Herpes simplex viral pneumonia after coronary artery bypass grafting

Abstract

We report a case of herpes simplex viral (HSV) pneumonia as a post-CABG pulmonary complication in a 70-year-old man. Chest radiography on postoperative day 9, showed a glass-like shadow and pleural effusion in the left lung field, and the man's condition began deteriorating rapidly. Bronchofiberscopy to detect the pathogen and a bronchoalveolar lavage with polymerase chain reaction (PCR) yielded a definitive diagnosis of HSV pneumonia. Once therapy with acyclovir was begun, his condition improved markedly. Our case suggests that 1 viral pulmonary infection should be considered as a possible cause in postoperative cardiac patients with unexplained progressive pulmonary infiltrates, and 2 DNA amplification using PCR is rapid--it can be completed within 1 day--and sensitive and specific in diagnosing such infections.

Viral infections in the ICU

“…To date, HSV bronchopneumonitis has mostly been described in patients taking immunosuppressants [20,21], with ARDS [22], after surgery [23][24][25][26], or burn victims [27,28]. It was recently demonstrated that HSV bronchopneumonitis was frequently detected among nonimmunocompromised patients with prolonged mechanical ventilation; in our monocentric study, we found that out of 201 patients suspected of having ventilatorassociated pneumonia (VAP), 42 (21%) were diagnosed with HSV bronchopneumonitis.…”

Herpes simplex virus pneumonia following mitral valve replacement

“…Recently, the polymerase chain reaction (PCR) has been utilized, providing a faster (i.e., approximately 24 h) diagnostic technique with high sensitivity and specifi city. 4,5,14 In the near future, PCR may become the gold standard used to diagnose HSV pneumonia.…”

“…1,2 However, clinical reports of HSV pneumonia after cardiac surgery are rare. [3][4][5] We report a patient who was diagnosed with HSV pneumonia and successfully treated with acyclovir during the postoperative period of mitral valve replacement (MVR).…”

What role do viruses play in nosocomial pneumonia?

“…In that study, reactivation was asymptomatic in 56% of the patients, but associated with herpetic labial ulceration or gingivostomatitis in 48 (44%) of 109 patients with oropharyngeal viral reactivation. HSV bronchopneumonitis was initially described in immunocompromised patients [28,29], but other data showed that it can occur in nonimmunosuppressed patients with acute respiratory distress syndrome (ARDS) [13], after surgery [9,14,30,31] or in burn victims [10,32]. However, HSV detection in the lower airways does not mean viral pulmonary parenchymal disease; HSV detection might reflect airway contamination by saliva, tracheobronchial reactivation without parenchymal involvement or true HSV bronchopneumonitis [8,27].…”