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Herpes Simplex Virus Re-Activation in Patients with SARS-CoV-2 Pneumonia: A Prospective, Observational Study

Background: Herpes simplex 1 co-infections in patients with COVID-19 are considered relatively uncommon; some reports on re-activations in patients in intensive-care units were published. The aim of the study was to analyze herpetic re-activations and their clinical manifestations in hospitalized CO...

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Autores principales: Franceschini, Erica, Cozzi-Lepri, Alessandro, Santoro, Antonella, Bacca, Erica, Lancellotti, Guido, Menozzi, Marianna, Gennari, William, Meschiari, Marianna, Bedini, Andrea, Orlando, Gabriella, Puzzolante, Cinzia, Digaetano, Margherita, Milic, Jovana, Codeluppi, Mauro, Pecorari, Monica, Carli, Federica, Cuomo, Gianluca, Alfano, Gaetano, Corradi, Luca, Tonelli, Roberto, De Maria, Nicola, Busani, Stefano, Biagioni, Emanuela, Coloretti, Irene, Guaraldi, Giovanni, Sarti, Mario, Luppi, Mario, Clini, Enrico, Girardis, Massimo, Gyssens, Inge C., Mussini, Cristina
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8465957/
https://www.ncbi.nlm.nih.gov/pubmed/34576791
http://dx.doi.org/10.3390/microorganisms9091896
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author Franceschini, Erica
Cozzi-Lepri, Alessandro
Santoro, Antonella
Bacca, Erica
Lancellotti, Guido
Menozzi, Marianna
Gennari, William
Meschiari, Marianna
Bedini, Andrea
Orlando, Gabriella
Puzzolante, Cinzia
Digaetano, Margherita
Milic, Jovana
Codeluppi, Mauro
Pecorari, Monica
Carli, Federica
Cuomo, Gianluca
Alfano, Gaetano
Corradi, Luca
Tonelli, Roberto
De Maria, Nicola
Busani, Stefano
Biagioni, Emanuela
Coloretti, Irene
Guaraldi, Giovanni
Sarti, Mario
Luppi, Mario
Clini, Enrico
Girardis, Massimo
Gyssens, Inge C.
Mussini, Cristina
author_facet Franceschini, Erica
Cozzi-Lepri, Alessandro
Santoro, Antonella
Bacca, Erica
Lancellotti, Guido
Menozzi, Marianna
Gennari, William
Meschiari, Marianna
Bedini, Andrea
Orlando, Gabriella
Puzzolante, Cinzia
Digaetano, Margherita
Milic, Jovana
Codeluppi, Mauro
Pecorari, Monica
Carli, Federica
Cuomo, Gianluca
Alfano, Gaetano
Corradi, Luca
Tonelli, Roberto
De Maria, Nicola
Busani, Stefano
Biagioni, Emanuela
Coloretti, Irene
Guaraldi, Giovanni
Sarti, Mario
Luppi, Mario
Clini, Enrico
Girardis, Massimo
Gyssens, Inge C.
Mussini, Cristina
author_sort Franceschini, Erica
collection PubMed
description Background: Herpes simplex 1 co-infections in patients with COVID-19 are considered relatively uncommon; some reports on re-activations in patients in intensive-care units were published. The aim of the study was to analyze herpetic re-activations and their clinical manifestations in hospitalized COVID-19 patients, performing HSV-1 PCR on plasma twice a week. Methods: we conducted a prospective, observational, single-center study involving 70 consecutive patients with severe/critical SARS-CoV-2 pneumonia tested for HSV-1 hospitalized at Azienda Ospedaliero-Universitaria of Modena. Results: of these 70 patients, 21 (30.0%) showed detectable viremia and 13 (62%) had clinically relevant manifestations of HSV-1 infection corresponding to 15 events (4 pneumonia, 5 herpes labialis, 3 gingivostomatitis, one encephalitis and two hepatitis). HSV-1 positive patients were more frequently treated with steroids than HSV-1 negative patients (76.2% vs. 49.0%, p = 0.036) and more often underwent mechanical ventilation (IMV) (57.1% vs. 22.4%, p = 0.005). In the unadjusted logistic regression analysis, steroid treatment, IMV, and higher LDH were significantly associated with an increased risk of HSV1 re-activation (odds ratio 3.33, 4.61, and 16.9, respectively). The association with the use of steroids was even stronger after controlling for previous use of both tocilizumab and IMV (OR = 5.13, 95% CI:1.36–19.32, p = 0.016). The effect size was larger when restricting to participants who were treated with high doses of steroids while there was no evidence to support an association with the use of tocilizumab Conclusions: our study shows a high incidence of HSV-1 re-activation both virologically and clinically in patients with SARS-CoV-2 severe pneumonia, especially in those treated with steroids.
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spelling pubmed-84659572021-09-27 Herpes Simplex Virus Re-Activation in Patients with SARS-CoV-2 Pneumonia: A Prospective, Observational Study Franceschini, Erica Cozzi-Lepri, Alessandro Santoro, Antonella Bacca, Erica Lancellotti, Guido Menozzi, Marianna Gennari, William Meschiari, Marianna Bedini, Andrea Orlando, Gabriella Puzzolante, Cinzia Digaetano, Margherita Milic, Jovana Codeluppi, Mauro Pecorari, Monica Carli, Federica Cuomo, Gianluca Alfano, Gaetano Corradi, Luca Tonelli, Roberto De Maria, Nicola Busani, Stefano Biagioni, Emanuela Coloretti, Irene Guaraldi, Giovanni Sarti, Mario Luppi, Mario Clini, Enrico Girardis, Massimo Gyssens, Inge C. Mussini, Cristina Microorganisms Article Background: Herpes simplex 1 co-infections in patients with COVID-19 are considered relatively uncommon; some reports on re-activations in patients in intensive-care units were published. The aim of the study was to analyze herpetic re-activations and their clinical manifestations in hospitalized COVID-19 patients, performing HSV-1 PCR on plasma twice a week. Methods: we conducted a prospective, observational, single-center study involving 70 consecutive patients with severe/critical SARS-CoV-2 pneumonia tested for HSV-1 hospitalized at Azienda Ospedaliero-Universitaria of Modena. Results: of these 70 patients, 21 (30.0%) showed detectable viremia and 13 (62%) had clinically relevant manifestations of HSV-1 infection corresponding to 15 events (4 pneumonia, 5 herpes labialis, 3 gingivostomatitis, one encephalitis and two hepatitis). HSV-1 positive patients were more frequently treated with steroids than HSV-1 negative patients (76.2% vs. 49.0%, p = 0.036) and more often underwent mechanical ventilation (IMV) (57.1% vs. 22.4%, p = 0.005). In the unadjusted logistic regression analysis, steroid treatment, IMV, and higher LDH were significantly associated with an increased risk of HSV1 re-activation (odds ratio 3.33, 4.61, and 16.9, respectively). The association with the use of steroids was even stronger after controlling for previous use of both tocilizumab and IMV (OR = 5.13, 95% CI:1.36–19.32, p = 0.016). The effect size was larger when restricting to participants who were treated with high doses of steroids while there was no evidence to support an association with the use of tocilizumab Conclusions: our study shows a high incidence of HSV-1 re-activation both virologically and clinically in patients with SARS-CoV-2 severe pneumonia, especially in those treated with steroids. MDPI 2021-09-07 /pmc/articles/PMC8465957/ /pubmed/34576791 http://dx.doi.org/10.3390/microorganisms9091896 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Franceschini, Erica
Cozzi-Lepri, Alessandro
Santoro, Antonella
Bacca, Erica
Lancellotti, Guido
Menozzi, Marianna
Gennari, William
Meschiari, Marianna
Bedini, Andrea
Orlando, Gabriella
Puzzolante, Cinzia
Digaetano, Margherita
Milic, Jovana
Codeluppi, Mauro
Pecorari, Monica
Carli, Federica
Cuomo, Gianluca
Alfano, Gaetano
Corradi, Luca
Tonelli, Roberto
De Maria, Nicola
Busani, Stefano
Biagioni, Emanuela
Coloretti, Irene
Guaraldi, Giovanni
Sarti, Mario
Luppi, Mario
Clini, Enrico
Girardis, Massimo
Gyssens, Inge C.
Mussini, Cristina
Herpes Simplex Virus Re-Activation in Patients with SARS-CoV-2 Pneumonia: A Prospective, Observational Study
title Herpes Simplex Virus Re-Activation in Patients with SARS-CoV-2 Pneumonia: A Prospective, Observational Study
title_full Herpes Simplex Virus Re-Activation in Patients with SARS-CoV-2 Pneumonia: A Prospective, Observational Study
title_fullStr Herpes Simplex Virus Re-Activation in Patients with SARS-CoV-2 Pneumonia: A Prospective, Observational Study
title_full_unstemmed Herpes Simplex Virus Re-Activation in Patients with SARS-CoV-2 Pneumonia: A Prospective, Observational Study
title_short Herpes Simplex Virus Re-Activation in Patients with SARS-CoV-2 Pneumonia: A Prospective, Observational Study
title_sort herpes simplex virus re-activation in patients with sars-cov-2 pneumonia: a prospective, observational study
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8465957/
https://www.ncbi.nlm.nih.gov/pubmed/34576791
http://dx.doi.org/10.3390/microorganisms9091896
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