Clinical relevance of herpes simplex virus viremia in Intensive Care Unit patients

J Infect. 2015 Jul;71(1):93-100. doi: 10.1016/j.jinf.2015.02.013. Epub 2015 Mar 4.


Objectives: To determine the clinical relevance of herpes simplex virus (HSV) viremia episodes in critically ill adult patients.

Methods: 1556 blood samples obtained for HSV PCR analysis in Intensive Care Unit (ICU) patients over 4 years were retrospectively analyzed, focusing on the comprehensive analysis of 88 HSV-viremic patients.

Results: HSV DNA was detected in 11.8% of samples from the ICU. HSV viral loads remained below 5×10(2) copies/ml in 68.2% of patients and exceeded 10(4) copies/ml in 7.9%. Episodes of HSV-viremia correlated with immunosuppressed status and mechanical ventilation in 79.5% and 65.9% of patients, respectively. Only a subset of patients exhibited HSV-related organ damage, including pneumonia and hepatitis (10.2% and 2.3%, respectively). The mortality rate in HSV-viremic patients was not significantly increased compared to the overall mortality rate in the ICU (27.3% vs. 22.9%, p = 0.33). Only patients with high HSV viral loads tended to have a higher, though non-significant, death rate (57.1%, p = 0.14).

Conclusions: Our results suggest HSV viremia is common in ICU patients, potentially favored by immunocompromised status and mechanical ventilation. The global impact of HSV-viremia on mortality in the ICU was low. Quantifying HSV DNA may help identifying patients at-risk of severe HSV-induced symptoms.

Keywords: Herpes simplex; Intensive Care Units; Viremia.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Blood / virology
  • Female
  • Herpes Simplex / diagnosis*
  • Herpes Simplex / epidemiology
  • Herpes Simplex / mortality
  • Herpes Simplex / pathology*
  • Humans
  • Intensive Care Units*
  • Male
  • Middle Aged
  • Polymerase Chain Reaction
  • Prevalence
  • Retrospective Studies
  • Simplexvirus / isolation & purification*
  • Survival Analysis
  • Viremia / diagnosis*
  • Viremia / epidemiology
  • Viremia / mortality
  • Viremia / pathology*