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All 25 patients were HSV seropositive; viral isolation in bronchial aspirate showed reactivation of HSV in 8 (32%) patients, thereby showing for the first time that HSV and CMV reactivation were associated (p = 0.
CMV reactivation developed in one third of our patients within 2 weeks of onset of septic shock, as has been found in studies using a similar prospective study design (3,11).
We hypothesize that upon CMV reactivation, patients with septic shock could mount a protective antiviral immune response, which was different from the immune response of most patients after transplantations (19); however, this hypothesis remains to be confirmed.
Association of tumor necrosis factor and pulmonary immunopathologic features of active CMV infection was recently confirmed in a mouse model showing murine CMV reactivation after cecal ligation and puncture (9).
In the mouse model of CMV reactivation, the causality between sepsis, CMV reactivation, and pulmonary disease has already been shown (9).
The effect of preemptive antiviral therapy or antiviral prophylaxis has not been tested so far in patients with septic shock; however, in the mouse model, prophylactic treatment with ganciclovir prevented murine CMV reactivation and CMV-associated pulmonary fibrosis (9).
Evaluation by polymerase chain reaction of cytomegalovirus reactivation in intensive care patients under mechanical ventilation.
Reactivation of human herpesvirus type 6 in multiple organ failure syndrome.
Selective reactivation of human herpesvirus 6 variant a occurs in critically ill immunocompetent hosts.