key: cord-0943634-em0tt1vy
authors: Honore, Patrick M.; Barreto Gutierrez, Leonel; Kugener, Luc; Redant, Sebastien; Attou, Rachid; Gallerani, Andrea; De Bels, David
title: SARS-CoV-2 infection as a risk factor for herpesviridae reactivation: consider the potential influence of corticosteroid therapy
date: 2020-10-22
journal: Crit Care
DOI: 10.1186/s13054-020-03349-9
sha: 99ff8fd61ef33345c9453246d5a5f24a08819a58
doc_id: 943634
cord_uid: em0tt1vy

nan

We read with great interest the recent article by Le Balc'h et al. who concluded that their results suggest that SARS-CoV-2 infection could be a risk factor for Herpesviridae reactivation [1] . We would like to make some comments. Glucocorticoid treatment increases the risk of opportunistic infection [2] . Infections that can arise during glucocorticoid use, and for which preventative measures can be taken, include reactivation of Herpesviridae that can lead to herpetic pneumonia [2] . In the study of Le Balc'h et al. [1] , 44% of patients in the Herpesviridae reactivation group received corticosteroids, compared to only 20% of patients in the non-reactivation group. Although the difference did not reach statistical significance due to the low number of patients, the difference is still notable and may explain, at least in part, the difference in Herpesviridae reactivation between the groups. Herpesviridae reactivations occur easily after high-dose steroids and may lead to fatal disease [3] . Possible infectious complications as a result of Herpesviridae reactivations should be considered in patients who receive high-dose glucocorticoid treatment amounting to more than 420 mg of steroid over 4 weeks [4] . This is equal to a daily dose of 52.5 mg of prednisolone [4] . The dose of steroid and the duration of treatment are not reported in the Le Balc'h et al. study [1] . Given that a dose of 52.5 mg of prednisolone is equal to 8 mg of dexamethasone, the dose used in the RECOVERY trial (6 mg) [5] may not increase the risk of reactivation of Herpesviridae. However, perhaps even the regimen of 6 mg dexamethasone for 10 days that was used in the RECOVERY trial could result in Herpesviridae pulmonary reactivation when given in the context of prolonged mechanical ventilation and concomitant bacterial sepsis.

Herpes simplex virus and cytomegalovirus reactivations among severe COVID-19 patients

Place Van Gehuchtenplein, 4, 1020 Brussels, Belgium • fast, convenient online submission • thorough peer review by experienced researchers in your field • rapid publication on acceptance • support for research data, including large and complex data types • gold Open Access which fosters wider collaboration and increased citations maximum visibility for your research: over 100M website views per year • At BMC, research is always in progress. Learn more biomedcentral.com/submissions Ready to submit your research Ready to submit your research ? Choose BMC

Herpes simplex virus pneumonia in an immunocompetent child on corticosteroids for acute wheezing. PediatrEmerg Care

Travel-associated neurological disease terminated in a postmortem diagnosed atypical HSV-1 encephalitis after high-dose steroid therapy-a case report

Infecties bij gebruik van glucocorticoïden

Dexamethasone in hospitalized patients with Covid-19-preliminary report

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations

None.

Authors' contributions PMH, SR, DDB designed the paper. All authors participated in drafting and reviewing. All authors read and approved the final manuscript.

None.

Not applicable.

Not applicable.

Not applicable.

The authors declare to have no competing interests.Received: 12 September 2020 Accepted: 16 October 2020