Immunosuppression and herpes viral reactivation in intensive care unit patients: one size does not fit all

Excerpt

More than 20 years after the initial description of cytomegalovirus (CMV) pneumonia in “non-immunocompromised” ICU patients by Papazian et al. [1], the treatment of herpes viruse reactivation in ICU is still a matter of debate. Recently, Mirouse et al. [2] reported a unique cohort of varicella-zoster virus (VZV)-related community acquired pneumonia in the ICU over 20 years. This highlighted that VZV infections in ICU patients are rare, with roughly a hundred cases over 20 years, in 29 French ICUs. Conversely, addressing a wider range of herpes viruses, two major papers recently reported a high frequency of viral reactivation in critically ill patients, and both showed variable plasma levels of various herpes viruses (Table 1) [3, 4]. Interestingly, almost 30% of the patients had multiple viremia events, and this viremia usually lasted until ICU discharge. The timing of viral reactivation was also informative, with herpes simplex virus (HSV)1 and Epstein-Barr virus (EBV) being detected earlier in the ICU course than CMV or human herpesvirus (HHV)6. …