Herpes simplex virus type-1 pneumonitis in immunocompetent young woman

Reyes, Cesar V.; Bolden, John R.

doi:10.1016/j.hrtlng.2009.05.002

Cited by 13 publications

(10 citation statements)

References 11 publications

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“…Some case reports suggest that acyclovir treatment may improve the clinical course of patients with detectable HSV reactivation [10][11][12][13]; however, this could not be confirmed in larger studies [14][15][16]. To date, only one study has suggested that acyclovir may reduce inhospital and ICU mortality, even after correcting for confounders via propensity score matching [17].…”

Section: Introductionmentioning

confidence: 99%

Impact of acyclovir use on survival of patients with ventilator-associated pneumonia and high load herpes simplex virus replication

et al. 2020

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Background: Herpes simplex virus (HSV) replication can be detected in the respiratory secretions of a high proportion of ventilated intensive care unit (ICU) patients. However, the clinical significance remains poorly defined. We investigated whether patients with ventilator-associated pneumonia not responding to antibiotics and in whom high levels of HSV could be detected in respiratory secretions benefit from acyclovir treatment. Methods: Respiratory secretions (bronchoalveolar lavage fluid or tracheal aspirates) were tested for HSV replication by quantitative real-time PCR. ICU survival times, clinical parameters, and radiographic findings were retrospectively compared between untreated and acyclovir treated patients with high (> 10 5 HSV copies/mL) and low (10 3 -10 5 HSV copies/mL) viral load.Results: Fifty-seven low and 69 high viral load patients were identified. Fewer patients with high viral load responded to antibiotic treatment (12% compared to 40% of low load patients, p = 0.001). Acyclovir improved median ICU survival (8 vs 22 days, p = 0.014) and was associated with a significantly reduced hazard ratio for ICU death (HR = 0.31, 95% CI 0.11-0.92, p = 0.035) in high load patients only. Moreover, circulatory and pulmonary oxygenation function of high load patients improved significantly over the course of acyclovir treatment: mean norepinephrine doses decreased from 0.05 to 0.02 μg/kg body weight/min between days 0 and 6 of treatment (p = 0.049), and median PaO 2 /FiO 2 ratio increased from 187 to 241 between day 3 and day 7 of treatment (p = 0.02). Chest radiographic findings also improved significantly (p < 0.001). Conclusions: In patients with ventilator-associated pneumonia, antibiotic treatment failure, and high levels of HSV replication, acyclovir treatment was associated with a significantly longer time to death in the ICU and improved circulatory and pulmonary function. This suggests a causative role for HSV in this highly selected group of patients.

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Section: Introductionmentioning

confidence: 99%

Impact of acyclovir use on survival of patients with ventilator-associated pneumonia and high load herpes simplex virus replication

et al. 2020

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“…7,8 In the context of pneumonia refractory to standard antimicrobial therapy, the possibility of HSV pneumonia must be pursued 9 , especially in the presence of ground glass or multifocal infiltrates on high-resolution tomography, without any specific difference between immunocompetent and immunocompromised patients. 3,5 As in other viral infections, spontaneous resolution may occur 3 , but it is consensual to treat patients who present with severe infection whenever HSV-1 is isolated from the lower respiratory tract. 6 Treatment includes the use of intravenous acyclovir 5-10 mg/kg three times a day, and alternatively oral acyclovir 400-800 mg/day or valacyclovir 1000 mg three times a day.…”

Section: Discussionmentioning

confidence: 99%

“…HSV-1 typically causes recurrent infections and similar to what happens with herpes zoster, the reactivation could occur through the lymph nodes where the virus is latent, in the absence of oropharyngeal lesions. 3 HSV-1 pneumonia is unusual, but may arise in primary or recurrent infection. There are case reports in burned, transplanted and cancer patients, people under corticosteroids 4 , mechanically ventilated, malnourished or infected with human immunodeficiency virus (HIV), but HSV-1 pneumonia is rarely described without any degree of immunosuppression.…”

Section: Introductionmentioning

confidence: 99%

Herpes simplex type-1 pneumonia in an immunocompetent patient: a case report

Camões¹,

Lima²,

Vasconcelos³

2019

Gal. Clin.

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Herpes simplex virus type-1 pneumonia is unusual and rarely described without any degree of immunosuppression. We share a case of herpes simplex virus type-1 pneumonia in an immunocompetent patient, not only by its rarity, but to call attention to the importance of thinking about this entity when respiratory symptoms persist despite various antibiotic schemes, especially in the presence of ground glass or multifocal pulmonary infiltrates, regardless of patients' immune status.

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“…We identified 5 patients using PubMed searches who appeared to have primary herpes pneumonia at presentation and had significant clinical disease. 9 - 13 These patients had not required prolonged mechanical ventilation before the infection was identified ( Tables 1 and 2 ). Our patient presumably had a reactivation of herpes in either the upper respiratory tract with dissemination to the lower respiratory tract or had reactivation of HSV-1 in the lung from latent of viral reservoirs in the vagal nuclei.…”

Section: Discussionmentioning

confidence: 99%

Herpes Simplex Pneumonia in an Immunocompetent Patient With Progression to Organizing Pneumonia

Mills

Ratra

El-Bakush

et al. 2014

Journal of Investigative Medicine High Impact Case Reports

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Background. Organizing pneumonia is an uncommon diffuse interstitial lung disease that affects the terminal and respiratory bronchioles, alveolar ducts, and alveoli. Most cases are idiopathic, but some are associated with infections. We present an uncommon case of organizing pneumonia associated with herpes simplex virus-1 (HSV-1). Case. A 39-year-old man with hypertension presented with dyspnea, fever, and productive cough for 2 weeks. He was treated for 5 days for acute bronchitis as an outpatient with no improvement. His examination revealed mild respiratory distress, O2 saturation 92% on room air, and right sided crackles. Labs included a white blood cell count of 19 300/µL. His chest x-ray showed bilateral infiltrates greater on the right. Bronchoalveolar lavage was positive for HSV-1; transbronchial biopsies showed focal pneumonitis with plentiful intra-alveolar macrophages. His respiratory status progressively deteriorated, and he was intubated for mechanical ventilation. He received 10 days of intravenous (IV) antibiotics and 14 days of IV acyclovir. He was readmitted 10 days later with worsening symptoms and was intubated for respiratory failure. His CT chest showed diffuse, patchy consolidation of both lungs, right more than left. Open lung biopsy showed extensive organizing pneumonia, diffuse alveolar damage, intra-alveolar macrophages, and pleural fibrosis; he was treated with IV corticosteroids. He was extubated after 10 days; within 2 weeks his chest x-ray was markedly improved. Discussion. Organizing pneumonia is usually idiopathic; infection is one of the secondary causes. To our knowledge this is only the second reported case associated with HSV. This association may have important pathogenic and therapeutic implications.

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Herpes simplex virus type-1 pneumonitis in immunocompetent young woman

Cited by 13 publications

References 11 publications

Impact of acyclovir use on survival of patients with ventilator-associated pneumonia and high load herpes simplex virus replication

Impact of acyclovir use on survival of patients with ventilator-associated pneumonia and high load herpes simplex virus replication

Herpes simplex type-1 pneumonia in an immunocompetent patient: a case report

Herpes Simplex Pneumonia in an Immunocompetent Patient With Progression to Organizing Pneumonia

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