The Impact of Human Herpesviruses in Clinical Practice of Inflammatory Bowel Disease in the Era of COVID-19

Abstract

Human herpesviruses (HHVs): herpes simplex virus (HSV) types 1 (HSV-1) and 2 (HSV-2), varicella-zoster virus (VZV), Epstein-Barr virus (EBV), cytomegalovirus (CMV), HHV-6, HHV-7, and HHV-8, are known to be part of a family of DNA viruses that cause several diseases in humans. In clinical practice of inflammatory bowel disease (IBD), the complication of CMV enterocolitis, which is caused by CMV reactivation under disruption of intestinal barrier function, inflammation, or strong immunosuppressive therapy, is well known to affect the prognosis of disease. However, the relationship between other HHVs and IBD remains unclear. In the transplantation field, reactivation of other viruses, such as HHV-6, could cause colitis under immunosuppressed condition. Recent research revealed that combined infection of some HHVs could be a risk factor for colectomy in patients with ulcerative colitis. This suggests that it would be important to clarify HHV behavior in the treatment for patients with IBD, especially in those under immunosuppressive therapies. Looking at the relationship with recently emerged novel coronaviruses (SARS-CoV-2), there are reports describe that SARS-CoV-2 might induce reactivation of HSV-1, EBV, VZV (herpes zoster), and HHV-6/7. If SARS-CoV-2 infection becomes common, vigilance against HHV reactivation may become more crucial. In this review, we discuss the impact of HHVs in clinical practice of inflammatory bowel diseases, especially during the SARS-CoV-2 pandemic.

Herpesvirus and neurological manifestations in patients with severe coronavirus disease

“…These data indicate that the state of immunosuppression in SARS-CoV-2 infection, characterized by symptoms such as lymphocytopenia, may possibly trigger a cycle of opportunistic virus reactivations, which makes it necessary to monitor the influence of these viruses on the course of COVID-19 [ 10 , 35 ]. These findings reiterate the importance of further studies on family Herpesviridae that investigate their reactivation frequency in the population and interference with other pathogens [ 36 ]. Interestingly, we detected HHV-8 in 17% of patients.…”

Encephalitis in the Course of HHV-7 Infection in an Infant

“…The interference of SARS-CoV-2 in the dysregulation of the immune system may be one of the factors involved in the reactivation of primary latency-capable virus infections [9,10]. Therefore, the immaturity of the immune system related to the patient's age and history of SARS-CoV-2 infection, further affecting CD4/CD8 lymphocyte suppression, may have had a significant impact on the development of neurological complications in the case studied.…”

Herpes simplex virus colitis mimicking acute severe ulcerative colitis: a case report and review of the literature

“…Opportunistic infections are a significant safety concern in patients with IBD. A well-recognized complication is CMV colitis, which is associated with significant morbidity and poor outcome [ 10 ]. However, the role of other herpesviruses in patients with IBD is less clear, and overt HSV colitis is exceedingly rare.…”