title: Herpes simplex virus type 1 and normal protein permeability in the lungs of critically ill patients: a case for low pathogenicity?
abstract: BACKGROUND
  The pathogenicity of late respiratory infections with herpes simplex virus type 1 (HSV-1) in the critically ill is unclear.
  
  
  METHODS
  In four critically ill patients with persistent pulmonary infiltrates of unknown origin and isolation of HSV-1 from tracheal aspirate or bronchoalveolar lavage fluid, at 7 (1-11) days after start of mechanical ventilatory support, a pulmonary leak index (PLI) for 67Gallium (67Ga)-transferrin (upper limit of normal 14.1 x 10(-3)/min) was measured.
  
  
  RESULTS
  The PLI ranged between 7.5 and 14.0 x 10(-3)/min in the study patients. Two patients received a course of acyclovir and all survived.
  
  
  CONCLUSIONS
  The normal capillary permeability observed in the lungs argues against pathogenicity of HSV-1 in the critically ill, and favors that isolation of the virus reflects reactivation in the course of serious illness and immunodepresssion, rather than primary or superimposed infection in the lungs.
authors.affiliation: Department of Intensive Care, Nuclear Medicine, Institute for Cardiovascular Research, Amsterdam, The Netherlands. j.verheij@vumc.nl
authors.forename: Joanne
authors.initials: J
authors.lastname: Verheij
authors.forename: A B Johan
authors.initials: AB
authors.lastname: Groeneveld
authors.forename: Albertus
authors.initials: A
authors.lastname: Beishuizen
authors.forename: Arthur
authors.initials: A
authors.lastname: van Lingen
authors.forename: Alberdina M
authors.initials: AM
authors.lastname: Simoons-Smit
authors.forename: Rob J M Strack
authors.initials: RJ
authors.lastname: van Schijndel
mesh_terms: D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use; D001992:Bronchoalveolar Lavage Fluid / Q000821:virology; D002199:Capillary Permeability; D016638:Critical Illness; D005260:Female; D005710:Gallium Radioisotopes / Q000493:pharmacokinetics; D018259:Herpesvirus 1, Human / Q000302:isolation & purification / Q000378:metabolism / Q000472:pathogenicity*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009942:Organometallic Compounds / Q000493:pharmacokinetics; D011024:Pneumonia, Viral / Q000097:blood / Q000821:virology*; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000097:blood / Q000821:virology; D014168:Transferrin / Q000493:pharmacokinetics; D014774:Virulence; D014775:Virus Activation
chemical_list: D000998:Antiviral Agents; D005710:Gallium Radioisotopes; D009942:Organometallic Compounds; D014168:Transferrin; C069724:gallium-transferrin complex