Abstract
The advent of highly sensitive molecular diagnostic techniques has improved our ability to detect viral pathogens leading to severe and often fatal infections that require admission to the Intensive Care Unit (ICU). Viral infections in the ICU have pleomorphic clinical presentations including pneumonia, acute respiratory distress syndrome, respiratory failure, central or peripheral nervous system manifestations, and viral-induced shock. Besides de novo infections, certain viruses fall into latency and can be reactivated in both immunosuppressed and immunocompetent critically ill patients. Depending on the viral strain, transmission occurs either directly through contact with infectious materials and large droplets, or indirectly through suspended air particles (airborne transmission of droplet nuclei). Many viruses can efficiently spread within hospital environment leading to in-hospital outbreaks, sometimes with high rates of mortality and morbidity, thus infection control measures are of paramount importance. Despite the advances in detecting viral pathogens, limited progress has been made in antiviral treatments, contributing to unexpectedly high rates of unfavorable outcomes. Herein, we review the most updated data on epidemiology, common clinical features, diagnosis, pathogenesis, treatment and prevention of severe community- and hospital-acquired viral infections in the ICU settings.
Highlights
The incidence of viral infections in critical care settings varies widely across different studies and geographical regions, but it has unambiguously increased over the last years as modern diagnostics have become more sensitive, rapid and accurate [1, 2]
Common viruses are detected in respiratory samples of patients with nosocomial pneumonia with an incidence ranging from 13.8 to 32% in adults, and as high as 69.2% in pediatric population [8,9,10,11,12,13]
Adults can be infected; up to 11.5% of adult hospitalizations for RTIs attributed to human parainfluenza viruses (HPIV) [31,32,33]
Summary
The incidence of viral infections in critical care settings varies widely across different studies and geographical regions, but it has unambiguously increased over the last years as modern diagnostics have become more sensitive, rapid and accurate [1, 2]. Due to the fact that antiviral therapies are still scarce, the mainstay of treatment for many life-threatening viral infections remains supportive, and critical care is of paramount importance for the management of severe viral infections [3]. In this narrative review we aim to present an updated overview of the epidemiology, geographic distribution, clinical features, diagnosis, treatment and specific preventative measures for viral pathogens associated with (i) severe community acquired respiratory tract infections and nosocomial pneumonia (ii) neurological and neuromuscular diseases requiring intensive care unit (ICU) admission, (iii) different types of shock and multi-organ injury, and (iv) re-activation, in critically ill patients. Common viruses are detected in respiratory samples of patients with nosocomial pneumonia with an incidence ranging from 13.8 to 32% in adults, and as high as 69.2% in pediatric population [8,9,10,11,12,13]
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