Herpes Simplex Virus Pneumonia in Immunocompetent Patients Undergoing Cardiac Surgery: Case Series
Abstract
OBJECTIVE
To describe the frequency, diagnosis, and management, of herpes simplex virus-1 (HSV-1) pneumonia in patients without known immunodeficiency undergoing cardiac surgery with cardiopulmonary bypass.
DESIGN
Retrospective observational case series.
SETTING
Intensive care unit.
PARTICIPANTS
Adult patients without known immunodeficiency who developed HSV-1 pneumonia after cardiac surgery.
INTERVENTIONS
Baseline, perioperative, and postoperative data were collected. HSV-1 pneumonia was diagnosed by a multidisciplinary team when progressive respiratory deterioration was unresponsive to standard antibiotic therapy and quantitative HSV-1 polymerase chain reaction in a bronchoalveolar lavage (BAL) or bronchial aspirate (BAS) sample documented a viral load >10,000 copies/mL.
MEASUREMENTS AND MAIN RESULTS
Among 818 patients undergoing cardiac surgery during the study period, 43 were tested for HSV. Among them, 15 (34.9%) had a positive BAL/BAS for HSV-1. In these patients (8 males [53%]; median age, 69 years [interquartile range (IQR), 63-73 years]), quantitative HSV-1 polymerase chain reaction on BAL/BAS documented a median of 3.21 × 10⁶ (IQR, 5.62 × 10⁵-5.73 × 10⁶) copies/mL. Diagnosis was made at a median of 12 days (range, 7.5-19 days) after surgery. Thirteen of the 15 patients (86.7%) were mechanically ventilated, and 11 (73.3%) met criteria for acute respiratory distress syndrome. Median C-reactive protein and procalcitonin values were 108.6 (IQR, 85.7-141.4) mg/L and 1.1…
How strong is the evidence?
Evidence Hub reads this as a case series, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health. Reported size: 818 participants or records.
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