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Review
. 2021 Feb 23:8:575580.
doi: 10.3389/fmed.2021.575580. eCollection 2021.

Update in Viral Infections in the Intensive Care Unit

Paraskevi C Fragkou  1 , Charalampos D Moschopoulos  1 , Emmanouil Karofylakis  1 , Theodoros Kelesidis  2 , Sotirios Tsiodras  1
Affiliations
Review

Update in Viral Infections in the Intensive Care Unit

Paraskevi C Fragkou et al. Front Med (Lausanne). .

Abstract

The advent of highly sensitive molecular diagnostic techniques has improved our ability to detect viral pathogens leading to severe and often fatal infections that require admission to the Intensive Care Unit (ICU). Viral infections in the ICU have pleomorphic clinical presentations including pneumonia, acute respiratory distress syndrome, respiratory failure, central or peripheral nervous system manifestations, and viral-induced shock. Besides de novo infections, certain viruses fall into latency and can be reactivated in both immunosuppressed and immunocompetent critically ill patients. Depending on the viral strain, transmission occurs either directly through contact with infectious materials and large droplets, or indirectly through suspended air particles (airborne transmission of droplet nuclei). Many viruses can efficiently spread within hospital environment leading to in-hospital outbreaks, sometimes with high rates of mortality and morbidity, thus infection control measures are of paramount importance. Despite the advances in detecting viral pathogens, limited progress has been made in antiviral treatments, contributing to unexpectedly high rates of unfavorable outcomes. Herein, we review the most updated data on epidemiology, common clinical features, diagnosis, pathogenesis, treatment and prevention of severe community- and hospital-acquired viral infections in the ICU settings.

Keywords: critical care; critically ill; intensive care unit; neurologic syndrome; reactivation; respiratory tract infection; shock; viral infections.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Global distribution of viruses causing critical illness divided in the 6 World Health Organization (WHO) Regions. Viruses that are restricted in specific WHO regions are grouped together, and different colors are attributed to each region. Viruses that share a worldwide distribution are grouped in the magenta colored box.
Figure 2
Figure 2
Host factors associated with severe viral infections. Multiple host conditions produce a dysregulated immune state that posits the host in risk of developing a serious viral infection. These factors affect both innate and adaptive immune mechanisms in various ways, the most significant of whom are illustrated here.
See this image and copyright information in PMC

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References

    1. Piralla A, Rovida F, Girello A, Premoli M, Mojoli F, Belliato M, et al. . Frequency of respiratory virus infections and next-generation analysis of influenza A/H1N1pdm09 dynamics in the lower respiratory tract of patients admitted to the ICU. PLoS ONE. (2017) 12:e0178926. 10.1371/journal.pone.0178926 - DOI - PMC - PubMed
    1. Cameron RJ, De Wit D, Welsh TN, Ferguson J, Grissell TV, Rye PJ. Virus infection in exacerbations of chronic obstructive pulmonary disease requiring ventilation. Intensive Care Med. (2006) 32:1022–9. 10.1007/s00134-006-0202-x - DOI - PMC - PubMed
    1. Kelesidis T, Mastoris I, Metsini A, Tsiodras S. How to approach and treat viral infections in ICU patients. BMC Infect Dis. (2014) 14:321. 10.1186/1471-2334-14-321 - DOI - PMC - PubMed
    1. Nguyen C, Kaku S, Tutera D, Kuschner WG, Barr J. Viral respiratory infections of adults in the intensive care unit. J Intensive Care Med. (2016) 31:427–41. 10.1177/0885066615585944 - DOI - PubMed
    1. Schnell D, Gits-Muselli M, Canet E, Lemiale V, Schlemmer B, Simon F, et al. . Burden of respiratory viruses in patients with acute respiratory failure. J Med Virol. (2014) 86:1198–202. 10.1002/jmv.23760 - DOI - PMC - PubMed