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Sepsis can reactivate dormant viruses
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Late-stage sepsis can trigger the reactivation of latent viruses, researchers from the Washington University School of Medicine in St. Louis have found.
“Patients with protracted sepsis may enter a state of immunosuppression, during which reactivation of multiple latent viruses occur, some of which may be contributing to organ failure,” study researcher Richard S. Hotchkiss, MD, told Infectious Disease News. “This remains to be determined. Most importantly, these results help support the rationale behind ongoing studies of immunotherapeutic agents which boost host immunity in patients with protracted sepsis who are determined to be immunosuppressed.”
Hotchkiss and colleagues used a rapid PCR assay to detect the reactivation of herpesviruses, polyomaviruses and torque teno virus (TTV) in 560 critically ill patients with sepsis. The same analysis was performed on 161 non-septic critically ill patients and 164 healthy patients undergoing outpatient surgery.
The researchers analyzed whole blood and plasma samples for cytomegalovirus (CMV), Epstein-Barr virus (EBV), herpes simplex virus, human herpes virus-6 (HHV-6) and TTV.
Overall detection rates were 24.2% for CMV, 53.2% for EBV, 14.1% for HSV, 10.4% for HHV-6 and 77.5% for TTV.
Figure 1. Data indicate the rate of viral conversion for patients with sepsis whose blood or plasma initially tested negative for virus and who subsequently became positive during the course of their sepsis. The time is in days after patients met the criteria for a diagnosis of sepsis. Of the patients with sepsis, 24% were positive for CMV, 53% for EBV, 14% for HSV, 10% for HHV-6 and 78% for TTV.
Source: PLOS ONE.
Patients with sepsis had an elevated frequency of detectable viruses; 42.7% had two or more viruses identified during their illness. The researchers said they believe that this is an underestimation because not all patients with sepsis were tested for every virus. In those who were, 54.1% tested positive for multiple viruses. Patients with sepsis also had elevated viral loads (>10,000 DNA copies/mL blood) for CMV, EBV and HSV.
Detectable viruses were generally uncommon in non-septic critically-ill patients and healthy controls, with the exception of TTV.
According to the researchers, septic patients with multiple viruses detected during their illness were more likely to have secondary bacterial and fungal infections, longer stays in the ICU and experience severe illness.
It is unclear whether the reactivation of dormant viruses contributes to morbidity and mortality in sepsis, the researchers said.
“We stumbled onto more viruses than we expected, and we don’t know yet whether some of these viruses are causing problems in their own right,” study researcher Gregory Storch, MD, said in a press release. “We think this paper will stimulate others to carry out further investigations of the role of latent viruses in sepsis.” — John Schoen
Disclosure: One of the researchers is an employee of bioMérieux, a company that is developing a method to determine a patient’s immune status by monitoring levels of viruses in blood. The company provided no funding for the study.
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