title: Herpes simplex virus load in bronchoalveolar lavage fluid is related to poor outcome in critically ill patients.
abstract: OBJECTIVE
  To evaluate the relationship between the HSV-1 and -2 loads in BAL fluid (BALF) and clinical outcome.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  The general intensive care unit of the University Hospital Maastricht.
  
  
  METHODS
  Five hundred and twenty-one BALF samples from 462 patients were included. Patients were divided into three groups; (1) patients admitted to the hospital <48 h before lavage (Community), (2) patients admitted to the ICU >48 h before lavage (ICU) and (3) the remaining patients (non-ICU group).
  
  
  METHODS
  No additional interventions were conducted.
  
  
  RESULTS
  HSV-1 and HSV-2 loads were determined by real-time polymerase chain reaction (PCR). HSV-1 DNA was detected in 4.3% (4/92) of samples in the community group, 15% (18/121) in the non-ICU group and in 32% (99/308) of the ICU group. In the age group <50 years HSV-1 DNA was less frequently isolated compared to the age group >or=50 years (16/129 (12%) versus 187/376 (25%), respectively, OR = 2.6; P < 0.001). HSV-1 loads of >10(5) genome equivalents (ge)/ml were associated with an increased 14-day in-hospital mortality compared to patients with a HSV-1 load <or=10(5) ge/ml in BALF (41 vs. 20%, respectively, P = 0.001). HSV-1 pneumonia was histologically proven in two patients with a HSV-1 load exceeding 10(5) ge/ml.
  
  
  CONCLUSIONS
  HSV-1 occurred more in critically ill patients and high loads in BALF were associated with an increased mortality. The higher mortality observed in patients with HSV-1 load >10(5) ge/ml enforces its clinical relevance and necessitates to start randomized medical intervention studies.
authors.affiliation: Department of Medical Microbiology, University Hospital Maastricht, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands. klin@lmib.azm.nl
authors.forename: Catharina F M
authors.initials: CF
authors.lastname: Linssen
authors.forename: Jan A
authors.initials: JA
authors.lastname: Jacobs
authors.forename: Foekje F
authors.initials: FF
authors.lastname: Stelma
authors.forename: Walther N K A
authors.initials: WN
authors.lastname: van Mook
authors.forename: Peter
authors.initials: P
authors.lastname: Terporten
authors.forename: Cornelis
authors.initials: C
authors.lastname: Vink
authors.forename: Marjolein
authors.initials: M
authors.lastname: Drent
authors.forename: Cathrien A
authors.initials: CA
authors.lastname: Bruggeman
authors.forename: Annick
authors.initials: A
authors.lastname: Smismans
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001992:Bronchoalveolar Lavage Fluid / Q000821:virology*; D016638:Critical Illness; D005260:Female; D006561:Herpes Simplex / Q000401:mortality*; D018259:Herpesvirus 1, Human / Q000302:isolation & purification*; D018258:Herpesvirus 2, Human / Q000302:isolation & purification; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D016017:Odds Ratio; D011024:Pneumonia, Viral / Q000401:mortality* / Q000821:virology; D012189:Retrospective Studies; D016019:Survival Analysis; D019562:Viral Load; D055815:Young Adult