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Herpes Tracheobronchitis: An Important but Overlooked Syndrome in ICU

Hahnemann University Hospital, Philadelphia, PA

PURPOSE: Tracheobronchitis (TCB) due to Herpes Simplex Virus (HSV) is thought to be uncommon as a lower respiratory pathogen. The literature mainly consists of small case series. To better define this syndrome, we identified and retrospectively reviewed charts of patients (pts) with HSV TCB at Hahnemann University Hospital (HUH).

METHODS: The pathology and microbiology computer databases were queried for pts with HSV cytopathic effect (CPE) and for patients with HSV (+) cultures (cx) from bronchoscopy (BCS) specimens. The diagnosis of HSV TCB was made based on evidence of CPE typical of HSV from BCS samples.

RESULTS: Twenty seven cases were identified over 7 yrs. Mean age was 63 yrs. 30% pts had prior history of HSV. 30% had other sites of active HSV. 37% used corticosteroids; 33% had cancer; 14% were undergoing chemotherapy. 20% had history of smoking. 44% pts had fever. 96% were intubated. 93% were short of breath and 56% had bronchospasm. All pts had other respiratory symptoms and abnormal BCS findings. The most common findings were bland nodules, erythema, exudate, ulcerations and edema. HSV was recovered in 19 cases; 1 pt had negative BCS HSV cx; 7 pts did not have cx performed. 85% received Acyclovir. Everyone recovered from TCB but the associated mortality was 48%.

CONCLUSION: 27 cases of HSV TCB were reviewed. Most pts did not have a prior history of HSV. Only half of pts were immunosupressed (e.g. steroids, cancer, chemotherapy). Nearly all pts were critically ill and intubated in intensive care. Bronchospasm, a commonly reported associated symptom, was seen in about half of pts. Nodules, erythema and exudate were the most common BCS findings. All pts recovered from TCB but many died from co-morbid conditions.

CLINICAL IMPLICATIONS: HSV TCB should be considered in critically ill pts with unexplained respiratory symptoms and the above described BCS findings.

DISCLOSURE: R.A. Promisloff, None.