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.
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.
Authors: Catharina F M Linssen; Jan A Jacobs; Foekje F Stelma; Walther N K A van Mook; Peter Terporten; Cornelis Vink; Marjolein Drent; Cathrien A Bruggeman; Annick Smismans Journal: Intensive Care Med Date: 2008-08-05 Impact factor: 17.440
Authors: Janet L Weslow-Schmidt; Nancy A Jewell; Sara E Mertz; J Pedro Simas; Joan E Durbin; Emilio Flaño Journal: J Virol Date: 2007-07-11 Impact factor: 5.103
Authors: Charles H Cook; Yingxue Zhang; Daniel D Sedmak; Larry C Martin; Scott Jewell; Ronald M Ferguson Journal: Crit Care Med Date: 2006-03 Impact factor: 7.598
Authors: Krishna M Sundar; Karl A Ludwig; William T Alward; Michael J Pearce; Clark T Bishop; Roy C Hammond; David R Hillyard; Steven W Freestone; Anne Ozment; Barbara C Cahill Journal: Indian J Crit Care Med Date: 2008-10