key: cord-0766171-x3f1yyjk authors: Simonnet, Arthur; Engelmann, Ilka; Moreau, Anne-Sophie; Garcia, Bruno; Six, Sophie; Kalioubie, Ahmed El; Robriquet, Laurent; Hober, Didier; Jourdain, Mercé title: High incidence of Epstein-Barr virus, cytomegalovirus, and human-herpes virus-6 reactivations in critically-ill patients with Covid-19 date: 2021-01-18 journal: Infect Dis Now DOI: 10.1016/j.idnow.2021.01.005 sha: 2aea29b0902c1abcdb7929208f17c8928e5f0213 doc_id: 766171 cord_uid: x3f1yyjk BACKGROUND: Systemic reactivation of herpesviruses may occur in intensive care unit (ICU) patients and is associated with morbidity and mortality. Data on severe Coronavirus disease-19 (Covid-19) and concomitant reactivation of herpesviruses are lacking. METHODS: We selected patients admitted to ICU for confirmed Covid-19 who underwent systematic testing for Epstein-Barr virus (EBV), cytomegalovirus (CMV) and human-herpes virus-6 (HHV-6) DNAemia while in the ICU. We retrospectively analyzed frequency, timing, duration and co-occurrence of viral DNAemia. RESULTS:Thirty-four patients were included. Viremia with EBV, CMV, and HHV-6 was detected in 28 (82%), 5 (15%), and 7 (22%) patients, respectively. EBV reactivation occurred early after ICU admission and was associated with longer ICU length-of-stay. CONCLUSIONS: While in the ICU, critically-ill patients with Covid-19 are prone to develop reactivations due to various types of herpesviruses. Reactivation of herpesviruses is common in critically-ill patients, even in the absence of pre-existing immunodeficiency [1] [2] [3] [4] . Risk factors include prolonged invasive mechanical ventilation, intensive care unit (ICU) length-of-stay, severity of illness, and use of anti-inflammatory drugs [1] [2] [3] [4] . All of these conditions are frequently met in critically-ill patients with severe Coronavirus disease-19 (Covid-19). To date, there has been no report on concomitant reactivation of herpesviruses after severe acute respiratory syndrome -coronavirus 2 (SARS-Cov-2) infection. Our aims in this study were to report the incidences of Epstein-Barr virus (EBV), cytomegalovirus (CMV), and human-herpes virus-6 (HHV-6) viremia in critically-ill patients with Covid-19 and to assess their association with clinical outcome. In this monocentric retrospective study, we included all patients admitted for severe acute respiratory syndrome-coronavirus 2 (SARS-Cov-2) infection between March 16 th and August 6 th , 2020 in our 10-bed ICU (Unit C, Intensive Care Department, "Centre Hospitalier Universitaire de Lille", France). All patients were diagnosed with SARS-Cov-2 infection according to the World Health Organization criteria [5] . Nasopharyngeal and throat swab samples were obtained at admission from all patients, who were tested, as previously described [6] , using real-time reverse transcriptasepolymerase chain reaction assays to identify SARS-CoV-2 infection [6] . Blood EBV DNA, CMV DNA and occasionally HHV-6 DNA are routinely quantified in our ICU for patients considered at high risk of reactivation. Critically-ill patients with Covid-19 were hypothesized as belonging to this category, and were therefore monitored for EBV, CMV and HHV-6 reactivations until ICU discharge or death. EBV, CMV, and HHV6 DNA detections were performed with quantitative PCR in whole blood by using Reactivation of Multiple Viruses in Patients with Sepsis Epstein-Barr virus reactivation in critically ill immunocompetent patients Epidemiology of Multiple Herpes Viremia in Previously Immunocompetent Patients With Septic Shock Early herpes and TTV DNAemia in septic shock patients: a pilot study World Health Organization. Clinical management of COVID Clinical features of patients infected with 2019 novel coronavirus in Wuhan Epstein-Barr Virus Epidemiology, Serology, and Genetic Variability of LMP-1 Oncogene Among Healthy Population: An Update Epstein-Barr virus reactivation in sepsis due to community-acquired pneumonia is associated with increased morbidity and an immunosuppressed host transcriptomic endotype Cytomegalovirus Infection in Critically Ill Patients Cytomegalovirus Reactivation in Critically Ill Immunocompetent Patients Effect of Ganciclovir on IL-6 Levels Among Cytomegalovirus-Seropositive Adults With Critical Illness: A Randomized Clinical Trial Active cytomegalovirus infection is common in mechanically ventilated medical intensive care unit patients* The authors declare no conflict of interest This study received no funding.