Herpes simplex virus and cytomegalovirus reactivations among severe COVID-19 patients
Pierre Le Balc’h, Kieran Pinceaux, Charlotte Pronier, Philippe Séguin, Jean‐Marc Tadié, Florian Reizine
Abstract
We reviewed all virology results for patients admitted to Rennes University Hospital (Rennes, France) for COVID-19 ARDS between March 3, 2020, and April 15, 2020. SARS-CoV-2 infection was confirmed by polymerase chain reaction (PCR) . Patients mechanically ventilated longer than 7 days and who had negative PCR for herpes simplex virus (HSV) and cytomegalovirus (CMV) were included in the analysis. Herpes simplex virus and cytomegalovirus replication were measured by quantitative real-time PCR on tracheal aspirates twice a week for each patient. Herpesviridae reactivation was defined as two consecutive positive HSV or CMV PCR on tracheal aspirates. The Mann-Whitney rank sum test was used to compare non-parametric continuous variables, and qualitative data were compared using Fisher’s exact test. Statistical significance was defined as P < .05. PRISM version 8 (GraphPad Software, San Diego, CA, USA) was used to perform statistical analyses. A total of 38 patients were included. Table 1 shows the demographic, clinical, and biological characteristics of the included patients. The mean age was 59 years (interquartile range (IQR), 54–71), and 27 (71%) were male. Of these 38 patients, 18 (47%) presented at least one viral pulmonary reactivation. Nine patients had HSV reactivation alone, 2 presented CMV reactivation alone, and 7 had co-reactivation. Herpesviridae infection was diagnosed at a median of 9 days (IQR, 5–14). The median number of positive samples was 3 (IQR, 2–5). Patients with Herpesviridae reactivation had significantly longer duration of MV compared with patients without Herpesviridae reactivation. Table 2 shows outcomes of patients according to Herpesviridae reactivation status.