Herpes simplex virus in the respiratory tract of critical care patients: a prospective study

• Published in: The Lancet (British edition) 2003-11, Vol.362 (9395), p.1536-1541
• Main Authors: Bruynseels, Peggy, Jorens, Philippe G, Demey, Hendrik E, Goossens, Herman, Pattyn, Stefaan R, Elseviers, Monique M, Weyler, Joost, Bossaert, Leo L, Mentens, Yves, Ieven, Margareta
• Format: Article
• Language: English
• Subjects: Activation; Adolescent; Adult; Aged; Aspirations (Psychology); Belgium - epidemiology; Biological and medical sciences; Bronchoalveolar Lavage; Central nervous system; Critical care; Critical Care - statistics & numerical data; Critical Illness - therapy; Diabetes; Female; Herpes simplex; Herpes Simplex - epidemiology; Herpes Simplex - virology; Herpes viruses; Hospitals; Human viral diseases; Humans; Infections; Infectious diseases; Influenza; Intensive care; Intubation; Laboratories; Male; Medical sciences; Menstruation; Middle Aged; Nervous system; Netherlands - epidemiology; Oropharynx - virology; Patients; Pharynx; Prevalence; Prospective Studies; Pulmonary arteries; Respiratory distress syndrome; Respiratory Distress Syndrome, Adult - epidemiology; Respiratory Distress Syndrome, Adult - virology; Respiratory syncytial virus; Respiratory System - virology; Respiratory tract; Respiratory tract diseases; Respiratory Tract Infections - epidemiology; Respiratory Tract Infections - virology; Risk analysis; Risk Factors; Simplexvirus - isolation & purification; Statistical analysis; Ultraviolet radiation; Viral diseases; Viral diseases of the respiratory system and ent viral diseases; Viral infections; Viruses; Viruses - isolation & purification
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(03)14740-X

Herpes simplex virus (HSV) is occasionally detected in the lower respiratory tract of patients in intensive care, but its clinical importance in such situations remains unclear. We did a prospective cohort study to define the prevalence, origin, risk factors, and clinical relevance of HSV in the respiratory tract of patients undergoing critical care. We tested 764 patients admitted to intensive care for the presence of HSV in the respiratory tract, and assessed statistical relations between this virus and clinical variables. HSV was detected by oropharyngeal swab in the upper respiratory tract of 169 (22%) of 764 patients, within 10 days of admission for 150 (89%) of these individuals. The virus was isolated in 58 (16%) of 361 patients whose lower respiratory tract was sampled. The presence of HSV in the throat was a risk factor for development of HSV infections in the lower respiratory tract (p < 0·001). HSV was isolated most frequently in patients with severe disease. HSV in the throat was associated with acute respiratory distress syndrome (p < 0·001) and with increased length of stay in intensive care (p < 0·001). Our data suggest that HSV reactivation or infection of the upper respiratory tract is frequent among patients in intensive care, and is a risk factor for development of lower respiratory tract infection with this virus, possibly by means of aspiration.