Session Type: ePosters
Session Title: ePosters
Authors(s): E. Franceschini (1), E. Bacca (1), M. Menozzi (1), A. Santoro (1), G. Lancellotti (1), M. Meschiari (1), A. Bedini (1), G. Orlando (1), F. Carli (1), C. Puzzolante (1), W. Gennari (2), M. Pecorari (2), M. Digaetano (1), M. Sarti (2), G. Guaraldi (1), A. Cozzi-Lepri (3), C. Mussini (1)
Authors Affiliations(s): (1) Infectious disease clinic, AOU Modena, Italy, (2) microbiology, AOU Modena, Italy, (3) Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, United Kingdom
Background:
Herpesviridae co-infections in hospitalized patients with COVID-19 are considered relatively uncommon; some reports on skin herpetic lesions and pulmonary re-activations in patients in intensive care unit have recently been published. The aim of this analysis is to evaluate systematically plasmatic herpetic re-activations in hospitalized COVID-19 patients and their clinical relevance.
Methods:Prospective, observational, single-center study analyzing herpes virus 1 (HSV-1) re-activation and clinical manifestations in hospitalized COVID-19 patients, performing HSV-1 plasma PCR twice a week.
Results:| Characteristics | Positive N=21 | Negative N=49 |
p-value* | Total N=70 |
|---|---|---|---|---|
| Age, years, median (IQR) | 72 (66, 76) | 67 (52, 76) | 0.185 | 70 (58, 76) |
| Baseline Po2/Fo2 | 161 (104, 187) | 157 (79, 296) | 0.438 | 159 (80, 285) |
| SOFA Score | 2 (0,4) | 2 (0,4) | 0.730 | 2 (0, 4) |
| Follow-up, days | 7 (3, 24) | 14 (6, 27) | 0.170 | 13 (6, 25) |
| Intervention, n(%) |
| 0.027 | ||
| Tocilizumab subcutaneous | 3 (27.3%) | 5 (12.5%) | 8 (15.7%) | |
| Tocilizumab intravenous | 11 (52.4%) | 30 (61.2%) | 41 (58.6%) | |
| Standard of care | 7 (33.3%) | 13 (26.5%) | 20 (28.6%) | |
| Steroids | 16 (76.2%) | 24 (49.0%) | 0.036 | 40 (57.1%) |
| Events, n(%) | ||||
| Mechanical ventilation | 12 (57.1%) | 11 (22.4%) | 0.005 | 23 (32.9%) |
| Death - all | 6 (28.6%) | 9 (18.4%) | 0.344 | 15 (21.4%) |
Seventy patients out of 435 (16.1%) with severe COVID-19 pneumonia seen at Azienda Ospedaliero-Universitaria of Modena, were tested for HSV-1. Of these 70 patients, 21 (30.0%) showed detectable viremia and 13 (62%) had clinically relevant manifestations corresponding to 14 events (4 pneumonia, 5 herpes labialis, 3 herpetic gingivostomatitis and two hepatitis). Of these patients 10 (47.6) required treatment with acyclovir.
Table 1 shows key baseline factors by HSV-1 status. Regarding baseline biomarkers only LDH were higher in HSV-1 positive patients (831 vs 609, p 0.022). In the unadjusted logistic regression analysis, steroid treatment, mechanical ventilation, and higher LDH were associated with an increased risk of HSV-1 re-activation (odd ratio 3.33, p 0.040, OR 4.61, p 0.006 and OR 16.9, p 0.036 respectively). The association with use of steroids was even stronger after controlling for age and previous use of invasive mechanical ventilation (OR=4.64, 95% CI:1.17-18.32, p=0.03). Furthermore, there was no evidence to support an association between use of tocilizumab and risk of HSV-1 reactivation.
Conclusions:
Our study shows a high incidence of HSV-1 reactivation with an high percentage of clinical relevant manifestations in hospitalized patients with SARS-CoV-2 severe pneumonia, especially in those treated with steroids. Herpesviridae prophylaxis in this population should be evaluated.
Keyword(s): herpes virus 1, steroids, sars cov2Session Type: ePosters
Session Title: ePosters
Authors(s): E. Franceschini (1), E. Bacca (1), M. Menozzi (1), A. Santoro (1), G. Lancellotti (1), M. Meschiari (1), A. Bedini (1), G. Orlando (1), F. Carli (1), C. Puzzolante (1), W. Gennari (2), M. Pecorari (2), M. Digaetano (1), M. Sarti (2), G. Guaraldi (1), A. Cozzi-Lepri (3), C. Mussini (1)
Authors Affiliations(s): (1) Infectious disease clinic, AOU Modena, Italy, (2) microbiology, AOU Modena, Italy, (3) Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, United Kingdom
Background:
Herpesviridae co-infections in hospitalized patients with COVID-19 are considered relatively uncommon; some reports on skin herpetic lesions and pulmonary re-activations in patients in intensive care unit have recently been published. The aim of this analysis is to evaluate systematically plasmatic herpetic re-activations in hospitalized COVID-19 patients and their clinical relevance.
Methods:Prospective, observational, single-center study analyzing herpes virus 1 (HSV-1) re-activation and clinical manifestations in hospitalized COVID-19 patients, performing HSV-1 plasma PCR twice a week.
Results:| Characteristics | Positive N=21 | Negative N=49 |
p-value* | Total N=70 |
|---|---|---|---|---|
| Age, years, median (IQR) | 72 (66, 76) | 67 (52, 76) | 0.185 | 70 (58, 76) |
| Baseline Po2/Fo2 | 161 (104, 187) | 157 (79, 296) | 0.438 | 159 (80, 285) |
| SOFA Score | 2 (0,4) | 2 (0,4) | 0.730 | 2 (0, 4) |
| Follow-up, days | 7 (3, 24) | 14 (6, 27) | 0.170 | 13 (6, 25) |
| Intervention, n(%) |
| 0.027 | ||
| Tocilizumab subcutaneous | 3 (27.3%) | 5 (12.5%) | 8 (15.7%) | |
| Tocilizumab intravenous | 11 (52.4%) | 30 (61.2%) | 41 (58.6%) | |
| Standard of care | 7 (33.3%) | 13 (26.5%) | 20 (28.6%) | |
| Steroids | 16 (76.2%) | 24 (49.0%) | 0.036 | 40 (57.1%) |
| Events, n(%) | ||||
| Mechanical ventilation | 12 (57.1%) | 11 (22.4%) | 0.005 | 23 (32.9%) |
| Death - all | 6 (28.6%) | 9 (18.4%) | 0.344 | 15 (21.4%) |
Seventy patients out of 435 (16.1%) with severe COVID-19 pneumonia seen at Azienda Ospedaliero-Universitaria of Modena, were tested for HSV-1. Of these 70 patients, 21 (30.0%) showed detectable viremia and 13 (62%) had clinically relevant manifestations corresponding to 14 events (4 pneumonia, 5 herpes labialis, 3 herpetic gingivostomatitis and two hepatitis). Of these patients 10 (47.6) required treatment with acyclovir.
Table 1 shows key baseline factors by HSV-1 status. Regarding baseline biomarkers only LDH were higher in HSV-1 positive patients (831 vs 609, p 0.022). In the unadjusted logistic regression analysis, steroid treatment, mechanical ventilation, and higher LDH were associated with an increased risk of HSV-1 re-activation (odd ratio 3.33, p 0.040, OR 4.61, p 0.006 and OR 16.9, p 0.036 respectively). The association with use of steroids was even stronger after controlling for age and previous use of invasive mechanical ventilation (OR=4.64, 95% CI:1.17-18.32, p=0.03). Furthermore, there was no evidence to support an association between use of tocilizumab and risk of HSV-1 reactivation.
Conclusions:
Our study shows a high incidence of HSV-1 reactivation with an high percentage of clinical relevant manifestations in hospitalized patients with SARS-CoV-2 severe pneumonia, especially in those treated with steroids. Herpesviridae prophylaxis in this population should be evaluated.
Keyword(s): herpes virus 1, steroids, sars cov2
Infectious Disease Clinic, AOU Modena, Italy
Session Type: ePosters
Session Title: ePosters
Authors(s): E. Franceschini (1), E. Bacca (1), M. Menozzi (1), A. Santoro (1), G. Lancellotti (1), M. Meschiari (1), A. Bedini (1), G. Orlando (1), F. Carli (1), C. Puzzolante (1), W. Gennari (2), M. Pecorari (2), M. Digaetano (1), M. Sarti (2), G. Guaraldi (1), A. Cozzi-Lepri (3), C. Mussini (1)
Authors Affiliations(s): (1) Infectious disease clinic, AOU Modena, Italy, (2) microbiology, AOU Modena, Italy, (3) Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, United Kingdom
Background:
Herpesviridae co-infections in hospitalized patients with COVID-19 are considered relatively uncommon; some reports on skin herpetic lesions and pulmonary re-activations in patients in intensive care unit have recently been published. The aim of this analysis is to evaluate systematically plasmatic herpetic re-activations in hospitalized COVID-19 patients and their clinical relevance.
Methods:Prospective, observational, single-center study analyzing herpes virus 1 (HSV-1) re-activation and clinical manifestations in hospitalized COVID-19 patients, performing HSV-1 plasma PCR twice a week.
Results:| Characteristics | Positive N=21 | Negative N=49 |
p-value* | Total N=70 |
|---|---|---|---|---|
| Age, years, median (IQR) | 72 (66, 76) | 67 (52, 76) | 0.185 | 70 (58, 76) |
| Baseline Po2/Fo2 | 161 (104, 187) | 157 (79, 296) | 0.438 | 159 (80, 285) |
| SOFA Score | 2 (0,4) | 2 (0,4) | 0.730 | 2 (0, 4) |
| Follow-up, days | 7 (3, 24) | 14 (6, 27) | 0.170 | 13 (6, 25) |
| Intervention, n(%) |
| 0.027 | ||
| Tocilizumab subcutaneous | 3 (27.3%) | 5 (12.5%) | 8 (15.7%) | |
| Tocilizumab intravenous | 11 (52.4%) | 30 (61.2%) | 41 (58.6%) | |
| Standard of care | 7 (33.3%) | 13 (26.5%) | 20 (28.6%) | |
| Steroids | 16 (76.2%) | 24 (49.0%) | 0.036 | 40 (57.1%) |
| Events, n(%) | ||||
| Mechanical ventilation | 12 (57.1%) | 11 (22.4%) | 0.005 | 23 (32.9%) |
| Death - all | 6 (28.6%) | 9 (18.4%) | 0.344 | 15 (21.4%) |
Seventy patients out of 435 (16.1%) with severe COVID-19 pneumonia seen at Azienda Ospedaliero-Universitaria of Modena, were tested for HSV-1. Of these 70 patients, 21 (30.0%) showed detectable viremia and 13 (62%) had clinically relevant manifestations corresponding to 14 events (4 pneumonia, 5 herpes labialis, 3 herpetic gingivostomatitis and two hepatitis). Of these patients 10 (47.6) required treatment with acyclovir.
Table 1 shows key baseline factors by HSV-1 status. Regarding baseline biomarkers only LDH were higher in HSV-1 positive patients (831 vs 609, p 0.022). In the unadjusted logistic regression analysis, steroid treatment, mechanical ventilation, and higher LDH were associated with an increased risk of HSV-1 re-activation (odd ratio 3.33, p 0.040, OR 4.61, p 0.006 and OR 16.9, p 0.036 respectively). The association with use of steroids was even stronger after controlling for age and previous use of invasive mechanical ventilation (OR=4.64, 95% CI:1.17-18.32, p=0.03). Furthermore, there was no evidence to support an association between use of tocilizumab and risk of HSV-1 reactivation.
Conclusions:
Our study shows a high incidence of HSV-1 reactivation with an high percentage of clinical relevant manifestations in hospitalized patients with SARS-CoV-2 severe pneumonia, especially in those treated with steroids. Herpesviridae prophylaxis in this population should be evaluated.
Keyword(s): herpes virus 1, steroids, sars cov2Session Type: ePosters
Session Title: ePosters
Authors(s): E. Franceschini (1), E. Bacca (1), M. Menozzi (1), A. Santoro (1), G. Lancellotti (1), M. Meschiari (1), A. Bedini (1), G. Orlando (1), F. Carli (1), C. Puzzolante (1), W. Gennari (2), M. Pecorari (2), M. Digaetano (1), M. Sarti (2), G. Guaraldi (1), A. Cozzi-Lepri (3), C. Mussini (1)
Authors Affiliations(s): (1) Infectious disease clinic, AOU Modena, Italy, (2) microbiology, AOU Modena, Italy, (3) Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, United Kingdom
Background:
Herpesviridae co-infections in hospitalized patients with COVID-19 are considered relatively uncommon; some reports on skin herpetic lesions and pulmonary re-activations in patients in intensive care unit have recently been published. The aim of this analysis is to evaluate systematically plasmatic herpetic re-activations in hospitalized COVID-19 patients and their clinical relevance.
Methods:Prospective, observational, single-center study analyzing herpes virus 1 (HSV-1) re-activation and clinical manifestations in hospitalized COVID-19 patients, performing HSV-1 plasma PCR twice a week.
Results:| Characteristics | Positive N=21 | Negative N=49 |
p-value* | Total N=70 |
|---|---|---|---|---|
| Age, years, median (IQR) | 72 (66, 76) | 67 (52, 76) | 0.185 | 70 (58, 76) |
| Baseline Po2/Fo2 | 161 (104, 187) | 157 (79, 296) | 0.438 | 159 (80, 285) |
| SOFA Score | 2 (0,4) | 2 (0,4) | 0.730 | 2 (0, 4) |
| Follow-up, days | 7 (3, 24) | 14 (6, 27) | 0.170 | 13 (6, 25) |
| Intervention, n(%) |
| 0.027 | ||
| Tocilizumab subcutaneous | 3 (27.3%) | 5 (12.5%) | 8 (15.7%) | |
| Tocilizumab intravenous | 11 (52.4%) | 30 (61.2%) | 41 (58.6%) | |
| Standard of care | 7 (33.3%) | 13 (26.5%) | 20 (28.6%) | |
| Steroids | 16 (76.2%) | 24 (49.0%) | 0.036 | 40 (57.1%) |
| Events, n(%) | ||||
| Mechanical ventilation | 12 (57.1%) | 11 (22.4%) | 0.005 | 23 (32.9%) |
| Death - all | 6 (28.6%) | 9 (18.4%) | 0.344 | 15 (21.4%) |
Seventy patients out of 435 (16.1%) with severe COVID-19 pneumonia seen at Azienda Ospedaliero-Universitaria of Modena, were tested for HSV-1. Of these 70 patients, 21 (30.0%) showed detectable viremia and 13 (62%) had clinically relevant manifestations corresponding to 14 events (4 pneumonia, 5 herpes labialis, 3 herpetic gingivostomatitis and two hepatitis). Of these patients 10 (47.6) required treatment with acyclovir.
Table 1 shows key baseline factors by HSV-1 status. Regarding baseline biomarkers only LDH were higher in HSV-1 positive patients (831 vs 609, p 0.022). In the unadjusted logistic regression analysis, steroid treatment, mechanical ventilation, and higher LDH were associated with an increased risk of HSV-1 re-activation (odd ratio 3.33, p 0.040, OR 4.61, p 0.006 and OR 16.9, p 0.036 respectively). The association with use of steroids was even stronger after controlling for age and previous use of invasive mechanical ventilation (OR=4.64, 95% CI:1.17-18.32, p=0.03). Furthermore, there was no evidence to support an association between use of tocilizumab and risk of HSV-1 reactivation.
Conclusions:
Our study shows a high incidence of HSV-1 reactivation with an high percentage of clinical relevant manifestations in hospitalized patients with SARS-CoV-2 severe pneumonia, especially in those treated with steroids. Herpesviridae prophylaxis in this population should be evaluated.
Keyword(s): herpes virus 1, steroids, sars cov2