Herpes simplex virus type 1 and normal protein permeability in the lungs of critically ill patients: a case for low pathogenicity?
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.
Verheij
Joanne
J
Department of Intensive Care, Nuclear Medicine, Institute for Cardiovascular Research, Amsterdam, The Netherlands. j.verheij@vumc.nl
Groeneveld
A B Johan
AB
Beishuizen
Albertus
A
van Lingen
Arthur
A
Simoons-Smit
Alberdina M
AM
van Schijndel
Rob J M Strack
RJ
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
D000998:Antiviral Agents; D005710:Gallium Radioisotopes; D009942:Organometallic Compounds; D014168:Transferrin; C069724:gallium-transferrin complex