Herpetic tracheobronchitis and pneumonia have been recognized in the past as distinct pathologic entities studied and reported mainly upon the basis of autopsy findings.

Herpetic tracheobronchitis and pneumonia have been recognized in the past as distinct pathologic entities studied and reported mainly upon the basis of autopsy findings.(1)(2)(3)(4)(5)(6)(7)(8) More freshly clinical studies have focused upon patients who were severely immunocompromised becoming to burns, underlying malignancy, chemotherapy, and organ and bone marrow transplantation.(1)(2)(3)(5)(6)(7) In 1988 Sherry et al(9) described nine immunocompetent patients with herpetic tracheobronchitis who were treated, apparently luckily with acyclovir. The report prompted a reasonably characteristic clinical course manifested on unexplained and unresolving acute bronchospasm, hypoxemia, and ventilator appurtenance in the over-60-year-old age form into groups The association of herpes simplex virus (HSV) with the lower respiratory tracts of patients with adult respiratory distress syndrome (ARDS) and with respiratory failure following cardiac surgery has been described recently; however, the part of HSV is unclear.(10)(11)(12)

Reported herein are new experiences involving patients with acute respiratory illness who had undergone surgery and were treated with acyclovir for HSV win backed from the lower respiratory tract. Available knowledge of this clinical entity is reviewed with the expectancy of further defining the clinical appearance of HSV infection of the lower respiratory tract and of further evaluating the significance of HSV when isolated therefrom.

METHODS

Patients

Because of the variability in the diagnosis, therapy, and coding of HSV infection of the respiratory tract, the charts of all patients at Morristown (NJ) Memorial Hospital who received acyclovir therapy, either orally or intravenously, were investigated retrospectively. A total of 249 patients received acyclovir therapy during a 22-month period (January 1990 within October 1992). Of this form into groups 36 patients, 14 of whom had undergone surgery were assumed to have HSV lower respiratory tract infection and were evaluated. Therefore, although this report is neither a prevalence nor an incidence cogitation approximately 40 percent of cases of HSV involvement of the lower respiratory tract was in patients following surgery

Each chart was carefully reviewed for demographic data, chronic medical or surgical question s therapy received as outpatients, the major indication for hospital admission, surgical intervention, the ne for mechanical ventilation, nosocomial infections, other pathogens isolated from the respiratory tract, inpatient antibiotic therapy, time of attack of the respiratory illness suspected to be of herpetic origin and its relation to other factors described, clinical features of like illness, laboratory information, chest radiographic patterns, bronchoscopic airway morphology, respiratory tract specimens used for diagnostic studies, and acyclovir therapy administered. Patients' deaths and their possible relationship to HSV infection were also reviewed.

Evaluation of Extrapulmonary Herpetic Infections

Patients exhibiting mucocutaneous lesions were examined by way of a senior dermatologist (E.B.) to ascertain the likelihood of HSV as the etiology. Microbiologic or cytologic confirmation was not performed forward such lesions.

Diagnostic Methods

Respiratory tract specimens were submitted for cytologic investigation for evidence of HSV cytopathic forces viral cultures, Gram stain, and routine bacterial agricultures Acid-fast smears and mycobacterial and fungal cultivations were performed in some cases. Specimens for cytologic studious mood were evaluated by experienced pathology technicians and reviewed on a pathologist. Viral cultures were performed at the Smith Kline Beecham Clinical Laboratories in King of Prussia, Pa, utilizing either a rapid 24-h shell vial technique or conventional tissue agriculture isolation.

The Hospital

The design of describing the hospital and its facilities is to define the population from which the patients described herein were studied. Morristown Memorial Hospital is a regional medical center in northwestern of recent origin Jersey. It has a total of 547 inpatient beds, of which 30 are critical care beds. There is a large oncology service and an interpret heart surgery program. There is no injure by fire [i]or[/i] heat unit, and organ transplantation is not performed. Approximately 6 percent of patients admitted to the hospital have HIV-related illnesses.

Statistical Analysis

Although various assemblages and subgroups of patients are described for comparative features, no statistical analysis was performed. The patients were a rareed group with a large variability in demographics, severity of illness, and therapeutic intervention, with no direct over any of these factors. Thus, while statistical differences or similarities may be raise such findings would be obscur by means of the lack of true comparability.

RESULTS

Fourteen patients had undergone a surgical deed prior to the finding of HSV; five had cardiac surgery couple had vascular surgery, and seven had abdominal surgery Of these patients, 75 percent received mechanical ventilation prior to HSV diagnosis. None were known to be smoker for at least 5 years prior to the surgery

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