Detection of herpesvirus EBV DNA in the lower respiratory tract of ICU patients: a marker of infection of the lower respiratory tract?

Friedrichs, I.; Bingold, Tobias M.; Keppler, Oliver T.; Pullmann, Barbara; Reinheimer, Claudia; Berger, Annemarie

doi:10.1007/s00430-013-0306-1

Cited by 25 publications

(28 citation statements)

References 24 publications

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“…Similarly, cytomegalovirus (CMV) reactivation can be detected in respiratory secretions of about 16% immunocompetent ICU patients [9]. Much like in HSV, the clinical consequences remain unclear.…”

Section: Introductionmentioning

confidence: 99%

Impact of acyclovir use on survival of patients with ventilator-associated pneumonia and high load herpes simplex virus replication

et al. 2020

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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 (> 10 5 HSV copies/mL) and low (10 3 -10 5 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 PaO 2 /FiO 2 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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Section: Introductionmentioning

confidence: 99%

Impact of acyclovir use on survival of patients with ventilator-associated pneumonia and high load herpes simplex virus replication

et al. 2020

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“…Several works have reported the detection of EBV DNA in the lower respiratory tract or in the blood of intensive care unit (ICU) patients without showing specific pathogenesis except inflammation. [10,11] During reactivation, EBV produces an interleukin-10 (IL-10) homolog, which is able to disturb the immune response, particularly, the activity of natural killer (NK) and CD4+ T cells. [12] EBV also produces proteins that impair the production of cytokines such as interferon, mainly during the lytic phase.…”

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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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“…Most of the time, infection is asymptomatic, and is rarely complicated by organ dysfunction. Several studies have reported detection of EBV DNA in the LRT or blood of ICU patients without showing specific pathogenesis, except inflammation . While some studies have involved EBV positivity in LRT or serum samples in specific populations, the potential pathogenicity is still a matter of debate.…”

Section: Discussionmentioning

confidence: 99%

“…EBV infection may induce immune suppression in several ways, which may influence the proper host response to other pathogens and may lead to a bad outcome for critically ill patients. Detection of EBV in lower respiratory tract (LRT) and serum samples have been reported in the ICU population , but the prognostic value of EBV positivity in these samples from critically ill patients with respiratory failure is unclear .…”

Section: Introductionmentioning

confidence: 99%

Positive Epstein–Barr virus detection and mortality in respiratory failure patients admitted to the intensive care unit

Wang²,

Wu³

et al. 2016

Clinical Respiratory J

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Detection of herpesvirus EBV DNA in the lower respiratory tract of ICU patients: a marker of infection of the lower respiratory tract?

Cited by 25 publications

References 24 publications

Impact of acyclovir use on survival of patients with ventilator-associated pneumonia and high load herpes simplex virus replication

Impact of acyclovir use on survival of patients with ventilator-associated pneumonia and high load herpes simplex virus replication

Epstein-Barr virus reactivation in critically ill immunocompetent patients

Positive Epstein–Barr virus detection and mortality in respiratory failure patients admitted to the intensive care unit

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