We read with great interest the recent article by Le Balc'h et al. who concluded that their results suggest that SARS-CoV-2 infection could be a risk factor for Herpesviridae reactivation [1]. We would like to make some comments. Glucocorticoid treatment increases the risk of opportunistic infection [2]. Infections that can arise during glucocorticoid use, and for which preventative measures can be taken, include reactivation of Herpesviridae that can lead to herpetic pneumonia [2]. In the study of Le Balc'h et al. [1], 44% of patients in the Herpesviridae reactivation group received corticosteroids, compared to only 20% of patients in the non-reactivation group. Although the difference did not reach statistical significance due to the low number of patients, the difference is still notable and may explain, at least in part, the difference in Herpesviridae reactivation between the groups. Herpesviridae reactivations occur easily after high-dose steroids and may lead to fatal disease [3]. Possible infectious complications as a result of Herpesviridae reactivations should be considered in patients who receive high-dose glucocorticoid treatment amounting to more than 420 mg of steroid over 4 weeks [4]. This is equal to a daily dose of 52.5 mg of prednisolone [4]. The dose of steroid and the duration of treatment are not reported in the Le Balc'h et al. study [1]. Given that a dose of 52.5 mg of prednisolone is equal to 8 mg of dexamethasone, the dose used in the RECOVERY trial (6 mg) [5] may not increase the risk of reactivation of Herpesviridae. However, perhaps even the regimen of 6 mg dexamethasone for 10 days that was used in the RECOVERY trial could result in Herpesviridae pulmonary reactivation when given in the context of prolonged mechanical ventilation and concomitant bacterial sepsis.
Acknowledgements
None.
Authors’ contributions
PMH, SR, DDB designed the paper. All authors participated in drafting and reviewing. All authors read and approved the final manuscript.
Funding
None.
Availability of data and materials
Not applicable.
Ethics approval and consent to participate
Not applicable.
Consent for publication
Not applicable.
Competing interests
The authors declare to have no competing interests.
Footnotes
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Contributor Information
Patrick M. Honore, Email: Patrick.Honore@CHU-Brugmann.be
Leonel Barreto Gutierrez, Email: Leonel.BarretoGutierrez@chu-brugmann.be.
Luc Kugener, Email: Luc.Kugener@CHU-Brugmann.be.
Sebastien Redant, Email: Sebastien.Redant@CHU-Brugmann.be.
Rachid Attou, Email: Rachid.Attou@CHU-Brugmann.be.
Andrea Gallerani, Email: Andrea.Gallerani@CHU-Brugmann.be.
David De Bels, Email: David.DeBels@CHU-Brugmann.be.
References
- 1.Le Balc'h P, Pinceaux K, Pronier C, Seguin P, Tadié JM, Reizine F. Herpes simplex virus and cytomegalovirus reactivations among severe COVID-19 patients. Crit Care. 2020;24(1):530. doi: 10.1186/s13054-020-03252-3. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Pines N, Tsabari R, Kerem E, Reiter J. Herpes simplex virus pneumonia in an immunocompetent child on corticosteroids for acute wheezing. PediatrEmerg Care. 2018 doi: 10.1097/PEC.0000000000001519. [DOI] [PubMed] [Google Scholar]
- 3.Osterman A, Ruf VC, Domingo C, et al. Travel-associated neurological disease terminated in a postmortem diagnosed atypical HSV-1 encephalitis after high-dose steroid therapy—a case report. BMC Infect Dis. 2020;20(1):150. doi: 10.1186/s12879-020-4859-5. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Minderhoud TC, van Meer MPA, van Thiel RJ, den Hoed CM, van Daele PLA, Schurink CAM. Infecties bij gebruik van glucocorticoïden [Infections during glucocorticoid use] Ned Tijdschr Geneeskd. 2018;162(37):D2215. [PubMed] [Google Scholar]
- 5.RECOVERY Collaborative Group Dexamethasone in hospitalized patients with Covid-19—preliminary report. N Engl J Med. 2020 doi: 10.1056/NEJMoa2021436. [DOI] [PMC free article] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
Not applicable.