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1
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Characteristics and prognosis of Herpesviridae-related pneumonia in critically ill burn patients. Burns 2022; 48:1155-1165. [PMID: 34823946 DOI: 10.1016/j.burns.2021.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 08/25/2021] [Accepted: 09/13/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND The aim of this study was to describe the prevalence, characteristics and outcome of critically burn patients with pulmonary HSV reactivation. METHODS Retrospective, single-center cohort study in a burn critical care unit in a tertiary center, including all consecutive severely burn patients with bronchoalveolar lavage performed for pneumoniae suspicion and screened for HSV from January 2013 and April 2017. We used logistic regression to identify factors associated with HSV reactivation and outcomes. RESULTS 94 patients were included, mean age was 51 (39-64) years; median total body surface area burned was 36 (25-54)% and ICU mortality 38%. Fifty-five patients (59%) had pulmonary HSV reactivation and 30 (55%) were treated with acyclovir. Patients with HSV reactivation were more severely ill with higher SOFA score at admission compared to patient without HSV reactivation (6 [3-8] vs. 2 [1-4], p < 0.0001 respectively). In multivariate analysis, sex, SOFA score at admission and smoke inhalation were significantly associated with HSV reactivation. Only septic shock was associated with 90-day mortality when HSV reactivation was not. CONCLUSIONS Pulmonary HSV reactivation is frequent among severely ill burn patients. Initial severity and smoke inhalation are risk factors. Antiviral treatment was not associated with outcome.
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2
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Fanning J, Panigada M, Li Bassi G. Nosocomial Pneumonia in the Mechanically Ventilated Patient. Semin Respir Crit Care Med 2022; 43:426-439. [PMID: 35714627 DOI: 10.1055/s-0042-1749448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Ventilator-associated pneumonia (VAP) is a common complication occurring in critically ill patients who are mechanically ventilated and is the leading cause of nosocomial infection-related death. Etiologic agents for VAP widely differ based on the population of intensive care unit patients, duration of hospital stay, and prior antimicrobial therapy. VAP due to multidrug-resistant pathogens is associated with the highest morbidity and mortality, likely due to delays in appropriate antimicrobial treatment. International guidelines are currently available to guide diagnostic and therapeutic strategies. VAP can be prevented through various pharmacological and non-pharmacological interventions, which are more effective when grouped as bundles. When VAP is clinically suspected, diagnostic strategies should include early collection of respiratory samples to guide antimicrobial therapy. Empirical treatment should be based on the most likely etiologic microorganisms and antibiotics likely to be active against these microorganisms. Response to therapy should be reassessed after 3 to 5 days and antimicrobials adjusted or de-escalated to reduce the burden of the disease. Finally, considering that drug resistance is increasing worldwide, several novel antibiotics are being tested to efficiently treat VAP in the coming decades.
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Affiliation(s)
- Jonathon Fanning
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Australia.,Intensive Care Unit, Royal Brisbane and Women's Hospital, Queensland, Australia.,Intensive Care Unit, St Andrew's War Memorial Hospital, Queensland, Australia.,Nuffield Department of Population Health, Oxford University, United Kingdom
| | - Mauro Panigada
- Department of Anaesthesiology, Intensive Care and EmergencyFondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Gianluigi Li Bassi
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Australia.,Intensive Care Unit, St Andrew's War Memorial Hospital, Queensland, Australia.,Queensland University of Technology, Brisbane, Australia.,Intensive Care Unit, The Wesley Hospital, Auchenflower, Queensland, Australia.,Wesley Medical Research, The Wesley Hospital, Auchenflower, Australia
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3
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Craviotto V, Furfaro F, Loy L, Zilli A, Peyrin-Biroulet L, Fiorino G, Danese S, Allocca M. Viral infections in inflammatory bowel disease: Tips and tricks for correct management. World J Gastroenterol 2021; 27:4276-4297. [PMID: 34366605 PMCID: PMC8316900 DOI: 10.3748/wjg.v27.i27.4276] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 04/01/2021] [Accepted: 05/15/2021] [Indexed: 02/06/2023] Open
Abstract
Over the past decades, the treatment of inflammatory bowel diseases (IBD) has become more targeted, anticipating the use of immune-modifying therapies at an earlier stage. This top-down approach has been correlated with favorable short and long-term outcomes, but it has also brought with it concerns regarding potential infectious complications. This large IBD population treated with immune-modifying therapies, especially if combined, has an increased risk of severe infections, including opportunistic infections that are sustained by viral, bacterial, parasitic, and fungal agents. Viral infections have emerged as a focal safety concern in patients with IBD, representing a challenge for the clinician: they are often difficult to diagnose and are associated with significant morbidity and mortality. The first step is to improve effective preventive strategies, such as applying vaccination protocols, adopt adequate prophylaxis and educate patients about potential risk factors. Since viral infections in immunosuppressed patients may present atypical signs and symptoms, the challenges for the gastroenterologist are to suspect, recognize and diagnose such complications. Appropriate treatment of common viral infections allows us to minimize their impact on disease outcomes and patients’ lives. This practical review supports this standard of care to improve knowledge in this subject area.
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Affiliation(s)
- Vincenzo Craviotto
- Humanitas Clinical and Research Center, IRCCS, Rozzano 20089, Milano, Italy
| | - Federica Furfaro
- Humanitas Clinical and Research Center, IRCCS, Rozzano 20089, Milano, Italy
| | - Laura Loy
- Humanitas Clinical and Research Center, IRCCS, Rozzano 20089, Milano, Italy
| | - Alessandra Zilli
- Humanitas Clinical and Research Center, IRCCS, Rozzano 20089, Milano, Italy
| | - Laurent Peyrin-Biroulet
- Department of Hepato-Gastroenterology and Inserm U954, University Hospital of Nancy, Lorraine University, Nancy 54511, France
| | - Gionata Fiorino
- Humanitas Clinical and Research Center, IRCCS, Rozzano 20089, Milano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele 20090, Milano, Italy
| | - Silvio Danese
- Humanitas Clinical and Research Center, IRCCS, Rozzano 20089, Milano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele 20090, Milano, Italy
| | - Mariangela Allocca
- Humanitas Clinical and Research Center, IRCCS, Rozzano 20089, Milano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele 20090, Milano, Italy
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4
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Verma M. Pediatric burn wound complicated with herpes simplex virus infection: A rare case report and literature review. INDIAN JOURNAL OF BURNS 2021. [DOI: 10.4103/ijb.ijb_19_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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5
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Viral Infections in Burn Patients: A State-Of-The-Art Review. Viruses 2020; 12:v12111315. [PMID: 33213058 PMCID: PMC7698518 DOI: 10.3390/v12111315] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 11/16/2020] [Indexed: 12/18/2022] Open
Abstract
Infections that are triggered by the accompanying immunosuppression in patients with burn wounds are very common regardless of age. Among burn patients, the most frequently diagnosed infections include the bacterial ones primarily caused by Pseudomonas aeruginosa or Klebsiella pneumonia, as well as fungal infections with the etiology of Candida spp. or Aspergillus spp. Besides, burn wounds are highly susceptible to viral infections mainly due to the impaired immune responses and defective functions of the immune cells within the wound microenvironment. The most prevalent viruses that invade burn wounds include herpes simplex virus (HSV), cytomegalovirus (CMV), human papilloma virus (HPV), and varicella zoster virus (VZV). Likewise, less prevalent infections such as those caused by the orf virus or Epstein-Barr Virus (EBV) might also occur in immunosuppressed burn patients. Viral infections result in increased morbidity and mortality rates in severely burned patients. Additionally, a positive correlation between the hospitalization duration and the severity of the viral infection has been demonstrated. Viral infections trigger the occurrence of various complications, ranging from mild symptoms to even fatal incidents. Accurate detection of viral infection is of great clinical importance because of the possibility for a quicker introduction of proper treatment therapy and shortening of hospitalization time. The aim of this paper is to provide a comprehensive review of the literature and summarize the findings regarding the most common viral infections in immunosuppressed burn patients.
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6
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Hagel S, Scherag A, Schuierer L, Hoffmann R, Luyt CE, Pletz MW, Kesselmeier M, Weis S. Effect of antiviral therapy on the outcomes of mechanically ventilated patients with herpes simplex virus detected in the respiratory tract: a systematic review and meta-analysis. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2020; 24:584. [PMID: 32993740 PMCID: PMC7522924 DOI: 10.1186/s13054-020-03296-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 09/16/2020] [Indexed: 12/12/2022]
Abstract
Background Herpes simplex virus (HSV) is frequently detected in the respiratory tract of mechanically ventilated patients. The aim of this study was to assess current evidence to determine whether antiviral therapy is associated with better outcomes in these patients. Methods MEDLINE, ISI Web of Science, Cochrane Database and ClinicalTrials.gov were searched from inception to 25 May 2020. All clinical studies investigating the effects of antiviral therapy on the outcome of mechanically ventilated ICU patients in whom HSV was detected in the respiratory tract were eligible for inclusion, regardless of study design, publication status or language. Titles and abstracts were reviewed independently by two authors. If the articles seemed eligible, full-text articles were reviewed and data extracted. We performed a random-effects meta-analysis to estimate relative risks (RRs) with corresponding 95% confidence intervals (CIs). The primary endpoint was hospital all-cause mortality. Results Nine studies were included in the meta-analysis (one randomized controlled trial, eight cohort studies). Antiviral treatment was associated with lower hospital mortality (with antiviral treatment, 40.6% (189 out of 465 patients); without, 52.7% (193 out of 366 patients); RR 0.74 [0.64, 0.85]; eight studies, low quality of evidence). Furthermore, antiviral treatment was associated with lower 30-day mortality (RR 0.75 [0.59, 0.94]; three studies, very low quality of evidence). We did not observe evidence for differences in ICU mortality (RR 0.73 [0.51, 1.05]; three studies, very low quality of evidence). Conclusions This meta-analysis of the available data shows that antiviral therapy might result in lower hospital and 30-day all-cause mortality in mechanically ventilated ICU patients who are positive for HSV in the respiratory tract. However, this result must be interpreted with great caution due to the high risk of bias and limited number of patients. Large, well-designed randomized controlled clinical trials are urgently needed. Trial registration The study was registered in advance on International Prospective Register of Systematic Reviews (CRD42020180053).
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Affiliation(s)
- Stefan Hagel
- Institute for Infectious Diseases and Infection Control, Jena University Hospital - Friedrich Schiller University Jena, Jena, Germany.
| | - André Scherag
- Research Group Clinical Epidemiology, Center for Sepsis Control and Care (CSCC), Jena University Hospital - Friedrich Schiller University Jena, Jena, Germany.,Institute of Medical Statistics, Computer and Data Sciences, Jena University Hospital - Friedrich Schiller University Jena, Jena, Germany
| | - Lukas Schuierer
- TUM Graduate School, Technical University of Munich (TUM), Munich, Germany.,Institute for Laboratory Medicine and Microbiology, University Hospital Augsburg, Augsburg, Germany
| | - Reinhard Hoffmann
- Institute for Laboratory Medicine and Microbiology, University Hospital Augsburg, Augsburg, Germany
| | - Charles-Edouard Luyt
- Service de Médecine Intensive Réanimation, Institut de Cardiologie, Groupe Hospitalier Pitié-Salpêtrière, Sorbonne-Université, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Mathias W Pletz
- Institute for Infectious Diseases and Infection Control, Jena University Hospital - Friedrich Schiller University Jena, Jena, Germany
| | - Miriam Kesselmeier
- Research Group Clinical Epidemiology, Center for Sepsis Control and Care (CSCC), Jena University Hospital - Friedrich Schiller University Jena, Jena, Germany.,Institute of Medical Statistics, Computer and Data Sciences, Jena University Hospital - Friedrich Schiller University Jena, Jena, Germany
| | - Sebastian Weis
- Institute for Infectious Diseases and Infection Control, Jena University Hospital - Friedrich Schiller University Jena, Jena, Germany.,Department of Anesthesiology and Intensive Care Therapy, Jena University Hospital - Friedrich Schiller University Jena, Jena, Germany.,Center for Sepsis Control and Care, Jena University Hospital - Friedrich Schiller University Jena, Jena, Germany
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7
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Abstract
Background: Viral infections after burns are less common than bacterial infections but usually occur in the more severely burned patients and have been associated with poor outcomes. Methods: Retrospective reviews and case series were examined to provide an overview of the management of viral infections in the burn patient. Results: The most common viral pathogens in these patients are the herpesviruses, which include herpes simplex, varicella zoster, cytomegalovirus, and human herpesvirus 6. Established viral infections that may complicate patient management include human immunodeficiency virus, hepatitis B and C, and, more recently, the novel coronavirus SARS-CoV-2. Herpesvirus infections can occur as primary or nosocomial pathogens but clinical manifestations most commonly are re-activation of latent viral infection. Because of the paucity of data in the burn population, much of the evidence for specific treatments is extrapolated from patients with severe immunosuppression or critical illness. Antiviral therapy is employed for the burn patient with herpesvirus infections. This is an area of active study, and further research is needed to better understand the risks, clinical manifestations, and attributable morbidity and mortality of viral infections. Conclusions: Major burn injury results in immunosuppression and viral infection in a small number of patients. Recognition and antiviral therapy are employed, but additional studies are necessary to improve outcomes in these patients.
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Affiliation(s)
- John L Kiley
- Brooke Army Medical Center, Fort Sam Houston, Texas, USA
| | - Kevin K Chung
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Dana M Blyth
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA
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8
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Koo HJ, Lim S, Choe J, Choi SH, Sung H, Do KH. Radiographic and CT Features of Viral Pneumonia. Radiographics 2018; 38:719-739. [PMID: 29757717 DOI: 10.1148/rg.2018170048] [Citation(s) in RCA: 405] [Impact Index Per Article: 57.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Viruses are the most common causes of respiratory infection. The imaging findings of viral pneumonia are diverse and overlap with those of other nonviral infectious and inflammatory conditions. However, identification of the underlying viral pathogens may not always be easy. There are a number of indicators for identifying viral pathogens on the basis of imaging patterns, which are associated with the pathogenesis of viral infections. Viruses in the same viral family share a similar pathogenesis of pneumonia, and the imaging patterns have distinguishable characteristics. Although not all cases manifest with typical patterns, most typical imaging patterns of viral pneumonia can be classified according to viral families. Although a definite diagnosis cannot be achieved on the basis of imaging features alone, recognition of viral pneumonia patterns may aid in differentiating viral pathogens, thus reducing the use of antibiotics. Recently, new viruses associated with recent outbreaks including human metapneumovirus, severe acute respiratory syndrome coronavirus, and Middle East respiratory syndrome coronavirus have been discovered. The imaging findings of these emerging pathogens have been described in a few recent studies. This review focuses on the radiographic and computed tomographic patterns of viral pneumonia caused by different pathogens, including new pathogens. Clinical characteristics that could affect imaging, such as patient age and immune status, seasonal variation and community outbreaks, and pathogenesis, are also discussed. The first goal of this review is to indicate that there are imaging features that should raise the possibility of viral infections. Second, to help radiologists differentiate viral infections, viruses in the same viridae that have similar pathogenesis and can have similar imaging characteristics are shown. By considering both the clinical and radiologic characteristics, radiologists can suggest the diagnosis of viral pneumonia. ©RSNA, 2018.
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Affiliation(s)
- Hyun Jung Koo
- From the Department of Radiology and Research Institute of Radiology (H.J.K., J.C., K.H.D.), Division of Infectious Disease, Department of Internal Medicine (S.H.C.), and Department of Laboratory Medicine (H.S.), Asan Medical Center, Olympic-ro 43-gil, Songpa-gu, 05505 Seoul, South Korea; and Department of Radiology, Ulsan University Hospital, Ulsan University College of Medicine, Ulsan, South Korea (S.L.)
| | - Soyeoun Lim
- From the Department of Radiology and Research Institute of Radiology (H.J.K., J.C., K.H.D.), Division of Infectious Disease, Department of Internal Medicine (S.H.C.), and Department of Laboratory Medicine (H.S.), Asan Medical Center, Olympic-ro 43-gil, Songpa-gu, 05505 Seoul, South Korea; and Department of Radiology, Ulsan University Hospital, Ulsan University College of Medicine, Ulsan, South Korea (S.L.)
| | - Jooae Choe
- From the Department of Radiology and Research Institute of Radiology (H.J.K., J.C., K.H.D.), Division of Infectious Disease, Department of Internal Medicine (S.H.C.), and Department of Laboratory Medicine (H.S.), Asan Medical Center, Olympic-ro 43-gil, Songpa-gu, 05505 Seoul, South Korea; and Department of Radiology, Ulsan University Hospital, Ulsan University College of Medicine, Ulsan, South Korea (S.L.)
| | - Sang-Ho Choi
- From the Department of Radiology and Research Institute of Radiology (H.J.K., J.C., K.H.D.), Division of Infectious Disease, Department of Internal Medicine (S.H.C.), and Department of Laboratory Medicine (H.S.), Asan Medical Center, Olympic-ro 43-gil, Songpa-gu, 05505 Seoul, South Korea; and Department of Radiology, Ulsan University Hospital, Ulsan University College of Medicine, Ulsan, South Korea (S.L.)
| | - Heungsup Sung
- From the Department of Radiology and Research Institute of Radiology (H.J.K., J.C., K.H.D.), Division of Infectious Disease, Department of Internal Medicine (S.H.C.), and Department of Laboratory Medicine (H.S.), Asan Medical Center, Olympic-ro 43-gil, Songpa-gu, 05505 Seoul, South Korea; and Department of Radiology, Ulsan University Hospital, Ulsan University College of Medicine, Ulsan, South Korea (S.L.)
| | - Kyung-Hyun Do
- From the Department of Radiology and Research Institute of Radiology (H.J.K., J.C., K.H.D.), Division of Infectious Disease, Department of Internal Medicine (S.H.C.), and Department of Laboratory Medicine (H.S.), Asan Medical Center, Olympic-ro 43-gil, Songpa-gu, 05505 Seoul, South Korea; and Department of Radiology, Ulsan University Hospital, Ulsan University College of Medicine, Ulsan, South Korea (S.L.)
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9
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Ishihara T, Yanagi H, Ozawa H, Takagi A. Severe herpes simplex virus pneumonia in an elderly, immunocompetent patient. BMJ Case Rep 2018; 2018:bcr-2017-224022. [PMID: 30021729 DOI: 10.1136/bcr-2017-224022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Although not common, herpes simplex virus (HSV) pneumonia can occur in immunocompromised patients. However, HSV pneumonia in immunocompetent hosts is very rare. The authors encountered a very rare case of severe HSV pneumonia in an immunocompetent host. The patient was an 85-year-old Japanese woman who presented with severe intractable pneumonia refractory to empirical antimicrobial therapy. Furthermore, the causative microorganisms remained unknown. Therefore, cytological examination of bronchoalveolar lavage fluid and protected brush biopsy of the lower respiratory tract were performed, which indicated herpes virus-infected cells with nuclear inclusions; PCR assay was positive for HSV DNA. Accordingly, the patient was diagnosed with HSV pneumonia. Her respiratory condition improved immediately after initiation of acyclovir monotherapy. In selected cases of intractable pneumonia refractory to standard antimicrobial therapy, the possibility of HSV pneumonia should be pursued.
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Affiliation(s)
- Toru Ishihara
- Division of General Internal Medicine, Tokai University School of Medicine, Isehara, kanagawa, Japan
| | - Hidetaka Yanagi
- Division of General Internal Medicine, Tokai University School of Medicine, Isehara, kanagawa, Japan
| | - Hideki Ozawa
- Division of General Internal Medicine, Tokai University School of Medicine, Isehara, kanagawa, Japan
| | - Atsushi Takagi
- Division of General Internal Medicine, Tokai University School of Medicine, Isehara, kanagawa, Japan
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Renshaw AA, Jin M, Wakely PE, Gould EW. Herpes simplex virus infections in pulmonary cytology rarely represent pulmonary disease but remain a marker for mortality risk. J Am Soc Cytopathol 2017; 6:194-197. [PMID: 31043242 DOI: 10.1016/j.jasc.2017.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Revised: 06/07/2017] [Accepted: 06/08/2017] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Herpes simplex virus (HSV) infection can be diagnosed in pulmonary cytology specimens. We sought to determine the clinical significance of this finding. METHODS Our medical records were searched for cases of HSV infection diagnosed in cytology specimens and the results compared with those in the literature. RESULTS In our sample, 9 patients had HSV inclusions. All patients had pulmonary disease, 8 of 9 had multi-organ system disease, and 8 of 9 had been treated with either steroids or chemotherapy. Patients were either not treated with antiviral therapy (6 of 9) or treated for oral with or without cutaneous disease only (3 of 9). Two patients died; pulmonary infection was confirmed in only 1 patient. Compared with prior series, the number of cases with 10 or fewer cells with inclusions was significantly higher (89% versus 17%, P < 0.001). CONCLUSIONS Compared with prior series, most patients with HSV inclusions in pulmonary cytology specimens have fewer cells with inclusions, have oral and or cutaneous disease as well, and are not treated for pulmonary HSV. Nevertheless, this finding is associated with a risk of death, from both pulmonary infection and/or comorbid disease.
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Affiliation(s)
- Andrew A Renshaw
- Department of Pathology, Baptist Hospital and Miami Cancer Institute, Miami, Florida.
| | - Ming Jin
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Paul E Wakely
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Edwin W Gould
- Department of Pathology, Baptist Hospital and Miami Cancer Institute, Miami, Florida
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11
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Sfeir M, Douglass E, Soave R. So Many Possibilities: Lung Nodules in a Transplant Recipient. Am J Med 2017; 130:534-536. [PMID: 28082166 DOI: 10.1016/j.amjmed.2016.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Revised: 12/28/2016] [Accepted: 12/28/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Maroun Sfeir
- Department of Medicine, Weill Cornell University/New York Presbyterian Hospital; Division of Infectious Disease, Weill Cornell University/New York Presbyterian Hospital; Department of Healthcare Policy and Research, Weill Cornell University/New York Presbyterian Hospital.
| | - Elijah Douglass
- Department of Medicine, Weill Cornell University/New York Presbyterian Hospital
| | - Rosemary Soave
- Department of Medicine, Weill Cornell University/New York Presbyterian Hospital; Division of Infectious Disease, Weill Cornell University/New York Presbyterian Hospital
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12
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Wurzer P, Cole MR, Clayton RP, Hundeshagen G, Nunez Lopez O, Cambiaso-Daniel J, Winter R, Branski LK, Hawkins HK, Finnerty CC, Herndon DN, Lee JO. Herpesviradae infections in severely burned children. Burns 2017; 43:987-992. [PMID: 28420570 DOI: 10.1016/j.burns.2017.01.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Revised: 12/31/2016] [Accepted: 01/24/2017] [Indexed: 10/19/2022]
Abstract
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±8days (N=76) and/or topically for 9±9days 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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Affiliation(s)
- Paul Wurzer
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, TX, United States; Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria.
| | - Megan R Cole
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, TX, United States
| | - Robert P Clayton
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, TX, United States; Sealy Center for Molecular Medicine and the Institute for Translational Sciences, University of Texas Medical Branch, Galveston, TX, United States
| | - Gabriel Hundeshagen
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, TX, United States
| | - Omar Nunez Lopez
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, TX, United States
| | - Janos Cambiaso-Daniel
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Raimund Winter
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Ludwik K Branski
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, TX, United States; Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Hal K Hawkins
- Department of Pathology, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, TX, United States
| | - Celeste C Finnerty
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, TX, United States; Sealy Center for Molecular Medicine and the Institute for Translational Sciences, University of Texas Medical Branch, Galveston, TX, United States
| | - David N Herndon
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, TX, United States
| | - Jong O Lee
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, TX, United States
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13
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Wurzer P, Guillory A, Parvizi D, Clayton RP, Branski LK, Kamolz LP, Finnerty CC, Herndon DN, Lee JO. Human herpes viruses in burn patients: A systematic review. Burns 2016; 43:25-33. [PMID: 27515422 DOI: 10.1016/j.burns.2016.02.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 02/03/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The contribution of human herpes viruses, including herpes simplex virus (HSV), cytomegalovirus (CMV), and varicella zoster virus (VZV) to morbidity and mortality after burns remains controversial. This systematic review was undertaken to assess evidence of herpes virus-related morbidity and mortality in burns. MATERIALS AND METHODS PubMed, Ovid, and Web of Science were searched to identify studies of HSV, CMV, or VZV infections in burn patients. Exclusion criteria included: A level of evidence (LoE) of IV or V; nonhuman in vivo studies; and non-English articles. There was no limitation by publication date. RESULTS Fifty articles were subjected to full-text analysis. Of these, 18 had LoE between I-III and were included in the final review (2 LoE I, 16 LoE II-III). Eight had a prospective study design, 9 had a retrospective study design, and 1 included both. CONCLUSIONS No direct evidence linked CMV and HSV infection with increased morbidity and mortality in burns. Following burn, CMV reactivation was more common than a primary CMV infection. Active HSV infection impaired wound healing but was not directly correlated to mortality. Infections with VZV are rare after burns but when they occur, VZV infections were associated with severe complications including mortality. The therapeutic effect of antiviral agents administered after burns warrants investigation via prospective randomized controlled trials.
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Affiliation(s)
- Paul Wurzer
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, TX, USA; Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria.
| | - Ashley Guillory
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, TX, USA
| | - Daryousch Parvizi
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Robert P Clayton
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, TX, USA; Sealy Center for Molecular Medicine and the Institute for Translational Sciences, University of Texas Medical Branch, Galveston, TX, USA
| | - Ludwik K Branski
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, TX, USA; Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Lars-P Kamolz
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Celeste C Finnerty
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, TX, USA; Sealy Center for Molecular Medicine and the Institute for Translational Sciences, University of Texas Medical Branch, Galveston, TX, USA
| | - David N Herndon
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, TX, USA
| | - Jong O Lee
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, TX, USA
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Abstract
Although originally described in Staphylococcus aureus, resistance among bacteria has now become a race to determine which classes of bacteria will become more resistant. Availability of antibacterial agents has allowed the development of entirely new diseases caused by nonbacterial pathogens, related largely to fungi that are inherently resistant to antibacterials. This article presents the growing body of knowledge of the herpes family of viruses, and their occurrence and consequences in patients with concomitant surgical disease or critical illness. The focus is on previously immunocompetent patients, as the impact of herpes viruses in immunosuppressed patients has received thorough coverage elsewhere.
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Affiliation(s)
- Christopher A Guidry
- Division of Acute Care Surgery and Outcomes Research, Department of Surgery, University of Virginia, Charlottesville, VA 22908, USA
| | - Sara A Mansfield
- Division of Trauma, Critical Care, and Burn, Department of Surgery, The Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - Robert G Sawyer
- Division of Acute Care Surgery and Outcomes Research, Department of Surgery, University of Virginia, Charlottesville, VA 22908, USA
| | - Charles H Cook
- Division of Acute Care Surgery, Trauma and Surgical Critical Care, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, Lowry 2G, Boston, MA 02215, USA.
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15
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Abstract
PURPOSE OF THE REVIEW Viruses are an increasingly recognized cause of community-acquired pneumonia (CAP), but their exact role in nosocomial pneumonia is still debated. This review focuses on the role of viruses as a cause of nosocomial pneumonia. RECENT FINDINGS Respiratory viruses may be responsible for healthcare-associated pneumonia, because affected patients and those with CAP have the same risk factors for viral disease. In mechanically ventilated patients, viruses belonging to the Herpesviridae family, namely herpes simplex virus (HSV) and cytomegalovirus, can be reactivated and cause bronchopneumonitis or ventilator-associated pneumonia, respectively. Recent results confirmed the high rate of HSV reactivation in the distal airways of mechanically ventilated patients, and that patients with high virus loads (>10(5) copies/ml of bronchoalveolar lavage fluid) have poorer outcomes than those with low or no virus load. However, the responsibility of mimivirus, initially described as a possible cause of pneumonia, was not confirmed for nosocomial pneumonia. SUMMARY Respiratory viruses are mainly responsible for CAP, but they may also cause healthcare-associated pneumonia. HSV bronchopneumonitis and cytomegalovirus pneumonia are not rare diseases, and patients with Herpesviridae lung infections have worse prognoses than those without. Whether or not those Herpesviridae infections are responsible for true morbidity or morbidity remains to be determined.
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16
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Libraty DH, Bocelli L, Fraire A. Herpes simplex virus bronchiolitis in a cannabis user. IDCases 2013; 1:2-4. [PMID: 26912481 PMCID: PMC4735107 DOI: 10.1016/j.idcr.2013.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Revised: 11/20/2013] [Accepted: 11/20/2013] [Indexed: 01/07/2023] Open
Abstract
Herpes simplex virus (HSV) lower respiratory tract infections in adults are uncommon. We present a case of HSV bronchiolitis and pneumonitis in an immunocompetent individual, likely linked to chronic habitual marijuana use and a herpetic orolabial ulcer. The case serves as a reminder to consider HSV as a potential unusual cause of lower respiratory tract infection/inflammation in individuals with chronic habitual marijuana use.
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Affiliation(s)
- Daniel H Libraty
- Division of Infectious Diseases and Immunology, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Lisa Bocelli
- Division of Infectious Diseases and Immunology, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Armando Fraire
- Department of Pathology, University of Massachusetts Medical School, Worcester, MA, USA
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17
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Vincent JL. Viral-associated Ventilator-associated Pneumonia. ANNUAL UPDATE IN INTENSIVE CARE AND EMERGENCY MEDICINE 2012 2012; 2012. [PMCID: PMC7120000 DOI: 10.1007/978-3-642-25716-2_28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Nosocomial pneumonia is the most commonly acquired infection in intensive care units (ICUs). Its frequency is approximately 10 cases/1000 admissions; however, the incidence may increase to 20 times that number in patients undergoing invasive mechanical ventilation [1–3]. The overall incidence of ventilator-associated pneumonia (VAP) may range between 15 % to 20 % [2–6]. This complication prolongs the length of hospital stay, increases healthcare costs and may increase mortality [4, 5, 7, 8].
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Affiliation(s)
- Jean-Louis Vincent
- grid.4989.c0000000123480746Department of Intensive Care Erasme Hospital, Université libre de Bruxelles, Route de Lennik 808, B-1070 Brussels, Belgium
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18
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Trupkovic T, Gille J, Fischer H, Kleinschmidt S. [Antimicrobial treatment in burn injury patients]. Anaesthesist 2012; 61:249-51, 254-6, 258. [PMID: 22430556 DOI: 10.1007/s00101-012-1994-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Infections are a great diagnostic and therapeutic challenge in intensive care patients with burn injuries. The major problems are due to bacteria with hospital-acquired multiresistance to antibiotics but fungal and viral infections may also be life-threatening. The main key points addressing pharmacotherapy with antibiotic, antifungal and antiviral agents in this special setting are exact diagnosis, early therapy with suitable drugs, adequate duration of treatment and adequate doses based on pharmacokinetic and pharmacodynamic characteristics of these compounds. The latter parameters are significantly altered in burn patients and show a wide interindividual and intraindividual variation in drug response as a result of the characteristic phases of burn injury. Drug concentration analysis may help to avoid inadequate dosing. In this review the main characteristics of burn injuries and the pharmacology of antibiotics, antifungal and antiviral agents in these patients are presented.
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Affiliation(s)
- T Trupkovic
- Abteilung für Anästhesie, Intensivmedizin und Schmerztherapie, Berufsgenossenschaftliche Unfallklinik Ludwigshafen, Deutschland
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19
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Huzar TF, Cross JM. Ventilator-associated pneumonia in burn patients: a cause or consequence of critical illness? Expert Rev Respir Med 2012; 5:663-73. [PMID: 21955236 DOI: 10.1586/ers.11.61] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Infectious complications are a constant threat to thermally injured patients during hospitalizations and are a predominant cause of death. Most of the infections that develop in burn patients are nosocomial and of a pulmonary etiology. The bacteria that cause ventilator associated pneumonia (VAP) take advantage of the fact that uniquely among intensive care unit patients endotracheal intubation allows them a 'free' passage to the sterile lower airways; however, the combination of severe thermal injury (systemic immunosuppression) and inhalation injury (local immunosuppression and tissue injury) create an ideal environment for development of VAP. Thus, strategies directed at preventing and treating VAP in burn patients must address not only rapid extubation and VAP prevention bundles known to work in other intensive care unit populations, but therapies directed to more rapid wound healing and restoration of pulmonary patency.
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Affiliation(s)
- Todd F Huzar
- Department of Surgery, University of Texas Medical School, Houston, TX, USA.
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20
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Herpes Simplex Activation Prolongs Recovery From Severe Burn Injury and Increases Bacterial Infection Risk. J Burn Care Res 2012; 33:393-7. [DOI: 10.1097/bcr.0b013e3182331e28] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Luyt CE. Infections respiratoires virales à herpesviridae en réanimation. MEDECINE INTENSIVE REANIMATION 2012; 21:331-338. [PMID: 32288727 PMCID: PMC7117814 DOI: 10.1007/s13546-011-0314-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Accepted: 09/26/2011] [Indexed: 11/12/2022]
Abstract
Les herpesviridae, essentiellement l’herpes simplex virus (HSV) et le cytomégalovirus (CMV), sont fréquemment détectés dans les voies aériennes des malades non immunodéprimés sous ventilation mécanique. Bien que leur présence traduise le plus souvent une réactivation virale sans réelle atteinte parenchymateuse, celle-ci peut néanmoins exister chez un certain nombre de patients. Si le diagnostic d’atteinte parenchymateuse à herpesviridae doit être étayé par une preuve histologique (effet cytopathogène spécifique), l’utilisation des outils de virologie moléculaire (amplification par polymerase chain reaction en temps réel pour estimer la charge virale) pourrait remplacer l’examen histologique dans un futur proche. La survenue d’une bronchopneumonie à HSV est associée à une réactivation du virus au niveau oropharyngé et à la présence de lésions labiales. Cette maladie semble avoir un réel impact sur l’évolution, puisqu’elle est associée à une durée de ventilation mécanique et à un séjour en réanimation prolongés. L’intérêt d’un traitement par acyclovir dans cette indication reste cependant à déterminer. Si la réactivation du CMV dans le sang est facile à détecter et associée à une évolution défavorable, la pneumonie à CMV est difficile à prouver du fait de la lourdeur des techniques diagnostiques (biopsie pulmonaire), et son impact sur le pronostic incertain. L’intérêt d’un traitement par ganciclovir dans cette indication reste aussi à démontrer.
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22
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López-Giraldo A, Sialer S, Esperatti M, Torres A. Viral-Reactivated Pneumonia during Mechanical Ventilation: Is There Need for Antiviral Treatment? Front Pharmacol 2011; 2:66. [PMID: 22073034 PMCID: PMC3210442 DOI: 10.3389/fphar.2011.00066] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Accepted: 10/11/2011] [Indexed: 11/13/2022] Open
Abstract
Respiratory viruses are not a common cause of ventilator-associated pneumonia (VAP). Herpesviridae [Herpes simplex virus (HSV) and cytomegalovirus (CMV)] are detected frequently in the lower respiratory tract of ventilated patients. HSV is detected between days 7 and 14 of invasive mechanical ventilation (IMV); presence of the virus does not necessarily imply pathogenicity, but the association with adverse clinical outcomes supports the hypothesis of a pathogenic role in a variable percentage of patients. Bronchopneumonitis associated with HSV should be considered in patients with prolonged IMV, reactivation with herpetic mucocutaneous lesions and those belonging to a risk population with burn injuries or acute lung injury. Reactivation of CMV is common in critically ill patients and usually occurs between days 14 and 21 in patients with defined risk factors. The potential pathogenic role of CMV seems clear in patients with acute lung injury and persistent respiratory failure in whom there is no isolation of bacterial agent as a cause of VAP. The best diagnostic test is not defined although lung biopsies should be considered in addition to the usual methods before starting specific treatment. The role of mimivirus is uncertain and is yet to be defined, but the serologic evidence of this new virus in the context of VAP appears to be associated with adverse clinical outcomes.
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23
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Peppercorn A, Veit L, Sigel C, Weber DJ, Jones S, Cairns BA. Overwhelming disseminated herpes simplex virus type 2 infection in a patient with severe burn injury: case report and literature review. J Burn Care Res 2011; 31:492-8. [PMID: 20453737 DOI: 10.1097/bcr.0b013e3181db51cb] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Viral-mediated organ disease is an infrequent but recognized complication of severe burn injury. This occurs primarily because of herpes family viruses such as cytomegalovirus, herpes simplex virus (HSV), and Epstein-Barr virus given their ability to establish lifelong latency after primary infection and reactivate in the setting of altered immune function. In this report, we describe a severely burned patient who succumbed to fulminant HSV-2 pneumonitis and hepatitis, and summarize the existing literature on HSV infections in this unique patient population. To our knowledge, this is the first report of disseminated visceral HSV-2 infection in a burn patient in the medical literature.
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Affiliation(s)
- Amanda Peppercorn
- Department of Medicine, University of North Carolina, Chapel Hill, NC 27599-7215, USA
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24
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25
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26
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Shah JN, Chemaly RF. Herpes Simplex Virus Pneumonia in Patients with Hematologic Malignancies. PULMONARY INVOLVEMENT IN PATIENTS WITH HEMATOLOGICAL MALIGNANCIES 2011. [PMCID: PMC7124034 DOI: 10.1007/978-3-642-15742-4_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Herpes simplex virus (HSV) pneumonia is rare and is usually seen in immunocompromised patients. Patients with hematologic malignancies and hematopoietic stem cell transplant (HSCT) are at risk. Most of the cases of HSV pneumonia are caused by HSV-1; however, cases caused by HSV-2 have also been reported. Mucocutaneous disease often precedes the development of pneumonia, with nonspecific symptoms that include fever, cough, and dyspnea. Worsening oxygenation and failure to wean off mechanical ventilation despite broad-spectrum antimicrobial coverage is also a common presentation. Diagnosis requires a high degree of suspicion and is based on isolation of the virus from respiratory secretions and demonstration of cytopathic effects on histopathology. Acyclovir is the most widely used drug for treatment and prophylaxis. With increasing evidence of resistance to acyclovir and its analogs, newer agents such as foscarnet and cidofovir are being recommended as treatment options. Prophylaxis in patients with seropositive HSV undergoing chemotherapy or in the immediate post-HSCT period has been shown to reduce HSV disease rates and mortality rates. This chapter will focus on incidence and transmission, pathogenesis, risk factors, clinical features, diagnosis, and management of HSV pneumonia in patients with hematologic malignancies and HSCT, as well as outcome and prognosis.
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27
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Sundar KM, Ludwig KA, Alward WT, Pearce MJ, Bishop CT, Hammond RC, Hillyard DR, Freestone SW, Ozment A, Cahill BC. Clinical course and spectrum of intensive care unit patients reactivating herpes simplex-1 virus: a retrospective analysis. Indian J Crit Care Med 2010; 12:145-52. [PMID: 19742269 PMCID: PMC2738328 DOI: 10.4103/0972-5229.45073] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background: Herpes simplex-1 virus (HSV-1) reactivation in the respiratory tract is common in intensive care unit (ICU) patients. However, susceptible ICU populations are poorly defined. Clinical recognition of HSV infection of the respiratory tract is difficult and the impact of such reactivation is not understood. Materials and Methods: A retrospective analysis of HSV-1 positive patients encountered over a 5-year period at a multispecialty ICU was carried out. HSV-1 was identified in respiratory secretions using a qualitative polymerase chain reaction (PCR) technique. Patient charts were reviewed for clinical features that would typify HSV-1 respiratory involvement, and the morbidity and mortality risks found with HSV-1 respiratory involvement. Results: A review of 48 HSV-1 positive ICU patients showed that patients reactivating HSV in the respiratory tract fell into one of the three categories: (1) septic elderly patients with and without ARDS, (2) immunosuppressed patients, especially those receiving high-dose steroids, and (3) post-thoracotomy patients. Abnormalities suggestive of HSV-1 reactivation in the respiratory tract included, haemorrhagic or excessive respiratory secretions, concomitant orofacial herpes (42%), and bronchoscopic abnormalities (hemorrhagic ulcers and mucosal friability) (83%). Twenty eight percent of the HSV-1 infected patients experienced postextubation stridor. HSV-1 reactivation was associated with extended ventilator stays, significant mortality (42%), and ventilator-associated pneumonias (52%). Conclusions: Identification of susceptible populations and definition of clinical features of HSV-1 related respiratory disease can enable diagnosis of HSV-1 infection in ICU patients. Although detection by a PCR technique can rapidly diagnose HSV-1 reactivation, prospective studies are required to clarify HSV disease versus mere shedding, and understand the impact of HSV-1 reactivation in hospitalized patients.
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Affiliation(s)
- Krishna M Sundar
- Department of Medicine, Utah Valley Reginal Medical Center, Provo, Utah, USA.
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28
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García-Montesinos-De la Peña M, Oteiza-López L, Aldunate-Calvo S, Gómez-Sánchez MJ, Sáenz-Bañuelos JJ, Tihista-Jiménez JA. [Herpes simplex virus bronchopneumonitis in patient with acute respiratory failure after surgery]. Med Intensiva 2009; 34:150-3. [PMID: 20156709 DOI: 10.1016/j.medin.2009.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2009] [Revised: 04/03/2009] [Accepted: 04/15/2009] [Indexed: 11/30/2022]
Abstract
Herpes simplex virus bronchopneumonitis is a clinical entity described in critically ill patients and classically associated to immunosuppression. Recent reports have shown a higher frequency of virus detection from samples obtained by bronchoalveolar lavage of immunocompetent critically ill patients undergoing mechanical ventilation. This fact suggests its role as an independent pathogenic substrate. We report the case of a female patient who was admitted after an elective surgery of rectal tumor with suspected bronchoaspiration during anesthetic induction. The patient presented persistent fever despite broad spectrum antibiotic treatment. All cultures were negative for bacterial growth. The chest X-ray did not show opacifities. Prolonged mechanical ventilation with repeated failures to wean made it mandatory to perform percutaneous tracheostomy. A fibrobronchoscopy with bronchoalveolar lavage, performed previously, showed positive result for herpes simplex virus (PCR and specific nuclear inclusions in cells). Thus, treatment was initiated with acyclovir, with clinical improvement and weaning from mechanical ventilation.
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29
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Aisenberg G, Torres H, Tarrand J, Safdar A, Bodey G, Chemaly RF. Herpes simplex virus lower respiratory tract infection in patients with solid tumors. Cancer 2008; 115:199-206. [DOI: 10.1002/cncr.24011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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30
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Linssen CFM, Jacobs JA, Stelma FF, van Mook WNKA, Terporten P, Vink C, Drent M, Bruggeman CA, Smismans A. Herpes simplex virus load in bronchoalveolar lavage fluid is related to poor outcome in critically ill patients. Intensive Care Med 2008; 34:2202-9. [PMID: 18679655 DOI: 10.1007/s00134-008-1231-4] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2007] [Accepted: 07/11/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To evaluate the relationship between the HSV-1 and -2 loads in BAL fluid (BALF) and clinical outcome. DESIGN Retrospective study. SETTING The general intensive care unit of the University Hospital Maastricht. PATIENTS Five hundred and twenty-one BALF samples from 462 patients were included. Patients were divided into three groups; (1) patients admitted to the hospital <48 h before lavage (Community), (2) patients admitted to the ICU >48 h before lavage (ICU) and (3) the remaining patients (non-ICU group). INTERVENTIONS No additional interventions were conducted. MEASUREMENTS AND RESULTS HSV-1 and HSV-2 loads were determined by real-time polymerase chain reaction (PCR). HSV-1 DNA was detected in 4.3% (4/92) of samples in the community group, 15% (18/121) in the non-ICU group and in 32% (99/308) of the ICU group. In the age group <50 years HSV-1 DNA was less frequently isolated compared to the age group >or=50 years (16/129 (12%) versus 187/376 (25%), respectively, OR = 2.6; P < 0.001). HSV-1 loads of >10(5) genome equivalents (ge)/ml were associated with an increased 14-day in-hospital mortality compared to patients with a HSV-1 load CONCLUSIONS HSV-1 occurred more in critically ill patients and high loads in BALF were associated with an increased mortality. The higher mortality observed in patients with HSV-1 load >10(5) ge/ml enforces its clinical relevance and necessitates to start randomized medical intervention studies.
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Affiliation(s)
- Catharina F M Linssen
- Department of Medical Microbiology, University Hospital Maastricht, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.
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31
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Maounis N, Blana A, Ellina E, Chorti M, Lekkakou A, Mermigkis D, Spanakis N, Emmanouilidou A. Simultaneous cytological diagnosis of herpes simplex virus infection and primary lung cancer: Report of two cases. Diagn Cytopathol 2008; 36:818-22. [DOI: 10.1002/dc.20921] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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32
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Wong SSY, Yuen KY. Antiviral therapy for respiratory tract infections. Respirology 2008; 13:950-71. [PMID: 18922142 PMCID: PMC7192202 DOI: 10.1111/j.1440-1843.2008.01404.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2008] [Revised: 07/10/2008] [Accepted: 08/04/2008] [Indexed: 12/24/2022]
Abstract
Viruses are important pathogens causing respiratory tract infections both in the community and health-care facility settings. They are extremely common causes of morbidity in the competent hosts and some are associated with significant mortality in the compromised individuals. With wider application of molecular techniques, novel viruses are being described and old viruses are found to have new significance in different epidemiological and clinical settings. Some of these emerging pathogens may have the potential to cause pandemics or global spread of a severe disease, as exemplified by severe acute respiratory syndrome and avian influenza. Antiviral therapy of viral respiratory infections is often unnecessary in the competent hosts because most of them are selflimiting and effective agents are not always available. In the immunocompromised individuals or for infections caused by highly pathogenic viruses, such as avian influenza viruses (AIV), antiviral treatment is highly desirable, despite the fact that many of the agents may not have undergone stringent clinical trials. In immunocompetent hosts, antiviral therapy can be stopped early because adaptive immune response can usually be mounted within 5-14 days. However, the duration of antiviral therapy in immunosuppressed hosts depends on clinical and radiological resolution, the degree and duration of immunosuppression, and therefore maintenance therapy is sometimes needed after the initial response. Immunotherapy and immunoprophylaxis appear to be promising directions for future research. Appropriate and targeted immunomodulation may play an important adjunctive role in some of these infections by limiting the extent of end-organ damage and multi-organ failure in some fulminant infections.
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Affiliation(s)
- Samson S Y Wong
- Department of Microbiology, Research Centre of Infection and Immunology, The University of Hong Kong, Queen Mary Hospital, Hong Kong
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34
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A case of atypical and fatal herpes simplex encephalitis in a severe burn patient. Burns 2008; 35:590-3. [PMID: 18789591 DOI: 10.1016/j.burns.2008.05.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2008] [Accepted: 05/11/2008] [Indexed: 11/22/2022]
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35
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Thymidine kinase sequence analysis of herpes simplex virus type 1 strains present in different compartments in an atypical impetiginous rash on the lesional skin of a burn patient. J Clin Microbiol 2008; 46:3162-4. [PMID: 18632917 DOI: 10.1128/jcm.00552-08] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We report the case of a 23-year-old male burn patient with an unusual herpes simplex virus (HSV) skin manifestation. The clinical symptoms and results of HSV type 1 (HSV-1) UL23 polymorphism analysis from saliva and lesional skin underscores the need for performing molecular analysis of HSV-1 infections in burned patients presenting unusual skin lesions.
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36
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Luyt CE, Combes A, Deback C, Aubriot-Lorton MH, Nieszkowska A, Trouillet JL, Capron F, Agut H, Gibert C, Chastre J. Herpes simplex virus lung infection in patients undergoing prolonged mechanical ventilation. Am J Respir Crit Care Med 2007; 175:935-42. [PMID: 17234903 DOI: 10.1164/rccm.200609-1322oc] [Citation(s) in RCA: 260] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
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.
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Affiliation(s)
- Charles-Edouard Luyt
- Service de Réanimation Médicale, Institut de Cardiologie, Groupe Hospitalier Pitié-Salpêtrière, Université de Paris Pierre et Marie Curie, Assistance Publique-Hôpitaux de Paris, Paris Cedex 13, France.
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Simoons-Smit AM, Kraan EM, Beishuizen A, Strack van Schijndel RJ, Vandenbroucke-Grauls CM. Herpes simplex virus type 1 and respiratory disease in critically-ill patients: real pathogen or innocent bystander? Clin Microbiol Infect 2006; 12:1050-9. [PMID: 17002604 DOI: 10.1111/j.1469-0691.2006.01475.x] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Herpes simplex virus type 1 (HSV-1) has been associated with pulmonary disease, mostly in severely immunocompromised patients. After reactivation and shedding in the oropharynx, the virus may reach the lower respiratory tract by aspiration or by contiguous spread. HSV-1 can be detected in clinical specimens by virus culture or quantitatively by nucleic acid amplification techniques. With these techniques, HSV-1 is often detected in the respiratory secretions of critically-ill patients. However, a clear diagnosis of HSV-1 pneumonia is difficult to establish because clinical criteria, radiological features and laboratory findings all lack specificity. Lower respiratory tract HSV-1 infections have not been associated with specific risk-factors. There is also an absence of consistent data concerning the effect of antiviral treatment on the outcome of critically-ill patients. Further studies are needed to better define the pathogenic role of HSV-1 in the lower respiratory tract of these patients, to improve the diagnosis, and, especially, to assess the need for antiviral treatment in the individual patient.
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Affiliation(s)
- A M Simoons-Smit
- Department of Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam, The Netherlands.
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Viral Infections in ICU Patients. TROPICAL AND PARASITIC INFECTIONS IN THE INTENSIVE CARE UNIT 2005. [PMCID: PMC7120721 DOI: 10.1007/0-387-23380-6_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Verheij J, Groeneveld ABJ, Beishuizen A, Lingen AV, Simoons-Smit AM, van Schijndel RJMS. Herpes simplex virus type 1 and normal protein permeability in the lungs of critically ill patients: a case for low pathogenicity? Crit Care 2004; 8:R139. [PMID: 15153242 PMCID: PMC468896 DOI: 10.1186/cc2850] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2003] [Revised: 02/03/2003] [Accepted: 03/12/2004] [Indexed: 11/16/2022] Open
Abstract
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 × 10-3/min) was measured. Results The PLI ranged between 7.5 and 14.0 × 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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Affiliation(s)
- Joanne Verheij
- From the Department of Intensive Care, Nuclear Medicine
- the Institute for Cardiovascular Research
- Department of Medical Microbiology and Infection Control
| | - AB Johan Groeneveld
- From the Department of Intensive Care, Nuclear Medicine
- Department of Medical Microbiology and Infection Control
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Ong GM, Lowry K, Mahajan S, Wyatt DE, Simpson C, O'Neill HJ, McCaughey C, Coyle PV. Herpes simplex type 1 shedding is associated with reduced hospital survival in patients receiving assisted ventilation in a tertiary referral intensive care unit. J Med Virol 2004; 72:121-5. [PMID: 14635019 DOI: 10.1002/jmv.10524] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The impact of shedding of herpes simplex virus type 1 (HSV-1) on hospital survival of patients receiving assisted ventilation in an adult tertiary referral, acute trauma intensive care unit was assessed. The study was designed to address a clinical impression linking HSV-1 recovery with poor survival. Two hundred and forty-one males and 152 females were enrolled into a longitudinal cohort study. Combined throat swabs and tracheal secretions were tested for HSV-1 shedding using a nested nucleic acid amplification protocol; patients were ranked as nonshedders, shedders, and high-level shedders. Nonparametric analysis assessed the impact of shedding on hospital survival and logistic regression measured the confounding influence of sex, age, and the Acute Physiology, Age and Chronic Health Evaluation (APACHE II) score. Linear-by-linear association determined the influence of the level of shedding on hospital survival. The observed mortality rate was 113/393 (28.8%). Patients shedding HSV-1 106/393 (27%) had a significant reduction in hospital survival 66/106 (62%) in HSV-1 shedders compared with 217/287 (75.6%) in nonshedders (P = 0.002). This difference remained significant when adjusted for age and sex (P = 0.026). Respective mortality figures for HSV-1 shedders and nonshedders were 43/106 (40.6%) and 70/287 (24.4%) (P = 0.002). HSV-1 shedding was associated with a significant reduction in hospital survival amongst patients receiving assisted ventilation. Hospital mortality in HSV-1 shedders was increased by 16.2% over nonshedders. The role of HSV-1 in this setting needs to be addressed.
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Affiliation(s)
- G M Ong
- Regional Virus Laboratory, Queens University Belfast, Royal Group of Hospitals Trust, Belfast, United Kingdom
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Bruynseels P, Jorens PG, Demey HE, Goossens H, Pattyn SR, Elseviers MM, Weyler J, Bossaert LL, Mentens Y, Ieven M. Herpes simplex virus in the respiratory tract of critical care patients: a prospective study. Lancet 2003; 362:1536-41. [PMID: 14615108 DOI: 10.1016/s0140-6736(03)14740-x] [Citation(s) in RCA: 112] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND 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. METHODS 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. FINDINGS 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). INTERPRETATION 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.
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Affiliation(s)
- Peggy Bruynseels
- Department of Microbiology, University Hospital of Antwerp, Antwerp, Belgium.
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Kobayashi M, Takahashi H, Herndon DN, Pollard RB, Suzuki F. Effect of a combination therapy between IL-12 and soluble IL-4 receptor (sIL-4R) on Candida albicans and herpes simplex virus type I infections in thermally injured mice. Can J Microbiol 2002; 48:886-94. [PMID: 12489778 DOI: 10.1139/w02-085] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The effectiveness of a combination using IL-12 and soluble IL-4 receptor (sIL-4R) to treat severe infections of herpes simplex virus type 1 (HSV-1) and Candida albicans in thermally injured mice was investigated. Although sIL-4R decreased burn-associated type 2 T-cell responses, the effect of sIL-4R was minimal on the morbidity and mortality of thermally injured mice exposed to 250 times LD50 of HSV-1 or 10 times LD50 of C. albicans. Compared with 100% mortality in control mice, mortality for HSV-1 and C. albicans was 40 and 20%, respectively, in thermally injured mice that received IL-12 and sIL-4R in combination. After stimulation with anti-CD3 monoclonal antibody, splenic T cells from thermally injured mice exposed to large amounts of HSV-1 or C. albicans did not produce gamma interferon (IFN-gamma) into their culture fluids. However, IFN-gamma was produced by splenic T cells from thermally injured and infected mice treated with IL-12 and sIL-4R in combination. These results suggest that therapeutic treatment with a combination of IL-12 and sIL-4R may be effective by inducing type 1 T-cell responses in thermally injured mice exposed to large amounts of HSV-1 or C. albicans.
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Affiliation(s)
- Makiko Kobayashi
- Department of Internal Medicine, The University of Texas Medical Branch, Galveston, TX 77555, USA
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Kim EA, Lee KS, Primack SL, Yoon HK, Byun HS, Kim TS, Suh GY, Kwon OJ, Han J. Viral pneumonias in adults: radiologic and pathologic findings. Radiographics 2002; 22 Spec No:S137-49. [PMID: 12376607 DOI: 10.1148/radiographics.22.suppl_1.g02oc15s137] [Citation(s) in RCA: 215] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Numerous viruses, including influenza virus, measles virus, Hantavirus, adenovirus, herpesviruses, varicella-zoster virus, cytomegalovirus, and Epstein-Barr virus, can cause lower respiratory tract infection in adults. Viral pneumonia in adults can be classified into two clinical groups: so-called atypical pneumonia in otherwise healthy hosts and viral pneumonia in immunocompromised hosts. Influenza virus types A and B cause most cases of viral pneumonia in immunocompetent adults. Immunocompromised hosts are susceptible to pneumonias caused by cytomegalovirus, herpesviruses, measles virus, and adenovirus. The radiographic findings, which consist mainly of patchy or diffuse ground-glass opacity with or without consolidation and reticular areas of increased opacity, are variable and overlapping. Computed tomographic findings, which are also overlapping, consist of poorly defined centrilobular nodules, ground-glass attenuation with a lobular distribution, segmental consolidation, or diffuse ground-glass attenuation with thickened interlobular septa. The radiologic findings reflect the variable extents of the histopathologic features: diffuse alveolar damage (intraalveolar edema, fibrin, and variable cellular infiltrates with a hyaline membrane), intraalveolar hemorrhage, and interstitial (intrapulmonary or airway) inflammatory cell infiltration. Clinical information such as patient age, immune status, community outbreaks, symptom onset and duration, and presence of a rash remain important aids in diagnosis of viral causes.
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Affiliation(s)
- Eun A Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-Dong, Kangnam-Ku, Seoul 135-710, Korea
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Furukawa K, Kobayashi M, Herndon DN, Pollard RB, Suzuki F. Appearance of monocyte chemoattractant protein 1 (MCP-1) early after thermal injury: role in the subsequent development of burn-associated type 2 T-cell responses. Ann Surg 2002; 236:112-9. [PMID: 12131093 PMCID: PMC1422556 DOI: 10.1097/00000658-200207000-00017] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine whether monocyte chemoattractant protein-1 (MCP-1), which initiates subsequent development of burn-associated type 2 T cells, is produced in mice early after thermal injury. SUMMARY BACKGROUND DATA A predominance of type 2 T-cell responses is commonly observed in animals and patients with severe thermal injuries. Burn-associated type 2 T cells have been identified as the cells responsible for the increased susceptibility of thermally injured mice to infections with herpes simplex virus type 1 and Candida albicans. Recently, the necessity of MCP-1 for the generation of type 2 T cells was shown in MCP-1 knockout mice. MCP-1 may have an important role in the increased susceptibility of thermally injured mice to various intracellular opportunistic pathogens. METHODS The production of MCP-1 in sera or in cultures of various cells prepared from thermally injured mice was measured. Dual-chamber transwell cultures were performed to determine the influence of MCP-1-producing cells on the generation of burn-associated type 2 T cells. RESULTS Without any stimulation, splenic macrophages from mice (1/2D-M(phi)) produced MCP-1 into their culture fluids 12 hours after thermal injury. Interleukin-4 was detected in culture fluids of splenic T cells from normal mice cultured with 1/2D-M(phi) in a dual-chamber transwell system; however, this cytokine was not produced by normal T cells cultured with normal macrophages in the transwells. Also, normal T cells cultured with 1/2D-M(phi) did not produce interleukin-4 when transwell cultures were performed in the presence of anti-MCP-1 monoclonal antibody. Further, normal T cells directly stimulated with MCP-1 produced interleukin-4 into their culture fluids. Normal T cells, cultured with 1/2D-M(phi) for 24 hours in the transwells and recultured with fresh medium for an additional 7 days, produced interleukin-10 (but not interferon-gamma) and expressed ST2L mRNA (but not interleukin-12 receptor beta2 chain) when they were stimulated with anti-CD3 monoclonal antibody. CONCLUSIONS Results indicate that MCP-1 is produced in mice within 1 day of thermal injury, and the subsequent development of burn-associated type 2 T-cell responses may be triggered by MCP-1 produced early after thermal injury.
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Affiliation(s)
- Katsunori Furukawa
- Department of Internal Medicine, The University of Texas Medical Branch, Galveston, Texas 77555-0435, USA
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Sheridan RL, Schulz JT, Weber JM, Ryan CM, Pasternack MS, Tompkins RG. Cutaneous herpetic infections complicating burns. Burns 2000; 26:621-4. [PMID: 10925184 DOI: 10.1016/s0305-4179(00)00025-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Many people harbor herpes simplex virus, often with a known history of "cold sores". During the relatively immunosuppressed state associated with a serious burn, recrudescence of such infections can occur. We report four adults and two children who developed severe herpetic ulceration, over the face and neck in five patients and in a partial thickness wound in one patient. Herpetic infection was diagnosed by culture and direct immunofluorescence testing and treatment was immediately instituted with systemic and topical Acylovir(R) (Zovirax, Glaxo Wellcome). Ulceration healed under treatment and did not leave visible scarring in any of the patients. Although these infections are rapidly progressive, they respond to prompt treatment with antiviral chemotherapy. Rapidly progressive vesicles and ulceration appearing on the face or in the wounds of burn patients should prompt immediate evaluation for herpetic infection.
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Affiliation(s)
- R L Sheridan
- Department of Surgery, Division of Burns and Trauma, Massachusetts General Hospital, Boston, MA, USA.
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Abstract
Herpes simplex virus (HSV) infection in the burn patient is thought to occur relatively frequently. Most commonly, children with significant burns, particularly involving the head and neck, are affected. Burn related immunosuppression is thought to allow reactivation of latent HSV in most cases, although primary HSV infection has been recognized. Clinical manifestations vary from asymptomatic viral shedding, to prolonged fever with eruption of vesicles, to rare cases of systemic visceral dissemination. Healing partial thickness wounds and donor sites are most prone to infection. Laboratory confirmation of HSV infection relies on direct demonstration of the virus and/or observation of a rise in antibody titer. Treatment of an established HSV infection includes use of IV Acyclovir, meticulous wound care, and efforts to prevent nosocomial spread. The vast majority of cases resolve without sequelae unless complicated by systemic, multiorgan HSV infection.
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Affiliation(s)
- S N McGill
- Department of Surgery, Queen's University, Kingston, Canada
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Abstract
Pulmonary infections decisively contribute to morbidity and mortality in immunocompromised patients. Bacterial, mycobacterial and infections with Pneumocystis carinii have been reviewed in an article in the last issue of Respiration. In this review, viral and fungal pulmonary infections are discussed in HIV-positive patients and in patients treated with high-dose chemotherapy, stem cell or solid-organ transplantation.
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Affiliation(s)
- M Tamm
- Division of Pneumology, University Hospital Basel, Switzerland.
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48
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Abstract
In adults, acute lung injury or adult respiratory distress syndrome (ARDS) may complicate a wide range of serious medical and surgical conditions, only some of which involve direct pulmonary insult. The characteristic histological feature of ARDS is an intense inflammatory process in the lungs, which may progress to fibrosis. The earliest physiological characteristic is an increase in the protein permeability across the endothelial and epithelial barriers of the lungs. This clinical syndrome is characterized by arterial hypoxaemia and bilateral radiographic infiltrates, which represent protein-rich oedema fluid. In addition there is a neutrophilic and macrophage infiltrate. Pulmonary endothelium is actively involved in the development of ARDS. It alters cell-cell adhesion as the initial step in leucocyte migration which, in turn, changes the permeability that allows protein-rich fluid to move into the interstitium. The quantity of this interstitial oedema may be sufficient to cause bulk flow through the epithelial barrier. There is probably independent epithelial injury. Finally, the endothelium can release and metabolize vasoactive and inflammatory substances, such as endothelins, nitric oxide and cytokines, etc. No single substance is responsible for acute lung injury, but rather a complex interplay exists between diverse pro- and anti-inflammatory mediators.
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Affiliation(s)
- P S Hasleton
- Department of Pathology, University Hospital of South Manchester, Wythenshawe Hospital, Wythenshawe, Manchester, UK.
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