Bronchoscopic suspect of Herpesvirus infection in critically ill COVID-19 patients: two case reports and brief literature review

Main Article Content

Cristian Deana
Luigi Vetrugno
Francesca Stefani
Flavio Bassi

Keywords

herpesvirus, bronchoalveolar lavage, ICU, critically ill patient, fiberoptic bronchoscopy, COVID-19

Abstract

Herpesviridae infection in COVID-19 patients has been reported, particularly muco-cutaneous lesions. Little is known about Herpesviridae lung infection in critically ill COVID-19 patients. Typical scattered lesions seen through fiberoptic bronchoscopy in these patients should raise the question as to whether to start empirically acyclovir treatment while a Herpesviridae diagnostics result becomes available.
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References

1. Yasushi K, Yasuko M, Hiroshi K. Human Herpesviruses. Springer, 1st Edition 2018.
2. Whitley RJ, Roizman B. Herpes simplex virus infections. Lancet 2001; 357:1513–8.
3. Ong DSY, Bonten MJM, Spitoni C, Lunel FMV, Frencken JF, Horn J, et al. Epidemiology of multiple herpes viremia in previously immunocompetent patients with septic shock. Clin Infect Dis. 2017;64(9):1204–10.
4. Marzano AV, Genovese G, Fabbrocini G, et al. Varicella-like exanthem as a specific COVID-19-associated skin manifestation: multicenter case series of 22 patients. J Am Acad Dermatol. 2020;83(1):280-285.
5. Luyt CE, Brechot N, Chastre J. What role do viruses play in nosocomial pneumonia? Curr Opin Infect Dis. 2014; 27:194–9.
6. Saugel B, Jakobus J, Huber W, Hoffmann D, Holzapfel K, Protzer U, et al. Herpes simplex virus in bronchoalveolar lavage fluid of medical intensive care unit patients: association with lung injury and outcome. J Crit Care. 2016; 32:138–44.
7. Schuierer L, Gebhard M, Ruf HG, Jaschinski U, Berghaus TM, Wittmann M, Braun G, Busch DH, Hoffmann R. Impact of acyclovir use on survival of patients with ventilator-associated pneumonia and high load herpes simplex virus replication. Crit Care. 2020 Jan 10;24(1):12.
8. Xu R, Zhou Y, Cai L, Wang L, Han J, Yang X, Chen J, Chen J, Ma C, Shen L. Co-reactivation of the human herpesvirus alpha subfamily (herpes simplex virus-1 and varicella zoster virus) in a critically ill patient with COVID-19. Br J Dermatol. 2020 Dec;183(6):1145-1147.
9. Le Balc'h P, Pinceaux K, Pronier C, Seguin P, Tadié JM, Reizine F. Herpes simplex virus and cytomegalovirus reactivations among severe COVID-19 patients. Crit Care. 2020 Aug 28;24(1):530.
10. Mehta P, McAuley DF, Brown M, Sanchez E, Tattersall RS, Manson JJ, et al. COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet. 2020;395(10229):1033–4.
11. Bradley H, Markowitz LE, Gibson T, McQuillan GM. Seroprevalence of herpes simplex virus types 1 and 2--United States, 1999-2010. J Infect Dis. 2014; 209:325–33.
12. Tartari F, Spadotto A, Zengarini C, Zanoni R, Guglielmo A, Adorno A, Valzania C, Pileri A. Herpes zoster in COVID-19-positive patients. Int J Dermatol. 2020 Aug;59(8):1028-1029. doi: 10.1111/ijd.15001.
13. Busani S, Bedini A, Biagioni E, Serio L, Tonelli R, Meschiari M, Franceschini E, Guaraldi G, Cossarizza A, Clini E, Maiorana A, Gennari W, De Maria N, Luppi M, Mussini C, Girardis M; Modena Covid-19 Working Group (MoCo19). Two fatal cases of acute liver failure due to HSV-1 infection in COVID-19 patients following immunomodulatory therapies. Clin Infect Dis. 2020 Aug 25:ciaa1246.
14. Franceschini E, Cozzi-Lepri A, Santoro A, Bacca E, Lancellotti G, Menozzi M, Gennari W, Meschiari M, Bedini A, Orlando G, Puzzolante C, Digaetano M, Milic J, Codeluppi M, Pecorari M, Carli F, Cuomo G, Alfano G, Corradi L, Tonelli R, De Maria N, Busani S, Biagioni E, Coloretti I, Guaraldi G, Sarti M, Luppi M, Clini E, Girardis M, Gyssens IC, Mussini C. Herpes Simplex Virus Re-Activation in Patients with SARS-CoV-2 Pneumonia: A Prospective, Observational Study. Microorganisms. 2021 Sep 7;9(9):1896. doi: 10.3390/microorganisms9091896. PMID: 34576791; PMCID: PMC8465957.
15. Patrucco F, Albera C, Bellocchia M, Foci V, Gavelli F, Castello LM, Bellan M, Sainaghi PP, Airoldi C, Balbo PE, Solidoro P. SARS-CoV-2 Detection on Bronchoalveolar Lavage: An Italian Multicenter experience. Respiration. 2020;99(11):970-978.