Published ahead of print on January 18, 2007, doi:10.1164/rccm.200609-1322OC
© 2007 American Thoracic Society doi: 10.1164/rccm.200609-1322OC
Herpes Simplex Virus Lung Infection in Patients Undergoing Prolonged Mechanical Ventilation1 Service de Réanimation Médicale, 2 Service de Virologie, and 3 Service d'Anatomo-Pathologie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France Correspondence and requests for reprints should be addressed to C.-E. Luyt, M.D., Ph.D., Service de Réanimation Médicale, Institut de Cardiologie, Groupe Hospitalier Pitié-Salpêtrière, Université de Paris Pierre et Marie Curie, Assistance Publique-Hôpitaux de Paris, 47, boulevard de l'Hôpital, 75651 Paris Cedex 13, France. E-mail: charles-edouard.luyt{at}psl.aphp.fr Rationale: It is not known whether the isolation of herpes simplex virus (HSV) from lower respiratory tract samples of nonimmunocompromised ventilated patients corresponds to bronchial contamination from the mouth and/or throat, local tracheobronchial excretion of HSV, or true HSV lung involvement (bronchopneumonitis) with its own morbidity/mortality. Objectives: This prospective, single-center, observational study was conducted to define the frequency, risk factors, and relevance of HSV bronchopneumonitis. Methods: All consecutive nonimmunocompromised patients receiving mechanical ventilation for 5 days or more were evaluated. Bronchoalveolar lavage, oropharyngeal swabs, and bronchial biopsies (presence of macroscopic bronchial lesions) were obtained for all who deteriorated clinically with suspected lung infection. HSV bronchopneumonitis was defined as this deterioration, associated with HSV in bronchoalveolar lavage and HSV-specific nuclear inclusions in cells recovered during lavage or bronchial biopsies. Measurements and Main Results: HSV bronchopneumonitis was diagnosed in 42 (21%) of the 201 patients who deteriorated clinically, with a mean mechanical ventilation duration before diagnosis of 14 ± 6 days. Risk factors associated with HSV bronchopneumonitis were oral–labial lesions, HSV in the throat, and macroscopic bronchial lesions seen during bronchoscopy. Patients with HSV bronchopneumonitis were comparable to those without at admission, but their courses were more complicated, with longer duration of mechanical ventilation and intensive care unit stays. Conclusions: HSV bronchopneumonitis is common in nonimmunocompromised patients with prolonged mechanical ventilation, is associated with HSV reactivation or infection of the mouth and/or throat, and seems to be associated with poorer outcome.
Key Words: Herpesviridae • bronchopneumonia • intensive care unit • immunocompetence • ventilator-associated pneumonia
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