Infections respiratoires à virus herpes simplex en réanimation

Abstract

Detection of herpes simplex virus (HSV) in the upper and lower respiratory tract is well described. In the throat, the viral reactivation is probably due to the immunoparalysis observed in such patients, and/or to micro trauma. It is not known whether the isolation of HSV from lower respiratory tract samples of nonimmunocompromised ventilated patients corresponds to bronchial contamination from mouth and/or throat, local tracheobronchial excretion of HSV, or true HSV lung involvement (bronchopneumonitis) with its own morbidity/mortality. This disease seems common, but its diagnosis remains difficult because clinical, biological and radiological signs are not specific. HSV bronchopneumonitis is defined as a clinical deterioration, associated with HSV in lower respiratory tract and HSV-specific nuclear inclusions in cells of the bronchiolo-alveolar compartment. Risk factors associated with HSV bronchopneumonitis are oral–labial lesions, HSV in throat and macroscopic bronchial lesions seen during bronchoscopy. HSV bronchopneumonitis seems associated with longer duration of mechanical ventilation and ICU stays, but the efficacy of a specific antiviral agent in this population remains to be determinate.