The Dynamics of Social Fragmentation by Information Toxicity: Asymmetries in Grim Trigger Strategies and the Mechanisms of Social Fragmentation -Proposal to the Public Health Risk

An increasingly documented yet rare complication of cytomegalovirus (CMV) infection in immunocompetent patients is acute haemolytic anaemia. Although rare, this can be detrimental to a patient’s outcome if not sought out for and recognised early on. Such infections can have a very severe and prolonged course requiring various interventions depending on the situation and human factors in the decision-making process. We report such a case in an individual, with no prior past medical history, who underwent extensive investigations for anaemia,
including haemoglobinopathies, structural and enzymatic causes to immune mediated processes and infections. He was eventually found to have severe anaemia following a primary CMV infection with no immune mechanism found, supported by negative serial Direct Antiglobulin Tests (DAT) and immunoglobins. This patient improved with blood transfusions, yet similar studies have reported that despite severe drops
in haemoglobin, a watch and wait policy can be implemented with good prognosis.
Background: Cytomegalovirus (CMV) is a common widespread virus with an estimated global prevalence of around 83% in the general population [1]. In the UK around 50-60% of adults are CMV seropositive [2]. Infections either occur as a primary insult or reactivation of the dormant virus in the latent period. It’s a well-documented cause of birth defects in the congenital period leading to varying disabling effects both biologically and psychosocially, including learning and intellectual disabilities [3]. CMV infections are associated with significant morbidity and life-threatening illnesses in immunocompromised hosts [3]. In stark contrast, it rarely causes substantial symptoms in immunocompetent hosts. Most people with CMV infection have no symptoms or present with a mononucleosis-like syndrome characterised by pyrexia, fatigue, pharyngitis, and cervical lymphadenopathy, often settling within a week [4]. There are several reports however, of severe symptomatic infections in immunocompetent individuals with organ-specific diseases such as pneumonitis, colitis, retinitis, gastroenteritis, and hepatitis [5]. The number of reported cases of CMV associated acute haemolytic anaemia in immunocompetent hosts are increasingly documented with several reports published in recent years [6-12]. We present a case of a normally fit and well man in his 30s with CMV positive severe haemolytic anaemia which self-resolved.

Keywords: Cytomegalovirus (CMV); Acute haemolytic anaemia; Birth defects; colitis, retinitis, gastroenteritis, and hepatitis