Herpes simplex type 2 pneumonia

Abstract

Extensive reviews of pulmonary infections in AIDS have reported few herpetic infections. Generally these infections are due to Herpes simplex type 1. Pneumonia due to herpes type 2 is extremely rare. We describe a 40 year-old HIV positive woman who complained of fever, cough and dyspnea for seven years. She had signs of heart failure and the appearance of her genital vesicles was highly suggestive of genital herpes. Echocardiography showed marked pulmonary hypertension, right ventricular hypertrophy and tricuspid insufficiency. After a few days of hospitalization she was treated with Aciclovir and later with Ganciclovir. An open pulmonary biopsy revealed an interstitial inflammation, localized in the alveolar walls. Some pulmonary arteries had widened walls and focal hyaline degeneration. Immunohistochemistry indicated that the nuclei had herpes simplex virus type 2 in many endothelial cells (including vessels with widened walls), macrophages in the alveolar septa and pneumocytes. There was clinical improvement after treatment for herpes. We concluded that as a consequence of herpes infection, endothelial involvement and interstitial inflammation supervene, with thickening of vascular walls and partial obliteration of the vessel lumen. A direct consequence of these changes in pulmonary vasculature was pulmonary hypertension followed by heart failure.

Herpes simplex virus type-1 pneumonitis in immunocompetent young woman

“…In contrast, HSV pneumonia, either type 1 or 2, is a rare occurrence and almost exclusively observed in immunocompromised hosts (eg, the elderly; bone marrow transplant recipients; and those with malnutrition, malignancy, burns, severe pulmonary disease, or human immunodeficiency virus infection). [1][2][3][4][5][6][7][8][9][10][11][12] HSV is a widespread pathogen isolated from nearly all visceral and mucocutaneous sites, recognized mostly in immunocompromised patients. HSV pneumonia is rare and usually manifests as an acute respiratory distress syndrome.…”

“…Viral culture is useful but may not distinguish a carrier from true infection in 1% to 5% of asymptomatic adults, whereas serology must reveal a 4-fold increase in titer from acute sera; otherwise, an antibody increase may be interpreted as equivocal, especially in recurrent infections. [1][2][3][4][5][6][7][8][9][10][11][12] In regard to transmission, HSV-1 is acquired through contact with oral secretions, gingivostomatitis in children, or recurrent labialis in older hosts. The organism is also involved in approximately 10% to 30% in herpes genitalis.…”

“…In contrast, HSV-2 is one of the well-known sexually transmitted disease causes, causing herpes genitalis, and at the same time may be recognized in 10% to 20% of cases in herpes labialis. [1][2][3][4][5][6][7][8][9][10][11][12] The pathogenesis of HSV pneumonia may follow a retrograde contiguous extension or aspiration of oral/lip infection, hematogenous spread from extragenital lesions or other sources, and reactivation of the original virus within vagal ganglia. The pathologic changes may be focal or diffuse ulceration of the tracheobronchial mucosa with or without necrotizing pneumonia in HSV-1 and interstitial pneumonitis and less tracheobronchial lesions in HSV-2 infection.…”

“…The pathologic changes may be focal or diffuse ulceration of the tracheobronchial mucosa with or without necrotizing pneumonia in HSV-1 and interstitial pneumonitis and less tracheobronchial lesions in HSV-2 infection. [1][2][3][4][5][6][7][8][9][10][11][12] In a series of 17 patients, radiographic imaging demonstrated bilateral lobar pneumonia in 12 cases, changes of air consolidation in 10 cases, and absent lung abnormality in 2 cases. 8 Typical changes of acute respiratory distress syndrome, as noted in our index patient, are also characteristic.…”

Pulmonary Manifestations of HIV Disease

“…The pneumonia may occur in association with cutaneous herpes and thus represent disseminated disease 239,240 . Varicella pneumonia has been described and may present as a recurrent pneumonia 241 .…”