Herpes simplex virus lung infection in patients undergoing prolonged mechanical ventilation.
BACKGROUND
It is not known whether the isolation of herpes simplex virus (HSV) from lower respiratory tract samples of nonimmunocompromised ventilated patients corresponds to bronchial contamination from the mouth and/or throat, local tracheobronchial excretion of HSV, or true HSV lung involvement (bronchopneumonitis) with its own morbidity/mortality.


OBJECTIVE
This prospective, single-center, observational study was conducted to define the frequency, risk factors, and relevance of HSV bronchopneumonitis.


METHODS
All consecutive nonimmunocompromised patients receiving mechanical ventilation for 5 days or more were evaluated. Bronchoalveolar lavage, oropharyngeal swabs, and bronchial biopsies (presence of macroscopic bronchial lesions) were obtained for all who deteriorated clinically with suspected lung infection. HSV bronchopneumonitis was defined as this deterioration, associated with HSV in bronchoalveolar lavage and HSV-specific nuclear inclusions in cells recovered during lavage or bronchial biopsies.


RESULTS
HSV bronchopneumonitis was diagnosed in 42 (21%) of the 201 patients who deteriorated clinically, with a mean mechanical ventilation duration before diagnosis of 14 +/- 6 days. Risk factors associated with HSV bronchopneumonitis were oral-labial lesions, HSV in the throat, and macroscopic bronchial lesions seen during bronchoscopy. Patients with HSV bronchopneumonitis were comparable to those without at admission, but their courses were more complicated, with longer duration of mechanical ventilation and intensive care unit stays.


CONCLUSIONS
HSV bronchopneumonitis is common in nonimmunocompromised patients with prolonged mechanical ventilation, is associated with HSV reactivation or infection of the mouth and/or throat, and seems to be associated with poorer outcome.
Luyt
Charles-Edouard
CE
Service de Réanimation Médicale, Institut de Cardiologie, Groupe Hospitalier Pitié-Salpêtrière, Université de Paris Pierre et Marie Curie, Assistance Publique-Hôpitaux de Paris, Paris Cedex 13, France. charles-edouard.luyt@psl.aphp.fr
Combes
Alain
A
Deback
Claire
C
Aubriot-Lorton
Marie-Hélène
MH
Nieszkowska
Ania
A
Trouillet
Jean-Louis
JL
Capron
Frédérique
F
Agut
Henri
H
Gibert
Claude
C
Chastre
Jean
J
D000328:Adult; D000368:Aged; D001980:Bronchi / Q000473:pathology / Q000821:virology; D001992:Bronchoalveolar Lavage Fluid / Q000166:cytology / Q000821:virology; D001996:Bronchopneumonia / Q000453:epidemiology / Q000473:pathology / Q000821:virology*; D005260:Female; D006561:Herpes Simplex / Q000175:diagnosis*; D006801:Humans; D015994:Incidence; D007181:Inclusion Bodies, Viral; D008297:Male; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology / Q000473:pathology / Q000821:virology*; D011446:Prospective Studies; D012307:Risk Factors; D018139:Simplexvirus / Q000302:isolation & purification*; D013997:Time Factors