Herpesviridae lung reactivation and infection in patients with severe COVID-19 or influenza virus pneumonia: a comparative study,Annals of Intensive Care

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Herpesviridae lung reactivation and infection in patients with severe COVID-19 or influenza virus pneumonia: a comparative study
Annals of Intensive Care ( IF 5.7 ) Pub Date : 2022-09-24 , DOI: 10.1186/s13613-022-01062-0
Charles-Edouard Luyt _{1,

2} , Sonia Burrel _{3,

4} , David Mokrani ₁ , Marc Pineton de Chambrun ₁ , Domitille Luyt ₁ , Juliette Chommeloux ₁ , Vincent Guiraud _{3,

4} , Nicolas Bréchot _{1,

2} , Matthieu Schmidt _{1,

2} , Guillaume Hekimian ₁ , Alain Combes _{1,

2} , David Boutolleau _{3,

4}

Affiliation

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.

中文翻译：

严重 COVID-19 或流感病毒肺炎患者的疱疹病毒肺再激活和感染：一项比较研究

背景

在 COVID-19 患者中报告了疱疹病毒科、单纯疱疹病毒 (HSV) 和巨细胞病毒 (CMV)的肺再激活。这些病毒再激活是否比其他患者更频繁尚不清楚。

方法

对 145 名需要有创机械通气的重症 COVID-19 肺炎患者进行回顾性单中心队列研究，这些患者在纤维支气管镜检查怀疑呼吸机相关性肺炎期间进行了支气管肺泡灌洗液中的 HSV 和 CMV 检测。评估了 HSV 和 CMV 肺再激活率以及 HSV 支气管肺炎的发生率，并与 89 名需要有创机械通气的严重流感肺炎患者的历史队列进行了比较。

结果

在包括的 145 名 COVID-19 患者中，分别有 50% 和 42% 有 HSV 和 CMV 肺再激活，而在 89 名流感患者中，分别有 63% 和 28% 有 HSV 和 CMV 肺再激活。流感患者 HSV 肺再激活（将拔管和死亡作为竞争事件）的累积发生率高于 COVID-19 患者（p = 0.03），而两组 HSV 支气管肺炎的发生率相似（31% 和 25% ，分别）。在 COVID-19 和流感患者中，CMV 肺再激活的累积发生率（考虑到拔管和死亡作为竞争事件）相似（p = 0.07)。HSV 或 CMV 肺再激活患者的结果与没有患者的结果相似，无论潜在情况如何，即 COVID-19 患者、流感患者或所有患者分组时。