Roe Thomas, Waddy Sam, Nikitas Nikitas
University Hospitals Plymouth NHS Trust, Plymouth, Devon, United Kingdom.
J Crit Care Med (Targu Mures). 2023 May 8;9(2):122-128. doi: 10.2478/jccm-2023-0010. eCollection 2023 Apr.
The immunological response to the SARS-CoV-2 virus and the treatment of COVID-19 disease present a potential susceptibility to viral reactivation, particularly Herpes simplex virus-1 (HSV-1).
A 49-year-old female presented to hospital with severe COVID-19 pneumonitis and was given sarilumab and dexamethasone. She was intubated and ventilated in the intensive care unit (ICU) and initially demonstrated biochemical and clinical evidence of improvement. This was followed by a severe acute deterioration in respiratory, renal, and cardiovascular function, accompanied by a vesicular rash on the face. Polymerase chain reaction confirmed HSV-1 reactivation and treatment with acyclovir was commenced. After 49 days in ICU the patient was successfully weaned from all organ support, and she made a satisfactory recovery.
HSV-1 reactivation is common in COVID-19 and likely contributes to poorer clinical outcomes. The mechanism causing susceptibility to viral reactivation is not clearly defined, however, the development of critical illness induced immunosuppression via dysfunction of interferon and interleukin pathways is a likely mechanism. This effect could be perpetuated with immunosuppressant medications, although further research is needed to characterise this phenomenon.
对严重急性呼吸综合征冠状病毒2（SARS-CoV-2）病毒的免疫反应以及冠状病毒病（COVID-19）的治疗存在病毒再激活的潜在易感性，尤其是单纯疱疹病毒1型（HSV-1）。
一名49岁女性因严重的COVID-19肺炎入院，接受了萨瑞鲁单抗和地塞米松治疗。她在重症监护病房（ICU）接受插管和通气治疗，最初表现出生化和临床改善的迹象。随后出现呼吸、肾脏和心血管功能严重急性恶化，并伴有面部水疱疹。聚合酶链反应证实HSV-1再激活，开始使用阿昔洛韦治疗。在ICU治疗49天后，患者成功撤掉所有器官支持，恢复情况良好。
HSV-1再激活在COVID-19中很常见，可能导致较差的临床结果。导致病毒再激活易感性的机制尚不清楚，然而，通过干扰素和白细胞介素途径功能障碍引起的危重病诱导免疫抑制是一种可能的机制。免疫抑制药物可能会使这种效应持续存在，尽管需要进一步研究来描述这一现象。
