Treatment of HSV and CMV Reactivations in the Intensive Care Unit: Who and When?

Abstract

Herpes simplex virus (HSV) and cytomegalovirus (CMV) reactivations are frequent in non-immunosuppressed patient hospitalized in the intensive care unit. HSV reactivation is localized in the airways; it starts in the throat, then infects the lower respiratory tract and can, in few patients, lead to a true HSV bronchopneumonitis. HSV reactivation is associated with unfavorable outcome. Prophylactic and preemptive treatments of HSV reactivations cannot be recommended to date. Curative treatment is based on expert opinion, in patients with either high HSV virus load in the lower respiratory tract or in patients with cytological signs of parenchymal involvement in cells obtained during bronchoalveolar lavage. Blood CMV reactivation is frequent, can be isolated or associated with lung reactivation and/or infection, and is also associated with unfavorable outcome. Prophylactic treatment of CMV reactivation cannot be recommended, and preemptive treatment is currently under investigation. Curative treatment of patients with CMV lung disease is based either on histological signs of lung involvement on lung biopsies or on a bundle of clinical and biological arguments suggesting CMV infection.