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Title: | Herpes Simplex Virus Re-Activation in Patients with SARS-CoV-2 Pneumonia: A Prospective, Observational Study | Authors: | 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 Mussini, Cristina |
Issue Date: | 2021 | Publisher: | MDPI | Source: | MICROORGANISMS, 9 (9) , (Art N° 1896) | Abstract: | 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. | Notes: | Franceschini, E; Mussini, C (corresponding author), Azienda Osped Univ Policlin, Infect Dis Unit, I-41124 Modena, Italy.; Mussini, C (corresponding author), Univ Modena & Reggio Emilia, Dept Infect Dis, I-41124 Modena, Italy. ericafranceschini0901@gmail.com; a.cozzi-lepri@ucl.ac.uk; antonella.santoro7@gmail.com; erica.bacca@gmail.com; glancellotti95@gmail.com; marymenozzi@gmail.com; gennari.william@aou.mo.it; mariannameschiari1209@gmail.com; andreabedini@yahoo.com; gabriella.orlando7@virgilio.it; cinzia.puzzolante@gmail.com; margheritadigaetano@alice.it; joyana.milic@gmail.com; fluppi45@gmail.com; pecorari.monica@polidinico.mo.it; fedecarli@gmail.com; gian.cuomo@gmail.com; gaetanoalfano85@gmail.com; corradi.luca59@gmail.com; roberto.tonelli@me.com; nicolademaria@alice.it; stefano.busani@unimore.it; emanuela.biagioni@gmail.com; irene.coloretti@gmail.com; giovanni.guaraldi@unimore.it; sarti.mario@aou.mo.it; mario.luppi@unimore.it; enrico.dini@unimore.it; girardis.massimo@unimore.it; Inge.Gyssens@radboudumc.nl; crimuss@unimore.it |
Keywords: | SARS-Cov-2; Herpesviridae; steroids; tocilizumab; re-activation | Document URI: | http://hdl.handle.net/1942/35770 | e-ISSN: | 2076-2607 | DOI: | 10.3390/microorganisms9091896 | ISI #: | WOS:000701127100001 | Rights: | © 2021 by the authors.Licensee MDPI, Basel, Switzerland.This article is an open access articledistributed under the terms andconditions of the Creative CommonsAttribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/) | Category: | A1 | Type: | Journal Contribution | Validations: | ecoom 2022 |
Appears in Collections: | Research publications |
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