads from one person to another through bodily fluids like saliva, blood, urine, semen and breast milk. There is no cure, but the symptoms can be managed by medications. CMV affects people only with a weak immunity and the majority of the people who get affected remain unaware.

Symptoms of CMV can be described as fever, sore throat, muscle aches, fatigue. This virus spreads quickly in areas that have a lot of young children such as nurseries or day care centers. A CMV infection can spread to a person through contact with eyes, nose or mouth after coming in contact with the bodily fluid of an infected person.

How has the virus affected people with COVID?

If a person who is COVID positive or post recovery has abdominal pain or traces of blood in their stool, should be assessed by a doctor. The cases that were reported so far complained of lower gastrointestinal bleed and with intestinal obstruction. Infections like COVID and the medications used to treat it tend to suppress the immunity of patients and make them susceptible to uncommon infections that have varied presentations. Infections like CMV, mucormycosis and white fungus are opportunistic infections that affect people with weak immune systems, as it was earlier seen in immunocompromised patients such as patients affected with cancer or HIV positive people .

CMV is present in 80 - 90 % of the indian population which presents clinically asymptomatic due to the inherent immunity which makes it strong enough to appear asymptomatic. Early diagnosis and an effective treatment with antiviral drugs (injections and tablets) can help COVID-19 patients that have developed the CMV infection.

Contributed by: Dr. Sarada Pasangulapati, Consultant Medical Gastroenterologist and Hepatologist, Yashoda Hospitals Hyderabad