Is acyclovir effective among critically ill patients with herpes simplex in the respiratory tract?

Traen, Stephanie; Bochanen, Niels; Ieven, Margareta; Schepens, Tom; Bruynseels, Peggy; Verbrugghe, Walter; Jorens, Philippe G.

doi:10.1016/j.jcv.2014.04.010

Cited by 36 publications

(38 citation statements)

References 28 publications

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“…In a specific population of ARDS patients, Ong et al [10] demonstrated that patients with CMV reactivation had a 15 (10-26) days median duration of MV as compared to 8 (6-12) days for non-reactivated patients. ICU length of stay was also longer [16 (11-28) vs. 9 (7)(8)(9)(10)(11)(12)(13)(14) days] for reactivated patients. Same results have been published concerning HSV reactivation [2,6], especially during ARDS.…”

Section: Discussionmentioning

confidence: 99%

“…Herpesviridae reactivation in immunocompetent ICU patients is associated with poorer outcome [5]. HSV pulmonary reactivation has been described to be associated with a longer mechanical ventilation (MV) duration, ICU stay and mortality [2,6,7]. CMV reactivation is also associated with a higher mortality, MV duration and ICU length of stay [8].…”

Section: Introductionmentioning

confidence: 99%

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Herpes simplex virus and Cytomegalovirus reactivation among severe ARDS patients under veno-venous ECMO

Hraiech

Bonnardel²,

Guervilly

et al. 2019

Ann. Intensive Care

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Background: Herpesviridae reactivation among non-immunocompromised critically ill patients is associated with impaired prognosis, especially during acute respiratory distress syndrome (ARDS). However, little is known about herpes simplex virus (HSV) and Cytomegalovirus (CMV) reactivation occurring in patients with severe ARDS under veno-venous extracorporeal membrane oxygenation (ECMO). We tried to determine the frequency of Herpesviridae reactivation and its impact on patients' prognosis during ECMO for severe ARDS.Results: During a 5-year period, 123 non-immunocompromised patients with a severe ARDS requiring a venovenous ECMO were included. Sixty-seven patients (54%) experienced HSV and/or CMV reactivation during ECMO course (20 viral co-infection, 40 HSV alone, and 7 CMV alone). HSV reactivation occurred earlier than CMV after the beginning of MV [(6-15) vs. 19 (13-29) days; p < 0.01] and after ECMO implementation [(2-8) vs. 14 (10-20) days; p < 0.01]. In univariate analysis, HSV/CMV reactivation was associated with a longer duration of mechanical ventilation [(22-52.5) vs. 17.5 (9-28) days; p < 0.01], a longer duration of .5) vs. 9 (5-14) days; p < 0.01], and a prolonged .5) vs. 16 (9-30) days; p < 0.01] and hospital stay [44 (29-63.5) vs. 24 (11-43) days; p < 0.01] as compared to non-reactivated patients. However, in multivariate analysis, viral reactivation remained associated with prolonged MV only. When considered separately, both HSV and CMV reactivation were associated with a longer duration of MV as compared to non-reactivation patients [29 (19.5-41) and 28 (20.5-37), respectively, vs. 17.5 (9-28) days; p < 0.05]. Co-reactivation patients had a longer duration of .3); p < 0.05] and ICU stay [51.5 (32.5-69) vs. 27.5 (17.75-35.5) and 29 (20-30.5), respectively] as compared to patients with HSV or CMV reactivation alone. In multivariate analysis, HSV reactivation remained independently associated with a longer duration of MV and hospital length of stay. Conclusions:Herpesviridae reactivation is frequent among patients with severe ARDS under veno-venous ECMO and is associated with a longer duration of mechanical ventilation. The direct causative link between HSV and CMV reactivation and respiratory function worsening under ECMO remains to be confirmed.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Herpes simplex virus and Cytomegalovirus reactivation among severe ARDS patients under veno-venous ECMO

Hraiech

Bonnardel²,

Guervilly

et al. 2019

Ann. Intensive Care

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“…Early treatment of herpes simplex infections in the respiratory tract can reduce mortality of critically ill patients [19]. In our studied cohort, one patient who contracted HSV-1 pneumonia following inhalation injury and one patient with HSV-2 infection of graft and donor sites expired.…”

Section: Discussionmentioning

confidence: 99%

Herpesviradae infections in severely burned children

Wurzer

Cole

Clayton

et al. 2017

Burns

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Objective Burn-related immunosuppression can promote human herpesviridae infections. However, the effect of these infections on morbidity and mortality after pediatric burn injuries is unclear. Methods We retrospectively analyzed pediatric patients with burns ≥10% of the total body surface area (TBSA) who were admitted between 2010 and 2015. On clinical suspicion of a viral infection, antiviral therapy was initiated. Viral infection was confirmed via Tzanck smear, viral culture, and/or PCR. Study endpoints were mortality, days of antiviral agent administration, type of viral test used, type of viral infection, and length of hospitalization. Results Of the 613 patients were analyzed, 28 presented with clinically diagnosed viral infections. The use of Tzanck smears decreased over the past 5 years, whereas PCR and viral cultures have become standard. Patients with viral infections had significantly larger burns (53±15% vs. 38±18%, p<0.001); however, length of stay per TBSA burn was comparable (0.5±0.4 vs. 0.6±0.2, p=0.211). The most commonly detected herpesviridae was herpes simplex virus 1. Two patients died due to sepsis, which was accompanied by HSV infection. The mortality rate among all patients (2.7%) was comparable to that in the infected group (7.1%, p=0.898). Acyclovir was given systemically for 9±8 days (N=76) and/or topically for 9±9 days for HSV (N=39, combination of both N=33). Ganciclovir was prescribed in three cases for CMV. Conclusions Viral infections occur more commonly in patients suffering from larger burns, and HSV infections can contribute to mortality.

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“…In a small randomized controlled trial published in 1987, prophylactic administration of acyclovir prevented the incidence of HSV effectively, but patient outcome did not improve [13]. In a retrospective analysis published in 2014, however, acyclovir treatment of patients in ICU with positive HSV-1 culture from BAL fluid was associated with reduced ICU mortality and in-hospital mortality [14]. Whether HSV-1 represents a relevant pathogen rather than a surrogate marker of severe disease and whether critically ill patients testing positive for HSV-1 need antiviral treatment remains to be investigated in interventional randomized controlled trials.…”

Section: Introductionmentioning

confidence: 99%

Herpes simplex type 1 pneumonitis and acute respiratory distress syndrome in a patient with chronic lymphatic leukemia: a case report

2017

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BackgroundPulmonary pathogenicity of herpes simplex virus type 1 in patients in intensive care without classic immunosuppression as well as the necessity of antiviral treatment in the case of herpes simplex virus detection in respiratory specimens in these patients is controversial. We present a case of acute respiratory distress syndrome in a patient with stable chronic lymphatic leukemia not requiring treatment, in whom we diagnosed herpes simplex virus type 1 bronchopneumonitis based on herpes simplex virus type 1 detection in bronchoalveolar lavage fluid and clinical response to antiviral treatment.Case presentationA 72-year-old white man presented with symptoms of lower respiratory tract infection. His medical history was significant for chronic lymphatic leukemia, which had been stable without treatment, arterial hypertension, multiple squamous cell carcinomas of the scalp, and alcohol overuse. Community-acquired pneumonia was suspected and appropriate broad-spectrum antibacterial treatment was initiated. Within a few hours, rapid respiratory deterioration led to cardiac arrest. He was successfully resuscitated, but developed acute respiratory distress syndrome. Furthermore, he remained febrile and inflammation markers remained elevated despite antibacterial treatment. Polymerase chain reaction from bronchoalveolar lavage fluid and viral culture from tracheobronchial secretions tested positive for herpes simplex virus type 1. We initiated antiviral treatment with acyclovir. Concomitantly we further escalated the antibacterial treatment, although no bacterial pathogen had been isolated at any point. Defervescence occurred rapidly and his C-reactive protein and leukocyte levels decreased. He was successfully weaned from mechanical ventilation, transferred to the ward, and eventually discharged to home.ConclusionsHerpes simplex virus should be considered a cause for lower respiratory tract infection in critically ill patients, especially in the setting of an underlying disease.Electronic supplementary materialThe online version of this article (doi:10.1186/s13256-017-1495-9) contains supplementary material, which is available to authorized users.

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Is acyclovir effective among critically ill patients with herpes simplex in the respiratory tract?

Cited by 36 publications

References 28 publications

Herpes simplex virus and Cytomegalovirus reactivation among severe ARDS patients under veno-venous ECMO

Herpes simplex virus and Cytomegalovirus reactivation among severe ARDS patients under veno-venous ECMO

Herpesviradae infections in severely burned children

Herpes simplex type 1 pneumonitis and acute respiratory distress syndrome in a patient with chronic lymphatic leukemia: a case report

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