Résumé
Les herpesviridae, essentiellement l’herpes simplex virus (HSV) et le cytomégalovirus (CMV), sont fréquemment détectés dans les voies aériennes des malades non immunodéprimés sous ventilation mécanique. Bien que leur présence traduise le plus souvent une réactivation virale sans réelle atteinte parenchymateuse, celle-ci peut néanmoins exister chez un certain nombre de patients. Si le diagnostic d’atteinte parenchymateuse à herpesviridae doit être étayé par une preuve histologique (effet cytopathogène spécifique), l’utilisation des outils de virologie moléculaire (amplification par polymerase chain reaction en temps réel pour estimer la charge virale) pourrait remplacer l’examen histologique dans un futur proche. La survenue d’une bronchopneumonie à HSV est associée à une réactivation du virus au niveau oropharyngé et à la présence de lésions labiales. Cette maladie semble avoir un réel impact sur l’évolution, puisqu’elle est associée à une durée de ventilation mécanique et à un séjour en réanimation prolongés. L’intérêt d’un traitement par acyclovir dans cette indication reste cependant à déterminer. Si la réactivation du CMV dans le sang est facile à détecter et associée à une évolution défavorable, la pneumonie à CMV est difficile à prouver du fait de la lourdeur des techniques diagnostiques (biopsie pulmonaire), et son impact sur le pronostic incertain. L’intérêt d’un traitement par ganciclovir dans cette indication reste aussi à démontrer.
Abstract
Herpesviridae, including herpes simplex virus (HSV) and cytomegalovirus (CMV), are commonly detected in the respiratory tract of non-immunocompromised patients receiving mechanical ventilation. Although their detection usually involves viral reactivation without the involvement of pulmonary tissue, viral lung disease may occur in a particular population of patients. Although histological examination for specific cytopathic effects forms the basis of diagnosis, the use of modern virological tests (amplification using real-time polymerase chain reaction to estimate the vial load) should replace the histological tests in the near future. HSV bronchopneumonitis is associated with the reactivation of HSV in oropharyngeal and oral-labial lesions. It seems to clearly affect patients’ outcome due to prolonged mechanical ventilation and length of stay in the intensive care unit (ICU). However, only interventional studies will be able to determine its real impact. To date, use of acyclovir in these patients remains to be assessed. Although CMV reactivation in the blood is frequent in ICU patients, CMV pneumonia is difficult to diagnose because of the cumbersomeness of the procedure (open lung biopsies). Its true prognosis remains uncertain. The use of ganciclovir in this subset of patients also remains to be assessed.
Article PDF
Avoid common mistakes on your manuscript.
Références
Peiris JS, Chu CM, Cheng VC, et al (2003) Clinical progression and viral load in a community outbreak of coronavirus-associated SARS pneumonia: a prospective study. Lancet 361:1767–1772
Beigel JH, Farrar J, Han AM, et al (2005) Avian influenza A (H5N1) infection in humans. N Engl J Med 353:1374–1385
Chastre J, Luyt CE, Combes A, Trouillet JL (2006) Use of quantitative cultures and reduced duration of antibiotic regimens for patients with ventilator-associated pneumonia to decrease resistance in the intensive care unit. Clin Infect Dis 43(Suppl 2): S75–S81
Woodhead M (2002) Community-acquired pneumonia in Europe: causative pathogens and resistance patterns. Eur Respir J Suppl 36:20s–27s
Diaz A, Barria P, Niederman M, et al (2007) Etiology of community-acquired pneumonia in hospitalized patients in chile: the increasing prevalence of respiratory viruses among classic pathogens. Chest 131:779–787
Jennings LC, Anderson TP, Beynon KA, et al (2008) Incidence and characteristics of viral community-acquired pneumonia in adults. Thorax 63:42–48
Bruynseels P, Jorens PG, Demey HE, et al (2003) Herpes simplex virus in the respiratory tract of critical care patients: a prospective study. Lancet 362:1536–1541
Bell CM, Redelmeier DA (2004) Waiting for urgent procedures on the weekend among emergently hospitalized patients. Am J Med 117:175–181
Luyt CE, Combes A, Deback C, et al (2007) Herpes simplex virus lung infection in patients undergoing prolonged mechanical ventilation. Am J Respir Crit Care Med 175:935–942
Porteous C, Bradley JA, Hamilton DN, et al (1984) Herpes simplex virus reactivation in surgical patients. Crit Care Med 12:626–628
Luyt CE, Combes A, Nieszkowska A, et al (2008) Viral infections in the ICU. Curr Opin Crit Care 14:605–608
Graham BS, Snell JD Jr (1983) Herpes simplex virus infection of the adult lower respiratory tract. Medicine (Baltimore) 62:384–393
Francois-Dufresne A, Garbino J, Ricou B, Wunderli W (1997) ARDS caused by herpes simplex virus pneumonia in a patient with Crohn’s disease: a case report. Intensive Care Med 23:345–347
Tuxen DV, Cade JF, McDonald MI, et al (1982) Herpes simplex virus from the lower respiratory tract in adult respiratory distress syndrome. Am Rev Respir Dis 126:416–419
Klainer AS, Oud L, Randazzo J, et al (1994) Herpes simplex virus involvement of the lower respiratory tract following surgery. Chest 106:8S–14S; discussion 34S–5S
Camazine B, Antkowiak JG, Nava ME, et al (1995) Herpes simplex viral pneumonia in the postthoracotomy patient. Chest 108:876–879
Arata K, Sakata R, Iguro Y, et al (2003) Herpes simplex viral pneumonia after coronary artery bypass grafting. Jpn J Thorac Cardiovasc Surg 51:158–159
Eisenstein LE, Cunha BA (2003) Herpes simplex virus pneumonia presenting as failure to wean from a ventilator. Heart Lung 32:65–66
Prellner T, Flamholc L, Haidl S, et al (1992) Herpes simplex virus: the most frequently isolated pathogen in the lungs of patients with severe respiratory distress. Scand J Infect Dis 24:283–292
Byers RJ, Hasleton PS, Quigley A, et al (1996) Pulmonary herpes simplex in burns patients. Eur Respir J 9:2313–2317
Nash G (1972) Necrotizing tracheobronchitis and bronchopneumonia consistent with herpetic infection. Hum Pathol 3:283–291
Nash G, Foley FD (1970) Herpetic infection of the middle and lower respiratory tract. Am J Clin Pathol 54:857–863
Bonadona A, Gratacap B, Hamidfar R, et al (2006) Réactivation herpétique dans le syndrome de détresse respiratoire aigu: une atteinte méconnue [résumé]. 34e Congrès de la Société de réanimation de langue française Paris
Schuller D, Spessert C, Fraser VJ, Goodenberger DM (1993) Herpes simplex virus from respiratory tract secretions: epidemiology, clinical characteristics, and outcome in immunocompromised and nonimmunocompromised hosts. Am J Med 94:29–33
Connolly MG Jr, Baughman RP, Dohn MN, Linnemann CC Jr (1994) Recovery of viruses other than cytomegalovirus from bronchoalveolar lavage fluid. Chest 105:1775–1781
Cook CH, Yenchar JK, Kraner TO, et al (1998) Occult herpes family viruses may increase mortality in critically ill surgical patients. Am J Surg 176:357–360
Cook CH, Martin LC, Yenchar JK, et al (2003) Occult herpes family viral infections are endemic in critically ill surgical patients. Crit Care Med 31:1923–1929
Ong GM, Lowry K, Mahajan S, et al (2004) Herpes simplex type 1 shedding is associated with reduced hospital survival in patients receiving assisted ventilation in a tertiary referral intensive care unit. J Med Virol 72:121–125
De Vos N, Van Hoovels L, Vankeerberghen A, et al (2009) Monitoring of herpes simplex virus in the lower respiratory tract of critically ill patients using real-time PCR: a prospective study. Clin Microbiol Infect 15:358–363
Simoons-Smit AM, Kraan EM, Beishuizen A, et al (2006) Herpes simplex virus type 1 and respiratory disease in critically-ill patients: real pathogen or innocent bystander? Clin Microbiol Infect 12:1050–1059
Buss DH, Scharyj M (1979) Herpesvirus infection of the esophagus and other visceral organs in adults. Incidence and clinical significance. Am J Med 66:457–462
Ramsey PG, Fife KH, Hackman RC, et al (1982) Herpes simplex virus pneumonia: clinical, virologic, and pathologic features in 20 patients. Ann Intern Med 97:813–820
Linssen CF, Jacobs JA, Stelma FF, et al (2008) Herpes simplex virus load in bronchoalveolar lavage fluid is related to poor outcome in critically ill patients. Intensive Care Med 34:2202–2209
Sherry MK, Klainer AS, Wolff M, Gerhard H (1988) Herpetic tracheobronchitis. Ann Intern Med 109:229–233
Tuxen DV, Wilson JW, Cade JF (1987) Prevention of lower respiratory herpes simplex virus infection with acyclovir in patients with the adult respiratory distress syndrome. Am Rev Respir Dis 136:402–405
Limaye AP, Kirby KA, Rubenfeld GD, et al (2008) Cytomegalovirus reactivation in critically ill immunocompetent patients. JAMA 300:413–422
Papazian L, Fraisse A, Garbe L, et al (1996) Cytomegalovirus. An unexpected cause of ventilator-associated pneumonia. Anesthesiology 84:280–287
Papazian L, Doddoli C, Chetaille B, et al (2007) A contributive result of open-lung biopsy improves survival in acute respiratory distress syndrome patients. Crit Care Med 35:755–762
Heininger A, Jahn G, Engel C, et al (2001) Human cytomegalovirus infections in nonimmunosuppressed critically ill patients. Crit Care Med 29:541–547
Chiche L, Forel JM, Roch A, et al (2009) Active cytomegalovirus infection is common in mechanically ventilated medical intensive care unit patients. Crit Care Med 37:1850–1857
Osawa R, Singh N (2009) Cytomegalovirus infection in critically ill patients: a systematic review. Crit Care 13:R68
Author information
Authors and Affiliations
Corresponding author
Additional information
Cet article correspond à la conférence faite par l’auteur au congrès de la SRLF 2012 dans la session: Maladies virales en réanimation.
Rights and permissions
About this article
Cite this article
Luyt, C.E. Infections respiratoires virales à herpesviridae en réanimation. Réanimation 21 (Suppl 2), 331–338 (2012). https://doi.org/10.1007/s13546-011-0314-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13546-011-0314-3