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Occult herpes family viruses may increase mortality in critically ill surgical patients
C H Cook1, J K Yenchar, T O Kraner
1Ohio State University Department of Surgery, Columbus, USA.
Background:
Effects of cytomegalovirus (CMV) or herpes simplex virus (HSV) infection on surgical intensive care unit (SICU) patients' hospital outcome are unknown.
Methods:
Between July 1, 1994, and September 1, 1995, general SICU patients with persistent sepsis and no bacterial or fungal source identifiable had viral cultures obtained. Patients with positive broncho-alveolar lavage, blood, skin, or sputum cultures for CMV or HSV were studied.
Results:
Twenty eligible patients had positive viral cultures during the study period, and 85% of these patients developed subsequent bacterial and/or fungal infections. Mortality was significantly higher following viral infection than in chronic SICU patients (65% vs 35%, P <0.006). Patients with thrombocytopenia complicating their viral infection had significantly higher mortality than those without thrombocytopenia (92% vs 25%, P <0.004).
Conclusions:
At least 14% of critically ill surgical patients have occult infection or reactivation of herpes family viruses. These viruses have known immunosuppressive effects, which may predispose chronic SICU patients to subsequent bacterial and fungal infection, and subsequent organ system failure and death.