Herpes simplex virus load in bronchoalveolar lavage fluid is related to poor outcome in critically ill patients

Linssen, Catharina F. M.; Jacobs, Jan; Stelma, F.F.; Mook, Walther N. K. A. van; Terporten, Peter; Vink, Cornelis; Drent, Marjolein; Bruggeman, Cathrien A.; Smismans, Annick

doi:10.1007/s00134-008-1231-4

Cited by 113 publications

(98 citation statements)

References 27 publications

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“…Moreover, we have included a significant number of elderly patients and cancer patients (with past history of cytotoxic therapies such as chemo or radiotherapy), and thus, the results obtained may not reflect a more diverse and younger population. [35][36][37] Another point is that we do not know if some patients had circulating DNA at admission. This could be important as it has been shown that healthy people without any disease could have circulating EBV with differences depending on gender or age.…”

Section: Discussionmentioning

confidence: 99%

Epstein-Barr virus reactivation in critically ill immunocompetent patients

et al. 2015

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O ver the past years, particular attention has been given to herpes virus reactivations among immunocompetent critically ill patients. Although the true pathogenicity of these reactivations is still debated, some authors have hypothesized that it could be related to specific immune failure caused by sepsis or multi-organ failure. Others have argued that it is only a marker of severity. There is increasing evidence that reactivation of cytomegalovirus (CMV) and herpes simplex virus (HSV) is associated with mortality or morbidity, mainly for ventilator-acquired pneumonia. [1,2] CMV seroprevalence ranges from 40% to 95% depending on several factors, including age and geographic area. HSV1 seroprevalence is around 65% among the French population. Epstein-Barr virus (EBV) reactivation has been well docu- Original Article Epstein-Barr Virus Reactivation in Critically IllImmunocompetent Patients Background: Herpes viruses can be reactivated among immunocompetent patients in intensive care unit (ICU). Cytomegalovirus (CMV) and herpes simplex virus (HSV) have been the most studied. We hypothesized that Epstein-Barr virus (EBV) could also be reactivated in immunocompetent patients during their stay in ICU and that this would be associated with morbidity and mortality. Methods:This prospective observational study included 90 patients with an ICU stay of ≥ 5 days. CMV and HSV were considered when clinically suspected and DNA was researched in blood or bronchoalveolar lavage (BAL). EBV DNA viral quantification was performed in the blood samples. Results:EBV DNA was detected in blood of 61 patients (median length for positivity of 7.5 days). CMV DNA was detected in blood of 16 patients (median length for positivity of 13.5 days) and BAL of 6 patients. HSV1 DNA was detected in the BAL of 28 patients (median length for positivity of 7.5 days). Nineteen patients had no viral reactivation, 1 experienced only CMV, 32 had only EBV, 5 had only HSV, 6 had EBV and CMV, 14 had EBV and HSV, and 9 patients reactivated three viruses. Mortality was higher among patients with EBV reactivation (33/61 vs. 7/25, p = 0.02). Length of stay (21 vs. 10 days, p < 0.001) and length of mechanical ventilation (15 vs. 7 days, p < 0.001) were higher among patients with EBV reactivation. Conclusions: This study shows that EBV DNA is detected in blood of diverse ICU patients with ≥ ≥ 5 days of stay and that it is associated with morbidity and mortality. Larger dynamic prospective studies are needed to correlate viral reactivation with immune system evolution during ICU stay and to determine the role of polyviral reactivations. (Biomed J 2015;38:70-76)

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Section: Discussionmentioning

confidence: 99%

Epstein-Barr virus reactivation in critically ill immunocompetent patients

et al. 2015

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“…No es claro si el aislamiento en el tracto respiratorio inferior de estos pacientes corresponde a una contaminación, una reactivación por su estado crítico o porque realmente corresponde a la etiología del cuadro clíni-co 6,7 . No obstante, sí se ha encontrado que su presencia se asocia con un peor pronóstico 4,[6][7][8] . Algunos de los factores de riesgo encontrados para neumonía por VHS-1 en los pacientes con ventilación mecánica por más de 5 días, fueron la presencia de lesiones oro-labiales, el hallazgo de el virus en la garganta y las lesiones vistas durante la broncoscopía 1 .…”

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Neumonía fatal en una niña inmunocompetente, asociada a herpes simple tipo 1

et al. 2011

Rev. chil. pediatr.

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“…In some patients, a true HSV bronchopneumonitis (defined as clinical signs of pneumonia, viral detection in the distal airways and cytological/histological confirmation of lung involvement) can develop: in an observational study performed in patients ventilated C5 days, Luyt et al [12] found that 24 % of them developed HSV bronchopneumonitis. Oropharyngeal HSV-1 reactivation, HSV-1 lung carriage and HSV bronchopneumonitis are associated with poor outcome (longer duration of MV, higher rate of bacterial ventilator-associated pneumonia and/or higher mortality rate) in observational studies [10,12,13]. Unfortunately, no strong data exist on the efficacy of a specific antiviral treatment (Table 1): most observational studies found no positive effect of aciclovir on outcome [12,14], and the only randomized controlled trial investigating the efficacy of aciclovir as a prophylactic treatment was underpowered to detect a beneficial effect [15].…”

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confidence: 99%

“…These lesions alter the epithelial barrier and may pave the way for bacterial infection. Secondly, the higher the viral load in the distal airways, the poorer the outcome [12,13], which is in favour of virus pathogenicity [20]. Thirdly, some specific mechanisms of adaptative immunity (overexpression of Herpes Virus Entry Mediator) in ICU septic patients favour the entry of HSV in lung cells [2].…”

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confidence: 99%