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

We reviewed all virology results for patients admitted to Rennes University Hospital (Rennes, France) for COVID-19 ARDS between March 3, 2020, and April 15, 2020. SARS-CoV-2 infection was confirmed by polymerase chain reaction (PCR) . Patients mechanically ventilated longer than 7 days and who had negative PCR for herpes simplex virus (HSV) and cytomegalovirus (CMV) were included in the analysis. Herpes simplex virus and cytomegalovirus replication were measured by quantitative real-time PCR on tracheal aspirates twice a week for each patient. Herpesviridae reactivation was defined as two consecutive positive HSV or CMV PCR on tracheal aspirates. The Mann-Whitney rank sum test was used to compare non-parametric continuous variables, and qualitative data were compared using Fisher’s exact test. Statistical significance was defined as P < .05. PRISM version 8 (GraphPad Software, San Diego, CA, USA) was used to perform statistical analyses. A total of 38 patients were included. Table 1 shows the demographic, clinical, and biological characteristics of the included patients. The mean age was 59 years (interquartile range (IQR), 54–71), and 27 (71%) were male. Of these 38 patients, 18 (47%) presented at least one viral pulmonary reactivation. Nine patients had HSV reactivation alone, 2 presented CMV reactivation alone, and 7 had co-reactivation. Herpesviridae infection was diagnosed at a median of 9 days (IQR, 5–14). The median number of positive samples was 3 (IQR, 2–5). Patients with Herpesviridae reactivation had significantly longer duration of MV compared with patients without Herpesviridae reactivation. Table 2 shows outcomes of patients according to Herpesviridae reactivation status.