Herpes simplex virus and cytomegalovirus reactivations among severe COVID-19 patients
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RESEARCH LETTER
Open Access
Herpes simplex virus and cytomegalovirus reactivations among severe COVID-19 patients Pierre Le Balc’h1,2, Kieran Pinceaux1,2, Charlotte Pronier3, Philippe Seguin4, Jean-Marc Tadié1,2 and Florian Reizine1,2* Dear Editor, The SARS-CoV-2 infection can lead to severe acute respiratory distress syndrome (ARDS) with prolonged mechanical ventilation (MV). Patients with coronavirus disease 2019 (COVID-19) associated ARDS usually met the diagnosis criteria for sepsis-associated immunosuppression as acquired infections, primarily bacterial and fungal co-infections [1], are frequently encountered. Such secondary infections are associated with late mortality. Herpesviridae reactivation is common in nonimmunocompromised patients with prolonged MV and could be responsible for increased mortality and longer duration of MV in ICU [2, 3]. Although the diagnosis of Herpesviridae pulmonary infection is challenging and not consensual in critically ill patients, therapeutic strategies are available to reduce morbidity and mortality [4]. As viral co-infections in these patients remain poorly investigated, we aimed to describe Herpesviridae pulmonary reactivations in patients with COVID-19 ARDS.
Methods We reviewed all virology results for patients admitted to Rennes University Hospital (Rennes, France) for COVID-19 ARDS between March 3, 2020, and April 15, 2020. SARS-CoV-2 infection was confirmed by polymerase chain reaction (PCR). Patients mechanically ventilated longer than 7 days and who had negative PCR for herpes simplex virus (HSV) and cytomegalovirus (CMV) were included in the analysis. Herpes simplex virus and * Correspondence: [email protected] 1 Service des Maladies Infectieuses et Réanimation Médicale, CHU Rennes, F-35033 Rennes, France 2 Faculté de Médecine, Biosit, Université Rennes 1, F-35043 Rennes, France Full list of author information is available at the end of the article
cytomegalovirus replication were measured by quantitative real-time PCR on tracheal aspirates twice a week for each patient. Herpesviridae reactivation was defined as two consecutive positive HSV or CMV PCR on tracheal aspirates. The Mann-Whitney rank sum test was used to compare non-parametric continuous variables, and qualitative data were compared using Fisher’s exact test. Statistical significance was defined as P < .05. PRISM version 8 (GraphPad Software, San Diego, CA, USA) was used to perform statistical analyses.
Results A total of 38 patients were included. Table 1 shows the demographic, clinical, and biological characteristics of the included patients. The mean age was 59 years (interquartile range (IQR), 54–71), and 27 (71%) were male. Of these 38 patients, 18 (47%) presented at least one viral pulmonary reactivation. Nine patients had HSV reactivation alone, 2 presented CMV reactivation alone, and 7 had co-reactivation. Herpesviridae infection was diagnosed at a median of 9 days (IQR, 5–14). The median number of positive samples was 3 (IQR, 2–5). Patients with Herpesviridae reactivation had sign
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