Herpes simplex virus lower respiratory tract infection in patients with solid tumors

BACKGROUND: The clinical significance of herpes simplex virus (HSV) isolated in lower respiratory tract specimens (LRTS) of patients with solid tumors (ST) is unknown. In the current study, the authors attempted to determine the clinical relevance of this finding among ST patients. METHODS: The authors reviewed records of ST patients admitted to the study institution between April 2000 and April 2004 with clinical and radiologic evidence of pneumonia, and HSV identified in LRTS by culture alone or culture and cytology. Patients were categorized as having proven (HSV identified by culture and cytology from the LRTS), probable (HSV as the sole pathogen by culture alone), and possible (HSV along with copathogens identified by culture) HSV pneumonia. RESULTS: Forty-five ST patients with either proven (6 patients), probable (25 patients), or possible (14 patients) HSV pneumonia were identified. When compared with patients with probable or possible HSV pneumonia, more patients with proven infection were on mechanical ventilation (40% vs 50% vs 100%, respectively; P = .03), and had longer length of stay in the intensive care unit (12 days vs 13 days vs 26 days, respectively; P = .05). The overall mortality rate was 22% (10 patients). Four of 25 (16%) patients who received HSV-directed antiviral therapy died during their hospital stay versus 6 of 20 (30%) who were not treated (P = .3). None of the 6 patients with proven HSV pneumonia who were treated with acyclovir died. On univariate analysis, risk factors for mortality included underlying breast cancer, an Acute Physiology and Chronic Health Evaluation (APACHE) II score >15, admission to the intensive care unit, and use of mechanical ventilation and vasopressors (all P < .05), with underlying breast cancer and APACHE II score >15 being found to be independent predictors of death by multiple logistic regression analysis (all P ≤ .05). CONCLUSIONS: Having a proven HSV pneumonia appears to be associated with high morbidity and with no increase in mortality in ST patients. This subset of patients appears to benefit from acyclovir therapy.