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Severe varicella-zoster virus pneumonia: a multicenter cohort study

Adrien Mirouse 1 Philippe Vignon 2 Prescillia Piron 3 René Robert 4 Laurent Papazian 5 Guillaume Geri 6 Pascal Blanc 7 Christophe Guitton 8, 9 Claude Guérin 10 Naiké Bigé 11, 12 Antoine Rabbat 13, 14 Aurelie Lefebvre Keyvan Razazi Muriel Fartoukh 15, 12 Eric Mariotte 16, 17 Lila Bouadma 18 Jean-Damien Ricard 18, 19 Amélie Seguin 20, 21, 12 Bertrand Souweine 22 Anne-Sophie Moreau 23 Stanislas Faguer 24, 25, 26 Arnaud Mari Julien Mayaux 27 Francis Schneider 28 Annabelle Stoclin Pierre Perez 29, 21, 12 Julien Maizel 30, 31 Charles Lafon Frederique Ganster 32 Laurent Argaud 33 Christophe Girault 34 François Barbier 35 Lucien Lecuyer 36 Jérôme Lambert 3 Emmanuel Canet 1
Abstract : Background: Pneumonia is a dreaded complication of varicella-zoster virus (VZV) infection in adults; however, the data are limited. Our objective was to investigate the clinical features, management, and outcomes of critically ill patients with VZV-related community-acquired pneumonia (VZV-CAP). Methods: This was an observational study of patients with VZV-CAP admitted to 29 intensive care units (ICUs) from January 1996 to January 2015. Results: One hundred and two patients with VZV-CAP were included. Patients were young (age 39 years (interquartile range 32-51)) and 53 (52%) were immunocompromised. Time since respiratory symptom onset was 2 (1-3) days. There was a seasonal distribution of the disease, with more cases during spring and winter time. All but four patients presented with typical skin rash on ICU admission. Half the patients received mechanical ventilation within 1 (1-2) day following ICU admission (the ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FiO(2)) = 150 (80-284), 80% with acute respiratory distress syndrome (ARDS)). Sequential Organ Failure Assessment (SOFA) score on day 1 (odds ratio (OR) 1.90 (1.33-2.70); p < 0.001), oxygen flow at ICU admission (OR 1.25 (1.08-1.45); p = 0.004), and early bacterial co-infection (OR 14.94 (2.00-111.8); p = 0.009) were independently associated with the need for mechanical ventilation. Duration of mechanical ventilation was 14 (7-21) days. ICU and hospital mortality rates were 17% and 24%, respectively. All patients were treated with aciclovir and 10 received adjunctive therapy with steroids. Compared to 60 matched steroid-free controls, patients treated with steroids had a longer mechanical ventilation duration, ICU length of stay, and a similar hospital mortality, but experienced more ICU-acquired infections. Conclusions: Severe VZV-CAP is responsible for an acute pulmonary involvement associated with a significant morbidity and mortality. Steroid therapy did not influence mortality, but increased the risk of superinfection.
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Adrien Mirouse, Philippe Vignon, Prescillia Piron, René Robert, Laurent Papazian, et al.. Severe varicella-zoster virus pneumonia: a multicenter cohort study. Critical Care, BioMed Central, 2017, 21 (1), ⟨10.1186/s13054-017-1731-0⟩. ⟨hal-01573746⟩

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