Herpes simplex virus pneumonia in immunocompetent patients undergoing cardiac surgery: a case series

Objective: To describethefrequency,diagnosis,andmanagement,ofherpessimplexvirus-1(HSV-1)pneumoniainpatientswithoutknown immunodeficiency undergoingcardiacsurgerywithcardiopulmonarybypass. Design: Retrospective observationalcaseseries. Setting: Intensive careunit. Participants: Adult patientswithoutknownimmunodeficiencywhodevelopedHSV-1pneumoniaaftercardiacsurgery. Interventions: Baseline, perioperative,andpostoperativedatawerecollected.HSV-1pneumoniawasdiagnosedbyamultidisciplinaryteam when progressiverespiratorydeteriorationwasunresponsivetostandardantibiotictherapyandquantitativeHSV-1polymerasechainreactionin a bronchoalveolarlavage(BAL)orbronchialaspirate(BAS)sampledocumentedaviralload >10,000 copies/mL. Measurements andMainResults: Among 818patientsundergoingcardiacsurgeryduringthestudyperiod,43weretestedforHSV.Among them, 15(34.9%)hadapositiveBAL/BASforHSV-1.Inthesepatients(8males[53%];medianage,69years[interquartilerange(IQR),63-73 years]), quantitativeHSV-1polymerasechainreactiononBAL/BASdocumentedamedianof3.21 £ 10⁶ (IQR, 5.62 £ 10⁵-5.73 £ 10⁶) copies/ mL. Diagnosiswasmadeatamedianof12days(range,7.5-19days)aftersurgery.Thirteenofthe15patients(86.7%)weremechanicallyventi- lated, and11(73.3%)metcriteriaforacuterespiratorydistresssyndrome.MedianC-reactiveproteinandprocalcitoninvalueswere108.6(IQR, 85.7-141.4) mg/Land1.1(IQR,0.4-1.4)ng/mL,respectively.Allpatientsreceivedantiviraltherapy.Themedianlengthofstayintheintensive care unitwas54days,andin-hospitalmortalityof66.7%,higherafterurgentsurgery(85.7%)comparedtoelectivesurgery(50.0%). Conclusions: HSV-1 infectionemergedasarelevantfindingamongthesecardiacsurgerypatientswithrespiratorydeterioration.Furtherstudies are warrantedtoclarifytheimpactofHSV-1onpatientoutcomesandtooptimizetreatmentstrategies.