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Observational Study
. 2025 Apr 11;37(1):19.
doi: 10.1186/s43046-025-00275-1.

Co-infections and Reactivation of some Herpesviruses (HHV) and Measles Virus (MeV) in Egyptian Cancer Patients infected with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)

Ahmed M Mayla  1 , Waleed S Mohamed  2 , Abdel-Rahman N Zekri  1 , Nora A Gouda  3 , Mai M Lotfy  1 , Mohamed G Seadawy  4 , Mohamed Abdel-Salam Elgohary  5 , Zeinab F Abdallah  1
Affiliations
Observational Study

Co-infections and Reactivation of some Herpesviruses (HHV) and Measles Virus (MeV) in Egyptian Cancer Patients infected with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)

Ahmed M Mayla et al. J Egypt Natl Canc Inst. .

Abstract

Background: Coinfections and reactivation of persistent or latent viral infections such as herpesviruses (HHV) and/or measles virus (MeV) have been reported among COVID-19 patients. However, there is limited information regarding cancer patients who experienced severe acute respiratory syndrome corona virus-2 (SARS-CoV-2). The primary purpose of this study was to investigate the interplay between SARS-CoV-2, HHV and MeV in cancer patients, aiming to provide insights into the pathophysiology of these infections and to enhance the patients' health outcomes.

Methods: A prospective observational study was conducted on 4 groups (n = 147): newly diagnosed cancer patients infected with SARS-CoV-2 (n = 37), newly diagnosed cancer patients non-infected with SARS-CoV-2 (n = 13), apparently normal individuals infected with SARS-CoV-2 (n = 82) and finally a normal control group (n = 15). All samples were tested for SARS-CoV-2 infection using the real-rime quantitative reverse transcription polymerase chain reaction (qRT-PCR). Antibody responses were analyzed using indirect enzyme-linked immunosorbent assay (ELISA), and antibody levels were compared between patients and controls. Potential re-activation was investigated using fourfold (i.e. 400%) rise model criterion.

Results: In all positive cases of SARS-CoV-2, recent infections or re-infection of herpes simplex viruses 1 and 2 (HSV1/2 or HHV1-2) were found to be significantly increased approximately three-fold higher in COVID-19 patients (p = 0.007) identified via pooled HSV1/2 IgM levels in plasma. Furthermore, reactivation of HSV1/2 was 29.7% in cancer/COVID-19 patients (n = 37) versus 0.0% of normal/COVID-19 group (n = 22) (p = 0.008). Likewise, Epstein-Barr Nuclear Antigen-1 (EBNA-1) IgG levels showed a ≥ fourfold increase in 20% (p = 0.034) of cancer patients (n = 50) versus 4.9% of controls (n = 41) for reactivation of Epstein-Barr virus (EBV or HHV-4). Obviously, MeV IgG levels increased up to 78.0% in cancer patients (n = 50) versus 17.5% in non-cancerous group (n = 40, p < 0.001). Reactivation of MeV in cancer and COVID-19 patients was 43.2% versus 30.8% cancer non-COVID-19 group, 3.3% normal COVID-19, and 0.0% in healthy volunteers (p < 0.001).

Conclusion: Cancer patients infected with SARS-CoV-2 were at increased risk of HHV and MeV co-infection and reactivation.

Keywords: COVID-19; Cancer; Human Herpesviruses (HHVs); Measles Virus (MeV); SARS-CoV-2; Viral reactivation.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The institutional review board (IRP) ethical committee approved this study, according to the Helsinki and Belmont principles, to be conducted at National Cancer Institute, Cairo University (IORG0003381) IRP No. IRB00004025. The patient’s data presented anonymously with protection of privacy and confidentiality. Informed written consent to participate in the study was provided by all participants for prospective observational studies. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

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