Herpetic tracheobronchitis detected at bronchoscopy: cytologic diagnosis by the immunoperoxidase method

Sputum characteristics of patients with severe COVID-19: report of two cases with immunocytochemical detection of SARS-CoV-2 spike protein

Patients with SARS-CoV-2 infection and with severe COVID-19 often have multiple coinfections, and their treatment is challenging. Here, we performed cytology analysis on sputum samples from two patients with severe COVID-19. The specimens were prepared using the rubbing method and stained with Papanicolaou stain. In both cases, several cells with frosted nuclei were observed, and the cytological findings per 100 cells were evaluated. The infected cells were mononuclear to multinuclear, showing chromatin aggregation at the nuclear margins, intranuclear inclusion bodies, eosinophilic cytoplasmic inclusion bodies, and mutual pressure exclusion of the nuclei. Immunocytochemical staining revealed that the cells were positive for AE1/AE3 and negative for CD68 expression, indicating their epithelial origin. Furthermore, infected cells with frosted nuclei were positive for surfactant protein A (SP-A) in Case 2, suggesting infection of type II alveolar pneumocytes or Clara cells. Moreover, in Case 2, the infected cells were positive for herpes simplex virus (HSV) I + II and SARS-CoV-2 spike protein, confirming double infection in these cells. In conclusion, sputum cytology is an important tool for determining the diversity of viral infection, and additional immunocytochemistry can be used for definitive diagnosis.

Herpetic tracheitis and polybacterial pneumonia in an immunocompetent young man is herpes tracheitis involved in the pathogenesis of bacterial pneumonia?

We report a 28-year-old immunocompetent man that after a course of corticoids developed a severe pneumonia in right lower lobe. A fiber-optic bronchoscopy showed a white membrane easily bloody on contact with bronchoscopy tube at trachea level. The tracheal biopsy showed typical cytopathological lesions of herpes simplex virus (HSV) and polymerase chain reaction was positive for type 1 HSV. Streptococcus viridans and Fusobacterium necrophorum grew in right bronchial secretion cultures. Clinical improvement was achieved after prolonged antibiotic therapy and before initiating treatment with acyclovir. Herpetic tracheitis could have been involved in the aspiration of oropharyngeal material that leaded to the development of this bacterial pneumonia.

A review of pulmonary cytopathology in the acquired immunodeficiency syndrome

Over the past 6 yr, we have observed an increase in cytologic specimens from the respiratory tract in patients suspected or known to have AIDS, from 7 of 81,031 cases in 1982 to 1,231 of 55,333 in 1987. Based on our experience with 1,140 patients, this article reviews the technical and morphologic evaluation of pulmonary cytologic specimens from AIDS patients.