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Boers LS, van Someren Gréve F, van Hattem JM, de Brabander J, Zwaan T, van Willigen H, Cornelissen M, de Jong M, van der Poll T, Duitman J, Schinkel J, Bos LDJ. Pulmonary herpes simplex virus and cytomegalovirus in patients with acute respiratory distress syndrome related to COVID-19. Intensive Care Med 2024; 50:1251-1264. [PMID: 39017695 DOI: 10.1007/s00134-024-07529-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 06/14/2024] [Indexed: 07/18/2024]
Abstract
PURPOSE Human herpesviruses, particularly cytomegalovirus (CMV) and herpes simplex virus (HSV), frequently reactivate in critically ill patients, including those with acute respiratory distress syndrome (ARDS) related to coronavirus disease 2019 (COVID-19). The clinical interpretation of pulmonary herpesvirus reactivation is challenging and there is ongoing debate about its association with mortality and benefit of antiviral medication. We aimed to quantify the incidence and pathogenicity of pulmonary CMV and HSV reactivations in critically ill COVID-19 patients. METHODS Mechanically ventilated COVID-19 patients seropositive for CMV or HSV were included in this observational cohort study. Diagnostic bronchoscopy with bronchoalveolar lavage was performed routinely and analyzed for alveolar viral loads and inflammatory biomarkers. Utilizing joint modeling, we explored the dynamic association between viral load trajectories over time and mortality. We explored alveolar inflammatory biomarker dynamics between reactivated and non-reactivated patients. RESULTS Pulmonary reactivation (> 104 copies/ml) of CMV occurred in 6% of CMV-seropositive patients (9/156), and pulmonary reactivation of HSV in 37% of HSV-seropositive patients (63/172). HSV viral load dynamics prior to or without antiviral treatment were associated with increased 90-day mortality (hazard ratio [HR] 1.24, 95% confidence interval [CI] 1.04-1.47). The alveolar concentration of several inflammatory biomarkers increased with HSV reactivation, including interleukin (IL)-6, IL-1β, granulocyte colony stimulating factor (G-CSF), and tumor necrosis factor (TNF). CONCLUSION In mechanically ventilated COVID-19 patients, HSV reactivations are common, while CMV reactivations were rare. HSV viral load dynamics prior to or without antiviral treatment are associated with mortality. Alveolar inflammation is elevated after HSV reactivation.
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Affiliation(s)
- Leonoor S Boers
- Intensive Care Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Room G3-228, 1105 AZ, Amsterdam, The Netherlands.
| | - Frank van Someren Gréve
- Medical Microbiology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Jarne M van Hattem
- Medical Microbiology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Justin de Brabander
- Center for Experimental and Molecular Medicine (CEMM), Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Tom Zwaan
- Intensive Care Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Room G3-228, 1105 AZ, Amsterdam, The Netherlands
| | - Hugo van Willigen
- Medical Microbiology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Marion Cornelissen
- Medical Microbiology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Menno de Jong
- Medical Microbiology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Tom van der Poll
- Center for Experimental and Molecular Medicine (CEMM), Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Infection and Immunity, Inflammatory Diseases, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - JanWillem Duitman
- Infection and Immunity, Inflammatory Diseases, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Pulmonary Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Experimental Immunology (EXIM), Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Janke Schinkel
- Medical Microbiology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Lieuwe D J Bos
- Intensive Care Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Room G3-228, 1105 AZ, Amsterdam, The Netherlands
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2
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Bhide M, Singh O, Nasa P, Juneja D. Cytomegalovirus infection in non-immunocompromised critically ill patients: A management perspective. World J Virol 2024; 13:89135. [PMID: 38616856 PMCID: PMC11008403 DOI: 10.5501/wjv.v13.i1.89135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 12/18/2023] [Accepted: 12/26/2023] [Indexed: 03/11/2024] Open
Abstract
Critically ill patients are a vulnerable group at high risk of developing secondary infections. High disease severity, prolonged intensive care unit (ICU) stay, sepsis, and multiple drugs with immunosuppressive activity make these patients prone to immuneparesis and increase the risk of various opportunistic infections, including cytomegalovirus (CMV). CMV seroconversion has been reported in up to 33% of ICU patients, but its impact on patient outcomes remains a matter of debate. Even though there are guidelines regarding the management of CMV infection in immunosuppressive patients with human immunodeficiency virus/ acquired immuno deficiency syndrome, the need for treatment and therapeutic approaches in immunocompetent critically ill patients is still ambiguous. Even the diagnosis of CMV infection may be challenging in such patients due to non-specific symptoms and multiorgan involvement. Hence, a better understanding of the symptomatology, diagnostics, and treatment options may aid intensive care physicians in ensuring accurate diagnoses and instituting therapeutic interventions.
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Affiliation(s)
- Madhura Bhide
- Institute of Critical Care Medicine, Max Super Speciality Hospital, Saket, New Delhi 110017, India
| | - Omender Singh
- Institute of Critical Care Medicine, Max Super Speciality Hospital, Saket, New Delhi 110017, India
| | - Prashant Nasa
- Department of Critical Care Medicine, NMC Specialty Hospital, Dubai 7832, United Arab Emirates
| | - Deven Juneja
- Institute of Critical Care Medicine, Max Super Speciality Hospital, Saket, New Delhi 110017, India
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3
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Febbo J, Revels J, Ketai L. Viral Pneumonias. Infect Dis Clin North Am 2024; 38:163-182. [PMID: 38280762 DOI: 10.1016/j.idc.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2024]
Abstract
Viral pneumonia is usually community acquired and caused by influenza, parainfluenza, respiratory syncytial virus, human metapneumovirus, and adenovirus. Many of these infections are airway centric and chest imaging demonstrates bronchiolitis and bronchopneumonia, With the exception of adenovirus infections, the presence of lobar consolidation usually suggests bacterial coinfection. Community-acquired viral pathogens can cause more severe pneumonia in immunocompromised hosts, who are also susceptible to CMV and varicella infection. These latter 2 pathogens are less likely to manifest the striking airway-centric pattern. Airway-centric pattern is distinctly uncommon in Hantavirus pulmonary syndrome, a rare environmentally acquired infection with high mortality.
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Affiliation(s)
- Jennifer Febbo
- University of New Mexico, 2211 Lomas Boulevard NE, Albuquerque, NM 87106, USA.
| | - Jonathan Revels
- University of New Mexico, 2211 Lomas Boulevard NE, Albuquerque, NM 87106, USA
| | - Loren Ketai
- Department of Radiology, MSC 10 5530, 1 University of New Mexico, Albuquerque, NM 87131-0001, USA
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Schinas G, Moustaka V, Polyzou E, Almyroudi MP, Dimopoulos G, Akinosoglou K. Targeting CMV Reactivation to Optimize Care for Critically Ill COVID-19 Patients: A Review on the Therapeutic Potential of Antiviral Treatment. Viruses 2023; 15:v15051165. [PMID: 37243251 DOI: 10.3390/v15051165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 05/10/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
Cytomegalovirus (CMV) reactivation has been linked to adverse clinical outcomes in critically ill patients, with emerging evidence suggesting a potential connection with severe COVID-19. Mechanisms driving this association may include primary lung injury, amplification of systemic inflammation, and secondary immunosuppression. Diagnostic challenges in detecting and assessing CMV reactivation necessitate a comprehensive approach to improve accuracy and inform treatment decisions. Currently, there is limited evidence on the efficacy and safety of CMV pharmacotherapy in critically ill COVID-19 patients. Although insights from non-COVID-19 critical illness studies suggest a potential role for antiviral treatment or prophylaxis, the risks and benefits must be carefully balanced in this vulnerable patient population. Understanding the pathophysiological role of CMV in the context of COVID-19 and exploring the advantages of antiviral treatment are crucial for optimizing care in critically ill patients. This review provides a comprehensive synthesis of available evidence, emphasizing the need for additional investigation to establish the role of CMV treatment or prophylaxis in the management of severe COVID-19 and to develop a framework for future research on this topic.
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Affiliation(s)
| | - Vasiliki Moustaka
- Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Eleni Polyzou
- Medical School, University of Patras, 26504 Patras, Greece
- Department of Internal Medicine and Infectious Diseases, University General Hospital of Patras, 26504 Patras, Greece
| | - Maria Panagiota Almyroudi
- Department of Emergency Medicine, University Hospital ATTIKON, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - George Dimopoulos
- 3rd Department of Critical Care, EVGENIDIO Hospital, Medical School, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Karolina Akinosoglou
- Medical School, University of Patras, 26504 Patras, Greece
- Department of Internal Medicine and Infectious Diseases, University General Hospital of Patras, 26504 Patras, Greece
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Tang AM, Xu JY, Wang R, Li YM. Treatment of a large area perioral viral herpes infection following noninvasive ventilation: A case report. World J Clin Cases 2023; 11:1857-1861. [PMID: 36969999 PMCID: PMC10037274 DOI: 10.12998/wjcc.v11.i8.1857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 01/14/2023] [Accepted: 02/22/2023] [Indexed: 03/07/2023] Open
Abstract
BACKGROUND Alphaherpesvirus belongs to the Herpesviridae family and has large, monopartite double-stranded linear DNA. It mainly infects the skin, mucosa, and nerves, and can affect various hosts, including humans and other animals. Here, we present a case of a patient seen by the gastroenterology department at our hospital who experienced an oral and perioral herpes infection following treatment with a ventilator. The patient was treated with oral and topical antiviral drugs, furacilin, oral and topical antibiotics, local epinephrine injection, topical thrombin powder, and nutritional and supportive care. A wet wound healing approach was also implemented with good response.
CASE SUMMARY A 73-year-old woman presented to the hospital with a chief complaint of "abdominal pain for 3 d with dizziness for 2 d." She was admitted to the intensive care unit for septic shock and spontaneous peritonitis secondary to cirrhosis and was given antiinflammatory and symptomatic supportive treatment. A ventilator was used to assist breathing for acute respiratory distress syndrome, which developed during her admission. A large area of herpes infection appeared in the perioral region 2 d following noninvasive ventilation. The patient was transferred to the gastroenterology department, at which time she had a body temperature of 37.8 C and a respiratory rate of 18/min. The patient's consciousness was intact, and she no longer had abdominal pain or distension, chest tightness, or asthma. At this point, the infected perioral region changed in appearance and was now accompanied by local bleeding with crusting of blood at the wounds. The surface area of the wounds measured approximately 10 cm × 10 cm. A cluster blisters appeared on the patient’s right neck, and ulcers developed in her mouth. On a subjective numerical pain scale, the patient reported a pain level of 2. Overall, her diagnoses other than the oral and perioral herpes infection included: (1) Septic shock; (2) spontaneous peritonitis; (3) abdominal infection; (4) decompensated cirrhosis; and (5) hypoproteinemia. Dermatology was consulted regarding the treatment of the patient’s wounds; they suggested treatment with oral antiviral drugs, an intramuscular injection of nutritious nerve drugs, and the application of topical penciclovir and mupirocin around the lips. Stomatology was also consulted and suggested the use of nitrocilin in a local wet application around the lips.
CONCLUSION Through multidisciplinary consultation, the patient’s oral and perioral herpes infection was successfully treated with the following combined approach: (1) Application of topical antviral and antibiotic treatments; (2) keeping the wound moist with a wet wound healing strategy; (3) systemic use of oral antiviral drugs; and (4) symptomatic and nutritional supportive care. The patient was discharged from the hospital after successful wound healing.
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Affiliation(s)
- A-Mao Tang
- Department of Digestion, The Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
| | - Jia-Ying Xu
- Department of Digestion, The Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
| | - Rong Wang
- Department of Digestion, The Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
| | - Yi-Min Li
- Department of Nursing, The Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
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Pérez-Pedrero Sánchez-Belmonte MJ, Sánchez-Casado M, Moran Gallego FJ, Piza Pinilla R, Gomez Hernando C, Paredes Borrachero I. [Herpes simplex virus type 1 (HSV-1) over-infection in patients with acute respiratory distress syndrome secondary to COVID-19 pneumonia: Impact on mortality]. Med Clin (Barc) 2023; 160:66-70. [PMID: 35760608 PMCID: PMC9167944 DOI: 10.1016/j.medcli.2022.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 04/08/2022] [Accepted: 04/10/2022] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Herpes simplex virus type1 (HSV-1) reactivation have been described in patients with invasive mechanical ventilation and recently in patients with acute respiratory distress syndrome (ARDS) secondary to COVID-19 with higher rates of reactivation than were detected previously in critical care, and although the diagnosis of HSV-1 pneumonia is not easy, its presence is associate with an increase in morbidity and mortality. The objective of this study is to determinate if the identification of HSV-1 in lower airway of patients with ARDS secondary to COVID-19 have influence in clinical outcome and mortality. METHOD Two hundred twenty-four admitted patients in intensive care unit (ICU) of Complejo Hospitalario Universitario de Toledo diagnosed of severe acute respiratory syndrome coronavirus2 (SARS-CoV-2) were reviewed and were selected those with mechanical ventilation who had undergone (BAL). It was registered all results of HSV-1 PCR (negative and positive). RESULTS During the study period (November 28, 2020 to April 13, 2021) was admitted 224 patients in ICU diagnosed of SARS-CoV-2 pneumonia. Eighty-three patients of them had undergone BAL, with HSV-1 PCR positive result in 47 (56%), and negative result in 36 (43.4%). We performed pathological anatomy study in BAL samples on 26 of the total BAL realized. Typical cytopathic characteristics of HSV-1 were found in 13 samples (50%) and 11 of them (84.6%) have had HSV-1 PCR positive result. Thirty days mortality was significantly higher in the group of patients with HSV-1 PCR positive result (33.5% vs. 57.4%, P=.015). This difference was stronger in the group of patients with HSV-1 findings in the pathological anatomy study (30.8% vs. 69.2%, P=.047). CONCLUSION Our results suggest that ARDS secondary to SARS-CoV-2 pneumonia is highly associated to HSV-1 reactivation and that the finding of HSV-1 in lower airway is associated with a worst prognostic and with significantly mortality increase. It is necessary to carry out more extensive studies to determinate if treatment with acyclovir can improve the prognosis of these patients.
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Affiliation(s)
| | - Marcelino Sánchez-Casado
- Departamento de Medicina Intensiva, Complejo Hospitalario de Toledo, Toledo, España,Autor para correspondencia
| | | | - Roman Piza Pinilla
- Departamento de Medicina Intensiva, Complejo Hospitalario de Toledo, Toledo, España
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7
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Pérez-Pedrero Sánchez-Belmonte MJ, Sánchez-Casado M, Moran Gallego FJ, Piza Pinilla R, Gomez Hernando C, Paredes Borrachero I. Herpes simplex virus type 1 (HSV-1) over-infection in patients with acute respiratory distress syndrome secondary to COVID-19 pneumonia: Impact on mortality. MEDICINA CLINICA (ENGLISH ED.) 2023; 160:66-70. [PMID: 36590241 PMCID: PMC9790862 DOI: 10.1016/j.medcle.2022.04.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 04/10/2022] [Indexed: 12/27/2022]
Abstract
Objective Herpes simplex virus type 1 (HSV-1) reactivation have been described in patients with invasive mechanical ventilation and recently in patients with acute respiratory distress syndrome (ARDS) secondary to COVID-19 with higher rates of reactivation than were detected previously in critical care, and although the diagnosis of HSV-1 pneumonia is not easy, its presence is associate with an increase in morbidity and mortality. The objective of this study is to determinate if the identification of HSV-1 in lower airway of patients with ARDS secondary to COVID-19 have influence in clinical outcome and mortality. Method Two hundred twenty-four admitted patients in intensive care unit (ICU) of Complejo Hospitalario Universitario de Toledo diagnosed of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were reviewed and were selected those with mechanical ventilation who had undergone (BAL). It was registered all results of HSV-1 PCR (negative and positive). Results During the study period (November 28, 2020 to April 13, 2021) was admitted 224 patients in ICU diagnosed of SARS-CoV-2 pneumonia. Eighty-three patients of them had undergone BAL, with HSV-1 PCR positive result in 47 (56%), and negative result in 36 (43.4%). We performed pathological anatomy study in BAL samples on 26 of the total BAL realized. Typical cytopathic characteristics of HSV-1 were found in 13 samples (50%) and 11 of them (84.6%) have had HSV-1 PCR positive result. Thirty days mortality was significantly higher in the group of patients with HSV-1 PCR positive result (33.5% vs. 57.4%, p = 0.015). This difference was stronger in the group of patients with HSV-1 findings in the pathological anatomy study (30.8% vs. 69.2%, p = 0.047). Conclusion Our results suggest that ARDS secondary to SARS-CoV-2 pneumonia is highly associated to HSV-1 reactivation and that the finding of HSV-1 in lower airway is associated with a worst prognostic and with significantly mortality increase. It is necessary to carry out more extensive studies to determinate if treatment with acyclovir can improve the prognosis of these patients.
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Affiliation(s)
| | - Marcelino Sánchez-Casado
- Departamento de Medicina Intensiva, Complejo Hospitalario de Toledo, Toledo, Spain,Corresponding author
| | | | - Roman Piza Pinilla
- Departamento de Medicina Intensiva, Complejo Hospitalario de Toledo, Toledo, Spain
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Cilloniz C, Luna CM, Hurtado JC, Marcos MÁ, Torres A. Respiratory viruses: their importance and lessons learned from COVID-19. Eur Respir Rev 2022; 31:31/166/220051. [PMID: 36261158 DOI: 10.1183/16000617.0051-2022] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 05/30/2022] [Indexed: 01/08/2023] Open
Abstract
Respiratory virus infection can cause severe illnesses capable of inducing acute respiratory failure that can progress rapidly to acute respiratory distress syndrome (ARDS). ARDS is related to poor outcomes, especially in individuals with a higher risk of infection, such as the elderly and those with comorbidities, i.e. obesity, asthma, diabetes mellitus and chronic respiratory or cardiovascular disease. Despite this, effective antiviral treatments available for severe viral lung infections are scarce. The coronavirus disease 2019 (COVID-19) pandemic demonstrated that there is also a need to understand the role of airborne transmission of respiratory viruses. Robust evidence supporting this exists, but better comprehension could help implement adequate measures to mitigate respiratory viral infections. In severe viral lung infections, early diagnosis, risk stratification and prognosis are essential in managing patients. Biomarkers can provide reliable, timely and accessible information possibly helpful for clinicians in managing severe lung viral infections. Although respiratory viruses highly impact global health, more research is needed to improve care and prognosis of severe lung viral infections. In this review, we discuss the epidemiology, diagnosis, clinical characteristics, management and prognosis of patients with severe infections due to respiratory viruses.
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Affiliation(s)
- Catia Cilloniz
- Pneumology Dept, Respiratory Institute, Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB), Barcelona, Spain .,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (Ciberes), Barcelona, Spain.,Faculty of Health Sciences, Continental University, Huancayo, Peru
| | - Carlos M Luna
- Pneumology Division, Hospital of Clínicas, Faculty of Medicine, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Juan Carlos Hurtado
- Dept of Microbiology, Hospital Clinic, Universitat de Barcelona, ISGlobal, Barcelona, Spain
| | - María Ángeles Marcos
- Dept of Microbiology, Hospital Clinic, Universitat de Barcelona, ISGlobal, Barcelona, Spain
| | - Antoni Torres
- Pneumology Dept, Respiratory Institute, Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (Ciberes), Barcelona, Spain
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Expression of Concern: Cytomegalovirus and Herpes Simplex Virus Effect on the Prognosis of Mechanically Ventilated Patients Suspected to Have Ventilator-Associated Pneumonia. PLoS One 2022; 17:e0278002. [PMID: 36512559 PMCID: PMC9746978 DOI: 10.1371/journal.pone.0278002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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10
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Saura O, Chommeloux J, Levy D, Assouline B, Lefevre L, Luyt CE. Updates in the management of respiratory virus infections in ICU patients: revisiting the non-SARS-CoV-2 pathogens. Expert Rev Anti Infect Ther 2022; 20:1537-1550. [PMID: 36220790 DOI: 10.1080/14787210.2022.2134116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Although viruses are an underestimated cause of community-acquired pneumonias (CAP) and hospital-acquired pneumonias (HAP)/ventilator-associated pneumonias (VAP) in intensive care unit (ICU) patients, they have an impact on morbidity and mortality. AREAS COVERED In this perspective article, we discuss the available data regarding the management of severe influenza CAP and herpesviridae HAP/VAP. We review diagnostic and therapeutic strategies in order to give clear messages and address unsolved questions. EXPERT OPINION Influenza CAP affects yearly thousands of people; however, robust data regarding antiviral treatment in the most critical forms are scarce. While efficacy of oseltamivir has been investigated in randomized controlled trials (RCT) in uncomplicated influenza, only observational data are available in ICU patients. Herpesviridae are an underestimated cause of HAP/VAP in ICU patients. Whilst incidence of herpesviridae identification in samples from lower respiratory tract of ICU patients is relatively high (from 20% to 50%), efforts should be made to differentiate local reactivation from true lung infection. Only few randomized controlled trials evaluated the efficacy of antiviral treatment in herpesviridae reactivation/infection in ICU patients and all were exploratory or negative. Further studies are needed to evaluate the impact of such treatment in specific populations.
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Affiliation(s)
- Ouriel Saura
- Médecine Intensive Réanimation, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Juliette Chommeloux
- Médecine Intensive Réanimation, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris, Paris, France.,Sorbonne Université, GRC 30, RESPIRE, UMRS 1166, ICAN Institute of Cardiometabolism and Nutrition, Paris, France
| | - David Levy
- Médecine Intensive Réanimation, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Benjamin Assouline
- Médecine Intensive Réanimation, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Lucie Lefevre
- Médecine Intensive Réanimation, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris, Paris, France.,Sorbonne Université, GRC 30, RESPIRE, UMRS 1166, ICAN Institute of Cardiometabolism and Nutrition, Paris, France
| | - Charles-Edouard Luyt
- Médecine Intensive Réanimation, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris, Paris, France.,Sorbonne Université, GRC 30, RESPIRE, UMRS 1166, ICAN Institute of Cardiometabolism and Nutrition, Paris, France
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Luyt CE, Burrel S, Mokrani D, Pineton de Chambrun M, Luyt D, Chommeloux J, Guiraud V, Bréchot N, Schmidt M, Hekimian G, Combes A, Boutolleau D. Herpesviridae lung reactivation and infection in patients with severe COVID-19 or influenza virus pneumonia: a comparative study. Ann Intensive Care 2022; 12:87. [PMID: 36153427 PMCID: PMC9509504 DOI: 10.1186/s13613-022-01062-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 09/12/2022] [Indexed: 11/12/2022] Open
Abstract
Background Lung reactivations of Herpesviridae, herpes simplex virus (HSV) and cytomegalovirus (CMV) have been reported in COVID-19 patients. Whether or not those viral reactivations are more frequent than in other patients is not known. Methods Retrospective monocentric cohort study of 145 patients with severe COVID-19 pneumonia requiring invasive mechanical ventilation and who were tested for HSV and CMV in bronchoalveolar lavage performed during fiberoptic bronchoscopy for ventilator-associated pneumonia suspicion. Rates of HSV and CMV lung reactivations, and HSV bronchopneumonitis were assessed and compared with an historical cohort of 89 patients with severe influenza pneumonia requiring invasive mechanical ventilation. Results Among the 145 COVID-19 patients included, 50% and 42% had HSV and CMV lung reactivations, respectively, whereas among the 89 influenza patients, 63% and 28% had HSV and CMV lung reactivations, respectively. Cumulative incidence of HSV lung reactivation (taking into account extubation and death as competing events) was higher in influenza than in COVID-19 patients (p = 0.03), whereas the rate of HSV bronchopneumonitis was similar in both groups (31% and 25%, respectively). Cumulative incidence of CMV lung reactivation (taking into account extubation and death as competing events) was similar in COVID-19 and influenza patients (p = 0.07). Outcomes of patients with HSV or CMV lung reactivations were similar to that of patients without, whatever the underlying conditions, i.e., in COVID-19 patients, in influenza patients, or when all patients were grouped. Conclusions HSV and CMV lung reactivations are frequent in COVID-19 patients, but not more frequent than in patients with influenza-associated severe pneumonia, despite a higher severity of illness at intensive care unit admission of the latter and a longer duration of mechanical ventilation of the former. Although no impact on outcome of HSV and CMV lung reactivations was detected, the effect of antiviral treatment against these Herpesviridae remains to be determined in these patients. Supplementary Information The online version contains supplementary material available at 10.1186/s13613-022-01062-0.
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12
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Characteristics and prognosis of Herpesviridae-related pneumonia in critically ill burn patients. Burns 2022; 48:1155-1165. [PMID: 34823946 DOI: 10.1016/j.burns.2021.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 08/25/2021] [Accepted: 09/13/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND The aim of this study was to describe the prevalence, characteristics and outcome of critically burn patients with pulmonary HSV reactivation. METHODS Retrospective, single-center cohort study in a burn critical care unit in a tertiary center, including all consecutive severely burn patients with bronchoalveolar lavage performed for pneumoniae suspicion and screened for HSV from January 2013 and April 2017. We used logistic regression to identify factors associated with HSV reactivation and outcomes. RESULTS 94 patients were included, mean age was 51 (39-64) years; median total body surface area burned was 36 (25-54)% and ICU mortality 38%. Fifty-five patients (59%) had pulmonary HSV reactivation and 30 (55%) were treated with acyclovir. Patients with HSV reactivation were more severely ill with higher SOFA score at admission compared to patient without HSV reactivation (6 [3-8] vs. 2 [1-4], p < 0.0001 respectively). In multivariate analysis, sex, SOFA score at admission and smoke inhalation were significantly associated with HSV reactivation. Only septic shock was associated with 90-day mortality when HSV reactivation was not. CONCLUSIONS Pulmonary HSV reactivation is frequent among severely ill burn patients. Initial severity and smoke inhalation are risk factors. Antiviral treatment was not associated with outcome.
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Herpes Simplex Virus 1 (HSV-1) Reactivation in Critically Ill COVID-19 Patients: A Brief Narrative Review. Infect Dis Ther 2022; 11:1779-1791. [PMID: 35913679 PMCID: PMC9340740 DOI: 10.1007/s40121-022-00674-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 07/04/2022] [Indexed: 01/08/2023] Open
Abstract
Systemic or pulmonary reactivations of herpes simplex virus 1 (HSV-1) have been reported in critically ill patients with COVID-19, posing a dilemma for clinicians in terms of their diagnostic and clinical relevance. Prevalence of HSV-1 reactivation may be as high as > 40% in this population, but with large heterogeneity across studies, likely reflecting the different samples and/or cut-offs for defining reactivation. There is frequently agreement on the clinical significance of HSV-1 reactivation in the presence of severe manifestations clearly attributable to the virus. However, the clinical implications of HSV-1 reactivations in the absence of manifest signs and symptoms remain controversial. Our review aims at providing immunological background and at reviewing clinical findings on HSV-1 reactivations in critically ill patients with COVID-19.
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Xi Y, Zhou J, Lin Z, Liang W, Yang C, Liu D, Xu Y, Nong L, Chen S, Yu Y, He W, Zhang J, Zhang R, Liu X, Liu X, Sang L, Xu Y, Li Y. Patients with infectious diseases undergoing mechanical ventilation in the intensive care unit have better prognosis after receiving metagenomic next-generation sequencing assay. Int J Infect Dis 2022; 122:959-969. [PMID: 35908725 DOI: 10.1016/j.ijid.2022.07.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 07/25/2022] [Accepted: 07/25/2022] [Indexed: 10/16/2022] Open
Abstract
OBJECTIVES To evaluate the relation between mNGS and the prognosis of patients with infectious diseases undergoing mechanical ventilation in the intensive care unit (ICU). DESIGN This is a single-center observational study, comparing non-randomly assigned diagnostic approaches. We analyzed the medical records of 228 patients with suspected infectious diseases undergoing mechanical ventilation in the ICU from March 2018 to May 2020. The concordance of pathogen results was also assessed for the results of mNGS, culture and PCR assays. RESULTS The 28-day mortality of the patients in the mNGS group was lower after the baseline difference correction (19.23% (20/104) vs. 29.03% (36/124) , p=0.039). Subgroup analysis showed that mNGS assay associates with improved 28-day mortality of non-immunosuppressive patients (14.06% vs. 29.82%, p=0.018) . Not performing mNGS assay, higher APACHE II score and hypertension are independent risk factors for 28-day mortality. The mNGS assay presented advantage in pathogen positivity (69.8% double positive and 25.0% mNGS positive only), and the concordance between thest two assays were 79.0%. CONCLUSIONS mNGS survey may be associated with a better prognosis as the reduction of 28-day mortality of patients with infectious diseases on mechanical ventilation in ICU. This technique presented advantage in pathogen positivity than traditional methods.
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Affiliation(s)
- Yin Xi
- State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Department of Pulmonary and Critical Care Medicine, 151 Yanjiang Road, Guangzhou, 510120, China
| | - Jing Zhou
- State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Department of Pulmonary and Critical Care Medicine, 151 Yanjiang Road, Guangzhou, 510120, China
| | - Zhimin Lin
- State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Department of Pulmonary and Critical Care Medicine, 151 Yanjiang Road, Guangzhou, 510120, China
| | - Weibo Liang
- State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Department of Pulmonary and Critical Care Medicine, 151 Yanjiang Road, Guangzhou, 510120, China
| | - Chun Yang
- State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Department of Pulmonary and Critical Care Medicine, 151 Yanjiang Road, Guangzhou, 510120, China
| | - Dongdong Liu
- State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Department of Pulmonary and Critical Care Medicine, 151 Yanjiang Road, Guangzhou, 510120, China
| | - Yonghao Xu
- State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Department of Pulmonary and Critical Care Medicine, 151 Yanjiang Road, Guangzhou, 510120, China
| | - Lingbo Nong
- State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Department of Pulmonary and Critical Care Medicine, 151 Yanjiang Road, Guangzhou, 510120, China
| | - Sibei Chen
- State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Department of Pulmonary and Critical Care Medicine, 151 Yanjiang Road, Guangzhou, 510120, China
| | - Yuheng Yu
- State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Department of Pulmonary and Critical Care Medicine, 151 Yanjiang Road, Guangzhou, 510120, China
| | - Weiqun He
- State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Department of Pulmonary and Critical Care Medicine, 151 Yanjiang Road, Guangzhou, 510120, China
| | - Jie Zhang
- State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Department of Pulmonary and Critical Care Medicine, 151 Yanjiang Road, Guangzhou, 510120, China
| | - Rong Zhang
- State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Department of Pulmonary and Critical Care Medicine, 151 Yanjiang Road, Guangzhou, 510120, China
| | - Xuesong Liu
- State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Department of Pulmonary and Critical Care Medicine, 151 Yanjiang Road, Guangzhou, 510120, China
| | - Xiaoqing Liu
- State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Department of Pulmonary and Critical Care Medicine, 151 Yanjiang Road, Guangzhou, 510120, China
| | - Ling Sang
- State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Department of Pulmonary and Critical Care Medicine, 151 Yanjiang Road, Guangzhou, 510120, China..
| | - Yuanda Xu
- State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Department of Pulmonary and Critical Care Medicine, 151 Yanjiang Road, Guangzhou, 510120, China..
| | - Yimin Li
- State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Department of Pulmonary and Critical Care Medicine, 151 Yanjiang Road, Guangzhou, 510120, China..
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Ong DSY, Chong GLM, Chemaly RF, Cremer OL. Comparative clinical manifestations and immune effects of cytomegalovirus infections following distinct types of immunosuppression. Clin Microbiol Infect 2022; 28:1335-1344. [PMID: 35709902 DOI: 10.1016/j.cmi.2022.05.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 05/23/2022] [Accepted: 05/30/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cytomegalovirus (CMV) infection is a well-recognized complication of solid organ and hematopoietic cell transplantation. However, CMV infection also occurs in patients with human immunodeficiency virus (HIV) infection, previously immunocompetent intensive care unit (ICU) patients, and individuals on immunosuppressive medications for various underlying diseases. OBJECTIVES This review describes the comparative effects of CMV infection in distinct types of acquired immunosuppression. SOURCES Selected peer-reviewed publications on CMV infections published until December 2021. CONTENT CMV infection affects various organ systems through direct cytolytic mechanisms, but may also exert indirect effects by promoting pro-inflammatory and immunosuppressive responses. This has been well studied in transplant recipients, for whom antiviral prophylaxis and pre-emptive therapy have now become standard practice. These strategies not only prevent direct CMV disease manifestations, but also mitigate various immunopathological processes to reduce graft-versus-host disease, graft rejection, and the occurrence of secondary bacterial and fungal infections. The efficacy of neither prophylactic nor pre-emptive treatment of CMV infection has been demonstrated for patients with critical illness- or medication-induced immunosuppression. Many observational studies have shown an independent association between CMV reactivation and a prolonged duration of mechanical ventilation or increased mortality in the ICU. Furthermore, data suggest that CMV reactivation may increase pulmonary inflammation and prolong the duration of mechanical ventilation. IMPLICATIONS A large number of observational and experimental studies suggest attributable morbidity and mortality related to CMV infection, not only in transplant recipients and patients with HIV infection but also in patients with critically illness- or medication-induced immunosuppression. Adequately powered randomized controlled trials investigating the efficacy of prophylaxis or pre-emptive treatment of CMV infection in these patients are lacking, with a notable exception for transplant recipients.
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Affiliation(s)
- David S Y Ong
- Department of Medical Microbiology and Infection Control, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands; Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
| | - Ga-Lai M Chong
- Erasmus University Medical Center, Department of Medical Microbiology & Infectious Diseases, Rotterdam, the Netherlands
| | - Roy F Chemaly
- Department of Infectious Diseases, Infection Control, & Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Olaf L Cremer
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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16
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Febbo J, Revels J, Ketai L. Viral Pneumonias. Radiol Clin North Am 2022; 60:383-397. [DOI: 10.1016/j.rcl.2022.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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17
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Fuest KE, Erber J, Berg-Johnson W, Heim M, Hoffmann D, Kapfer B, Kriescher S, Ulm B, Schmid RM, Rasch S, Lahmer T. Risk factors for <em>Herpes simplex</em> virus (HSV) and <em>Cytomegalovirus</em> (CMV) infections in critically-ill COVID-19 patients. Multidiscip Respir Med 2022; 17:815. [PMID: 35340709 PMCID: PMC8941339 DOI: 10.4081/mrm.2022.815] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 12/07/2021] [Indexed: 12/12/2022] Open
Abstract
Background To assess the prevalence of Herpes simplex and Cytomegalovirus infection in respiratory samples of critically-ill COVID-19 patients, its role in outcome and mortality and the influence of dexamethasone treatment in the early stage of SARS-CoV-2 infection. Methods All mechanically ventilated COVID-19 patients treated on ICU between March 2020 and January 2021 were included. Respiratory specimens were tested for Herpes simplex virus (HSV) type 1, 2 and Cytomegalovirus (CMV) by quantitative real-time PCR. Clinical parameters were compared in the cohorts with and without HSV-1- infection. Results 134 patients with a median age of 72.5 years (73.0% male, n=98) were included. HSV-1 reactivation occurred in 61 patients (45.5%), after median 9 (7-13) days of mechanical ventilation. The main factor for reactivation was length of stay on ICU (24 days vs 13 days, p<0.001) and duration of mechanical ventilation (417 vs 214 hours, p<0.001). Treatment with dexamethasone and a history of immunosuppression did not associate with HSV-infection in the univariate analysis (39 vs 41, p=0.462 and 27.9% vs 23.3%, p=0.561, respectively). Both ICU and hospital mortality were not significantly different in the cohorts with and without HSV-infection (57.4% vs 45.2%, p=0.219). Conclusions Our study shows a high prevalence of HSV-infection in critically-ill COVID-19 patients which was unexpectedly higher than the prevalence of CMV-infections and unrelated to dexamethasone treatment. The main risk factors for HSV and CMV in the studied cohorts were the length of ICU stay and duration of mechanical ventilation. Therefore, we recommend routine monitoring of critically ill COVID-19 patients for these viral co-infections and consider treatment in those patients.
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18
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Chiesa AF, Pallanza M, Martinetti G, Lanzi F, Previsdomini M, Pagnamenta A, Elzi L. Herpes simplex virus reactivation in patients with COVID-19 and acute respiratory distress syndrome: a prospective cohort study. Antivir Ther 2022. [DOI: 10.1177/13596535211068613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background There is a paucity of data about the occurrence and risk factors of herpes simplex virus (HSV) reactivation among patients with severe COVID-19 presenting with acute respiratory distress syndrome (ARDS). Methods We performed a nested case-control study among a cohort of SARS-CoV-2 infected patients with ARDS. Between March and April 2020, all consecutive mechanically ventilated patients ≥18 years old with a positive PCR for SARS-CoV-2 on mucocutaneous samples were included in the study. We collected data on demographics, medical history, laboratory variables, administration of antivirals and other agents, respiratory and organ support procedures, microbiological results, and management of ARDS with prone positioning and the use of steroids. Univariate and multivariable Cox regression models were performed in order to identify predictors of HSV reactivation. Results Eighty-three patients with laboratory-confirmed SARS-CoV-2 infection were admitted to the ICU for mechanical ventilation. 18/83 (21.7%) patients developed mucocutaneous herpes simplex virus reactivation after a median of 17 days (IQR, 14–20). Prone positioning was the only independent risk factor for HSV reactivation (adj. hazard ratios, 1.60; 95% CI, 1.11–2.30; P = 0.009). All patients with mucocutaneous HSV reactivation were treated with antivirals. The outcome in terms of ventilator-associated pneumonia, catheter-related bloodstream infections, and in-hospital mortality was similar for patients with and without HSV reactivation. Conclusions HSV reactivation is frequent in COVID-19 patients with ARDS, especially if prolonged invasive mechanical ventilation with prone positioning is needed. Prompt testing for HSV and initiation of antiviral therapy should be performed in case of mucocutaneous lesions in this population.
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Affiliation(s)
- Alessandro F Chiesa
- Department of Intensive Care Medicine, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Department of Internal Medicine, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Micol Pallanza
- Department of Internal Medicine, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Division of Infectious Diseases, Regional Hospital of Bellinzona and Locarno, Locarno, Switzerland
| | - Gladys Martinetti
- Institute of Microbiology, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Fabio Lanzi
- Department of Intensive Care Medicine, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Marco Previsdomini
- Department of Intensive Care Medicine, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Alberto Pagnamenta
- Department of Intensive Care Medicine, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Clinical Trial Unit, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Division of Pneumology, University Hospital of Geneva, Geneva, Switzerland
| | - Luigia Elzi
- Department of Internal Medicine, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Division of Infectious Diseases, Regional Hospital of Bellinzona and Locarno, Locarno, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
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19
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Cillóniz C, Pericàs JM, Rojas JR, Torres A. Severe Infections Due to Respiratory Viruses. Semin Respir Crit Care Med 2022; 43:60-74. [PMID: 35172359 DOI: 10.1055/s-0041-1740982] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Severe viral infections may result in severe illnesses capable of causing acute respiratory failure that could progress rapidly to acute respiratory distress syndrome (ARDS), related to worse outcomes, especially in individuals with a higher risk of infection, including the elderly and those with comorbidities such as asthma, diabetes mellitus and chronic respiratory or cardiovascular disease. In addition, in cases of severe viral pneumonia, co-infection with bacteria such as Streptococcus pneumoniae and Staphylococcus aureus is related to worse outcomes. Respiratory viruses like influenza, rhinovirus, parainfluenza, adenovirus, metapneumovirus, respiratory syncytial virus, and coronavirus have increasingly been detected. This trend has become more prevalent, especially in critically ill patients, due to the availability and implementation of molecular assays in clinical practice. Respiratory viruses have been diagnosed as a frequent cause of severe pneumonia, including cases of community-acquired pneumonia, hospital-acquired pneumonia, and ventilator-associated pneumonia. In this review, we will discuss the epidemiology, diagnosis, clinical characteristics, management, and prognosis of patients with severe infections due to respiratory viruses, with a focus on influenza viruses, non-influenza viruses, and coronaviruses.
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Affiliation(s)
- Catia Cillóniz
- Department of Pneumology, Institut Clinic del Tórax, Hospital Clinic of Barcelona-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB), Ciber de Enfermedades Respiratorias (Ciberes), Barcelona, Spain
| | - Juan M Pericàs
- Department of Infectious Diseases, Hospital Clinic of Barcelona, Barcelona, Spain.,Internal Medicine Department, Vall d'Hebron Institute for Research, Barcelona, Spain
| | - Jorge R Rojas
- Department of Pneumology, Hospital Regional Docente Clínico Quirúrgico Daniel Alcides Carrión, Huancayo, Perú
| | - Antoni Torres
- Department of Pneumology, Institut Clinic del Tórax, Hospital Clinic of Barcelona-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB), Ciber de Enfermedades Respiratorias (Ciberes), Barcelona, Spain
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20
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Giacobbe DR, Di Bella S, Dettori S, Brucci G, Zerbato V, Pol R, Segat L, D’Agaro P, Roman-Pognuz E, Friso F, Principe L, Lucangelo U, Ball L, Robba C, Battaglini D, De Maria A, Brunetti I, Patroniti N, Briano F, Bruzzone B, Guarona G, Magnasco L, Dentone C, Icardi G, Pelosi P, Luzzati R, Bassetti M. Reactivation of Herpes Simplex Virus Type 1 (HSV-1) Detected on Bronchoalveolar Lavage Fluid (BALF) Samples in Critically Ill COVID-19 Patients Undergoing Invasive Mechanical Ventilation: Preliminary Results from Two Italian Centers. Microorganisms 2022; 10:microorganisms10020362. [PMID: 35208817 PMCID: PMC8875622 DOI: 10.3390/microorganisms10020362] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 01/14/2022] [Accepted: 01/31/2022] [Indexed: 02/01/2023] Open
Abstract
Reactivation of herpes simplex virus type 1 (HSV-1) has been described in critically ill patients with coronavirus disease 2019 (COVID-19) pneumonia. In the present two-center retrospective experience, we primarily aimed to assess the cumulative risk of HSV-1 reactivation detected on bronchoalveolar fluid (BALF) samples in invasively ventilated COVID-19 patients with worsening respiratory function. The secondary objectives were the identification of predictors for HSV-1 reactivation and the assessment of its possible prognostic impact. Overall, 41 patients met the study inclusion criteria, and 12/41 patients developed HSV-1 reactivation (29%). No independent predictors of HSV-1 reactivation were identified in the present study. No association was found between HSV-1 reactivation and mortality. Eleven out of 12 patients with HSV-1 reactivation received antiviral therapy with intravenous acyclovir. In conclusion, HSV-1 reactivation is frequently detected in intubated patients with COVID-19. An antiviral treatment in COVID-19 patients with HSV-1 reactivation and worsening respiratory function might be considered.
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Affiliation(s)
- Daniele Roberto Giacobbe
- Department of Health Sciences (DISSAL), University of Genoa, 16132 Genoa, Italy; (S.D.); (G.B.); (A.D.M.); (F.B.); (G.I.); (M.B.)
- Clinica Malattie Infettive, San Martino Policlinico Hospital-IRCCS for Oncology and Neurosciences, 16132 Genoa, Italy; (L.M.); (C.D.)
- Correspondence:
| | - Stefano Di Bella
- Clinical Department of Medical, Surgical and Health Sciences, University of Trieste, 34127 Trieste, Italy; (S.D.B.); (E.R.-P.); (R.L.)
| | - Silvia Dettori
- Department of Health Sciences (DISSAL), University of Genoa, 16132 Genoa, Italy; (S.D.); (G.B.); (A.D.M.); (F.B.); (G.I.); (M.B.)
- Clinica Malattie Infettive, San Martino Policlinico Hospital-IRCCS for Oncology and Neurosciences, 16132 Genoa, Italy; (L.M.); (C.D.)
| | - Giorgia Brucci
- Department of Health Sciences (DISSAL), University of Genoa, 16132 Genoa, Italy; (S.D.); (G.B.); (A.D.M.); (F.B.); (G.I.); (M.B.)
- Clinica Malattie Infettive, San Martino Policlinico Hospital-IRCCS for Oncology and Neurosciences, 16132 Genoa, Italy; (L.M.); (C.D.)
| | - Verena Zerbato
- Infectious Diseases Unit, Trieste University Hospital, 34127 Trieste, Italy; (V.Z.); (R.P.)
| | - Riccardo Pol
- Infectious Diseases Unit, Trieste University Hospital, 34127 Trieste, Italy; (V.Z.); (R.P.)
| | - Ludovica Segat
- Laboratorio di Riferimento per SARS-CoV-2, Regione Friuli-Venezia Giulia, Azienda Sanitaria Universitaria Integrata Giuliano-Isontina (ASUGI), UCO Igiene e Sanità Pubblica, 34127 Trieste, Italy; (L.S.); (P.D.)
| | - Pierlanfranco D’Agaro
- Laboratorio di Riferimento per SARS-CoV-2, Regione Friuli-Venezia Giulia, Azienda Sanitaria Universitaria Integrata Giuliano-Isontina (ASUGI), UCO Igiene e Sanità Pubblica, 34127 Trieste, Italy; (L.S.); (P.D.)
| | - Erik Roman-Pognuz
- Clinical Department of Medical, Surgical and Health Sciences, University of Trieste, 34127 Trieste, Italy; (S.D.B.); (E.R.-P.); (R.L.)
| | - Federica Friso
- Department of Perioperative Medicine, Intensive Care and Emergency, Cattinara Hospital, Trieste University, 34149 Trieste, Italy; (F.F.); (U.L.)
| | - Luigi Principe
- Clinical Pathology and Microbiology Unit, “San Giovanni di Dio” Hospital, 88900 Crotone, Italy;
| | - Umberto Lucangelo
- Department of Perioperative Medicine, Intensive Care and Emergency, Cattinara Hospital, Trieste University, 34149 Trieste, Italy; (F.F.); (U.L.)
| | - Lorenzo Ball
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, 16132 Genoa, Italy; (L.B.); (C.R.); (N.P.); (P.P.)
- Anaesthesia and Intensive Care, San Martino Policlinico Hospital-IRCCS for Oncology and Neurosciences, 16132 Genoa, Italy; (D.B.); (I.B.)
| | - Chiara Robba
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, 16132 Genoa, Italy; (L.B.); (C.R.); (N.P.); (P.P.)
- Anaesthesia and Intensive Care, San Martino Policlinico Hospital-IRCCS for Oncology and Neurosciences, 16132 Genoa, Italy; (D.B.); (I.B.)
| | - Denise Battaglini
- Anaesthesia and Intensive Care, San Martino Policlinico Hospital-IRCCS for Oncology and Neurosciences, 16132 Genoa, Italy; (D.B.); (I.B.)
- Department of Medicine, University of Barcelona, 08007 Barcelona, Spain
| | - Andrea De Maria
- Department of Health Sciences (DISSAL), University of Genoa, 16132 Genoa, Italy; (S.D.); (G.B.); (A.D.M.); (F.B.); (G.I.); (M.B.)
- Clinica Malattie Infettive, San Martino Policlinico Hospital-IRCCS for Oncology and Neurosciences, 16132 Genoa, Italy; (L.M.); (C.D.)
| | - Iole Brunetti
- Anaesthesia and Intensive Care, San Martino Policlinico Hospital-IRCCS for Oncology and Neurosciences, 16132 Genoa, Italy; (D.B.); (I.B.)
| | - Nicolò Patroniti
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, 16132 Genoa, Italy; (L.B.); (C.R.); (N.P.); (P.P.)
- Anaesthesia and Intensive Care, San Martino Policlinico Hospital-IRCCS for Oncology and Neurosciences, 16132 Genoa, Italy; (D.B.); (I.B.)
| | - Federica Briano
- Department of Health Sciences (DISSAL), University of Genoa, 16132 Genoa, Italy; (S.D.); (G.B.); (A.D.M.); (F.B.); (G.I.); (M.B.)
- Clinica Malattie Infettive, San Martino Policlinico Hospital-IRCCS for Oncology and Neurosciences, 16132 Genoa, Italy; (L.M.); (C.D.)
| | - Bianca Bruzzone
- Hygiene Unit, San Martino Policlinico Hospital-IRCCS for Oncology and Neurosciences, 16132 Genoa, Italy; (B.B.); (G.G.)
| | - Giulia Guarona
- Hygiene Unit, San Martino Policlinico Hospital-IRCCS for Oncology and Neurosciences, 16132 Genoa, Italy; (B.B.); (G.G.)
| | - Laura Magnasco
- Clinica Malattie Infettive, San Martino Policlinico Hospital-IRCCS for Oncology and Neurosciences, 16132 Genoa, Italy; (L.M.); (C.D.)
| | - Chiara Dentone
- Clinica Malattie Infettive, San Martino Policlinico Hospital-IRCCS for Oncology and Neurosciences, 16132 Genoa, Italy; (L.M.); (C.D.)
| | - Giancarlo Icardi
- Department of Health Sciences (DISSAL), University of Genoa, 16132 Genoa, Italy; (S.D.); (G.B.); (A.D.M.); (F.B.); (G.I.); (M.B.)
- Hygiene Unit, San Martino Policlinico Hospital-IRCCS for Oncology and Neurosciences, 16132 Genoa, Italy; (B.B.); (G.G.)
| | - Paolo Pelosi
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, 16132 Genoa, Italy; (L.B.); (C.R.); (N.P.); (P.P.)
- Anaesthesia and Intensive Care, San Martino Policlinico Hospital-IRCCS for Oncology and Neurosciences, 16132 Genoa, Italy; (D.B.); (I.B.)
| | - Roberto Luzzati
- Clinical Department of Medical, Surgical and Health Sciences, University of Trieste, 34127 Trieste, Italy; (S.D.B.); (E.R.-P.); (R.L.)
| | - Matteo Bassetti
- Department of Health Sciences (DISSAL), University of Genoa, 16132 Genoa, Italy; (S.D.); (G.B.); (A.D.M.); (F.B.); (G.I.); (M.B.)
- Clinica Malattie Infettive, San Martino Policlinico Hospital-IRCCS for Oncology and Neurosciences, 16132 Genoa, Italy; (L.M.); (C.D.)
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21
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Fumagalli J, Panigada M, Klompas M, Berra L. Ventilator-associated pneumonia among SARS-CoV-2 acute respiratory distress syndrome patients. Curr Opin Crit Care 2022; 28:74-82. [PMID: 34932525 PMCID: PMC8711306 DOI: 10.1097/mcc.0000000000000908] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW We conducted a systematic literature review to summarize the available evidence regarding the incidence, risk factors, and clinical characteristics of ventilator-associated pneumonia (VAP) in patients undergoing mechanical ventilation because of acute respiratory distress syndrome secondary to SARS-CoV-2 infection (C-ARDS). RECENT FINDINGS Sixteen studies (6484 patients) were identified. Bacterial coinfection was uncommon at baseline (<15%) but a high proportion of patients developed positive bacterial cultures thereafter leading to a VAP diagnosis (range 21-64%, weighted average 50%). Diagnostic criteria varied between studies but most signs of VAP have substantial overlap with the signs of C-ARDS making it difficult to differentiate between bacterial colonization versus superinfection. Most episodes of VAP were associated with Gram-negative bacteria. Occasional cases were also attributed to herpes virus reactivations and pulmonary aspergillosis. Potential factors driving high VAP incidence rates include immunoparalysis, prolonged ventilation, exposure to immunosuppressants, understaffing, lapses in prevention processes, and overdiagnosis. SUMMARY Covid-19 patients who require mechanical ventilation for ARDS have a high risk (>50%) of developing VAP, most commonly because of Gram-negative bacteria. Further work is needed to elucidate the disease-specific risk factors for VAP, strategies for prevention, and how best to differentiate between bacterial colonization versus superinfection.
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Affiliation(s)
- Jacopo Fumagalli
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca’ Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Mauro Panigada
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca’ Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Michael Klompas
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Healthcare Institute
- Department of Medicine, Brigham and Women's Hospital
| | - Lorenzo Berra
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, USA
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22
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Luyt CE, Hékimian G, Bréchot N, Chastre J. Viral Ventilator-Associated Pneumonia/Hospital-Acquired Pneumonia. Semin Respir Crit Care Med 2022; 43:310-318. [PMID: 35100650 DOI: 10.1055/s-0041-1740981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Among the viruses possibly responsible for hospital-acquired and ventilator-associated pneumonia, herpes simplex virus (HSV) is probably the most often involved: HSV reactivation is frequent in intensive care unit patients, and lung parenchymal infection (HSV bronchopneumonitis) has been well described, either using cytological signs of parenchymal involvement in cells obtained during bronchoalveolar lavage or using HSV virus load in the lower respiratory tract. Although treating patients with HSV bronchopneumonitis may be recommended, based on expert opinion, prophylactic or preemptive treatment of HSV reactivation should be avoided. Ventilator-associated pneumonia due to cytomegalovirus (CMV) is less frequent than HSV bronchopneumonitis, and more difficult to diagnose. No data exists on the impact of antiviral treatment on CMV pneumonia. The involvement of respiratory viruses has been described in patients with healthcare-associated pneumonia and hospital-acquired pneumonia, but their role in ventilator-associated pneumonia is not clear.
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Affiliation(s)
- Charles-Edouard Luyt
- Service de Médecine Intensive Réanimation, Sorbonne Université, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris.,INSERM UMRS_1166-iCAN, Institute of Cardiometabolism and Nutrition, Paris
| | - Guillaume Hékimian
- Service de Médecine Intensive Réanimation, Sorbonne Université, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris.,INSERM UMRS_1166-iCAN, Institute of Cardiometabolism and Nutrition, Paris
| | - Nicolas Bréchot
- Service de Médecine Intensive Réanimation, Sorbonne Université, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris.,INSERM UMRS_1166-iCAN, Institute of Cardiometabolism and Nutrition, Paris
| | - Jean Chastre
- Service de Médecine Intensive Réanimation, Sorbonne Université, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris.,INSERM UMRS_1166-iCAN, Institute of Cardiometabolism and Nutrition, Paris
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23
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Cytomegalovirus reactivation in critically-ill Coronavirus Disease 2019 patients: A case series of 11 patients. IDCases 2022; 27:e01402. [PMID: 35036326 PMCID: PMC8748205 DOI: 10.1016/j.idcr.2022.e01402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 01/10/2022] [Accepted: 01/10/2022] [Indexed: 12/15/2022] Open
Abstract
The mortality associated with Coronavirus Disease 2019 is greatly influenced by known risk factors such as elderly age, cardiovascular disease, hypertension, diabetes, and immunosuppression. As cytomegalovirus reactivation in critically ill patients has been linked with higher morbidity and mortality in intensive care settings, it has been suggested that cytomegalovirus reactivation might lead to worse clinical outcomes of patients with Coronavirus Disease 2019. Here we describe the clinical course of 11 patients with Coronavirus Disease 2019 and concomitant cytomegalovirus viremia. We conclude that further research is necessary to formulate guidelines on diagnosis and treatment of cytomegalovirus reactivation in Coronavirus Disease 2019 patients.
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24
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Ferravante C, Sanna G, Melone V, Fromentier A, Rocco T, D'Agostino Y, Lamberti J, Alexandrova E, Pecoraro G, Pagliano P, Astorri R, Manzin A, Weisz A, Giurato G, Galdiero M, Rizzo F, Franci G. Nasopharyngeal virome analysis of COVID-19 patients during three different waves in Campania region of Italy. J Med Virol 2022; 94:2275-2283. [PMID: 34989406 PMCID: PMC9015490 DOI: 10.1002/jmv.27571] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 12/14/2021] [Accepted: 12/30/2021] [Indexed: 01/08/2023]
Abstract
From December 2019, severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection has spread rapidly, leading to a global pandemic. Little is known about possible relationships between SARS‐CoV‐2 and other viruses in the respiratory system affecting patient prognosis and outcomes. This study aims to characterize respiratory virome profiles in association with SARS‐CoV‐2 infection and disease severity, through the analysis in 89 nasopharyngeal swabs collected in a patient's cohort from the Campania region (Southern Italy). Results show coinfections with viral species belonging to Coronaviridae, Retroviridae, Herpesviridae, Poxviridae, Pneumoviridae, Pandoraviridae, and Anelloviridae families and only 2% of the cases (2/89) identified respiratory viruses. The severe acute respiratory syndrome coronavirus 2 infection is considered a major global threat that is still spreading around the world. Nasopharyngeal swabs samples were collected from the Campania region cohort of 89 Covid‐19 patients. Descriptive analysis of respiratory virome was carried out with the HOME‐BIO pipeline, that performed viral taxonomy profiling. It detected coinfections with viral species belonging to Coronaviridae, Retroviridae, Herpesviridae, Poxviridae, Pneumoviridae, Pandoraviridae, and Anelloviridae family. Only 2% of the cases (2/89) identified respiratory viruses.
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Affiliation(s)
- Carlo Ferravante
- Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana", University of Salerno, Baronissi, Italy
| | - Giuseppina Sanna
- Department of Biomedical Sciences, University of Cagliari, Cittadella Universitaria, Monserrato, Cagliari, Italy
| | - Viola Melone
- Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana", University of Salerno, Baronissi, Italy
| | - Aurore Fromentier
- Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana", University of Salerno, Baronissi, Italy
| | - Teresa Rocco
- Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana", University of Salerno, Baronissi, Italy.,Medical Genomics Program, Clinical Microbiology Program, Infectivology and NAT Molecular Biology Units, AOU 'S. Giovanni di Dio e Ruggi d'Aragona' Università di Salerno, Salerno, Italy
| | - Ylenia D'Agostino
- Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana", University of Salerno, Baronissi, Italy.,Medical Genomics Program, Clinical Microbiology Program, Infectivology and NAT Molecular Biology Units, AOU 'S. Giovanni di Dio e Ruggi d'Aragona' Università di Salerno, Salerno, Italy
| | - Jessica Lamberti
- Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana", University of Salerno, Baronissi, Italy
| | - Elena Alexandrova
- Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana", University of Salerno, Baronissi, Italy
| | - Giovanni Pecoraro
- Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana", University of Salerno, Baronissi, Italy
| | - Pasquale Pagliano
- Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana", University of Salerno, Baronissi, Italy.,Medical Genomics Program, Clinical Microbiology Program, Infectivology and NAT Molecular Biology Units, AOU 'S. Giovanni di Dio e Ruggi d'Aragona' Università di Salerno, Salerno, Italy
| | - Roberta Astorri
- Department of Mental Health and Public Medicine, Infection Disease Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Aldo Manzin
- Department of Biomedical Sciences, University of Cagliari, Cittadella Universitaria, Monserrato, Cagliari, Italy
| | - Alessandro Weisz
- Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana", University of Salerno, Baronissi, Italy.,Medical Genomics Program, Clinical Microbiology Program, Infectivology and NAT Molecular Biology Units, AOU 'S. Giovanni di Dio e Ruggi d'Aragona' Università di Salerno, Salerno, Italy.,Genome Research Center for Health (CRGS), University of Salerno, Baronissi, Italy
| | - Giorgio Giurato
- Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana", University of Salerno, Baronissi, Italy.,Genome Research Center for Health (CRGS), University of Salerno, Baronissi, Italy
| | - Massimiliano Galdiero
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Francesca Rizzo
- Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana", University of Salerno, Baronissi, Italy.,Genome Research Center for Health (CRGS), University of Salerno, Baronissi, Italy
| | - Gianluigi Franci
- Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana", University of Salerno, Baronissi, Italy.,Medical Genomics Program, Clinical Microbiology Program, Infectivology and NAT Molecular Biology Units, AOU 'S. Giovanni di Dio e Ruggi d'Aragona' Università di Salerno, Salerno, Italy
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25
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Abstract
Reactivation of herpsviruses, mainly HSV, CMV and EBV, are frequent among critically ill patients. Although they are not immunocompromised from a classical point of view, these patients often present an alteration of their immune system favoring viral reactivation. Seropositive patients with sepsis and under mechanical ventilation are particularly at risk. Herpesviruses have a pulmonary tropism and can be responsible for non-resolving forms of acute respiratory distress syndrome with high mortality. However, the direct causality between herpesviruses reactivation and impaired outcomes among severely ill patients remains under debate.
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26
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Fromentin M, Ricard JD, Roux D. Lung Microbiome in Critically Ill Patients. Life (Basel) 2021; 12:life12010007. [PMID: 35054400 PMCID: PMC8778861 DOI: 10.3390/life12010007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/16/2021] [Accepted: 12/17/2021] [Indexed: 12/11/2022] Open
Abstract
The historical hypothesis of sterility of the lungs was invalidated over a decade ago when studies demonstrated the existence of sparse but very diverse bacterial populations in the normal lung and the association between pulmonary dysbiosis and chronic respiratory diseases. Under mechanical ventilation, dysbiosis occurs rapidly with a gradual decline in diversity over time and the progressive predominance of a bacterial pathogen (mainly Proteobacteria) when lung infection occurs. During acute respiratory distress syndrome, an enrichment in bacteria of intestinal origin, mainly Enterobacteriaceae, is observed. However, the role of this dysbiosis in the pathogenesis of ventilator-associated pneumonia and acute respiratory distress syndrome is not yet fully understood. The lack of exploration of other microbial populations, viruses (eukaryotes and prokaryotes) and fungi is a key issue. Further analysis of the interaction between these microbial kingdoms and a better understanding of the host−microbiome interaction are necessary to fully elucidate the role of the microbiome in the pathogenicity of acute diseases. The validation of a consensual and robust methodology in order to make the comparison of the different studies relevant is also required. Filling these different gaps should help develop preventive and therapeutic strategies for both acute respiratory distress syndrome and ventilator-associated pneumonia.
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Affiliation(s)
- Mélanie Fromentin
- Anesthesiology and Intensive Care Department, AP-HP, Hôpital Cochin, 75014 Paris, France;
- UMR1137 IAME, Université de Paris, INSERM, 75018 Paris, France;
| | - Jean-Damien Ricard
- UMR1137 IAME, Université de Paris, INSERM, 75018 Paris, France;
- Médecine Intensive Réanimation, AP-HP, Hôpital Louis Mourier, DMU ESPRIT, 92700 Colombes, France
| | - Damien Roux
- Médecine Intensive Réanimation, AP-HP, Hôpital Louis Mourier, DMU ESPRIT, 92700 Colombes, France
- Institut Necker-Enfants Malades, Université de Paris, INSERM U1151, CNRS UMR 8253, 75015 Paris, France
- Correspondence: ; Tel.: +33-1-47-60-63-29
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27
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Gu WJ, Huang J, Jiang HY. Efficacy and safety of antiviral therapy in critically ill patients with mechanical ventilation: a meta-analysis with trial sequential analysis of randomized controlled trials. Clin Microbiol Infect 2021; 28:792-800. [PMID: 34910999 DOI: 10.1016/j.cmi.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 11/05/2021] [Accepted: 12/04/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Viral reactivation is frequently detected in critically ill patients with mechanical ventilation and is associated with worse outcomes. However, the efficacy and safety of antiviral therapy in these patients remain unknown. OBJECTIVES To assess the effects of antiviral therapy on mortality, viral reactivation, and adverse events in critically ill patients with mechanical ventilation. DATA SOURCES Medline, Embase, the Cochrane Library, and reference lists. STUDY ELIGIBILITY CRITERIA Randomized controlled trials that compared antiviral therapy with placebo, standard care, or no treatment. PARTICIPANTS Critically ill patients with mechanical ventilation. INTERVENTIONS Antiviral therapy. ASSESSMENT OF RISK OF BIAS Cochrane risk of bias tool. METHODS OF DATA SYNTHESIS Risk ratios (RR) with 95% confidence intervals (CIs) were pooled using a random-effects model for meta-analysis with trial sequential analysis. RESULTS Nine trials with a broad spectrum of critically ill patients were included. No association was found between antiviral therapy and all-cause mortality at the longest follow-up (nine trials; 1790 patients; RR 0.93, 95% CI 0.79-1.11; I2 = 3%). Trial sequential analysis showed that the cumulative Z-curve crossed the futility boundary establishing sufficient evidence. No association also was found between antiviral therapy and 28-day mortality, in-hospital mortality, 60-day mortality, or 90-day mortality. But antiviral therapy was associated with a reduction in viral reactivation (five trials; 644 patients; RR 0.23, 95% CI 0.14-0.37; I2 = 0%). Trial sequential analysis showed that the cumulative Z-curve crossed the trial sequential monitoring boundary for benefit establishing sufficient evidence. Antiviral therapy was not associated with an increased risk of renal insufficiency (eight trials; 1574 patients; RR 0.88, 95% CI 0.73-1.05; I2 =0%). CONCLUSIONS No association between antiviral therapy and mortality was found, but antiviral therapy reduced viral reactivation without increasing the risk of renal insufficiency in critically ill patients with mechanical ventilation.
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Affiliation(s)
- Wan-Jie Gu
- Department of Anaesthesiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing 210008, China.
| | - Jiao Huang
- Department of Anaesthesiology, The First Affiliated Hospital, Guangxi Medical University, 22 Shuangyong Road, Nanning 530021, China
| | - Hai-Yin Jiang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Centre for Infectious Diseases, Collaborative Innovation Centre for Diagnosis and Treatment of Infectious Diseases, Department of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou 310003, China
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28
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Meyer A, Buetti N, Houhou-Fidouh N, Patrier J, Abdel-Nabey M, Jaquet P, Presente S, Girard T, Sayagh F, Ruckly S, Wicky PH, de Montmollin E, Bouadma L, Sonneville R, Descamps D, Timsit JF. HSV-1 reactivation is associated with an increased risk of mortality and pneumonia in critically ill COVID-19 patients. Crit Care 2021; 25:417. [PMID: 34872611 PMCID: PMC8647503 DOI: 10.1186/s13054-021-03843-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 11/25/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Data in the literature about HSV reactivation in COVID-19 patients are scarce, and the association between HSV-1 reactivation and mortality remains to be determined. Our objectives were to evaluate the impact of Herpes simplex virus (HSV) reactivation in patients with severe SARS-CoV-2 infections primarily on mortality, and secondarily on hospital-acquired pneumonia/ventilator-associated pneumonia (HAP/VAP) and intensive care unit-bloodstream infection (ICU-BSI). METHODS We conducted an observational study using prospectively collected data and HSV-1 blood and respiratory samples from all critically ill COVID-19 patients in a large reference center who underwent HSV tests. Using multivariable Cox and cause-specific (cs) models, we investigated the association between HSV reactivation and mortality or healthcare-associated infections. RESULTS Of the 153 COVID-19 patients admitted for ≥ 48 h from Feb-2020 to Feb-2021, 40/153 (26.1%) patients had confirmed HSV-1 reactivation (19/61 (31.1%) with HSV-positive respiratory samples, and 36/146 (24.7%) with HSV-positive blood samples. Day-60 mortality was higher in patients with HSV-1 reactivation (57.5%) versus without (33.6%, p = 0.001). After adjustment for mortality risk factors, HSV-1 reactivation was associated with an increased mortality risk (hazard risk [HR] 2.05; 95% CI 1.16-3.62; p = 0.01). HAP/VAP occurred in 67/153 (43.8%) and ICU-BSI in 42/153 (27.5%) patients. In patients with HSV-1 reactivation, multivariable cause-specific models showed an increased risk of HAP/VAP (csHR 2.38, 95% CI 1.06-5.39, p = 0.037), but not of ICU-BSI. CONCLUSIONS HSV-1 reactivation in critically ill COVID-19 patients was associated with an increased risk of day-60 mortality and HAP/VAP.
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Affiliation(s)
- Antoine Meyer
- INSERM, IAME, University of Paris, 75006, Paris, France.,Medical and Infectious Diseases Intensive Care Unit, APHP, Bichat University Hospital, Paris, France
| | - Niccolò Buetti
- INSERM, IAME, University of Paris, 75006, Paris, France. .,Infection Control Program and WHO Collaborating Centre on Patient Safety, Service PCI, University of Geneva Hospitals and Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland.
| | - Nadhira Houhou-Fidouh
- Virology Department, GH APHP.Nord, Bichat-Claude Bernard University Hospital, 75018, Paris, France
| | - Juliette Patrier
- Medical and Infectious Diseases Intensive Care Unit, APHP, Bichat University Hospital, Paris, France
| | - Moustafa Abdel-Nabey
- Medical and Infectious Diseases Intensive Care Unit, APHP, Bichat University Hospital, Paris, France
| | - Pierre Jaquet
- Medical and Infectious Diseases Intensive Care Unit, APHP, Bichat University Hospital, Paris, France
| | - Simona Presente
- Medical and Infectious Diseases Intensive Care Unit, APHP, Bichat University Hospital, Paris, France
| | - Tiphaine Girard
- Medical and Infectious Diseases Intensive Care Unit, APHP, Bichat University Hospital, Paris, France
| | - Faiza Sayagh
- Medical and Infectious Diseases Intensive Care Unit, APHP, Bichat University Hospital, Paris, France
| | - Stephane Ruckly
- INSERM, IAME, University of Paris, 75006, Paris, France.,Medical and Infectious Diseases Intensive Care Unit, APHP, Bichat University Hospital, Paris, France
| | - Paul-Henri Wicky
- Medical and Infectious Diseases Intensive Care Unit, APHP, Bichat University Hospital, Paris, France
| | - Etienne de Montmollin
- INSERM, IAME, University of Paris, 75006, Paris, France.,Medical and Infectious Diseases Intensive Care Unit, APHP, Bichat University Hospital, Paris, France
| | - Lila Bouadma
- INSERM, IAME, University of Paris, 75006, Paris, France.,Medical and Infectious Diseases Intensive Care Unit, APHP, Bichat University Hospital, Paris, France
| | - Romain Sonneville
- Medical and Infectious Diseases Intensive Care Unit, APHP, Bichat University Hospital, Paris, France.,INSERM, UMR1148, Université de Paris, 75018, Paris, France
| | - Diane Descamps
- Virology Department, GH APHP.Nord, Université de Paris, IAME INSERM UMR1137, Bichat-Claude Bernard University Hospital, 75018, Paris, France
| | - Jean-Francois Timsit
- INSERM, IAME, University of Paris, 75006, Paris, France.,Medical and Infectious Diseases Intensive Care Unit, APHP, Bichat University Hospital, Paris, France
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29
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Mallet F, Diouf L, Meunier B, Perret M, Reynier F, Leissner P, Quemeneur L, Griffiths AD, Moucadel V, Pachot A, Venet F, Monneret G, Lepape A, Rimmelé T, Tan LK, Brengel-Pesce K, Textoris J. Herpes DNAemia and TTV Viraemia in Intensive Care Unit Critically Ill Patients: A Single-Centre Prospective Longitudinal Study. Front Immunol 2021; 12:698808. [PMID: 34795661 PMCID: PMC8593420 DOI: 10.3389/fimmu.2021.698808] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 10/12/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction We analysed blood DNAemia of TTV and four herpesviruses (CMV, EBV, HHV6, and HSV-1) in the REAnimation Low Immune Status Marker (REALISM) cohort of critically ill patients who had presented with either sepsis, burns, severe trauma, or major surgery. The aim was to identify common features related to virus and injury-associated pathologies and specific features linking one or several viruses to a particular pathological context. Methods Overall and individual viral DNAemia were measured over a month using quantitative PCR assays from the 377 patients in the REALISM cohort. These patients were characterised by clinical outcomes [severity scores, mortality, Intensive Care Unit (ICU)-acquired infection (IAI)] and 48 parameters defining their host response after injury (cell populations, immune functional assays, and biomarkers). Association between viraemic event and clinical outcomes or immune markers was assessed using χ2-test or exact Fisher’s test for qualitative variables and Wilcoxon test for continuous variables. Results The cumulative incidence of viral DNAemia increased from below 4% at ICU admission to 35% for each herpesvirus during the first month. EBV, HSV1, HHV6, and CMV were detected in 18%, 12%, 10%, and 9% of patients, respectively. The incidence of high TTV viraemia (>10,000 copies/ml) increased from 11% to 15% during the same period. Herpesvirus viraemia was associated with severity at admission; CMV and HHV6 viraemia correlated with mortality during the first week and over the month. The presence of individual herpesvirus during the first month was significantly associated (p < 0.001) with the occurrence of IAI, whilst herpesvirus DNAemia coupled with high TTV viraemia during the very first week was associated with IAI. Herpesvirus viraemia was associated with a lasting exacerbated host immune response, with concurrent profound immune suppression and hyper inflammation, and delayed return to immune homeostasis. The percentage of patients presenting with herpesvirus DNAemia was significantly higher in sepsis than in all other groups. Primary infection in the hospital and high IL10 levels might favour EBV and CMV reactivation. Conclusion In this cohort of ICU patients, phenotypic differences were observed between TTV and herpesviruses DNAemia. The higher prevalence of herpesvirus DNAemia in sepsis hints at further studies that may enable a better in vivo understanding of host determinants of herpesvirus viral reactivation. Furthermore, our data suggest that EBV and TTV may be useful as additional markers to predict clinical deterioration in ICU patients.
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Affiliation(s)
- François Mallet
- EA 7426 "Pathophysiology of Injury-Induced Immunosuppression" (Université Claude Bernard Lyon 1-Hospices Civils de Lyon-bioMérieux), Joint Research Unit HCL-bioMérieux, Immunology Laboratory & Anesthesia and Critical Care Medicine Department, Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon, France
| | - Léa Diouf
- EA 7426 "Pathophysiology of Injury-Induced Immunosuppression" (Université Claude Bernard Lyon 1-Hospices Civils de Lyon-bioMérieux), Joint Research Unit HCL-bioMérieux, Immunology Laboratory & Anesthesia and Critical Care Medicine Department, Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon, France.,IVIDATA, Levallois-Perret, France
| | - Boris Meunier
- EA 7426 "Pathophysiology of Injury-Induced Immunosuppression" (Université Claude Bernard Lyon 1-Hospices Civils de Lyon-bioMérieux), Joint Research Unit HCL-bioMérieux, Immunology Laboratory & Anesthesia and Critical Care Medicine Department, Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon, France.,Soladis Inc., Cambridge, MA, United States
| | - Magali Perret
- BIOASTER Technology Research Institute, Lyon, France
| | | | | | | | - Andrew D Griffiths
- Laboratoire de Biochimie (LBC), École Supérieure de Physique et de Chimie Industrielles de la ville de Paris (ESPCI) Paris, Paris Sciences & Lettres (PSL) Université, Centre National de la Recherche Scientifique (CNRS) UMR8231, Paris, France
| | - Virginie Moucadel
- EA 7426 "Pathophysiology of Injury-Induced Immunosuppression" (Université Claude Bernard Lyon 1-Hospices Civils de Lyon-bioMérieux), Joint Research Unit HCL-bioMérieux, Immunology Laboratory & Anesthesia and Critical Care Medicine Department, Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon, France
| | - Alexandre Pachot
- EA 7426 "Pathophysiology of Injury-Induced Immunosuppression" (Université Claude Bernard Lyon 1-Hospices Civils de Lyon-bioMérieux), Joint Research Unit HCL-bioMérieux, Immunology Laboratory & Anesthesia and Critical Care Medicine Department, Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon, France
| | - Fabienne Venet
- EA 7426 "Pathophysiology of Injury-Induced Immunosuppression" (Université Claude Bernard Lyon 1-Hospices Civils de Lyon-bioMérieux), Joint Research Unit HCL-bioMérieux, Immunology Laboratory & Anesthesia and Critical Care Medicine Department, Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon, France
| | - Guillaume Monneret
- EA 7426 "Pathophysiology of Injury-Induced Immunosuppression" (Université Claude Bernard Lyon 1-Hospices Civils de Lyon-bioMérieux), Joint Research Unit HCL-bioMérieux, Immunology Laboratory & Anesthesia and Critical Care Medicine Department, Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon, France
| | - Alain Lepape
- EA 7426 "Pathophysiology of Injury-Induced Immunosuppression" (Université Claude Bernard Lyon 1-Hospices Civils de Lyon-bioMérieux), Joint Research Unit HCL-bioMérieux, Immunology Laboratory & Anesthesia and Critical Care Medicine Department, Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon, France
| | - Thomas Rimmelé
- EA 7426 "Pathophysiology of Injury-Induced Immunosuppression" (Université Claude Bernard Lyon 1-Hospices Civils de Lyon-bioMérieux), Joint Research Unit HCL-bioMérieux, Immunology Laboratory & Anesthesia and Critical Care Medicine Department, Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon, France
| | | | - Karen Brengel-Pesce
- EA 7426 "Pathophysiology of Injury-Induced Immunosuppression" (Université Claude Bernard Lyon 1-Hospices Civils de Lyon-bioMérieux), Joint Research Unit HCL-bioMérieux, Immunology Laboratory & Anesthesia and Critical Care Medicine Department, Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon, France
| | - Julien Textoris
- EA 7426 "Pathophysiology of Injury-Induced Immunosuppression" (Université Claude Bernard Lyon 1-Hospices Civils de Lyon-bioMérieux), Joint Research Unit HCL-bioMérieux, Immunology Laboratory & Anesthesia and Critical Care Medicine Department, Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon, France
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Reizine F, Liard C, Pronier C, Thibault V, Maamar A, Gacouin A, Tadié JM. Herpesviridae systemic reactivation in patients with COVID-19-associated ARDS. J Hosp Infect 2021; 119:189-191. [PMID: 34800612 PMCID: PMC8596658 DOI: 10.1016/j.jhin.2021.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 11/07/2021] [Accepted: 11/07/2021] [Indexed: 12/29/2022]
Affiliation(s)
- F Reizine
- CHU Rennes, Maladies Infectieuses et Réanimation Médicale, Rennes, France; Université Rennes 1, Faculté de Médecine, Biosit, Rennes, France.
| | - C Liard
- CHU Rennes, Maladies Infectieuses et Réanimation Médicale, Rennes, France; Université Rennes 1, Faculté de Médecine, Biosit, Rennes, France
| | - C Pronier
- CHU Rennes, Service de Virologie, Rennes, France
| | - V Thibault
- CHU Rennes, Service de Virologie, Rennes, France
| | - A Maamar
- CHU Rennes, Maladies Infectieuses et Réanimation Médicale, Rennes, France; Université Rennes 1, Faculté de Médecine, Biosit, Rennes, France
| | - A Gacouin
- CHU Rennes, Maladies Infectieuses et Réanimation Médicale, Rennes, France; Université Rennes 1, Faculté de Médecine, Biosit, Rennes, France
| | - J-M Tadié
- CHU Rennes, Maladies Infectieuses et Réanimation Médicale, Rennes, France; Université Rennes 1, Faculté de Médecine, Biosit, Rennes, France
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Seeßle J, Hippchen T, Schnitzler P, Gsenger J, Giese T, Merle U. High rate of HSV-1 reactivation in invasively ventilated COVID-19 patients: Immunological findings. PLoS One 2021; 16:e0254129. [PMID: 34197543 PMCID: PMC8248692 DOI: 10.1371/journal.pone.0254129] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 06/18/2021] [Indexed: 12/23/2022] Open
Abstract
SARS-CoV-2 infection can lead to severe acute respiratory distress syndrome with the need of invasive ventilation. Pulmonary herpes simplex-1 (HSV-1) reactivation in invasively ventilated patients is a known phenomenon. To date very little is known about the frequency and the predisposing factors of HSV-1 reactivation in COVID-19. Therefore, we evaluated our cohort of invasively ventilated COVID-19 patients with severe pneumonia for HSV-1 in respiratory specimens and combined these results with functional immunomonitoring of the peripheral blood. Tracheal secretions and bronchial lavages were screened by PCR for HSV-1 positivity. Comprehensive immunophenotyping and quantitative gene expression analysis of Interferon-stimulated genes (IFI44L, MX1, RSAD2, ISIG15 and IFIT1) and IL-1 beta were performed in whole blood. Time course of infection beginning at symptom onset was grouped into three phases ("early" phase 1: day 1-10, "middle" phase 2: day 11-30 and "late" phase 3: day 31-40). Pulmonary HSV-1 reactivation was exclusively observed in the later phases 2 and 3 in 15 of 18 analyzed patients. By FACS analysis a significant increase in activated CD8 T cells (CD38+HLADR+) in phase 2 was found when compared with phase 1 (p<0.05). Expression of Interferon-stimulated genes (IFI44L, RSAD2 ISIG15, MX1, IFIT1) was significantly lower after HSV-1 detection than before. Taken together, reactivation of HSV-1 in the later phase of SARS-CoV-2- infection occurs in parallel with a drop of antiviral innate responsiveness as shown by decreased expression of Interferon-stimulated genes and a concurrent increase of highly activated CD38+HLADR+ CD8 T cells.
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Affiliation(s)
- Jessica Seeßle
- Department of Gastroenterology, University Hospital Heidelberg, Heidelberg, Germany
| | - Theresa Hippchen
- Department of Gastroenterology, University Hospital Heidelberg, Heidelberg, Germany
| | - Paul Schnitzler
- Institute of Virology, University Hospital Heidelberg, Heidelberg, Germany
| | - Julia Gsenger
- Institute of Virology, University Hospital Heidelberg, Heidelberg, Germany
| | - Thomas Giese
- Institute of Immunology, University Hospital Heidelberg, Heidelberg, Germany
| | - Uta Merle
- Department of Gastroenterology, University Hospital Heidelberg, Heidelberg, Germany
- * E-mail:
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Leuzinger K, Stolz D, Gosert R, Naegele K, Prince SS, Tamm M, Hirsch HH. Comparing cytomegalovirus diagnostics by cell culture and quantitative nucleic acid testing in broncho-alveolar lavage fluids. J Med Virol 2021; 93:3804-3812. [PMID: 33136288 DOI: 10.1002/jmv.26649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 10/23/2020] [Accepted: 10/30/2020] [Indexed: 12/13/2022]
Abstract
Many clinical laboratories have replaced virus isolation in cell-culture (VIC) for cytomegalovirus (CMV) by quantitative-nucleic-acid testing (QNAT), rendering clinically relevant CMV-replication difficult to distinguish from CMV-shedding or latent infection. We compared direct VIC in 1109 consecutive bronchoalveolar lavage fluids (BALFs) and a well-validated CMV-QNAT (Basel-CMV-UL111a-77bp). In the retrospective Group 1 (N = 694) and Group 2 (N = 303), CMV-QNAT was performed within 48 h from 2-fold and 10-fold concentrated total nucleic acid (TNA) eluates, respectively. In Group 3 (N = 112), 2-fold and 10-fold concentrated TNA eluates were prospectively analyzed in parallel to VIC. CMV was detected by VIC in 79 of 694 (11%) and 26 of 303 (9%) of Groups 1 and 2, but in 114 of 694 (16%) and 57 of 303 (17%) by CMV-QNAT, respectively. Median CMV loads were significantly higher in VIC-positive than in VIC-negative BALF. The likelihood for CMV detection by VIC was 85% for BALF CMV- loads >4 log10 copies/ml. In the prospective Group 3, CMV was detected by VIC in 10 of 112 (9%), and in 14 of 112 (13%) and 20 of 112 (18%) by CMV-QNAT, when using 2-fold and 10-fold concentrated TNA eluates, respectively. Notably, CMV was undetectable by CMV-QNAT in 10 VIC-positive cases of Groups 1 and 2, but in none of Group 3. We conclude that CMV-QNAT can be adopted to BALF diagnostics but requires several careful steps in validation. CMV-QNAT loads >10 000 copies/ml in BALF may indicate significant CMV replication as defined by VIC, if short shipment and processing procedures can be guaranteed. Discordance of detecting CMV in time-matched plasma samples emphasises the role of local pulmonary CMV replication, for which histopathology remains the gold standard of proven CMV pneumonia.
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Affiliation(s)
- Karoline Leuzinger
- Clinical Virology, Laboratory Medicine, University Hospital Basel, Basel, Switzerland
- Transplantation & Clinical Virology, Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Daiana Stolz
- Medical Faculty, University of Basel, Basel, Switzerland
- Clinic of Pneumology and Pulmonary Cell Research, University Hospital Basel, Basel, Switzerland
| | - Rainer Gosert
- Clinical Virology, Laboratory Medicine, University Hospital Basel, Basel, Switzerland
- Transplantation & Clinical Virology, Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Klaudia Naegele
- Clinical Virology, Laboratory Medicine, University Hospital Basel, Basel, Switzerland
- Transplantation & Clinical Virology, Department of Biomedicine, University of Basel, Basel, Switzerland
| | | | - Michael Tamm
- Medical Faculty, University of Basel, Basel, Switzerland
- Clinic of Pneumology and Pulmonary Cell Research, University Hospital Basel, Basel, Switzerland
| | - Hans H Hirsch
- Clinical Virology, Laboratory Medicine, University Hospital Basel, Basel, Switzerland
- Transplantation & Clinical Virology, Department of Biomedicine, University of Basel, Basel, Switzerland
- Medical Faculty, University of Basel, Basel, Switzerland
- Infectious Diseases & Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
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Bost P, De Sanctis F, Canè S, Ugel S, Donadello K, Castellucci M, Eyal D, Fiore A, Anselmi C, Barouni RM, Trovato R, Caligola S, Lamolinara A, Iezzi M, Facciotti F, Mazzariol A, Gibellini D, De Nardo P, Tacconelli E, Gottin L, Polati E, Schwikowski B, Amit I, Bronte V. Deciphering the state of immune silence in fatal COVID-19 patients. Nat Commun 2021. [PMID: 33674591 DOI: 10.1101/2020.08.10.20170894] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023] Open
Abstract
Since the beginning of the SARS-CoV-2 pandemic, COVID-19 appeared as a unique disease with unconventional tissue and systemic immune features. Here we show a COVID-19 immune signature associated with severity by integrating single-cell RNA-seq analysis from blood samples and broncho-alveolar lavage fluids with clinical, immunological and functional ex vivo data. This signature is characterized by lung accumulation of naïve lymphoid cells associated with a systemic expansion and activation of myeloid cells. Myeloid-driven immune suppression is a hallmark of COVID-19 evolution, highlighting arginase-1 expression with immune regulatory features of monocytes. Monocyte-dependent and neutrophil-dependent immune suppression loss is associated with fatal clinical outcome in severe patients. Additionally, our analysis shows a lung CXCR6+ effector memory T cell subset is associated with better prognosis in patients with severe COVID-19. In summary, COVID-19-induced myeloid dysregulation and lymphoid impairment establish a condition of 'immune silence' in patients with critical COVID-19.
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Affiliation(s)
- Pierre Bost
- Department of Immunology, Weizmann Institute of Science, Rehovot, Israel
- Systems Biology Group, Department of Computational Biology and USR 3756, Institut Pasteur and CNRS, Paris, France
- Sorbonne Universite, Complexite du vivant, Paris, France
| | - Francesco De Sanctis
- Immunology Section, Department of Medicine, University and Hospital Trust of Verona, Verona, Italy
| | - Stefania Canè
- Immunology Section, Department of Medicine, University and Hospital Trust of Verona, Verona, Italy
| | - Stefano Ugel
- Immunology Section, Department of Medicine, University and Hospital Trust of Verona, Verona, Italy
| | - Katia Donadello
- Intensive Care Unit, Department of Surgery, Dentistry, Maternity and Infant, University and Hospital Trust of Verona, Verona, Italy
| | - Monica Castellucci
- The Center for Technological Platforms, University of Verona, Verona, Italy
| | - David Eyal
- Department of Immunology, Weizmann Institute of Science, Rehovot, Israel
| | - Alessandra Fiore
- Immunology Section, Department of Medicine, University and Hospital Trust of Verona, Verona, Italy
| | - Cristina Anselmi
- Immunology Section, Department of Medicine, University and Hospital Trust of Verona, Verona, Italy
| | - Roza Maria Barouni
- Immunology Section, Department of Medicine, University and Hospital Trust of Verona, Verona, Italy
| | - Rosalinda Trovato
- Immunology Section, Department of Medicine, University and Hospital Trust of Verona, Verona, Italy
| | - Simone Caligola
- Immunology Section, Department of Medicine, University and Hospital Trust of Verona, Verona, Italy
| | - Alessia Lamolinara
- CAST- Center for Advanced Studies and Technology, Department of Neurosciences, Imaging and Clinical Sciences, University of G. D'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Manuela Iezzi
- CAST- Center for Advanced Studies and Technology, Department of Neurosciences, Imaging and Clinical Sciences, University of G. D'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Federica Facciotti
- Department of Experimental Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Annarita Mazzariol
- Microbiology Unit, Department of Diagnostics and Public Health, University and Hospital Trust of Verona, Verona, Italy
| | - Davide Gibellini
- Microbiology Unit, Department of Diagnostics and Public Health, University and Hospital Trust of Verona, Verona, Italy
| | - Pasquale De Nardo
- Division of Infectious Diseases, Department of Diagnostics and Public Health, University and Hospital Trust of Verona, Verona, Italy
| | - Evelina Tacconelli
- Division of Infectious Diseases, Department of Diagnostics and Public Health, University and Hospital Trust of Verona, Verona, Italy
| | - Leonardo Gottin
- Intensive Care Unit, Department of Surgery, Dentistry, Maternity and Infant, University and Hospital Trust of Verona, Verona, Italy
| | - Enrico Polati
- Intensive Care Unit, Department of Surgery, Dentistry, Maternity and Infant, University and Hospital Trust of Verona, Verona, Italy
| | - Benno Schwikowski
- Systems Biology Group, Department of Computational Biology and USR 3756, Institut Pasteur and CNRS, Paris, France
| | - Ido Amit
- Department of Immunology, Weizmann Institute of Science, Rehovot, Israel.
| | - Vincenzo Bronte
- Immunology Section, Department of Medicine, University and Hospital Trust of Verona, Verona, Italy.
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Bost P, De Sanctis F, Canè S, Ugel S, Donadello K, Castellucci M, Eyal D, Fiore A, Anselmi C, Barouni RM, Trovato R, Caligola S, Lamolinara A, Iezzi M, Facciotti F, Mazzariol A, Gibellini D, De Nardo P, Tacconelli E, Gottin L, Polati E, Schwikowski B, Amit I, Bronte V. Deciphering the state of immune silence in fatal COVID-19 patients. Nat Commun 2021; 12:1428. [PMID: 33674591 PMCID: PMC7935849 DOI: 10.1038/s41467-021-21702-6] [Citation(s) in RCA: 88] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 01/31/2021] [Indexed: 12/15/2022] Open
Abstract
Since the beginning of the SARS-CoV-2 pandemic, COVID-19 appeared as a unique disease with unconventional tissue and systemic immune features. Here we show a COVID-19 immune signature associated with severity by integrating single-cell RNA-seq analysis from blood samples and broncho-alveolar lavage fluids with clinical, immunological and functional ex vivo data. This signature is characterized by lung accumulation of naïve lymphoid cells associated with a systemic expansion and activation of myeloid cells. Myeloid-driven immune suppression is a hallmark of COVID-19 evolution, highlighting arginase-1 expression with immune regulatory features of monocytes. Monocyte-dependent and neutrophil-dependent immune suppression loss is associated with fatal clinical outcome in severe patients. Additionally, our analysis shows a lung CXCR6+ effector memory T cell subset is associated with better prognosis in patients with severe COVID-19. In summary, COVID-19-induced myeloid dysregulation and lymphoid impairment establish a condition of 'immune silence' in patients with critical COVID-19.
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Affiliation(s)
- Pierre Bost
- Department of Immunology, Weizmann Institute of Science, Rehovot, Israel
- Systems Biology Group, Department of Computational Biology and USR 3756, Institut Pasteur and CNRS, Paris, France
- Sorbonne Universite, Complexite du vivant, Paris, France
| | - Francesco De Sanctis
- Immunology Section, Department of Medicine, University and Hospital Trust of Verona, Verona, Italy
| | - Stefania Canè
- Immunology Section, Department of Medicine, University and Hospital Trust of Verona, Verona, Italy
| | - Stefano Ugel
- Immunology Section, Department of Medicine, University and Hospital Trust of Verona, Verona, Italy
| | - Katia Donadello
- Intensive Care Unit, Department of Surgery, Dentistry, Maternity and Infant, University and Hospital Trust of Verona, Verona, Italy
| | - Monica Castellucci
- The Center for Technological Platforms, University of Verona, Verona, Italy
| | - David Eyal
- Department of Immunology, Weizmann Institute of Science, Rehovot, Israel
| | - Alessandra Fiore
- Immunology Section, Department of Medicine, University and Hospital Trust of Verona, Verona, Italy
| | - Cristina Anselmi
- Immunology Section, Department of Medicine, University and Hospital Trust of Verona, Verona, Italy
| | - Roza Maria Barouni
- Immunology Section, Department of Medicine, University and Hospital Trust of Verona, Verona, Italy
| | - Rosalinda Trovato
- Immunology Section, Department of Medicine, University and Hospital Trust of Verona, Verona, Italy
| | - Simone Caligola
- Immunology Section, Department of Medicine, University and Hospital Trust of Verona, Verona, Italy
| | - Alessia Lamolinara
- CAST- Center for Advanced Studies and Technology, Department of Neurosciences, Imaging and Clinical Sciences, University of G. D'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Manuela Iezzi
- CAST- Center for Advanced Studies and Technology, Department of Neurosciences, Imaging and Clinical Sciences, University of G. D'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Federica Facciotti
- Department of Experimental Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Annarita Mazzariol
- Microbiology Unit, Department of Diagnostics and Public Health, University and Hospital Trust of Verona, Verona, Italy
| | - Davide Gibellini
- Microbiology Unit, Department of Diagnostics and Public Health, University and Hospital Trust of Verona, Verona, Italy
| | - Pasquale De Nardo
- Division of Infectious Diseases, Department of Diagnostics and Public Health, University and Hospital Trust of Verona, Verona, Italy
| | - Evelina Tacconelli
- Division of Infectious Diseases, Department of Diagnostics and Public Health, University and Hospital Trust of Verona, Verona, Italy
| | - Leonardo Gottin
- Intensive Care Unit, Department of Surgery, Dentistry, Maternity and Infant, University and Hospital Trust of Verona, Verona, Italy
| | - Enrico Polati
- Intensive Care Unit, Department of Surgery, Dentistry, Maternity and Infant, University and Hospital Trust of Verona, Verona, Italy
| | - Benno Schwikowski
- Systems Biology Group, Department of Computational Biology and USR 3756, Institut Pasteur and CNRS, Paris, France
| | - Ido Amit
- Department of Immunology, Weizmann Institute of Science, Rehovot, Israel.
| | - Vincenzo Bronte
- Immunology Section, Department of Medicine, University and Hospital Trust of Verona, Verona, Italy.
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35
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Papazian L, Jaber S, Hraiech S, Baumstarck K, Cayot-Constantin S, Aissaoui N, Jung B, Leone M, Souweine B, Schwebel C, Bourenne J, Allardet-Servent J, Kamel T, Lu Q, Zandotti C, Loundou A, Penot-Ragon C, Chastre J, Forel JM, Luyt CE. Preemptive ganciclovir for mechanically ventilated patients with cytomegalovirus reactivation. Ann Intensive Care 2021; 11:33. [PMID: 33570708 PMCID: PMC7876264 DOI: 10.1186/s13613-020-00793-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 12/18/2020] [Indexed: 12/13/2022] Open
Abstract
Background The effect of cytomegalovirus (CMV) reactivation on the length of mechanical ventilation and mortality in immunocompetent ICU patients requiring invasive mechanical ventilation remains controversial. The main objective of this study was to determine whether preemptive intravenous ganciclovir increases the number of ventilator-free days in patients with CMV blood reactivation. Methods This double-blind, placebo-controlled, randomized clinical trial involved 19 ICUs in France. Seventy-six adults ≥ 18 years old who had been mechanically ventilated for at least 96 h, expected to remain on mechanical ventilation for ≥ 48 h, and exhibited reactivation of CMV in blood were enrolled between February 5th, 2014, and January 23rd, 2019. Participants were randomized to receive ganciclovir 5 mg/kg bid for 14 days (n = 39) or a matching placebo (n = 37). Results The primary endpoint was ventilator-free days from randomization to day 60. Prespecified secondary outcomes included day 60 mortality. The trial was stopped for futility based on the results of an interim analysis by the DSMB. The subdistribution hazard ratio for being alive and weaned from mechanical ventilation at day 60 for patients receiving ganciclovir (N = 39) compared with control patients (N = 37) was 1.14 (95% CI from 0.63 to 2.06; P = 0.66). The median [IQR] numbers of ventilator-free days for ganciclovir-treated patients and controls were 10 [0–51] and 0 [0–43] days, respectively (P = 0.46). Mortality at day 60 was 41% in patients in the ganciclovir group and 43% in the placebo group (P = .845). Creatinine levels and blood cells counts did not differ significantly between the two groups. Conclusions In patients mechanically ventilated for ≥ 96 h with CMV reactivation in blood, preemptive ganciclovir did not improve the outcome.
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Affiliation(s)
- Laurent Papazian
- Médecine Intensive Réanimation, Aix-Marseille Université, Hôpital Nord, Chemin des Bourrely, 13015, Marseille, France.
| | - Samir Jaber
- Réanimation Chirurgicale, Centre Hospitalier Universitaire de Montpellier, Hôpital St-Eloi, Montpellier, France
| | - Sami Hraiech
- Médecine Intensive Réanimation, Aix-Marseille Université, Hôpital Nord, Chemin des Bourrely, 13015, Marseille, France
| | - Karine Baumstarck
- Laboratoire de Santé Publique, Aix-Marseille Université, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | | | - Nadia Aissaoui
- Médecine Intensive Réanimation, Hôpital Européen Georges-Pompidou, APHP, Paris, France
| | - Boris Jung
- Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Montpellier, Hôpital Lapeyronie, Montpellier, France
| | - Marc Leone
- Service d'Anesthésie-Réanimation, Aix-Marseille Université, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Bertrand Souweine
- Réanimation Médicale, CHU Gabriel-Montpied, Clermont-Ferrand, France
| | - Carole Schwebel
- Médecine Intensive Réanimation, CHU Grenoble Alpes, La Tronche, France
| | - Jérémy Bourenne
- Réanimation des Urgences et Médicale, Aix-Marseille Université, Hôpital Timone, APHM, Marseille, France
| | | | - Toufik Kamel
- Médecine Intensive Réanimation, Centre Hospitalier Régional, Orléans, France
| | - Qin Lu
- Réanimation Chirurgicale Polyvalente, Département d'Anesthésie-Réanimation, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, APHP, Paris, France
| | - Christine Zandotti
- Laboratoire de Virologie, IHU Méditerranée Infection, CHU Timone UMR190-Emergence des Pathologies Virales, Marseille, France
| | - Anderson Loundou
- Laboratoire de Santé Publique, Aix-Marseille Université, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | | | - Jean Chastre
- Sorbonne Université, INSERM, Médecine Intensive Réanimation, Institut de Cardiologie, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jean-Marie Forel
- Médecine Intensive Réanimation, Aix-Marseille Université, Hôpital Nord, Chemin des Bourrely, 13015, Marseille, France
| | - Charles-Edouard Luyt
- Sorbonne Université, INSERM, Médecine Intensive Réanimation, Institut de Cardiologie, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Assistance Publique-Hôpitaux de Paris, Paris, France
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Fromentin M, Ricard JD, Roux D. Respiratory microbiome in mechanically ventilated patients: a narrative review. Intensive Care Med 2021; 47:292-306. [PMID: 33559707 PMCID: PMC7871139 DOI: 10.1007/s00134-020-06338-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 12/15/2020] [Indexed: 12/12/2022]
Abstract
The respiratory microbiome has been less explored than the gut microbiome. Despite the speculated importance of dysbiosis of the microbiome in ventilator-associated pneumonia (VAP) and acute respiratory distress syndrome (ARDS), only few studies have been performed in invasively ventilated ICU patients. And only the results of small cohorts have been published. An overlap exists between bacterial populations observed in the lower respiratory tract and the oropharyngeal tract. The bacterial microbiota is characterized by relatively abundant bacteria difficult to cultivate by standard methods. Under mechanical ventilation, a dysbiosis occurs with a drop overtime in diversity. During VAP development, lung dysbiosis is characterized by a shift towards a dominant bacterial pathogen (mostly Proteobacteria) whereas enrichment of gut-associated bacteria mainly Enterobacteriaceae is the specific feature discriminating ARDS patients. However, the role of this dysbiosis in VAP and ARDS pathogenesis is not yet fully understood. A more in-depth analysis of the interplay between bacteria, virus and fungi and a better understanding of the host-microbiome interaction could provide a more comprehensive view of the role of the microbiome in VAP and ARDS pathogenesis. Priority should be given to validate a consensual and robust methodology for respiratory microbiome research and to conduct longitudinal studies. A deeper understanding of microbial interplay should be a valuable guide for care of ARDS and VAP preventive/therapeutic strategies. We present a review on the current knowledge and expose perspectives and potential clinical applications of respiratory microbiome research in mechanically ventilated patients.
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Affiliation(s)
- Mélanie Fromentin
- Anesthesiology and Intensive Care Department, AP-HP, Hôpital Cochin, 75014, Paris, France.,UMR1137 IAME, INSERM, Université de Paris, 75018, Paris, France
| | - Jean-Damien Ricard
- Médecine Intensive Réanimation, DMU ESPRIT, AP-HP, Hôpital Louis Mourier, 92700, Colombes, France.,UMR1137 IAME, INSERM, Université de Paris, 75018, Paris, France
| | - Damien Roux
- Médecine Intensive Réanimation, DMU ESPRIT, AP-HP, Hôpital Louis Mourier, 92700, Colombes, France. .,UMR1137 IAME, INSERM, Université de Paris, 75018, Paris, France.
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37
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Clark JM, Durrani H, Hagan JD, Watson C, Richards WT, Taylor D, Ang DN. Statewide Seasonal Variations of Infections Within the Intensive Care Unit Among the Trauma Population. Am Surg 2020; 87:623-630. [PMID: 33135937 DOI: 10.1177/0003134820951496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Infections within intensive care unit (ICU) are a persistent problem among the critically ill. Viral pneumonias have already been established as having a season variations. We attempt to evaluate the seasonal variations of pneumonia among the traumatically injured and the critically ill. MATERIALS AND METHODS A retrospective cohort study among traumatized patients admitted from 1997 to 2017 to an ICU within the state of Florida was performed who were diagnosed with pneumonia. A multivariate regression analysis was performed to adjust for confounders. Time periods were divided into seasons: summer, winter, spring, and fall. A subset analysis of geriatric patients (>65 years) was also performed. RESULTS A total of 869 553 patients were identified. The most common viral infection was influenza with adenovirus the least. The most common bacterial pneumonia was Staphylococcus aureus with Bordetella pertussis the least. Pneumonias had a seasonal variation. Compared to summer, winter had a higher likelihood of pneumonia overall (Adjusted Odds Ratio (AOR)1.13). This was seen in the spring (AOR 1.04) but not in fall (AOR 1.00). Viral infections were more pronounced (AOR 3.79) in all other seasons, while bacterial showed increased likelihood during winter (AOR 1.05). In geriatrics, pneumonia was again more likely in the winter (AOR 1.22) with both viral and bacterial infections being more pronounced during winter (AOR 4.79, AOR 1.09). DISCUSSION Pneumonias are seen more frequently within the ICU during the winter for the traumatized patient. This held true with the critically ill geriatric population as well. This effect was observed in both viral and bacterial pneumonias.
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Affiliation(s)
- Jason M Clark
- Department of Surgery, University of South Florida, Tampa, FL, USA.,Department of Medical Education, University of Central Florida, Orlando, FL, USA.,Department of Trauma, Ocala Regional Medical Center, Ocala, FL, USA
| | - Hamza Durrani
- Department of Medical Education, University of Central Florida, Orlando, FL, USA.,Department of Trauma, Ocala Regional Medical Center, Ocala, FL, USA
| | - Josh D Hagan
- Department of Surgery, University of South Florida, Tampa, FL, USA.,Department of Medical Education, University of Central Florida, Orlando, FL, USA.,Department of Trauma, Ocala Regional Medical Center, Ocala, FL, USA
| | - Carrie Watson
- Department of Surgery, University of South Florida, Tampa, FL, USA.,Department of Medical Education, University of Central Florida, Orlando, FL, USA.,Department of Trauma, Ocala Regional Medical Center, Ocala, FL, USA
| | - Winston T Richards
- Department of Surgery, University of South Florida, Tampa, FL, USA.,Department of Medical Education, University of Central Florida, Orlando, FL, USA.,Department of Trauma, Ocala Regional Medical Center, Ocala, FL, USA
| | - Dana Taylor
- Department of Surgery, University of South Florida, Tampa, FL, USA.,Department of Medical Education, University of Central Florida, Orlando, FL, USA.,Department of Trauma, Ocala Regional Medical Center, Ocala, FL, USA
| | - Darwin N Ang
- Department of Surgery, University of South Florida, Tampa, FL, USA.,Department of Medical Education, University of Central Florida, Orlando, FL, USA.,Department of Trauma, Ocala Regional Medical Center, Ocala, FL, USA
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Melamed KH, Williams J, Wang X, Hu S, Nguyen C, Cui J, Deng JC. Development of secondary bacterial pneumonia in adults presenting with influenza versus noninfluenza viral respiratory infection. Ther Adv Respir Dis 2020; 14:1753466620963026. [PMID: 33121394 PMCID: PMC7607758 DOI: 10.1177/1753466620963026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Respiratory viral infections, particularly influenza, are known to cause significant morbidity and mortality, often due to secondary infections. Our aim was to comparatively analyze the incidence, epidemiology, and outcomes of secondary pneumonia in adult patients hospitalized with influenza versus noninfluenza viral infections and determine whether influenza particularly predisposes to secondary infections. METHODS This was a retrospective analysis from a single tertiary medical center of adult patients admitted to the hospital between 2008 and 2010 with respiratory viral infections. Microbiological patterns and clinical outcomes were compared between those with influenza (VI, n = 57) and those with noninfluenza (NI, n = 77) respiratory viral infections. RESULTS The NI group was older (60.6 ± 14.0 versus 53.3 ± 19.7 years, p = 0.019) with higher rates of lung transplantation (29% versus 9%, p = 0.009) than VI. Overall, 35% developed secondary pneumonia, higher among NI (44%) than VI (23%, p = 0.017). Staphylococcus aureus was the most common cause of pneumonia in VI, whereas Gram-negative rods were most frequently identified in NI. The NI group had longer hospital [median 10 (interquartile range (IQR) 6-19) versus 6 (IQR 4-15) days, p = 0.019] and intensive care unit [median 4 (IQR 0-12) versus 0 (IQR 0-8) days, p = 0.029] stays compared with VI. Further, the NI group was more likely to be admitted to the intensive care unit compared with VI (62% versus 39%, p = 0.011). A trend towards increased mortality was observed in viral infections complicated by secondary pneumonia than primary viral infections (28% versus 15%, p = 0.122). CONCLUSION Secondary pneumonia is common among adults hospitalized with viral respiratory infections. Within our population, NI results in more frequent secondary pneumonia and longer hospital stays than those with VI. Given the high number of infections caused by Gram-negative rods, monitoring local epidemiology is critical for guiding initial antibiotic selection in empirical treatment of secondary infections.The reviews of this paper are available via the supplemental material section.
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Affiliation(s)
- Kathryn H Melamed
- Division of Pulmonary and Critical Care Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Justin Williams
- Department of Biostatistics, University of California at Los Angeles, Los Angeles, CA, USA
| | - Xiaoyan Wang
- Department of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA
| | - Scott Hu
- Division of Pulmonary and Critical Care Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Christopher Nguyen
- Department of Pulmonary Medicine, Kaiser Oakland Medical Center, Oakland, CA, USA
| | - Jing Cui
- Department of Cardiothoracic Anesthesiology, Morristown Medical Center, Morristown, NJ, USA
| | - Jane C Deng
- Pulmonary and Critical Care Medicine, Veterans Affairs Ann Arbor Healthcare System, 2215 Fuller Road, 111G (Pulmonary), Ann Arbor, MI 48105, USA.,Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA
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Le Balc'h P, Pinceaux K, Pronier C, Seguin P, Tadié JM, Reizine F. Herpes simplex virus and cytomegalovirus reactivations among severe COVID-19 patients. Crit Care 2020; 24:530. [PMID: 32859241 PMCID: PMC7453668 DOI: 10.1186/s13054-020-03252-3] [Citation(s) in RCA: 113] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 08/12/2020] [Indexed: 11/10/2022] Open
Affiliation(s)
- Pierre Le Balc'h
- Service des Maladies Infectieuses et Réanimation Médicale, CHU Rennes, F-35033, Rennes, France
- Faculté de Médecine, Biosit, Université Rennes 1, F-35043, Rennes, France
| | - Kieran Pinceaux
- Service des Maladies Infectieuses et Réanimation Médicale, CHU Rennes, F-35033, Rennes, France
- Faculté de Médecine, Biosit, Université Rennes 1, F-35043, Rennes, France
| | | | - Philippe Seguin
- Service de Réanimation Chirurgicale, CHU Rennes, F-35033, Rennes, France
| | - Jean-Marc Tadié
- Service des Maladies Infectieuses et Réanimation Médicale, CHU Rennes, F-35033, Rennes, France
- Faculté de Médecine, Biosit, Université Rennes 1, F-35043, Rennes, France
| | - Florian Reizine
- Service des Maladies Infectieuses et Réanimation Médicale, CHU Rennes, F-35033, Rennes, France.
- Faculté de Médecine, Biosit, Université Rennes 1, F-35043, Rennes, France.
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Schildermans J, De Vlieger G. Cytomegalovirus: A Troll in the ICU? Overview of the Literature and Perspectives for the Future. Front Med (Lausanne) 2020; 7:188. [PMID: 32500076 PMCID: PMC7243473 DOI: 10.3389/fmed.2020.00188] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 04/20/2020] [Indexed: 12/12/2022] Open
Abstract
Cytomegalovirus (CMV) is one of the most pathogenic viruses in human. After a primary infection, CMV resides in the host for life as a latent infection. When immunity is reduced, CMV can escape the suppressive effects of the immune system and lead to viremia and antigenemia. This reactivation, first seen in transplant patients, has also been documented in non-immunocompromised CMV-seropositive critically ill patients and is associated with higher morbidity and mortality. In the latter, it is not clear whether CMV reactivation is an innocent bystander or the cause of this observed worse outcome. Two studies showed no difference in the outcome of CMV-seropositive and seronegative patients. In addition, proof-of-concept studies investigating prophylactic antiviral treatment to prevent CMV reactivation during critical illness, failed to show a beneficial effect on interleukin levels or clinical outcome. Further research is necessary to resolve the question whether CMV replication impairs the prognosis in non-immunocompromised critically ill patients. We here give a concise overview on the available data and propose strategies to further unravel this question. First, post-mortem investigation may be useful to evaluate the effect of viral replication on organ inflammation and function. Second, further research should focus on the question whether the level of viremia needs to exceed a threshold to be associated with worse outcome. Third, clinical and biochemical assessments may help to identify patients at high risk for reactivation. Fourth, preemptive treatment based upon early detection of the virus is currently under investigation. Finally, immune-stimulating biologicals may be beneficial in high-risk groups.
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Affiliation(s)
- Jolien Schildermans
- Clinical Division of Intensive Care Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Greet De Vlieger
- Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
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Abstract
OBJECTIVES Reactivation viremia is associated with adverse clinical outcomes and immune dysfunction in adults with sepsis. We determined the incidence of viremia and its association with clinical outcomes and immune paralysis phenotype in children with severe sepsis. DESIGN Prospective cohort study. SETTING Single academic PICU from September 2016 to March 2018. PATIENTS Fifty-nine patients 2-17 years old treated for severe sepsis. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We performed real-time polymerase chain reaction assays on whole blood specimens to determine the incidence of cytomegalovirus. Cytomegalovirus was detected in three patients (5%). All patients with cytomegalovirus viremia were seropositive, with an incidence of 13% in this subset. We additionally performed Epstein-Barr virus and human herpesvirus-6 polymerase chain reaction assays on last available specimens and detected Epstein-Barr virus in 4% and human herpesvirus-6 in 30% of the study population. Overall, viremia was not associated with clinical outcomes or immune function in univariable analyses. However, viremia was associated with lower odds of complicated course (defined as death within 28 d or ≥ 2 organ dysfunctions at 7 d) after controlling for age, Pediatric Risk of Mortality III score, and blood transfusion (adjusted odds ratio, 0.08; 95% CI, 0.01-0.84; p = 0.04). CONCLUSIONS Children with severe sepsis had low rates of detectable viremia, which limited analyses of its association with clinical outcomes or immune paralysis phenotype. Given the rare occurrence of cytomegalovirus viremia, in particular, our study does not support a role for viremia as a biomarker of illness severity or as a modifiable risk factor of clinical outcomes for most patients. Future studies on the role of viremia in pediatric sepsis will need to consider the challenges posed by low rates of viremia in this population.
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Clariot S, Constant O, Lepeule R, Fihman V, Razazi K, Cook F, Attias A, Merle JC, Hemery F, Levesque E, Decousser JW, Langeron O, Mongardon N. Clinical relevance and impact of Corynebacterium isolation in lower respiratory tract of critically ill patients requiring mechanical ventilation. Infection 2020; 48:413-420. [PMID: 32185636 PMCID: PMC7222949 DOI: 10.1007/s15010-020-01411-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 03/06/2020] [Indexed: 01/10/2023]
Abstract
Purpose Corynebacterium spp. (C. spp.) is commonly considered as a contaminant in respiratory specimens. No study has ever focused on its clinical relevance in the lower respiratory tract of patients admitted to the intensive care unit (ICU) and requiring mechanical ventilation. The aims were to describe the characteristics of ICU patients with a C. spp. positive deep respiratory specimen, to investigate the impact of C. spp. on the occurrence of pneumonia, and to evaluate the outcomes of these pneumonia. Methods We retrospectively included all adult patients admitted to ICU in a 1000-bed University Hospital (2007–2017) who had a C. spp. positive lower respiratory tract specimen at a significant quantitative level. We used clinical, radiological, and microbiological criteria to classify the likelihood of such pneumonia. Results Among the 31 patients included, acute respiratory failure and postoperative care after major surgery were the main reasons of admission. SAPS II was 47 [34–60]. C. spp. pneumonia was considered as probable, possible and unlikely in 10, 14, and 7 patients, respectively. Fifty-two and 94% of C. spp. strains were sensitive to amoxicillin, and vancomycin/linezolid, respectively. Seventeen patients had a complete course of antibiotic against C. spp. The overall ICU mortality was 58%. Conclusion Corynebacterium spp seems to be responsible for authentic pneumonia in mechanically ventilated patients. It should be considered as clinically relevant when predominantly present in respiratory specimen from patients suspected with pneumonia in ICU, and empirically treated.
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Affiliation(s)
- Simon Clariot
- Service d'Anesthésie-Réanimation Chirurgicale, DMU CARE, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, CHU Henri Mondor, 51 avenue du Maréchal de Lattre de Tassigny, 94000, Créteil, France
| | - Ophélie Constant
- Service d'Anesthésie-Réanimation Chirurgicale, DMU CARE, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, CHU Henri Mondor, 51 avenue du Maréchal de Lattre de Tassigny, 94000, Créteil, France
| | - Raphaël Lepeule
- Unité Transversale de Traitement Des Infections (UT2I), Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, 94010, Créteil, France
| | - Vincent Fihman
- Unité de Bactériologie-Hygiène, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor Henri Mondor, 94010, Créteil, France.,Faculté de Santé, EA DYNAMYC UPEC, Ecole Nationale Vétérinaire d'Alfort, 94010, Créteil, France
| | - Keyvan Razazi
- Service de Réanimation Médicale, Groupe de Recherche Clinique CARMAS, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, 94010, Créteil, France
| | - Fabrice Cook
- Service d'Anesthésie-Réanimation Chirurgicale, DMU CARE, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, CHU Henri Mondor, 51 avenue du Maréchal de Lattre de Tassigny, 94000, Créteil, France
| | - Arié Attias
- Service d'Anesthésie-Réanimation Chirurgicale, DMU CARE, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, CHU Henri Mondor, 51 avenue du Maréchal de Lattre de Tassigny, 94000, Créteil, France
| | - Jean-Claude Merle
- Service d'Anesthésie-Réanimation Chirurgicale, DMU CARE, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, CHU Henri Mondor, 51 avenue du Maréchal de Lattre de Tassigny, 94000, Créteil, France
| | - François Hemery
- Département d'Informatique Médicale, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, 94010, Créteil, France
| | - Eric Levesque
- Service d'Anesthésie-Réanimation Chirurgicale, DMU CARE, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, CHU Henri Mondor, 51 avenue du Maréchal de Lattre de Tassigny, 94000, Créteil, France.,Faculté de Santé, Univ Paris Est Creteil, 94010, Créteil, France.,Faculté de Santé, EA DYNAMYC UPEC, Ecole Nationale Vétérinaire d'Alfort, 94010, Créteil, France
| | - Jean-Winoc Decousser
- Unité de Bactériologie-Hygiène, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor Henri Mondor, 94010, Créteil, France.,Faculté de Santé, Univ Paris Est Creteil, 94010, Créteil, France.,Faculté de Santé, EA DYNAMYC UPEC, Ecole Nationale Vétérinaire d'Alfort, 94010, Créteil, France
| | - Olivier Langeron
- Service d'Anesthésie-Réanimation Chirurgicale, DMU CARE, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, CHU Henri Mondor, 51 avenue du Maréchal de Lattre de Tassigny, 94000, Créteil, France.,Faculté de Santé, Univ Paris Est Creteil, 94010, Créteil, France
| | - Nicolas Mongardon
- Service d'Anesthésie-Réanimation Chirurgicale, DMU CARE, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, CHU Henri Mondor, 51 avenue du Maréchal de Lattre de Tassigny, 94000, Créteil, France. .,Faculté de Santé, Univ Paris Est Creteil, 94010, Créteil, France. .,U955-IMRB, Equipe 03 "Pharmacologie et technologies pour les malades cardiovasculaires (PROTECT)", Inserm, Université Paris Est Creteil, Ecole Nationale Vétérinaire D'Alfort, 94700, Maisons-Alfort, France.
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Luyt CE, Forel JM, Hajage D, Jaber S, Cayot-Constantin S, Rimmelé T, Coupez E, Lu Q, Diallo MH, Penot-Ragon C, Clavel M, Schwebel C, Timsit JF, Bedos JP, Hauw-Berlemont C, Bourenne J, Mayaux J, Lefrant JY, Mira JP, Combes A, Wolff M, Chastre J, Papazian L. Acyclovir for Mechanically Ventilated Patients With Herpes Simplex Virus Oropharyngeal Reactivation: A Randomized Clinical Trial. JAMA Intern Med 2020; 180:263-272. [PMID: 31841577 PMCID: PMC6990840 DOI: 10.1001/jamainternmed.2019.5713] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
IMPORTANCE The role of herpes simplex virus (HSV) reactivation on morbidity and mortality in patients in the intensive care unit requiring mechanical ventilation remains unknown. OBJECTIVE To determine whether preemptive treatment with intravenous acyclovir reduces the duration of mechanical ventilation in patients with HSV oropharyngeal reactivation. DESIGN, SETTING, AND PARTICIPANTS A double-blind, placebo-controlled randomized clinical trial was conducted in 16 intensive care units in France. Participants included 239 adults (age, >18 years) who received mechanical ventilation for at least 96 hours and continued to receive mechanical ventilation for 48 hours or more, with HSV oropharyngeal reactivation. Patients were enrolled between February 2, 2014, and February 22, 2018. INTERVENTIONS Participants were randomized to receive intravenous acyclovir, 5 mg/kg, 3 times daily for 14 days or a matching placebo. MAIN OUTCOMES AND MEASURES The primary end point was ventilator-free days from randomization to day 60. Prespecified secondary outcomes included mortality at 60 days. Main analyses were conducted on an intention-to-treat basis. RESULTS Of 239 patients enrolled and randomized, 1 patient withdrew consent, leaving 238 patients, with 119 patients in both the acyclovir and placebo (control) groups (median [IQR] age, 61 [50-70] years; 76 [32%] women) available for primary outcome measurement. On day 60, the median (IQR) numbers of ventilator-free days were 35 (0-53) for acyclovir recipients and 36 (0-50]) for controls (P = .17 for between-group comparison). Among secondary outcomes, 26 patients (22%) and 39 patients (33%) had died at day 60 (risk difference, 0.11, 95% CI, -0.004 to 0.22, P = .06). The adverse event frequency was similar for both groups (28% in the acyclovir group and 23% in the placebo group, P = .40), particularly acute renal failure post randomization affecting 3 acyclovir recipients (3%) and 2 controls (2%). Four patients (3%) in the acyclovir group vs none in the placebo group stopped the study drug for treatment-related adverse events. CONCLUSIONS AND RELEVANCE In patients receiving mechanical ventilation for 96 hours or more with HSV reactivation in the throat, use of acyclovir, 5 mg/kg, 3 times daily for 14 days, did not increase the number of ventilator-free days at day 60, compared with placebo. These findings do not appear to support routine preemptive use of acyclovir in this setting. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02152358.
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Affiliation(s)
- Charles-Edouard Luyt
- Sorbonne Université, INSERM, Médecine Intensive Réanimation, Institut de Cardiologie, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jean-Marie Forel
- Médecine Intensive Réanimation, Aix-Marseille Université, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - David Hajage
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Département Biostatistique Santé Publique et Information Médicale, Centre de Pharmacoépidémiologie, Paris, France
| | - Samir Jaber
- Réanimation Chirurgicale, Centre Hospitalier Universitaire de Montpellier, Hôpital St-Eloi, Montpellier, France
| | - Sophie Cayot-Constantin
- Département de médecine periopératoire, Centre Hospitalier Universitaire Clermont-Ferrand, Clermont-Ferrand, France
| | - Thomas Rimmelé
- Réanimation Chirurgicale, Hôpital Edouard-Herriot, Hospices Civils de Lyon, Lyon, France
| | - Elisabeth Coupez
- Réanimation Médicale, Centre Hospitalier Universitaire Gabriel-Montpied, Clermont-Ferrand, France
| | - Qin Lu
- Réanimation Chirurgicale Polyvalente, Département d'Anesthésie-Réanimation, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Mamadou Hassimiou Diallo
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpitaux Universitaires Pitié Salpêtrière Charles Foix, Unité de Recherche Clinique, Paris, France
| | - Christine Penot-Ragon
- Pharmacie, Hôpitaux Sud, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Marc Clavel
- Réanimation Polyvalente, Centre Hospitalier Universitaire Dupuytren, Limoges, France
| | - Carole Schwebel
- Médecine Intensive Réanimation, Centre Hospitalier Universitaire Grenoble Alpes, La Tronche, France
| | - Jean-François Timsit
- Médecine Intensive Réanimation, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - Caroline Hauw-Berlemont
- Médecine Intensive Réanimation, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jérémy Bourenne
- Réanimation des Urgences et Médicale, Aix-Marseille Université, Hôpital Timone, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Julien Mayaux
- Pneumologie, Médecine Intensive Réanimation, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jean-Yves Lefrant
- Réanimation Chirurgicale, Centre Hospitalier Universitaire Nîmes, Nîmes, France
| | - Jean-Paul Mira
- Médecine Intensive Réanimation, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Alain Combes
- Sorbonne Université, INSERM, Médecine Intensive Réanimation, Institut de Cardiologie, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Michel Wolff
- Réanimation Neurochirurgicale, Hôpital Sainte-Anne, Paris, France
| | - Jean Chastre
- Sorbonne Université, INSERM, Médecine Intensive Réanimation, Institut de Cardiologie, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Laurent Papazian
- Médecine Intensive Réanimation, Aix-Marseille Université, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Marseille, France
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Schuierer L, Gebhard M, Ruf HG, Jaschinski U, Berghaus TM, Wittmann M, Braun G, Busch DH, Hoffmann R. Impact of acyclovir use on survival of patients with ventilator-associated pneumonia and high load herpes simplex virus replication. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2020; 24:12. [PMID: 31924246 PMCID: PMC6954562 DOI: 10.1186/s13054-019-2701-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 12/11/2019] [Indexed: 01/31/2023]
Abstract
Background Herpes simplex virus (HSV) replication can be detected in the respiratory secretions of a high proportion of ventilated intensive care unit (ICU) patients. However, the clinical significance remains poorly defined. We investigated whether patients with ventilator-associated pneumonia not responding to antibiotics and in whom high levels of HSV could be detected in respiratory secretions benefit from acyclovir treatment. Methods Respiratory secretions (bronchoalveolar lavage fluid or tracheal aspirates) were tested for HSV replication by quantitative real-time PCR. ICU survival times, clinical parameters, and radiographic findings were retrospectively compared between untreated and acyclovir treated patients with high (> 105 HSV copies/mL) and low (103–105 HSV copies/mL) viral load. Results Fifty-seven low and 69 high viral load patients were identified. Fewer patients with high viral load responded to antibiotic treatment (12% compared to 40% of low load patients, p = 0.001). Acyclovir improved median ICU survival (8 vs 22 days, p = 0.014) and was associated with a significantly reduced hazard ratio for ICU death (HR = 0.31, 95% CI 0.11–0.92, p = 0.035) in high load patients only. Moreover, circulatory and pulmonary oxygenation function of high load patients improved significantly over the course of acyclovir treatment: mean norepinephrine doses decreased from 0.05 to 0.02 μg/kg body weight/min between days 0 and 6 of treatment (p = 0.049), and median PaO2/FiO2 ratio increased from 187 to 241 between day 3 and day 7 of treatment (p = 0.02). Chest radiographic findings also improved significantly (p < 0.001). Conclusions In patients with ventilator-associated pneumonia, antibiotic treatment failure, and high levels of HSV replication, acyclovir treatment was associated with a significantly longer time to death in the ICU and improved circulatory and pulmonary function. This suggests a causative role for HSV in this highly selected group of patients.
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Affiliation(s)
- Lukas Schuierer
- TUM Graduate School, Technical University of Munich (TUM), Munich, Germany.,Institute for Laboratory Medicine and Microbiology, University Hospital Augsburg, Stenglinstr.2, 86156, Augsburg, Germany.,Faculty of Medicine, Augsburg University, Augsburg, Germany
| | - Michael Gebhard
- Department of Radiology, University Hospital Augsburg, Augsburg, Germany
| | - Hans-Georg Ruf
- Institute for Laboratory Medicine and Microbiology, University Hospital Augsburg, Stenglinstr.2, 86156, Augsburg, Germany
| | - Ulrich Jaschinski
- Department of Anesthesiology and Surgical Intensive Care Medicine, University Hospital Augsburg, Augsburg, Germany
| | - Thomas M Berghaus
- Department of Internal Medicine I, University Hospital Augsburg, Augsburg, Germany
| | - Michael Wittmann
- Department of Internal Medicine II, University Hospital Augsburg, Augsburg, Germany
| | - Georg Braun
- Department of Internal Medicine III, University Hospital Augsburg, Augsburg, Germany
| | - Dirk H Busch
- Institute for Medical Microbiology, Immunology and Hygiene, Technical University of Munich, Munich, Germany
| | - Reinhard Hoffmann
- Institute for Laboratory Medicine and Microbiology, University Hospital Augsburg, Stenglinstr.2, 86156, Augsburg, Germany. .,Faculty of Medicine, Augsburg University, Augsburg, Germany.
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45
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Hraiech S, Bonnardel E, Guervilly C, Fabre C, Loundou A, Forel JM, Adda M, Parzy G, Cavaille G, Coiffard B, Roch A, Papazian L. Herpes simplex virus and Cytomegalovirus reactivation among severe ARDS patients under veno-venous ECMO. Ann Intensive Care 2019; 9:142. [PMID: 31872319 PMCID: PMC6928167 DOI: 10.1186/s13613-019-0616-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 12/09/2019] [Indexed: 12/12/2022] Open
Abstract
Background Herpesviridae reactivation among non-immunocompromised critically ill patients is associated with impaired prognosis, especially during acute respiratory distress syndrome (ARDS). However, little is known about herpes simplex virus (HSV) and Cytomegalovirus (CMV) reactivation occurring in patients with severe ARDS under veno-venous extracorporeal membrane oxygenation (ECMO). We tried to determine the frequency of Herpesviridae reactivation and its impact on patients’ prognosis during ECMO for severe ARDS. Results During a 5-year period, 123 non-immunocompromised patients with a severe ARDS requiring a veno-venous ECMO were included. Sixty-seven patients (54%) experienced HSV and/or CMV reactivation during ECMO course (20 viral co-infection, 40 HSV alone, and 7 CMV alone). HSV reactivation occurred earlier than CMV after the beginning of MV [(6–15) vs. 19 (13–29) days; p < 0.01] and after ECMO implementation [(2–8) vs. 14 (10–20) days; p < 0.01]. In univariate analysis, HSV/CMV reactivation was associated with a longer duration of mechanical ventilation [(22–52.5) vs. 17.5 (9–28) days; p < 0.01], a longer duration of ECMO [15 (10–22.5) vs. 9 (5–14) days; p < 0.01], and a prolonged ICU [29 (19.5–47.5) vs. 16 (9–30) days; p < 0.01] and hospital stay [44 (29–63.5) vs. 24 (11–43) days; p < 0.01] as compared to non-reactivated patients. However, in multivariate analysis, viral reactivation remained associated with prolonged MV only. When considered separately, both HSV and CMV reactivation were associated with a longer duration of MV as compared to non-reactivation patients [29 (19.5–41) and 28 (20.5–37), respectively, vs. 17.5 (9–28) days; p < 0.05]. Co-reactivation patients had a longer duration of MV [58.5 (38–72.3); p < 0.05] and ICU stay [51.5 (32.5–69) vs. 27.5 (17.75–35.5) and 29 (20–30.5), respectively] as compared to patients with HSV or CMV reactivation alone. In multivariate analysis, HSV reactivation remained independently associated with a longer duration of MV and hospital length of stay. Conclusions Herpesviridae reactivation is frequent among patients with severe ARDS under veno-venous ECMO and is associated with a longer duration of mechanical ventilation. The direct causative link between HSV and CMV reactivation and respiratory function worsening under ECMO remains to be confirmed.
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Affiliation(s)
- Sami Hraiech
- Service de Médecine Intensive - Réanimation, APHM, Hôpital Nord, Marseille, France. .,CEReSS-Center for Studies and Research on Health Services and Quality of Life EA3279, Aix-Marseille University, Marseille, France.
| | - Eline Bonnardel
- Magellan Medico-Surgical Center, South Department of Anaesthesia and Critical Care, CHU Bordeaux, 33000, Bordeaux, France
| | - Christophe Guervilly
- Service de Médecine Intensive - Réanimation, APHM, Hôpital Nord, Marseille, France.,CEReSS-Center for Studies and Research on Health Services and Quality of Life EA3279, Aix-Marseille University, Marseille, France
| | - Cyprien Fabre
- CEReSS-Center for Studies and Research on Health Services and Quality of Life EA3279, Aix-Marseille University, Marseille, France
| | - Anderson Loundou
- CEReSS-Center for Studies and Research on Health Services and Quality of Life EA3279, Aix-Marseille University, Marseille, France
| | - Jean-Marie Forel
- Service de Médecine Intensive - Réanimation, APHM, Hôpital Nord, Marseille, France.,CEReSS-Center for Studies and Research on Health Services and Quality of Life EA3279, Aix-Marseille University, Marseille, France
| | - Mélanie Adda
- Service de Médecine Intensive - Réanimation, APHM, Hôpital Nord, Marseille, France.,CEReSS-Center for Studies and Research on Health Services and Quality of Life EA3279, Aix-Marseille University, Marseille, France
| | - Gabriel Parzy
- Service de Médecine Intensive - Réanimation, APHM, Hôpital Nord, Marseille, France.,CEReSS-Center for Studies and Research on Health Services and Quality of Life EA3279, Aix-Marseille University, Marseille, France
| | - Guilhem Cavaille
- Service de Médecine Intensive - Réanimation, APHM, Hôpital Nord, Marseille, France.,CEReSS-Center for Studies and Research on Health Services and Quality of Life EA3279, Aix-Marseille University, Marseille, France
| | - Benjamin Coiffard
- Service de Médecine Intensive - Réanimation, APHM, Hôpital Nord, Marseille, France.,CEReSS-Center for Studies and Research on Health Services and Quality of Life EA3279, Aix-Marseille University, Marseille, France
| | - Antoine Roch
- Service de Médecine Intensive - Réanimation, APHM, Hôpital Nord, Marseille, France.,CEReSS-Center for Studies and Research on Health Services and Quality of Life EA3279, Aix-Marseille University, Marseille, France
| | - Laurent Papazian
- Service de Médecine Intensive - Réanimation, APHM, Hôpital Nord, Marseille, France.,CEReSS-Center for Studies and Research on Health Services and Quality of Life EA3279, Aix-Marseille University, Marseille, France
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46
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Cantan B, Luyt CE, Martin-Loeches I. Influenza Infections and Emergent Viral Infections in Intensive Care Unit. Semin Respir Crit Care Med 2019; 40:488-497. [PMID: 31585475 PMCID: PMC7117087 DOI: 10.1055/s-0039-1693497] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Critically ill patients are admitted to an intensive care unit (ICU) for multiple reasons. In this study, we aim to analyze the current evidence and findings associated with influenza and other emergent viral infections, namely, herpes simplex virus type 1 (HSV-1), Epstein-Barr virus (EBV), and cytomegalovirus (CMV). Among medical conditions, community-acquired respiratory infections are the most frequent reason for ventilatory support in ICUs. Community-acquired pneumonia in a severe form including the need of invasive mechanical ventilation and/or vasopressors is associated with high mortality rates. However, after the pandemic that occurred in 2009 by H1N1 influenza, the number of cases being admitted to ICUs with viral infections is on the rise. Patients in whom an etiology would not have been identified in the past are currently being tested with more sensitive viral molecular diagnostic tools, and patients being admitted to ICUs have more preexisting medical conditions that can predispose to viral infections. Viral infections can trigger the dysregulation of the immune system by inducing a massive cytokine response. This cytokine storm can cause endothelial damage and dysfunction, deregulation of coagulation, and, consequently, alteration of microvascular permeability, tissue edema, and shock. In severe influenza, this vascular hyperpermeability can lead to acute lung injury, multiorgan failure, and encephalopathy. In immunocompetent patients, the most common viral infections are respiratory, and influenza should be considered in patients with severe respiratory failure being admitted to ICU. Seasonality and coinfection are two important features when considering influenza as a pathogen in critically ill patients. Herpesviridae (HSV, CMV, and EBV) may reactivate in ICU patients, and their reactivation is associated with morbidity/mortality. However, whether a specific treatment may impact on outcome remains to be determined.
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Affiliation(s)
- Ben Cantan
- Multidisciplinary Intensive Care Research Organization, St James's Hospital, Dublin, Ireland
| | - Charles-Edouard Luyt
- Médecine Intensive Réanimation, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne University (Paris 6), Paris, France.,INSERM, UMRS 1166-iCAN, Institute of Cardiometabolism and Nutrition, Paris, France
| | - Ignacio Martin-Loeches
- Multidisciplinary Intensive Care Research Organization, St James's Hospital, Dublin, Ireland.,Department of Pulmonology, Hospital Clínic de Barcelona, Universitat de Barcelona and IDIBAPS, Barcelona, Spain.,Centro de Investigación Biomédica en Red (CIBER), University of Barcelona, Barcelona, Spain
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47
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Luyt CE, Hékimian G, Bréchot N. Réactivations à herpès virus (HSV, CMV) en réanimation : qui et quand traiter ? MEDECINE INTENSIVE REANIMATION 2019. [DOI: 10.3166/rea-2019-0110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Les réactivations à herpès simplex virus (HSV) et à cytomégalovirus (CMV) sont fréquentes chez le patient non immunodéprimé de réanimation. La réactivation HSV est localisée aux voies aériennes ; elle débute au niveau oropharyngé, progresse de façon descendante avec la contamination des voies aériennes distales et peut aboutir, chez certains malades, à une véritable bronchopneumonie herpétique. Elle est en outre associée à un pronostic défavorable. Le traitement prophylactique et préemptif des réactivations HSV ne peut pas être préconisé à l’heure actuelle. Le traitement curatif repose sur un avis d’experts, chez des malades présentant soit une charge virale élevée dans les voies aériennes distales, soit des signes cytologiques d’atteinte parenchymateuse pulmonaire sur les cellules recueillies lors du lavage bronchoalvéolaire. La réactivation CMV sanguine est fréquente et peut être isolée ou associée à une réactivation/atteinte pulmonaire et est aussi associée à un pronostic défavorable. Le traitement prophylactique de la réactivation CMV ne peut pas être préconisé, et le traitement préemptif est en cours d’évaluation. À l’heure actuelle, le traitement curatif des maladies pulmonaires à CMV repose soit sur des signes histologiques d’atteinte pulmonaire, soit sur un faisceau d’arguments clinicobiologiques évoquant une possible maladie à CMV.
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48
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Marandu T, Dombek M, Cook CH. Impact of cytomegalovirus load on host response to sepsis. Med Microbiol Immunol 2019; 208:295-303. [DOI: 10.1007/s00430-019-00603-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 03/22/2019] [Indexed: 12/24/2022]
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49
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Ong DSY, Bonten MJM, Spitoni C, Verduyn Lunel FM, Frencken JF, Horn J, Schultz MJ, van der Poll T, Klein Klouwenberg PMC, Cremer OL. Epidemiology of Multiple Herpes Viremia in Previously Immunocompetent Patients With Septic Shock. Clin Infect Dis 2018; 64:1204-1210. [PMID: 28158551 DOI: 10.1093/cid/cix120] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Accepted: 02/01/2017] [Indexed: 01/12/2023] Open
Abstract
Background Systemic reactivations of herpesviruses may occur in intensive care unit (ICU) patients, even in those without prior immune deficiency. However, the clinical relevance of these events is uncertain. Methods In this study we selected patients admitted with septic shock and treated for more than 4 days from a prospectively enrolled cohort of consecutive adults in the mixed ICUs of 2 tertiary care hospitals in the Netherlands. We excluded patients who had received antiviral treatment in the week before ICU admission and those with known immunodeficiency. We studied viremia episodes with cytomegalovirus (CMV), Epstein-Barr virus (EBV), human herpesvirus 6 (HHV-6), herpes simplex virus types 1 (HSV-1) and 2 (HSV-2), and varicella zoster virus (VZV) by weekly polymerase chain reaction in plasma. Results Among 329 patients, we observed 399 viremia episodes in 223 (68%) patients. Viremia with CMV, EBV, HHV-6, HSV-1, HSV-2, and VZV was detected in 60 (18%), 157 (48%), 80 (24%), 87 (26%), 13 (4%), and 2 (0.6%) patients, respectively; 112 (34%) patients had multiple concurrent viremia events. Crude mortality in the ICU was 36% in this latter group compared to 19% in remaining patients (P < .01). After adjustment for potential confounders, time-dependent bias, and competing risks, only concurrent CMV and EBV reactivations remained independently associated with increased mortality (adjusted subdistribution hazard ratio, 3.17; 95% confidence interval, 1.41-7.13). Conclusions Herpesvirus reactivations were documented in 68% of septic shock patients without prior immunodeficiency and frequently occurred simultaneously. Concurrent reactivations could be independently associated with mortality. Clinical Trials Registration NCT01905033.
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Affiliation(s)
- David S Y Ong
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marc J M Bonten
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Cristian Spitoni
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Mathematics, Utrecht University, The Netherlands
| | - Frans M Verduyn Lunel
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jos F Frencken
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Janneke Horn
- Department of Intensive Care, Academic Medical Center, Amsterdam, The Netherlands
| | - Marcus J Schultz
- Department of Intensive Care, Academic Medical Center, Amsterdam, The Netherlands
| | - Tom van der Poll
- Division of Infectious Diseases & Center of Experimental and Molecular Medicine Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Center for Infection and Immunity Amsterdam, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Peter M C Klein Klouwenberg
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Olaf L Cremer
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
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50
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Alyazidi R, Murthy S, Slyker JA, Gantt S. The Potential Harm of Cytomegalovirus Infection in Immunocompetent Critically Ill Children. Front Pediatr 2018; 6:96. [PMID: 29692984 PMCID: PMC5902572 DOI: 10.3389/fped.2018.00096] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 03/26/2018] [Indexed: 12/17/2022] Open
Abstract
Cytomegalovirus (CMV) is a ubiquitous infection that causes disease in congenitally infected children and immunocompromised patients. Although nearly all CMV infections remain latent and asymptomatic in immunologically normal individuals, numerous studies have found that systemic viral reactivation is common in immunocompetent critically ill adults, as measured by detection of CMV in the blood (viremia). Furthermore, CMV viremia is strongly correlated with adverse outcomes in the adult intensive care unit (ICU), including prolonged stay, duration of mechanical ventilation, and death. Increasing evidence, including from a randomized clinical trial of antiviral treatment, suggests that these effects of CMV may be causal. Therefore, interventions targeting CMV might improve outcomes in adult ICU patients. CMV may have an even greater impact on critically ill children, particularly in low and middle income countries (LMIC), where CMV is regularly acquired in early childhood, and where inpatient morbidity and mortality are inordinately high. However, to date, there are few data regarding the clinical relevance of CMV infection or viremia in immunocompetent critically ill children. We propose that CMV infection should be studied as a potential modifiable cause of disease in critically ill children, and that these studies be conducted in LMIC. Below, we briefly review the role of CMV in immunologically normal critically ill adults and children, outline age-dependent differences in CMV infection that may influence ICU outcomes, and describe an agenda for future research.
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Affiliation(s)
- Raidan Alyazidi
- University of British Columbia and BC Children's Hospital, Vancouver, BC, Canada.,Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Srinivas Murthy
- University of British Columbia and BC Children's Hospital, Vancouver, BC, Canada
| | | | - Soren Gantt
- University of British Columbia and BC Children's Hospital, Vancouver, BC, Canada
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