Indian Journal of Critical Care Medicine

Register      Login



Volume / Issue

Online First

Related articles

VOLUME 12 , ISSUE 4 ( December, 2008 ) > List of Articles


Clinical course and spectrum of intensive care unit patients reactivating herpes simplex-1 virus: A retrospective analysis

Krishna M. Sundar, Karl A. Ludwig, William T. Alward, Michael J. Pearce, Clark T. Bishop, Roy C. Hammond, David R. Hillyard, Steven W. Freestone, Anne Ozment, Barbara C. Cahill

Keywords : Herpes simplex-1 virus, pneumonia, viral, ventilator associated

Citation Information : Sundar KM, Ludwig KA, Alward WT, Pearce MJ, Bishop CT, Hammond RC, Hillyard DR, Freestone SW, Ozment A, Cahill BC. Clinical course and spectrum of intensive care unit patients reactivating herpes simplex-1 virus: A retrospective analysis. Indian J Crit Care Med 2008; 12 (4):145-152.

DOI: 10.4103/0972-5229.45073

License: CC BY-ND 3.0

Published Online: 01-01-2012

Copyright Statement:  Copyright © 2008; The Author(s).


Background: Herpes simplex-1 virus (HSV-1) reactivation in the respiratory tract is common in intensive care unit (ICU) patients. However, susceptible ICU populations are poorly defined. Clinical recognition of HSV infection of the respiratory tract is difficult and the impact of such reactivation is not understood. Materials and Methods: A retrospective analysis of HSV-1 positive patients encountered over a 5-year period at a multispecialty ICU was carried out. HSV-1 was identified in respiratory secretions using a qualitative polymerase chain reaction (PCR) technique. Patient charts were reviewed for clinical features that would typify HSV-1 respiratory involvement, and the morbidity and mortality risks found with HSV-1 respiratory involvement. Results: A review of 48 HSV-1 positive ICU patients showed that patients reactivating HSV in the respiratory tract fell into one of the three categories: (1) septic elderly patients with and without ARDS, (2) immunosuppressed patients, especially those receiving high-dose steroids, and (3) post-thoracotomy patients. Abnormalities suggestive of HSV-1 reactivation in the respiratory tract included, haemorrhagic or excessive respiratory secretions, concomitant orofacial herpes (42%), and bronchoscopic abnormalities (hemorrhagic ulcers and mucosal friability) (83%). Twenty eight percent of the HSV-1 infected patients experienced postextubation stridor. HSV-1 reactivation was associated with extended ventilator stays, significant mortality (42%), and ventilator-associated pneumonias (52%). Conclusions: Identification of susceptible populations and definition of clinical features of HSV-1 related respiratory disease can enable diagnosis of HSV-1 infection in ICU patients. Although detection by a PCR technique can rapidly diagnose HSV-1 reactivation, prospective studies are required to clarify HSV disease versus mere shedding, and understand the impact of HSV-1 reactivation in hospitalized patients.

PDF Share
  1. Herpes simplex virus. In: Mandell, Bennett and Dolin, editors. Principles and practice of infectious diseases, 6 th ed. Churchill Livingstone; 2005.
  2. Herpes simplex virus pneumonia: Clinical, virologic and pathologic features in 20 patients. Ann Intern Med 1982;97:813-20.
  3. Effect of sequence polymorphisms on performance of two real-time PCR assays for detection of herpes simplex virus. J Clin Microbiol 2005;43:2391-8.
  4. Herpes simplex type 2 pneumonia. Braz J Infect Dis 2002;6:305-8.
  5. Herpetic tracheobronchitis. Ann Intern Med 1988;109:229-33.
  6. Herpes simplex virus infection of the adult lower respiratory tract. Medicine 1983;62:384-93.
  7. Pulmonary herpes simplex in burns patients. Eur Respir J 1996;9:2313-7.
  8. Necrotizing tracheobronchitis and bronchopneumonia consistent with herpetic infection. Hum Pathol 1972;3:283-90.
  9. Herpes simplex virus from the lower respiratory tract in adult respiratory distress syndrome. Am Rev Respir Dis 1982;126;416-9.
  10. The role of herpes simplex virus in respiratory complications after cardiac surgery. Am Rev Respir Dis 1991;143:A474.
  11. Herpes simplex viral pneumonia in the postthoracotomy patient. Chest 1995;108:876-9.
  12. Herpes simplex virus: The most frequently isolated pathogen in the lungs of patients with severe respiratory distress. Scand J Infect Dis 1992;24:283-92.
  13. Herpes simplex virus in the respiratory tract of critical care patients: A prospective study. Lancet 2003;362:1536-41.
  14. Occult herpes family viruses may increase mortality in critically ill surgical patients. Am J Surg 1998;176:357-60.
  15. Herpes simplex virus pneumonia in trauma patients. J Trauma 2000;49:547-9.
  16. Herpes simplex virus lung infection in patients undergoing prolonged mechanical ventilation. Am J Respir Crit Care Med 2007;175:935-42.
  17. Respiratory herpes simplex virus type I infection/colonization in the critically ill: Marker or mediator? J Clin Virol 2004;30:68-72.
  18. Routine use of highly automated and internally controlled real-time PCR assay for the diagnosis of herpes simplex and varicella-zoster virus infections. J Clin Virol 2004;30:39-44.
  19. Quantitative detection of herpes simplex DNA in the lower respiratory tract. J Med Virol 2007;79:597-604.
  20. Isolation of latent herpes simplex virus from the superior cervical and vagus ganglions of human beings. N Engl J Med 1978;298:1068-9.
  21. Tracheal stenosis and failure to wean from mechanical ventilation from herpetic tracheitis. Chest 1990;98:1520-2.
  22. Herpes simplex virus type 1 and normal protein permeability in the lungs of critically ill patients: A case of low pathogenicity? Crit Care 2004;8:R139-44.
  23. Prevention of lymphocyte apoptosis: A potential treatment of sepsis? Clin Infect Dis 2005;41:S465-9.
  24. Herpes simplex virus broncho-pneumonitis in mechanically ventilated patients: A prospective study. Proc Am Thorac Soc 2006;3:A740.
  25. Fatal herpetic hepatitis in adult following short corticotherapy: A case report. Intensive Care Med 1999;25:415-7.
  26. Fatal herpes simplex virus infection in Darier disease under corticotherapy. Eur J Dermatol 2005;15:293-7.
  27. Nosocomial viral ventilator-associated pneumonia in the intensive care unit: A prospective cohort study. Intensive Care Med 2005;31:1116-22.
  28. Effect of dexamethasone on herpes simplex virus replication in mouse neuroblastoma cells (NB41A3): Receptor characteristics. J Clin Lab Anal 1989;3:236-43.
  29. Herpes simplex type 1 shedding is associated with reduced hospital survival in patients receiving assisted ventilation in a tertiary referral intensive care unit. J Med Virol 2004;72:121-5.
  30. The American-European consensus conference of ARDS, definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med 1994;149:818-24.
  31. 2001 SCCM/ESICM/ACCP/ATS/SIS international sepsis definitions conference. Crit Care Med 2003;31:1250-6.
  32. A randomized study of diagnostic techniques for ventilator-associated pneumonia. N Engl J Med 2006;355:2619-30.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.