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Early herpes and TTV DNAemia in septic shock patients: a pilot study
Intensive Care Medicine Experimental Pub Date : 2019-05-18 , DOI: 10.1186/s40635-019-0256-z
François Mallet 1, 2 , Magali Perret 3 , Trang Tran 3 , Boris Meunier 1, 4 , Audrey Guichard 2 , Olivier Tabone 1 , Marine Mommert 2 , Karen Brengel-Pesce 2 , Fabienne Venet 1, 5 , Alexandre Pachot 1 , Guillaume Monneret 1, 5 , Frederic Reynier 3 , Christophe Védrine 3 , Philippe Leissner 3 , Virginie Moucadel 1 , Alain Lepape 6, 7, 8 , Julien Textoris 1, 9 , ,
Affiliation  

BackgroundSeptic shock patients exhibit an increased incidence of viral reactivation. Precise timing of such reactivation—as an early marker of immune suppression, or as a consequence of the later—is not known precisely. Here, using a fully designed nucleic acid extraction automated procedure together with tailored commercial PCR kits, we focused on the description of early reactivation within the first week of ICU admission of several herpes viruses and Torque Teno virus (TTV) in 98 septic shock patients.ResultsMost of septic shock patients had at least one viremia event during the first week (88%). TTV and herpesviruses were detected in 56% and 53% of septic shock patient, respectively. The two most frequent herpesviruses detected within the first week were EBV (35%) and HSV1 (26%). Different kinetic were observed among herpesviruses, faster for EBV and HSV1 than for CMV and HHV6. Although no association was found between herpes viremia and secondary infections, patients with herpesviridae-related viremia were more severe, e.g., higher SOFA scores and plasma lactate levels. While reactivating only 1 virus was not associated with mortality, patients with multiple viremia events had higher ICU mortality. Surprisingly, EBV + TTV early reactivation seemed associated with a lower D28 mortality. No clear association was observed between viremia and immune biomarkers.ConclusionApplying a semi-automated process of viral DNAemia determination to this cohort of 98 patients with septic shock, we observed that the number of patients with positive viremia increased during the first week in the ICU. Of note, there was no improvement in predicting the outcome when using viremia status. Nevertheless, this pilot study, introducing standardized procedures from extraction to detection, provides the basis for future standardized diagnostic criteria. A prospective longitudinal clinical study using these procedures will enable determination of whether such viremia is due to a lack of a latent virus control by the immune system or a true clinical viral infection.

中文翻译:

感染性休克患者的早期疱疹和 TTV DNA 血症:一项初步研究

背景感染性休克患者的病毒再激活发生率增加。这种重新激活的准确时间——作为免疫抑制的早期标志,或作为免疫抑制的结果——尚不清楚。在这里,我们使用完全设计的核酸提取自动化程序以及定制的商业 PCR 试剂盒,重点描述了 98 名感染性休克患者在入住 ICU 的第一周内几种疱疹病毒和 Torque Teno 病毒 (TTV) 的早期再激活。结果大多数感染性休克患者在第一周内至少发生过一次病毒血症事件 (88%)。TTV 和疱疹病毒分别在 56% 和 53% 的感染性休克患者中检测到。在第一周内检测到的两种最常见的疱疹病毒是 EBV (35%) 和 HSV1 (26%)。在疱疹病毒中观察到不同的动力学,EBV 和 HSV1 比 CMV 和 HHV6 更快。虽然没有发现疱疹病毒血症与继发感染之间存在关联,但疱疹病毒科相关病毒血症患者更严重,例如 SOFA 评分和血浆乳酸水平更高。虽然仅重新激活 1 种病毒与死亡率无关,但发生多次病毒血症事件的患者 ICU 死亡率更高。令人惊讶的是,EBV + TTV 早期再激活似乎与较低的 D28 死亡率相关。在病毒血症和免疫生物标志物之间没有观察到明确的关联。结论 对 98 名感染性休克患者应用病毒 DNA 血症测定的半自动过程,我们观察到在 ICU 的第一周内病毒血症阳性患者的数量增加。值得注意的是,在使用病毒血症状态预测结果方面没有改善。然而,这项试点研究引入了从提取到检测的标准化程序,为未来的标准化诊断标准提供了基础。使用这些程序的前瞻性纵向临床研究将能够确定这种病毒血症是由于免疫系统缺乏潜伏病毒控制还是真正的临床病毒感染。
更新日期:2019-05-18
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