Frequency and clinical significance of Herpes simplex virus type 1/2 reactivation in adult patients with mild to moderately severe community-acquired pneumonia: a multicentre cohort study.

in Infection by Christina Bahrs, Christian Schönherr, Marcus Panning, Norman Rose, Theo Dähne, Stefan Hagel, Sebastian Weis, Jan Rupp, Gernot Rohde, Martin Witzenrath, Mathias W Pletz,

TLDR

  • HSV-1 reactivation is common in CAP, but not associated with specific risk factors or complications.
  • The study highlights the importance of considering HSV reactivation in older CAP patients with oncological comorbidities.

Abstract

This study assessed the frequency, clinical significance, and risk factors for Herpes simplex virus (HSV) reactivation in immunocompetent patients with community-acquired pneumonia (CAP). The study included adult CAP-patients who were enrolled in the CAPNETZ study between 2007 and 2017 and had a residual sputum sample available for analysis. In addition to routine diagnostics, sputum and blood samples were tested for HSV-1/2 using PCR. Demographics, comorbidities, and CRB-65 score were compared between HSV-positive and negative patients using Fisher exact or Mann Whitney test. Logistic regression analyses investigated the influence of HSV reactivation on a modified hospital recovery scale (HRS) until day 7, divided into 3 categories (no oxygen therapy, oxygen therapy, ICU admission or death). Among 245 patients, HSV-1 and HSV-2 were detected in 30 patients (12.2%, 95%CI 8.7-16.9) and 0 patients, respectively. All HSV-positive patients were hospitalized, had a CRB-65 severity score of 0-2 and survived the first 28 day. In the HSV-positive group, patients had a non-significantly higher median age (70.5 versus 66 years) and a higher rate of oncological comorbidities (16.7% versus 8.8%) compared to the HSV-negative group. Distribution of co-pathogens and outcome parameters did not significantly differ between both groups. In a multivariate logistic regression model, age (AOR 1.029, p = 0.012) and CRB-65 score (AOR 1.709, p = 0.048), but not HSV-1 as single or co-pathogen were independently associated with higher HRS. Our study suggests that HSV-1 reactivation is common in CAP but might not be associated with specific risk factors or a complicated disease course.

Overview

  • The study aimed to investigate the frequency, clinical significance, and risk factors for Herpes simplex virus (HSV) reactivation in immunocompetent patients with community-acquired pneumonia (CAP).
  • The study included adult CAP patients who were enrolled in the CAPNETZ study between 2007 and 2017 and had a residual sputum sample available for analysis.
  • The primary objective of the study was to identify the risk factors and clinical significance of HSV reactivation in CAP patients.

Comparative Analysis & Findings

  • Among 245 patients, HSV-1 and HSV-2 were detected in 30 patients (12.2%, 95%CI 8.7-16.9) and 0 patients, respectively.
  • A non-significantly higher median age and a higher rate of oncological comorbidities were observed in the HSV-positive group compared to the HSV-negative group.
  • The distribution of co-pathogens and outcome parameters did not significantly differ between the two groups.

Implications and Future Directions

  • The study suggests that HSV-1 reactivation may not be associated with specific risk factors or a complicated disease course.
  • The findings highlight the importance of considering HSV reactivation in CAP patients, particularly older patients with oncological comorbidities.
  • Future studies could investigate the potential role of antiviral therapy in HSV-positive CAP patients and examine the relationship between HSV reactivation and disease severity.
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