image: The data show the rate of viral conversion for septic patients whose blood or plasma initially tested negative for virus and who subsequently became positive during the course of their sepsis. The time is in days after patients met the criteria for a diagnosis of sepsis. Of the septic patients, overall 24 percent were positive for CMV, 53 percent for EBV, 14 percent for HSV, 10 percent for HHV-6 and 78 percent for TTV. Abbreviations: Cytomegalovirus, CMV; Epstein-Barr virus, EBV; HSV, herpes simplex viruses 1 and 2; HHV-6, human herpes virus 6; Torque teno virus, TTV. view more
Credit: Citation: Walton AH, Muenzer JT, Rasche D, Boomer JS, Sato B, et al. (2014) Reactivation of Multiple Viruses in Patients with Sepsis. PLoS ONE 9(6): e98819. doi:10.1371/journal.pone.0098819
A new study finds that late-stage sepsis, a leading cause of death in hospitals, is linked to prolonged episodes of infection with reactivation of otherwise-dormant viruses in the body. The research, published June 11 in the open access journal PLOS ONE by Richard S. Hotchkiss and colleagues from the Washington University School of Medicine in St. Louis, suggests that drugs that "rev up" the immune system could be incorporated into the treatment of late-stage sepsis.
In healthy people, latent viruses are kept in check by the immune system. Sepsis develops when the body mounts a massive immune response to infection, triggering excessive inflammation that can lead quickly to organ failure. This study provides strong evidence that when sepsis lingers for more than a few days, as is common, viruses re-emerge and enter the bloodstream, signaling that the immune system has become suppressed, and leaving patients unable to fight off secondary infections.
In the current study, the authors used polymerase chain reaction (PCR) testing to detect a range of viruses in blood and urine samples from critically ill patients with sepsis. As a comparison, they performed the same test on critically ill patients in the hospital who did not have sepsis and healthy patients who were having outpatient surgery.
Researchers noted that 43 percent of sepsis patients who were tested for some viruses had two or more viruses detected in their blood or urine during their hospital stays, and in a subgroup of patients tested for all viruses, 54 percent were positive for two or more. The authors also found that septic patients with higher levels of viruses in their blood were more likely to have severe illnesses, secondary fungal and bacterial infections, and longer stays in the intensive care unit.
"We stumbled onto more viruses than we expected, and we don't know yet whether some of these viruses are causing problems in their own right," co-author Gregory Storch, MD, said. "We think this paper will stimulate others to carry out further investigations of the role of latent viruses in sepsis."
The authors hope that, in addition to using powerful antibiotics to fight off infections in patients with sepsis, immunotherapy drugs that boost the immune system may be an effective therapy.
All works published in PLOS ONE are Open Access, which means that everything is immediately and freely available. Use this URL in your coverage to provide readers access to the paper upon publication: http://dx.plos.org/10.1371/journal.pone.0098819
Citation: Walton AH, Muenzer JT, Rasche D, Boomer JS, Sato B, et al. (2014) Reactivation of Multiple Viruses in Patients with Sepsis. PLoS ONE 9(6): e98819. doi:10.1371/journal.pone.0098819
Funding: This work received financial support from the following National Institutes of Health grants: GM 441181, GM 55194, GM09839, AI101530, and HL 104985. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing Interests: Dr. Alexandre Pachot is an employee of Biomérieux. Biomérieux is trying to develop a method to follow the levels of various viruses in patient blood as an indicator of their immune status. Biomérieux provided no funding for the study and had no impact on writing up the study. This does not alter the authors' adherence to PLOS ONE policies on sharing data and materials.
Journal
PLOS ONE