Clinical utility not yet clear, but data promising
The investigators have demonstrated that reactivation of latent viral infections may well contribute to the death of critically ill septic patients. Some of the viral reactivations were associated with secondary fungal infection as well.
Although viral DNA was detected as early as 1 day into sepsis, the bulk of the manifested reactivations occurred over the subsequent 2 weeks. Viral reactivation is a clear marker that the "late" immune suppression of sepsis is a real phenomenon and leads to real sequelae.
Nevertheless, it is not yet clear exactly how this information will become useful in practice, as the cost of daily DNA screening for multiple viruses would be prohibitive, unless high-volume demand drives pricing down. One can see, under that scenario, how viral reactivation could be the signal that immune augmentation therapy is required, and that it might be beneficial. This work is not quite ready for prime time, but it is getting ever closer.
Dr. Steven Q. Simpson is professor of medicine University of Kansas, Kansas City. He is also founder of the Kansas Sepsis Project. He had no disclosures.
