Ulzerierende Herpes-simplex-Infektionen bei intensivpflichtigen Patienten

Abstract

Herpes simplex infections are potentially a life-threatening situation for immunocompromised as well as critically ill patients. The correct diagnosis is made more difficult in comatose patients by the fact that the characteristic symptom of extreme pain cannot be registered. The clinical dermatological findings (polycyclic configuration, easily bleeding ulcers) are thus especially important in patients under intensive care conditions. As examples, the cases of 3 critically ill patients (subarachnoid bleeding or head injury) developing therapy-resistant, flat sacral or perioral skin ulcers with peripheral blisters are presented. Herpes simplex virus was confirmed immunohistologically and in the smear test. All patients subsequently died. These cases emphasize that patients in the intensive care unit are in danger of developing a chronic persistent Herpes simplex infection due to latent immunosuppression. Chronic persistent Herpes infections may be underrated in intensive therapy, and must always be ruled out in case of therapy-resistant erosions or ulcerations.

Key dermatological symptoms in the intensive care unit

“…These were usually caused by pressure. However, a number of differential diagnoses like atypical Herpes infections, initial Staphylococcal‐scalded skin syndrome or toxic epidermal necrolysis must be ruled out in these patients 7,8,9,10 . Nonetheless, in the patient groups examined here, mechanical damage from pressure was the most frequent cause of both the blisters/erosions and the ulcers.…”

Skin diseases in intensive care medicine

“…In addition to bacterial infections persistent herpes simplex infections are significant in the intensive care setting, as patients have a predisposition due to latent immunosuppression [41, 42]. Clinically they present as erosions and easily bleeding shallow ulcerations periorally and sometimes in the anogenital region [42]. In the usually unconscious patients it is difficult to assess pain, which is an important clinical symptom in conscious patients.…”