Herpes Simplex Virus Bronchopneumonitis in Patients Receiving Mechanical Ventilation in the Intensive Care Unit

Abstract

Detection of herpes simplex virus (HSV) in the upper and lower respiratory tracts has been well described. In the throat, the viral reactivation is probably because of the immunoparalysis observed in such patients and/or as a result of microtrauma. However, it is not known whether the isolation of HSV from lower respiratory tract samples of nonimmunocompromised ventilated patients corresponds to bronchial contamination from mouth and/or throat, local tracheobronchial excretion of HSV, or true HSV lung involvement (bronchopneumonitis) with its own morbidity and mortality.The frequency of HSV bronchopneumonitis is variable in the literature but seems to be a common manifestation. Its diagnosis remains difficult because of unspecific clinical, biologic, and radiologic symptoms. HSV bronchopneumonitis is defined as a clinical deterioration, associated with HSV in the lower respiratory tract and HSV-specific nuclear inclusions in the cells of the bronchioloalveolar compartment. Risk factors associated with HSV bronchopneumonitis are immunosuppression, multiorgan failure, surgery, oral-labial lesions, HSV in the throat and macroscopic bronchial lesions seen during bronchoscopy. HSV bronchopneumonitis seems to be associated with longer duration of mechanical ventilation and intensive care unit (ICU) stay, but the efficacy of a specific antiviral agent in this population remains to be determined.

Pulmonary Herpes Simplex Infection: A Case Report

“…It could be secondary to a critical disease and local microtrauma due to endotracheal and gastric tubes and oropharyngeal cavity suction. 2 It was postulated that the virus could enter the lower respiratory tract by aspiration or contiguous propagation after oropharynx reactivation, and spread may occur following orotracheal intubation. 3 HSV-pneumonia diagnosis is based on microscopic findings and characteristic cytopathic cellular changes in specimens obtained by bronchial brushing, bronchoalveolar lavage, or tissue biopsy, such as intranuclear inclusions or homogenization of nuclear chromatin.…”