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

He, Hangyong; Wang, Yajing; Wu, Meng Huan; Sun, Bing

doi:10.1111/crj.12433

Cited by 17 publications

(24 citation statements)

References 9 publications

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“…EBV has been identified in lung biopsy specimens of subjects with idiopathic pulmonary fibrosis [142]. EBV can frequently be detected in the lower respiratory tract specimens of patients admitted to the intensive care unit with hypoxic respiratory failure [143]. Lower respiratory tract detection of EBV does not appear to be associated with unfavourable clinical outcomes; however, positive EBV serology in this patient group was associated with a significant increase in mortality [143].…”

Section: Epstein-barr Virus In Copdmentioning

confidence: 99%

Respiratory viral infection: a potential “missing link” in the pathogenesis of COPD

et al. 2019

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Chronic obstructive pulmonary disease (COPD) is currently the third most common cause of global mortality. Acute exacerbations of COPD frequently necessitate hospital admission to enable more intensive therapy, incurring significant healthcare costs. COPD exacerbations are also associated with accelerated lung function decline and increased risk of mortality. Until recently, bacterial pathogens were believed to be responsible for the majority of disease exacerbations. However, with the advent of cultureindependent molecular diagnostic techniques it is now estimated that viruses are detected during half of all COPD exacerbations and are associated with poorer clinical outcomes. Human rhinovirus, respiratory syncytial virus and influenza are the most commonly detected viruses during exacerbation. The role of persistent viral infection (adenovirus) has also been postulated as a potential pathogenic mechanism in COPD. Viral pathogens may play an important role in driving COPD progression by acting as triggers for exacerbation and subsequent lung function decline whilst the role of chronic viral infection remains a plausible hypothesis that requires further evaluation. There are currently no effective antiviral strategies for patients with COPD. Herein, we focus on the current understanding of the cellular and molecular mechanisms of respiratory viral infection in COPD.

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Section: Epstein-barr Virus In Copdmentioning

confidence: 99%

Respiratory viral infection: a potential “missing link” in the pathogenesis of COPD

et al. 2019

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“…These results could not support that reactivation leads a poor outcome by infection. On the other hand, in our previous report [3], the seropositivity for EBV associated with mortality maybe correlated with a low CD3+ CD8+ T cell count. Thus, the Open Access biomarkers of an ARDS or sepsis-induced immunoparalysis should be explored as a possible mechanism of reactivation and poor outcome [5].…”

Section: Dear Editormentioning

confidence: 53%

mentioning

confidence: 53%

“…Furthermore, Hraiech and colleagues [1] found that HSV reactivation occurred earlier than CMV reactivation. In our study, airway sample may show an earlier and higher positivity than serum samples for EBV [3]. Therefore, the time of reactivation for HSV and CMV should be compared for samples from serum and airway, respectively.Finally, why Herpesviridae reactivation caused a poor outcome in ARDS patients with ECMO support is still unclear.…”

mentioning

confidence: 83%

“…However, whether a positive PCR from the airway sample should be treated as a reactivation or as an evidence of infection is still debatable [2]. Previous study [3,4] found that seropositivity for Epstein-Barr virus (EBV), one of Herpesviridae, was associated with mortality of ICU patients with respiratory failure. Thus, when looking for the association of reactivation and the outcome, we suggested that only patients with a seropositivity for Herpesviridae should be included.…”

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confidence: 99%

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Herpesviridae reactivation for poor outcome in ARDS patients with ECMO: criminal or witness?

Huang

2020

Ann. Intensive Care

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We read with interest of the report by Hraiech and colleagues [1] about the Herpesviridae reactivation among non-immunocompromised critically ill patients with acute respiratory distress syndrome (ARDS) supported with extracorporeal membrane oxygenation (ECMO). They found that Herpesviridae reactivation is frequent among patients with severe ARDS under ECMO and is associated with a longer duration of mechanical ventilation. From our point of view, a few other concerns related to who, how and why for the Herpesviridae reactivation affects outcome in ARDS could be raised.First, who has a Herpesviridae reactivation should be focused? In Hraiech's study [1], they determined the frequency of Herpesviridae reactivation and its impact on prognosis only in patients during ECMO for severe ARDS. However, Herpesviridae reactivation occurring in all ARDS patients should be investigated. Within all ARDS patients, by comparing the reactivation related to ARDS with no-ECMO support, and the reactivation after ECMO insertion, whether a Herpesviridae reactivation was worsening under ECMO could be confirmed.The second question is how a Herpesviridae reactivation or active infection should be defined in ARDS patients? In Hraiech's report [1], Herpes Simplex Virus (HSV) reactivation was diagnosed mainly by throat or BAL samples, and only 3 patients (5%) exhibited a positive HSV viremia, and cytomegalovirus (CMV) reactivation was diagnosed mainly from blood PCR. However, whether a positive PCR from the airway sample should be treated as a reactivation or as an evidence of infection is still debatable [2]. Previous study [3,4] found that seropositivity for Epstein-Barr virus (EBV), one of Herpesviridae, was associated with mortality of ICU patients with respiratory failure. Thus, when looking for the association of reactivation and the outcome, we suggested that only patients with a seropositivity for Herpesviridae should be included. Furthermore, Hraiech and colleagues [1] found that HSV reactivation occurred earlier than CMV reactivation. In our study, airway sample may show an earlier and higher positivity than serum samples for EBV [3]. Therefore, the time of reactivation for HSV and CMV should be compared for samples from serum and airway, respectively.Finally, why Herpesviridae reactivation caused a poor outcome in ARDS patients with ECMO support is still unclear. On the one hand, Herpesviridae reactivation may indicate an active infection and related damage to the organ function, which lead to a poor prognosis. However, in Hraiech's study [1], the definition of reactivation by a positive airway sample could not interpreted as true infection. And they reported that alveolar procollagen III level, an indicator of pulmonary fibrosis, was not different between both groups. These results could not support that reactivation leads a poor outcome by infection. On the other hand, in our previous report [3], the seropositivity for EBV associated with mortality maybe correlated with a low CD3+ CD8+ T cell count. Thus, the

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Epstein-Barr Virus–Positive Plasma Cell Neoplasm of Nasal Cavity in an Immunocompetent Adult

Ryan

Chen

2022

JAMA Otolaryngol Head Neck Surg

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

Abstract: This study showed that EBV DNA is detected in LRT and serum samples of a significant number of ICU patients with respiratory failure, and seropositivity for EBV was associated with mortality. This finding maybe correlated with a low CD3+CD8+ T cell count.

Cited by 17 publications

References 9 publications

Respiratory viral infection: a potential “missing link” in the pathogenesis of COPD

Respiratory viral infection: a potential “missing link” in the pathogenesis of COPD

Herpesviridae reactivation for poor outcome in ARDS patients with ECMO: criminal or witness?

Epstein-Barr Virus–Positive Plasma Cell Neoplasm of Nasal Cavity in an Immunocompetent Adult

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