Herpes simplex virus (HSV) pneumonia in the non-ventilated immunocompromised host: Burden and predictors

Luzzati, Roberto; D’Agaro, Pierlanfranco; Busca, Annalisa; Maurel, Cristina; Martellani, F.; Rosin, Chiara; Segat, Ludovica; Gatti, Giuseppe; Mascarello, Marta; Confalonieri, Marco

doi:10.1016/j.jinf.2018.09.010

Cited by 13 publications

(6 citation statements)

References 24 publications

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“…Mortality approached to 25% in these cases. Another study evaluating patients with viral pneumonia highlight that HSV1-DNA was detected in 32% of the cases, but no difference in terms of mortality could be detected after treatment with acyclovir, making rather questionable the role of HSV in these cases [40,41].…”

Section: Other Viral Etiologies Of Viral Pneumoniamentioning

confidence: 99%

Characteristics of viral pneumonia in the COVID-19 era: an update

et al. 2021

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Influenza virus, rhinovirus, and adenovirus frequently cause viral pneumonia, an important cause of morbidity and mortality especially in the extreme ages of life. During the last two decades, three outbreaks of coronavirus-associated pneumonia, namely Severe Acute Respiratory Syndrome, Middle-East Respiratory Syndrome, and the ongoing Coronavirus Infectious Disease—2019 (COVID-19) were reported. The rate of diagnosis of viral pneumonia is increasingly approaching 60% among children identified as having community-acquired pneumonia (CAP). Clinical presentation ranges from mild to severe pneumonitis complicated by respiratory failure in severe cases. The most vulnerable patients, the elderly and those living with cancer, report a relevant mortality rate. No clinical characteristics can be useful to conclusively distinguish the different etiology of viral pneumonia. However, accessory symptoms, such as anosmia or ageusia together with respiratory symptoms suggest COVID-19. An etiologic-based treatment of viral pneumonia is possible in a small percentage of cases only. Neuraminidase inhibitors have been proven to reduce the need for ventilatory support and mortality rate while only a few data support the large-scale use of other antivirals. A low-middle dose of dexamethasone and heparin seems to be effective in COVID-19 patients, but data regarding their possible efficacy in viral pneumonia caused by other viruses are conflicting. In conclusion, viral pneumonia is a relevant cause of CAP, whose interest is increasing due to the current COVID-19 outbreak. To set up a therapeutic approach is difficult because of the low number of active molecules and the conflicting data bearing supportive treatments such as steroids.

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Section: Other Viral Etiologies Of Viral Pneumoniamentioning

confidence: 99%

Characteristics of viral pneumonia in the COVID-19 era: an update

et al. 2021

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“…The prognosis of herpetic pneumonia is poor [2], so that the prevention should be of essential importance. Oropharyngeal HSV infection has been confirmed as a risk factor for HSV pneumonia in large cohorts [7, 10]. One of the serious problems in the present case was that the medical staff did not recognize the painful oropharyngeal lesions of the aged patient in a poor performance status.…”

Section: Discussionmentioning

confidence: 73%

Herpes Simplex Virus Pneumonia: Importance of Aspiration Etiology

Odani

Tachibana

Tamashima

et al. 2019

Case Reports in Pathology

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Herpes simplex virus (HSV) pneumonia caused by aspiration from the oropharyngeal exudates is described. An 89-year-old Japanese male in a poor performance state complained of appetite loss followed by difficulty in swallowing, and bilateral pulmonary infiltrates with interstitial reactions were radiologically pointed out. Antibiotics administration was ineffective, and he died on the 6th day of hospitalization. At autopsy, HSV-induced multiple mucosal erosions were observed on the tongue, pharynx, epiglottis, and trachea. In bilateral lower lobes of the lung, HSV infected bronchiolar and type-II alveolar cells in association with acute interstitial reactions. The infected cells with intranuclear inclusion bodies were immunoreactive with HSV antiserum. HSV-1 infection was confirmed by immunostaining with monospecific monoclonal antibodies and by type-specific real-time polymerase chain reaction. It is very likely that HSV pneumonia was provoked by aspiration of infected exudates from the upper airway (namely, sequential infection from the tongue, epiglottis, and trachea to lung). Oropharyngeal herpes might cause anorexia and difficulty in swallowing, probably accelerating aspiration. The medical staff did not recognize the oropharyngeal lesions of this aged patient. We must realize again the importance of oral care for hospitalized patients to avoid aspiration pneumonia, including herpetic pneumonia.

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“…Third, we had limited data about concomitant HSV-1-DNA counts in blood (mostly searched in patients with positive HSV-1-DNA on BALF), that precluded an assessment of their potential impact on mortality in our cohort. Fourth, it should be necessarily noted that no defined criteria currently exist for diagnosing HSV pneumonia in the absence of histopathological confirmation, which was unavailable in our study [21]. From this standpoint, we must recognize that our choice of the quantitative cut-off for HSV-1 reactivation was arbitrary, although motivated by the concomitant presence of a consistent clinical picture, and also that higher other cut-offs have been previously proposed in non-COVID-19 patients [9,22,23].…”

Section: Discussionmentioning

confidence: 95%

Reactivation of Herpes Simplex Virus Type 1 (HSV-1) Detected on Bronchoalveolar Lavage Fluid (BALF) Samples in Critically Ill COVID-19 Patients Undergoing Invasive Mechanical Ventilation: Preliminary Results from Two Italian Centers

et al. 2022

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Reactivation of herpes simplex virus type 1 (HSV-1) has been described in critically ill patients with coronavirus disease 2019 (COVID-19) pneumonia. In the present two-center retrospective experience, we primarily aimed to assess the cumulative risk of HSV-1 reactivation detected on bronchoalveolar fluid (BALF) samples in invasively ventilated COVID-19 patients with worsening respiratory function. The secondary objectives were the identification of predictors for HSV-1 reactivation and the assessment of its possible prognostic impact. Overall, 41 patients met the study inclusion criteria, and 12/41 patients developed HSV-1 reactivation (29%). No independent predictors of HSV-1 reactivation were identified in the present study. No association was found between HSV-1 reactivation and mortality. Eleven out of 12 patients with HSV-1 reactivation received antiviral therapy with intravenous acyclovir. In conclusion, HSV-1 reactivation is frequently detected in intubated patients with COVID-19. An antiviral treatment in COVID-19 patients with HSV-1 reactivation and worsening respiratory function might be considered.

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Herpes simplex virus (HSV) pneumonia in the non-ventilated immunocompromised host: Burden and predictors

Cited by 13 publications

References 24 publications

Characteristics of viral pneumonia in the COVID-19 era: an update

Characteristics of viral pneumonia in the COVID-19 era: an update

Herpes Simplex Virus Pneumonia: Importance of Aspiration Etiology

Reactivation of Herpes Simplex Virus Type 1 (HSV-1) Detected on Bronchoalveolar Lavage Fluid (BALF) Samples in Critically Ill COVID-19 Patients Undergoing Invasive Mechanical Ventilation: Preliminary Results from Two Italian Centers

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