Impact and Occurrence of Herpesvirus and Aspergillosis Superinfection in Patients with Severe COVID-19 Pneumonia

Abstract

Background: Pulmonary superinfections with Herpesviridae and Aspergillus spp. are common in severe coronavirus disease 2019 (COVID-19) pneumonia but their epidemiology and impact remain poorly understood. Methods: We conducted a retrospective observational study of 61 mechanically ventilated COVID-19 patients at Deventer Hospital’s ICU (2020–2021) who underwent bronchoalveolar lavage (BL) due to clinical deterioration. We analyzed blood and respiratory samples, treatment, and clinical outcomes. Results: Among 61 mechanically ventilated COVID-19 patients who underwent BL, 34 (55.7%) had superinfections, with 18 having COVID-19-associated pulmonary aspergillosis (CAPA), 7 having herpes simplex virus (HSV) infection, and 9 having both. Patients with HSV had later diagnoses (median 14 vs. 8 days, p = 0.014), longer mechanical ventilation (median 47 vs. 18.5 days, p = 0.015), and longer ICU stays (median 74 vs. 24 days, p = 0.021) compared to CAPA patients. At baseline, laboratory parameters and treatment (dexamethasone or tocilizumab) showed no significant association with superinfections. Mortality did not differ significantly among groups. Conclusion: In mechanically ventilated COVID-19 patients undergoing bronchoalveolar lavage, HSV reactivation occurred later in the course of illness and was associated with longer mechanical ventilation and ICU stays compared to CAPA. Baseline parameters did not predict superinfections.

Keywords

• herpes simplex virus
• COVID-19 superinfection
• CAPA