Clinical relevance of herpes simplex virus viremia in Intensive Care Unit patients.
OBJECTIVE
To determine the clinical relevance of herpes simplex virus (HSV) viremia episodes in critically ill adult patients.


METHODS
1556 blood samples obtained for HSV PCR analysis in Intensive Care Unit (ICU) patients over 4 years were retrospectively analyzed, focusing on the comprehensive analysis of 88 HSV-viremic patients.


RESULTS
HSV DNA was detected in 11.8% of samples from the ICU. HSV viral loads remained below 5×10(2) copies/ml in 68.2% of patients and exceeded 10(4) copies/ml in 7.9%. Episodes of HSV-viremia correlated with immunosuppressed status and mechanical ventilation in 79.5% and 65.9% of patients, respectively. Only a subset of patients exhibited HSV-related organ damage, including pneumonia and hepatitis (10.2% and 2.3%, respectively). The mortality rate in HSV-viremic patients was not significantly increased compared to the overall mortality rate in the ICU (27.3% vs. 22.9%, p = 0.33). Only patients with high HSV viral loads tended to have a higher, though non-significant, death rate (57.1%, p = 0.14).


CONCLUSIONS
Our results suggest HSV viremia is common in ICU patients, potentially favored by immunocompromised status and mechanical ventilation. The global impact of HSV-viremia on mortality in the ICU was low. Quantifying HSV DNA may help identifying patients at-risk of severe HSV-induced symptoms.
Laboratoire de Virologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France; Inserm U1109, Strasbourg, France; Université de Strasbourg, Strasbourg, France; Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France.
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Lepiller
Laboratoire de Virologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France; Inserm U1109, Strasbourg, France; Université de Strasbourg, Strasbourg, France; Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France.
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Sueur
Laboratoire de Virologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France; Inserm U1109, Strasbourg, France; Université de Strasbourg, Strasbourg, France; Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France.
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Solis
Laboratoire de Virologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France; Inserm U1109, Strasbourg, France; Université de Strasbourg, Strasbourg, France; Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France.
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Barth
Laboratoire de Virologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France; Université de Strasbourg, Strasbourg, France.
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Glady
Université de Strasbourg, Strasbourg, France; Département d'Information Médicale, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
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Lefebvre
Laboratoire de Virologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France; Inserm U1109, Strasbourg, France; Université de Strasbourg, Strasbourg, France; Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France.
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Fafi-Kremer
Université de Strasbourg, Strasbourg, France; Service de Réanimation Médicale, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
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Schneider
Laboratoire de Virologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France; Inserm U1109, Strasbourg, France; Université de Strasbourg, Strasbourg, France; Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France. Electronic address: francoise.stoll@unistra.fr.
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Stoll-Keller
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001769:Blood / Q000821:virology; D005260:Female; D006561:Herpes Simplex / Q000175:diagnosis* / Q000453:epidemiology / Q000401:mortality / Q000473:pathology*; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D015995:Prevalence; D012189:Retrospective Studies; D018139:Simplexvirus / Q000302:isolation & purification*; D016019:Survival Analysis; D014766:Viremia / Q000175:diagnosis* / Q000453:epidemiology / Q000401:mortality / Q000473:pathology*
Herpes simplex; Intensive Care Units; Viremia