Herpes simplex virus load in bronchoalveolar lavage fluid is related to poor outcome in critically ill patients.
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.
Linssen
Catharina F M
CF
Department of Medical Microbiology, University Hospital Maastricht, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands. klin@lmib.azm.nl
Jacobs
Jan A
JA
Stelma
Foekje F
FF
van Mook
Walther N K A
WN
Terporten
Peter
P
Vink
Cornelis
C
Drent
Marjolein
M
Bruggeman
Cathrien A
CA
Smismans
Annick
A
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