Available online 25 April 2023, 105470

Author links open overlay panel, , , ABSTRACTObjective

To assess the clinical relevance of varicella zoster virus (VZV) lung detection among patients hospitalized in intensive care unit (ICU).

Methods

We present a monocentric retrospective cohort study from 2012 to 2020. VZV genome was detected in bronchoalveolar lavage (BAL) fluid by real-time PCR.

Results

Twelve of 1389 (0.8%) patients exhibited VZV lung detection, corresponding to an incidence of 13.4 (95% confidence interval [CI] 5.8-21.0) per 100 person-years. Immunosuppression and prolonged ICU stay constituted the main risks factors. VZV detection was not associated with pulmonary deterioration but associated with a risk of shingles occurrence during the following days.

Conclusion

VZV lung detection is a rare event among ICU patients, occurring mostly in immunocompromised patients with prolonged ICU stay. Due to its scarcity and the lack of association with pulmonary failure, a targeted approach to the VZV lung detection diagnosis may allow a significant cost saving without affecting the quality of patients care.

Section snippetsINTRODUCTION

Reactivation of herpesviruses in the lung, particularly herpes simplex virus (HSV) and cytomegalovirus (CMV), is common among mechanically ventilated patients in intensive care unit (ICU). These infections are associated with poor prognosis, including increased length of mechanical ventilation, ICU stay, and all-cause mortality [1]. Risk factors for herpes zoster (varicella zoster virus [VZV] reactivation) are well described: immunosuppression (glucocorticoids, solid organ transplantation,

METHODS

All patients hospitalized in ICU in Pitié-Salpêtrière Hospital (Paris, France) from July 2012 to December 2020 for whom VZV detection in BAL was performed were included. Patients’ baseline characteristics were collected retrospectively from medical records and manually checked using a standardized form. Immunosuppression was defined as follows: use of corticosteroids, solid or hematopoietic stem cell transplantation, HIV infection, autoimmune disease. HSV, CMV, VZV genomes and albumin gene were

RESULTS

During the study period, 1,392 patients were included, corresponding to 2,325 BAL fluid samples tested for Herpesviridae. Three (0.2%) patients admitted for varicella pneumonia were excluded. VZV lung detection was observed in 12 (0.8%) patients, corresponding to an incidence of 13.4 (95% confidence interval [CI] 5.8-21.0) events per 100 patient-years. During this period, HSV and CMV lung detections were observed in 524 (37.6%) and 253 (18.2%) patients, respectively.

Patients with VZV lung

DISCUSSION

We present here the first cohort study addressing the question of the clinical relevance of VZV lung detection in ICU patients. Our results showed that this is a rare event (incidence 0.8%) occurring mostly in immunocompromised patients with a long ICU stay. Moreover, VZV detection in BAL fluid was strongly associated with the subsequent occurrence of shingles, especially in the absence of an anti-herpetic treatment, but not with a deterioration of lung function.

VZV infection has been reported

Fundings

The authors declare no specific funding for this study.

Declaration of interests

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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