Clinical Considerations when Herpes Simplex Virus Is Isolated from Bronchoscopy Specimens

Abstract

The purpose of this pilot study was to define the clinical relevance of herpes simplex virus (HSV) isolated from bronchoscopy specimens. A retrospective review of clinical characteristics, bronchoscopic features and outcome for 40 patients (24 patients with Acquired Immunodeficiency Syndrome (AIDS), 16 without AIDS) was conducted during an 18 month period in a major university hospital. HSV was isolated from bronchoscopy specimens from all patients in the study. Procedures included flexible fiberoptic bronchoscopy with bronchoalveolar (BAL) washings, brushings and/or bronchoscopic lung biopsy. Hospital records, clinical studies, potential risk factors for HSV infection, and results of bronchoscopic examination were reviewed. 20 patients were hospitalized in the Intensive Care Unit (4 with AIDS, 16 without AIDS). Bronchoscopy revealed raised white plaques with surrounding erythema in the airways of 17 (42.5%) patients. Other potentially pathogenic organisms were present in 30 patients (75%). Cytology revealed inflammation in 2 (8.3%) patients with AIDS and in 9 (56.3%) patients without AIDS. HSV-like cellular changes, however, were seen in only 14 patients (5 with AIDS, 9 without AIDS). The isolation of HSV from bronchoscopy specimens may have different clinical relevance for patients, depending upon host immune status and other underlying illnesses. Regardless, the determination of the clinical relevance of HSV isolation in bronchoscopy specimens is complex. The full spectrum of HSV-related lower respiratory infections can only be addressed by well-designed, prospective studies that address histopathology, operating characteristics of bronchoscopic appearance, selective sampling of various parts of the respiratory tract, and specific antiviral therapy.