Severe varicella-zoster virus pneumonia: a multicenter cohort study

Adrien Mirouse Philippe Vignon 1, 2 Prescillia Piron René Robert 3 Laurent Papazian 4 Guillaume Geri 5 Pascal Blanc 6 Christophe Guitton 7, 8 Claude Guérin 9 Naiké Bigé 10, 11 Antoine Rabbat 12, 13 Aurelie Lefebvre Keyvan Razazi Muriel Fartoukh 14, 11 Eric Mariotte 15, 16 Lila Bouadma 17 Jean-Damien Ricard 17, 18 Amélie Seguin 19, 20, 11 Bertrand Souweine 21 Anne-Sophie Moreau 22 Stanislas Faguer 23, 24, 25 Arnaud Mari Julien Mayaux 26 Francis Schneider 27 Annabelle Stoclin Pierre Perez 28, 20, 11 Julien Maizel 29, 30 Charles Lafon Frederique Ganster 31 Laurent Argaud 32 Christophe Girault 33 François Barbier 34 Lucien Lecuyer 35 Jérôme Lambert Emmanuel Canet 36
4 URMITE - Unité de Recherche sur les Maladies Infectieuses Tropicales Emergentes
URMITE - Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes
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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Critical Care, BioMed Central, 2017, 21 (1), 〈10.1186/s13054-017-1731-0〉
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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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