Reactivation of Epstein-Barr virus among intensive care patients: a prospective observational study.
Cytomegalovirus
Epstein–Barr virus
Herpesvirus
Intensive care medicine
Viral reactivation
Journal
Intensive care medicine
ISSN: 1432-1238
Titre abrégé: Intensive Care Med
Pays: United States
ID NLM: 7704851
Informations de publication
Date de publication:
Mar 2024
Mar 2024
Historique:
received:
11
10
2023
accepted:
02
02
2024
pubmed:
4
3
2024
medline:
4
3
2024
entrez:
4
3
2024
Statut:
ppublish
Résumé
Herpesvirus reactivation has been documented among patients in the intensive care unit (ICU) and is associated with increased morbidity and mortality, particularly for cytomegalovirus (CMV). Epstein-Barr virus (EBV) has been poorly studied despite >95% of the population being seropositive. Our preliminary study suggested an association between EBV reactivation and increased morbidity and mortality. This study aimed to investigate this association among patients admitted to the ICU. In this multicenter prospective study, polymerase chain reaction was performed to quantify EBV in patients upon ICU admission and then twice a week during their stay. Follow-up was 90 days. The study included 129 patients; 70 (54.3%) had EBV reactivation. On day 90, there was no difference in mortality rates between patients with and without reactivation (25.7% vs 15.3%, p = 0.22). Patients with EBV reactivation at admission had increased mortality compared with those without reactivation and those with later reactivation. EBV reactivation was associated with increased morbidity. Patients with EBV reactivation had fewer ventilator-free days at day 28 than those without reactivation (18 [1-22] vs. 21 days [5-26], p = 0.037) and a higher incidence of acute respiratory distress syndrome (34.3% vs. 17%, p = 0.04), infections (92.9% vs. 78%, p = 0.03), and septic shock (58.6% vs. 32.2%, p = 0.004). More patients with EBV reactivation required renal replacement therapy (30% vs. 11.9%, p = 0.02). EBV reactivation was also associated with a more inflammatory immune profile. While EBV reactivation was not associated with increased 90-day mortality, it was associated with significantly increased morbidity.
Identifiants
pubmed: 38436725
doi: 10.1007/s00134-024-07345-3
pii: 10.1007/s00134-024-07345-3
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
418-426Informations de copyright
© 2024. Springer-Verlag GmbH Germany, part of Springer Nature.
Références
Domart Y, Trouillet J-L, Fagon J-Y et al (1990) Incidence and Morbidity of Cytomegaloviral Infection in Patients with Mediastinitis following Cardiac Surgery. Chest 97:18–22. https://doi.org/10.1378/chest.97.1.18
doi: 10.1378/chest.97.1.18
pubmed: 2153065
Ong G, m., Lowry K, Mahajan S, et al (2004) Herpes simplex type 1 shedding is associated with reduced hospital survival in patients receiving assisted ventilation in a tertiary referral intensive care unit. J Med Virol 72:121–125. https://doi.org/10.1002/jmv.10524
doi: 10.1002/jmv.10524
pubmed: 14635019
Limaye AP, Boeckh M (2010) CMV in critically ill patients: pathogen or bystander? Rev Med Virol 20:372–379. https://doi.org/10.1002/rmv.664
doi: 10.1002/rmv.664
pubmed: 20931610
pmcid: 2987685
Cohen JI (2009) CMV in the ICU: Pathogen or passenger? Crit Care Med 37:2095–2096. https://doi.org/10.1097/CCM.0b013e3181a5e725
doi: 10.1097/CCM.0b013e3181a5e725
pubmed: 19448451
pmcid: 2775818
Luyt C-E, Combes A, Deback C et al (2007) Herpes Simplex Virus Lung Infection in Patients Undergoing Prolonged Mechanical Ventilation. Am J Respir Crit Care Med 175:935–942. https://doi.org/10.1164/rccm.200609-1322°C2OC
doi: 10.1164/rccm.200609-1322°C2OC
pubmed: 17234903
Chiche L, Forel JM, Papazian L (2011) The role of viruses in nosocomial pneumonia. Curr Opin Infect 24:152–156. https://doi.org/10.1097/QCO.0b013e328343b6e4
doi: 10.1097/QCO.0b013e328343b6e4
Gkrania-Klotsas E, Langenberg C et al (2012) Higher immunoglobulin G antibody levels against cytomegalovirus are associated with incident ischemic heart disease in the population-based EPIC-Norfolk cohort. J Infect Dis. 206:1897–1903. https://doi.org/10.1093/infdis/jis620
doi: 10.1093/infdis/jis620
pubmed: 23045624
Libert N, Bigaillon C, Chargari C et al (2015) Epstein-Barr Virus Replication in Critically Ill Immunocompetent Patients. Biomed J 38:70–76. https://doi.org/10.4103/2319-4170.132905
doi: 10.4103/2319-4170.132905
pubmed: 25179711
Schober P, Vetter TR (2018) Repeated Measures Designs and Analysis of Longitudinal Data: If at First You Do Not Succeed—Try, Try Again. Anesth Analg 127:569–575. https://doi.org/10.1213/ANE.0000000000003511
doi: 10.1213/ANE.0000000000003511
pubmed: 29905618
pmcid: 6072386
Coşkun O, Yazici E, Şahiner F et al (2017) Cytomegalovirus and Epstein-Barr virus replication in the intensive care unit. Med Klin-Intensivmed Notfallmedizin 112:239–245. https://doi.org/10.1007/s00063-016-016-0198-0c
doi: 10.1007/s00063-016-016-0198-0c
Goh C, Burnham KL, Ansari MA et al (2020) Epstein-Barr virus replication in sepsis due to community acquired pneumonia is associated with increased morbidity and an immunosuppressed host transcriptomic endotype. Sci Rep 10:9838. https://doi.org/10.1038/s41598-020-66713-3
doi: 10.1038/s41598-020-66713-3
pubmed: 32555213
pmcid: 7299986
Smith CA, Conroy LT, Pollock M et al (2010) Detection of herpes viruses in respiratory secretions of patients undergoing artificial ventilation. J Med Virol 82:1406–1409. https://doi.org/10.1002/jmv.21794
doi: 10.1002/jmv.21794
pubmed: 20572072
Ong DSY, Bonten MJM, Spitoni C et al (2017) Epidemiology of Multiple Herpes Viremia in Previously Immunocompetent Patients With Septic Shock. Clin Infect Dis 64:1204–1210. https://doi.org/10.1093/cid/cix120
doi: 10.1093/cid/cix120
pubmed: 28158551
Friedrichs I, Bingold T, Keppler OT et al (2013) Detection of herpesvirus EBV DNA in the lower respiratory tract of ICU patients: a marker of infection of the lower respiratory tract? Med Microbiol Immunol (Berl) 202:431–436. https://doi.org/10.1007/s00430-013-0306-1
doi: 10.1007/s00430-013-0306-1
pubmed: 23900401
Simonnet A, Engelmann I, Moreau A-S et al (2021) High incidence of Epstein-Barr virus, cytomegalovirus, and human-herpes virus-6 reactivations in critically ill patients with COVID-19. Infect Dis Now 51:296–299. https://doi.org/10.1016/j.idnow.2021.01.005
doi: 10.1016/j.idnow.2021.01.005
pubmed: 33495765
pmcid: 7816954
Lehner GF, Klein SJ, Zoller H et al (2020) Correlation of interleukin-6 with Epstein-Barr virus levels in COVID-19. Crit Care 24:657. https://doi.org/10.1186/s13054-020-03384-6
doi: 10.1186/s13054-020-03384-6
pubmed: 33228750
pmcid: 7682685
He H, Wang Y, Wu M, Sun B (2017) Positive Epstein-Barr virus detection and mortality in respiratory failure patients admitted to the intensive care unit. Clin Respir J 11:895–900. https://doi.org/10.1111/crj.12433
doi: 10.1111/crj.12433
pubmed: 26663042
Walton AH, Muenzer JT, Rasche D et al (2014) Replication of Multiple Viruses in Patients with Sepsis. PLoS One 9:e98819
doi: 10.1371/journal.pone.0098819
pubmed: 24919177
pmcid: 4053360
Gaudreault E, Fiola S, Olivier M, Gosselin J (2007) Epstein-Barr Virus Induces MCP-1 Secretion by Human Monocytes via TLR2. J Virol 81:8016–8024. https://doi.org/10.1128/JVI.00403-07
doi: 10.1128/JVI.00403-07
pubmed: 17522215
pmcid: 1951286
Samanta M, Iwakiri D, Takada K (2008) Epstein-Barr virus-encoded small RNA induces IL-10 through RIG-I-mediated IRF-3 signaling. Oncogene 27:4150–4160. https://doi.org/10.1038/onc.2008.75
doi: 10.1038/onc.2008.75
pubmed: 18362887
Lay JD, Tsao CJ, Chen JY et al (1997) Upregulation of tumor necrosis factor-alpha gene by Epstein-Barr virus and activation of macrophages in Epstein-Barr virus-infected T cells in the pathogenesis of hemophagocytic syndrome. J Clin Invest 100:1969–1979
doi: 10.1172/JCI119728
pubmed: 9329960
pmcid: 508386
Huang D, Song S-J, Wu Z-Z et al (2017) Epstein-Barr Virus-Induced VEGF and GM-CSF Drive Nasopharyngeal Carcinoma Metastasis via Recruitment and Activation of Macrophages. Cancer Res 77:3591–3604. https://doi.org/10.1158/0008-5472.CAN-16-2706
doi: 10.1158/0008-5472.CAN-16-2706
pubmed: 28484077
Peluso MJ, Deveau T-M, Munter SE et al (2022) Impact of Pre-Existing Chronic Viral Infection and Reactivation on the Development of Long COVID. MedRxiv Prepr Serv Health Sci. https://doi.org/10.1101/2022.06.21.22276660
doi: 10.1101/2022.06.21.22276660