Dermatitis during Spaceflight Associated with HSV-1 Reactivation
Satish K. Mehta,
Moriah L. Szpara,
Bridgette V. Rooney,
Douglass M. Diak,
Mackenzie M. Shipley,
Daniel W. Renner,
Stephanie S. Krieger,
Mayra A. Nelman-Gonzalez,
Sara R. Zwart,
Scott M. Smith,
Brian E. Crucian
Affiliations
Satish K. Mehta
JES Tech, Human Health and Performance Directorate, Houston, TX 77058, USA
Moriah L. Szpara
Center for Infectious Disease Dynamics, Departments of Biology, Biochemistry and Molecular Biology, Huck Institute for the Life Sciences, Pennsylvania State University, University Park, PA 16802, USA
Bridgette V. Rooney
GeoControl Systems, Human Health and Performance Directorate, Houston, TX 77054, USA
Douglass M. Diak
Aegis Aerospace, Human Health and Performance Directorate, Houston, TX 77058, USA
Mackenzie M. Shipley
Center for Infectious Disease Dynamics, Departments of Biology, Biochemistry and Molecular Biology, Huck Institute for the Life Sciences, Pennsylvania State University, University Park, PA 16802, USA
Daniel W. Renner
Center for Infectious Disease Dynamics, Departments of Biology, Biochemistry and Molecular Biology, Huck Institute for the Life Sciences, Pennsylvania State University, University Park, PA 16802, USA
Stephanie S. Krieger
KBR, Human Health and Performance Directorate, Houston, TX 77058, USA
Mayra A. Nelman-Gonzalez
KBR, Human Health and Performance Directorate, Houston, TX 77058, USA
Sara R. Zwart
University of Texas Medical Branch, Preventive Medicine and Population Health, Galveston, TX 77555, USA
Scott M. Smith
National Aeronautics and Space Administration (NASA) Johnson Space Center, Human Health and Performance Directorate, Houston, TX 77058, USA
Brian E. Crucian
National Aeronautics and Space Administration (NASA) Johnson Space Center, Human Health and Performance Directorate, Houston, TX 77058, USA
Human alpha herpesviruses herpes simplex virus (HSV-1) and varicella zoster virus (VZV) establish latency in various cranial nerve ganglia and often reactivate in response to stress-associated immune system dysregulation. Reactivation of Epstein Barr virus (EBV), VZV, HSV-1, and cytomegalovirus (CMV) is typically asymptomatic during spaceflight, though live/infectious virus has been recovered and the shedding rate increases with mission duration. The risk of clinical disease, therefore, may increase for astronauts assigned to extended missions (>180 days). Here, we report, for the first time, a case of HSV-1 skin rash (dermatitis) occurring during long-duration spaceflight. The astronaut reported persistent dermatitis during flight, which was treated onboard with oral antihistamines and topical/oral steroids. No HSV-1 DNA was detected in 6-month pre-mission saliva samples, but on flight day 82, a saliva and rash swab both yielded 4.8 copies/ng DNA and 5.3 × 104 copies/ng DNA, respectively. Post-mission saliva samples continued to have a high infectious HSV-1 load (1.67 × 107 copies/ng DNA). HSV-1 from both rash and saliva samples had 99.9% genotype homology. Additional physiological monitoring, including stress biomarkers (cortisol, dehydroepiandrosterone (DHEA), and salivary amylase), immune markers (adaptive regulatory and inflammatory plasma cytokines), and biochemical profile markers, including vitamin/mineral status and bone metabolism, are also presented for this case. These data highlight an atypical presentation of HSV-1 during spaceflight and underscore the importance of viral screening during clinical evaluations of in-flight dermatitis to determine viral etiology and guide treatment.
