Key result
HSV-1 isolation in critically ill patients suggests low pathogenicity given a normal pulmonary leak index.
Why the study?
The pathogenicity of late respiratory infections with herpes simplex virus type 1 in critically ill patients is unclear.
Observational (n=4)
No
Normal capillary permeability in critically ill patients with HSV-1 isolation suggests the virus reflects reactivation rather than primary or superimposed pathogenic lung infection.
HSV-1 isolation may reflect reactivation without pathogenicity; leaves open antiviral indications pending prospective data.
INTRODUCTION: The pathogenicity of late respiratory infections with herpes simplex virus type 1 (HSV-1) in the critically ill is unclear. METHODS: In four critically ill patients with persistent pulmonary infiltrates of unknown origin and isolation of HSV-1 from tracheal aspirate or bronchoalveolar lavage fluid, at 7 (1-11) days after start of mechanical ventilatory support, a pulmonary leak index (PLI) for 67Gallium (67Ga)-transferrin (upper limit of normal 14.1 x 10(-3)/min) was measured. RESULTS: The PLI ranged between 7.5 and 14.0 x 10(-3)/min in the study patients. Two patients received a course of acyclovir and all survived. CONCLUSIONS: The normal capillary permeability observed in the lungs argues against pathogenicity of HSV-1 in the critically ill, and favors that isolation of the virus reflects reactivation in the course of serious illness and immunodepresssion, rather than primary or superimposed infection in the lungs.
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Verheij et al. (2004) conducted an observational in Critically ill with persistent pulmonary infiltrates and HSV-1 isolation (n=4). Herpes simplex virus type 1 (HSV-1) isolation was evaluated on Pulmonary leak index (PLI) for gallium-67-labelled transferrin. In four critically ill patients with persistent pulmonary infiltrates and HSV-1 isolation, the pulmonary leak index was normal (ranging from 7.5 to 14.0 × 10–3/min), suggesting low pathogenicity of the virus.
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