Herpetic tracheobronchitis: immunohistologic demonstration of herpes simplex virus antigen

Herpes simplex virus pneumonia following mitral valve replacement

We describe a rare case of a 79-year-old woman who developed herpes simplex virus pneumonia after mitral valve replacement. The patient showed persistent hypoxemia with bilateral glass-like shadows on chest radiography. Cytopathology examination of intratracheal secretions revealed herpes simplex virus infection. The patient, who improved gradually after acyclovir administration, was taken off the ventilator completely. Physicians should consider viral pulmonary infection to be a potential cause of unexplained hypoxemia that does not respond to conventional antibiotic treatment in critically ill, immunocompromised patients.

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.

Cutaneous herpetic infections complicating burns

Many people harbor herpes simplex virus, often with a known history of "cold sores". During the relatively immunosuppressed state associated with a serious burn, recrudescence of such infections can occur. We report four adults and two children who developed severe herpetic ulceration, over the face and neck in five patients and in a partial thickness wound in one patient. Herpetic infection was diagnosed by culture and direct immunofluorescence testing and treatment was immediately instituted with systemic and topical Acylovir(R) (Zovirax, Glaxo Wellcome). Ulceration healed under treatment and did not leave visible scarring in any of the patients. Although these infections are rapidly progressive, they respond to prompt treatment with antiviral chemotherapy. Rapidly progressive vesicles and ulceration appearing on the face or in the wounds of burn patients should prompt immediate evaluation for herpetic infection.

Immunocytochemical confirmation of oral and respiratory herpesvirus infection by the immunoperoxidase method

Recognition of diagnostic viral changes in general, and due to herpesvirus infection (HVI) in particular, from a variety of materials examined cytologically has added a new dimension to diagnostic cytology. Such recognition provides valuable information to the clinician when no infection is suspected. Previously, the diagnosis of HVI of the respiratory tract was only possible at postmortem, tissue culture, or diagnostic rise in antibody titer. This study describes our experience in the diagnosis of HVI of the respiratory tract initially suggested by sputum cytology and later confirmed by the immunoperoxidase method. The importance of sputum cytology in the diagnosis of HVI is emphasized.

Herpes zoster of the larynx after intubational trauma

Multiple or prolonged endotracheal intubations may result in laryngeal trauma. This case illustrates that recrudescence of latent varicella-zoster virus as herpes zoster of the larynx, with subsequent laryngeal paralysis, can complicate intubation. Consequently, physicians should strive to minimize laryngeal injury in this setting. It is advised that careful laryngeal examination follow extubation.

Herpes simplex viral infection in human neonates: an immunohistochemical and electron microscopic study

Specimens obtained at autopsy from six neonates with herpes simplex virus (HSV) infections were examined microscopically, electron microscopically, and immunohistochemically. Coagulative necrosis with inclusions was found in the livers and adrenal glands in all cases, as well as in various other organs, including the spleen, bone marrow, lungs, esophagus, tongue, and thymus, in some cases. Distinct hemorrhagic diathesis was found in three cases. No characteristic clinical findings, such as skin rashes or elevated titers of the antibody to HSV, were found, and clinical diagnosis was therefore difficult. In three cases isolation and typing of the causative virus were performed virologically, and type 1 HSV (HSV-1) was identified as the causative virus. Immunohistochemically, the type and distribution of the virus were evaluated in all cases with type-specific antisera to types 1 and 2 (HSV-2) antigens by the peroxidase-antiperoxidase method. In five cases the infections were found to be due to HSV-1 and in only one case to HSV-2. In the placenta in one case of HSV-2 infection, HSV antigen was demonstrated in the chorionic villi. Electron microscopic study confirmed the existence of viral particles in the placenta in that case and, thus, the possibility of a transplacental route of infection.

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

Herpes simplex virus (HSV) infection of the respiratory tract requires rapid specific diagnosis to avoid late complications and maximize the efficacy of available drug therapy. We report a method of accomplishing this that was tested in 33 cytologic specimens derived from sputum, washings, or brushings from 25 debilitated elderly males suffering from a variety of underlying neoplastic and nonneoplastic chronic diseases. All specimens had shown either single cells (54%), multinucleated groups (8%), or both (38%); they displayed the ground-glass appearance (86%), discrete nuclear inclusions (4%), or both (10%), as appreciated by the Papanicolaou stain. The specimens were processed by the peroxidase-antiperoxidase technique utilizing anti-HSV-1 antibody and 3,3'-diaminobenzidine (DAB) as the chromogen. In six cases, aminoethylcarbazol (AEC) was used for comparison. Twenty-nine of the 33 specimens (88%) stained positively for HSV-1 as did control sections of herpetic encephalitis and esophagitis; there were no false positives with appropriate negative controls. All 12 bronchoscopic specimens revealed virocytes with HSV immunopositivity; in contrast, 17 of 21 (80%) sputum specimens were positive for HSV. The strongest positivity was noted in bronchial brushings and washings whereas the only four negative smears were from sputum specimens. The DAB immunostain was coarser and stronger at the periphery of the cytoplasm, and the hematoxylin counterstain permitted a clear identification of nuclear viral changes. With AEC, the immunostain was more vivid and evenly distributed, but counterstaining was impaired due to the greater solubility of the chromogen. The technique is sensitive, reproducible, and less expensive and time-consuming than electron microscopy (EM) or viral cultures.