title: Cytomegalovirus and Epstein-Barr virus reactivation in the intensive care unit.
abstract: OBJECTIVE
  The purpose of this work was to evaluate the reactivation of cytomegalovirus (CMV) and Epstein-Barr virus (EBV) in immunocompetent patients in the intensive care unit (ICU) and to identify risk factors associated with reactivation.
  
  
  METHODS
  In this observational prospective study, 60 adult immunocompetent patients who stayed at least 7 days in an ICU were evaluated. During hospitalization, the viral load was monitored at admission and on day 7 with polymerase chain reaction to detect viral reactivation and weekly thereafter on days 14, 21, and 28 if hospitalization continued.
  
  
  RESULTS
  The mean age of patients was 63.3 years (±23.4 years) and 34 (56.7 %) of them were male. Mean APACHE II scores for patients was 25 at admission. Of these patients, 28 were hospitalized in the internal ICU and 32 were hospitalized in the anesthesiology ICU. CMV/EBV reactivation was found in 17 individuals (12 for EBV, 3 for CMV, and 2 for both). The median high-sensitive C-reactive protein value in patients with CMV reactivation was significantly higher than in those patients without CMV reactivation (p = 0.037). EBV reactivation was statistically higher in patients with mechanical ventilation compared to patients without mechanical ventilation (p = 0.023). EBV reactivation in patients with fever was found to be statistically higher than in the patients without fever (p = 0.035).
  
  
  CONCLUSIONS
  There is a need for extended studies with a larger number of patients from specific groups to better understand the reactivation frequency and identify risk factors. EBV and CMV reactivation should be taken into consideration in critically ill patients with fever, without specific symptoms and unresponsive to the treatment.
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Gulhane Military Medical Academy, Etlik/Ankara, Turkey.
authors.forename: O
authors.initials: O
authors.lastname: Coşkun
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Gulhane Military Medical Academy, Etlik/Ankara, Turkey.
authors.forename: E
authors.initials: E
authors.lastname: Yazici
authors.affiliation: Department of Medical Microbiology, Virology Unit, Gulhane Military Medical Academy, Ankara, Turkey.
authors.forename: F
authors.initials: F
authors.lastname: Şahiner
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Gulhane Military Medical Academy, Etlik/Ankara, Turkey. akarakas@gata.edu.tr.
authors.forename: A
authors.initials: A
authors.lastname: Karakaş
authors.affiliation: Department of Public Health and Epidemiology, Gulhane Military Medical Academy, Ankara, Turkey.
authors.forename: S
authors.initials: S
authors.lastname: Kiliç
authors.affiliation: Department of Anesthesiology and Reanimation, Gulhane Military Medical Academy, Ankara, Turkey.
authors.forename: M
authors.initials: M
authors.lastname: Tekin
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Gulhane Military Medical Academy, Etlik/Ankara, Turkey.
authors.forename: C
authors.initials: C
authors.lastname: Artuk
authors.affiliation: Department of Intensive Care Unit, Gulhane Military Medical Academy, Ankara, Turkey.
authors.forename: L
authors.initials: L
authors.lastname: Yamanel
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Gulhane Military Medical Academy, Etlik/Ankara, Turkey.
authors.forename: B A
authors.initials: BA
authors.lastname: Beşirbellioğlu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002097:C-Reactive Protein / Q000032:analysis; D003587:Cytomegalovirus; D003586:Cytomegalovirus Infections / Q000175:diagnosis* / Q000821:virology*; D004797:Enzyme-Linked Immunosorbent Assay; D020031:Epstein-Barr Virus Infections / Q000175:diagnosis / Q000821:virology*; D005260:Female; D004854:Herpesvirus 4, Human; D006801:Humans; D007121:Immunocompetence / Q000276:immunology; D007153:Immunologic Deficiency Syndromes / Q000276:immunology; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D019562:Viral Load; D014775:Virus Activation / Q000502:physiology*
chemical_list: D002097:C-Reactive Protein
keywords: C‑reactive protein; Fever; Immunosuppression; Mechanical ventilation; Mortality