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Article Dans Une Revue Critical Care Année : 2017

Severe varicella-zoster virus pneumonia: a multicenter cohort study

1 Service de Réanimation Médicale, Hôpital Saint Louis, Paris, France
2 Service de Réanimation Polyvalente [CHU Limoges]
3 SBIM - Service de biostatistique et information médicale de l’hôpital Saint Louis (Equipe ECSTRA)
4 Service de Réanimation, Hôpital Jean Bernard, CHU de Poitiers, Poitiers, France
5 DRIS - Service de réanimation-Détresses Respiratoires et Infections Sévères [Hôpital Nord - APHM]
6 Service de réanimation médicale polyvalente [CHU Cochin]
7 Service de Réanimation
8 U1064 Inserm - CRTI - Centre de Recherche en Transplantation et Immunologie
9 CHU Nantes - Centre Hospitalier Universitaire de Nantes
10 Service de Réanimation Médicale, Groupement Hospitalier Nord, Hospices Civils de Lyon, Lyon, France
11 CHU Saint-Antoine [AP-HP]
12 UPMC - Université Pierre et Marie Curie - Paris 6
13 UMR_S567 / UMR 8104 - Institut Cochin
14 Service de Pneumologie – Réanimation Médicale
15 CHU Tenon [AP-HP]
16 Hémostase et biologie vasculaire
17 Service de réanimation médicale
18 IAME (UMR_S_1137 / U1137) - Infection, Anti-microbiens, Modélisation, Evolution
19 Service de Réanimation Médico-Chirurgicale [Hôpital Louis Mourier]
20 Service de réanimation médicale [CHU Caen]
21 CHU Gabriel Montpied [Clermont-Ferrand]
22 EPFL - Ecole Polytechnique Fédérale de Lausanne
23 Département de Néphrologie et Transplantation d'organes [CHU Toulouse]
24 SODARE - Centre de Référence du sud-Ouest des maladies rénales rares [CHU Toulouse]
25 I2MC - Institut des Maladies Métaboliques et Cardiovasculaires
26 CHU Pitié-Salpêtrière [AP-HP]
27 Service de Réanimation Médicale [Strasbourg]
28 CHRU Nancy - Centre Hospitalier Régional Universitaire de Nancy
29 Unité Médicale de Soins Intensifs
30 Mécanismes physiologiques et conséquences des calcifications cardiovasculaires: rôle des remodelages cardiovasculaires et osseux
31 CH E.Muller Mulhouse - Centre Hospitalier Emile Muller [Mulhouse]
32 Hôpital Edouard Herriot [CHU - HCL]
33 CHU Rouen
34 IRHS - Institut de Recherche en Horticulture et Semences
35 Service de biostatistiques et information médicale [Saint-Louis]
Aurelie Lefebvre
  • Fonction : Auteur
Keyvan Razazi
  • Fonction : Auteur
Arnaud Mari
  • Fonction : Auteur
Annabelle Stoclin
  • Fonction : Auteur
Charles Lafon
  • Fonction : Auteur
Christophe Girault
  • Fonction : Auteur

Résumé

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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Dates et versions

hal-01573746 , version 1 (07-05-2018)

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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, 2017, 21 (1), ⟨10.1186/s13054-017-1731-0⟩. ⟨hal-01573746⟩
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