Reactivation of Herpes Simplex Virus Type 1 (HSV-1) Detected on Bronchoalveolar Lavage Fluid (BALF) Samples in Critically Ill COVID-19 Patients Undergoing Invasive Mechanical Ventilation: Preliminary Results from Two Italian Centers.

Daniele Roberto Giacobbe,Riccardo Pol,Federica Friso,Chiara Robba,Chiara Dentone,Erik Roman-Pognuz,Bianca Bruzzone,Matteo Bassetti,Verena Zerbato,Stefano Di Bella,Andrea De Maria,Lorenzo Ball,Umberto Lucangelo,Silvia Dettori,Nicolò Patroniti,Federica Briano,Giorgia Brucci,Giulia Guarona,Pierlanfranco D’Agaro,Luigi Principe,Paolo Pelosi,Giancarlo Icardi,Iole Brunetti,Laura Magnasco,Denise Battaglini,Ludovica Segat,Roberto Luzzati

doi:10.3390/microorganisms10020362

Abstract

Reactivation of herpes simplex virus type 1 (HSV-1) has been described in critically ill patients with coronavirus disease 2019 (COVID-19) pneumonia. In the present two-center retrospective experience, we primarily aimed to assess the cumulative risk of HSV-1 reactivation detected on bronchoalveolar fluid (BALF) samples in invasively ventilated COVID-19 patients with worsening respiratory function. The secondary objectives were the identification of predictors for HSV-1 reactivation and the assessment of its possible prognostic impact. Overall, 41 patients met the study inclusion criteria, and 12/41 patients developed HSV-1 reactivation (29%). No independent predictors of HSV-1 reactivation were identified in the present study. No association was found between HSV-1 reactivation and mortality. Eleven out of 12 patients with HSV-1 reactivation received antiviral therapy with intravenous acyclovir. In conclusion, HSV-1 reactivation is frequently detected in intubated patients with COVID-19. An antiviral treatment in COVID-19 patients with HSV-1 reactivation and worsening respiratory function might be considered.

Highlights

Ill patients with coronavirus disease 2019 (COVID-19) pneumonia requiring invasive mechanical ventilation are at risk of developing bacterial, fungal, and viral superinfections [1,2,3,4]
12/41 patients developed herpes simplex virus type 1 (HSV-1) reactivation (29%). This crude percentage is in line with the cumulative risk of developing HSV-1 reactivation reached at 30 days and measured with cumulative incidence curve (Figure 1)
From our study, an independent association was found between steroid treatment and HSV-1 reactivation [2]

Summary

Introduction

Ill patients with coronavirus disease 2019 (COVID-19) pneumonia requiring invasive mechanical ventilation are at risk of developing bacterial, fungal, and viral superinfections [1,2,3,4]. Reactivation of herpes simplex virus type 1 (HSV-1) has been described in intubated critically ill patients with coronavirus disease 2019 (COVID-19) pneumonia [2,3,5,6,7,8]. Both predictors and prognostic implications of HSV-1 reactivation in this peculiar population remain largely elusive, making its management highly heterogenous in terms of prophylactic and therapeutic approaches [2,3,5]. In the present two-center retrospective experience, we aimed to assess the cumulative risk of HSV-1 reactivation detected on bronchoalveolar fluid (BALF) samples in invasively ventilated COVID-19 patients with worsening respiratory function, as well as to exploratorily assess the predictors of HSV-1 reactivation and its possible prognostic impact

Objectives

Methods

Results

Conclusion