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Postgraduate Thesis: Herpes simplex virus infection of respiratory tract in intensive care unit
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TitleHerpes simplex virus infection of respiratory tract in intensive care unit
 
AuthorsLui, Mei-sze
雷美詩
 
Issue Date2012
 
PublisherThe University of Hong Kong (Pokfulam, Hong Kong)
 
AbstractBackground Herpes Simplex virus (HSV) is commonly isolated from the specimen of respiratory tract in hospitalized patients. It can indicate asymptomatic shedding from respiratory epithelium, viral reactivation with macroscopic airway lesion, or even pneumonia. There are significant differences in the awareness, interpretation and management strategies of the condition among departments and hospitals. Objective A retrospective case review of clinical features, management and outcomes of hospitalized subjects from whom HSV is detected in the bronchoalveolar lavage specimen Method The medical records of all the patients with pneumonia and bronchoalveolar lavage (BAL) being positive for HSV culture, who were admitted between 2004 and 2011 to Queen Mary Hospital, were retrieved from the clinical management system or record folders. Their demographic data, laboratory results, progress and outcomes were recorded. Results A total of 32 patients were identified over the period of seven years. 81.3% of them were emergency admission while 18.8% were elective admission. Most of them (90.6%) required admission to the Adult Intensive Care Unit. 59.3% (n=19) required intubation and mechanical ventilation during hospitalization. The mean age was 57.1 (SD 13.8) year old. 71.9% were male patients. No patients with HSV detected in BAL had macroscopic lesion on bronchoscopy. No cytological examination on the BAL was performed. HSV reactivation is commonly associated other opportunistic pathogens such as Pneumocystis jivoreci (21.9%) and cytomegalovirus antigenemia (18.8%). Majority of the subjects (90.6%, n=29) with HSV infection were lymphopenic (absolute lymphocyte count <1 x 109/L) which could indicate underlying impairment in cell-mediated immunity related to malnutrition, hematological disorders, use of immunosuppressants. Similar proportion in the surviving group received anti-viral treatment as compared to the mortality group (53.8% versus 66.7%, respectively), implicating that treatment with anti-viral medication might not have important impact on mortality rate. Conclusion The awareness of significance of HSV reactivation in lower respiratory tract is highly variable. Lymphopenic patients are at high risk of HSV reactivation or HSV pnemonitis. The presence of lymphopenia, or other immunocompromised state should prompt the physicians to perform a thorough work-up for HSV infection even in the absence of macroscopic lesions.
 
DescriptionThesis (P. Dip.)--University of Hong Kong, 2012.
"This work is submitted to Faculty of Medicine of the University of Hong Kong in partial fulfillment of the requirements for the Postgraduate Diploma in Infectious Diseases, PDipID (HK)."
Includes bibliographical references (p. 21-26).
 
DegreePostgraduate Diploma in Infectious Diseases
 
SubjectHerpes simplex virus.
Respiratory infections.
 
Dept/ProgramMicrobiology
 
DC FieldValue
dc.contributor.authorLui, Mei-sze
 
dc.contributor.author雷美詩
 
dc.date.accessioned2012-11-01T02:50:30Z
 
dc.date.available2012-11-01T02:50:30Z
 
dc.date.issued2012
 
dc.description.abstractBackground Herpes Simplex virus (HSV) is commonly isolated from the specimen of respiratory tract in hospitalized patients. It can indicate asymptomatic shedding from respiratory epithelium, viral reactivation with macroscopic airway lesion, or even pneumonia. There are significant differences in the awareness, interpretation and management strategies of the condition among departments and hospitals. Objective A retrospective case review of clinical features, management and outcomes of hospitalized subjects from whom HSV is detected in the bronchoalveolar lavage specimen Method The medical records of all the patients with pneumonia and bronchoalveolar lavage (BAL) being positive for HSV culture, who were admitted between 2004 and 2011 to Queen Mary Hospital, were retrieved from the clinical management system or record folders. Their demographic data, laboratory results, progress and outcomes were recorded. Results A total of 32 patients were identified over the period of seven years. 81.3% of them were emergency admission while 18.8% were elective admission. Most of them (90.6%) required admission to the Adult Intensive Care Unit. 59.3% (n=19) required intubation and mechanical ventilation during hospitalization. The mean age was 57.1 (SD 13.8) year old. 71.9% were male patients. No patients with HSV detected in BAL had macroscopic lesion on bronchoscopy. No cytological examination on the BAL was performed. HSV reactivation is commonly associated other opportunistic pathogens such as Pneumocystis jivoreci (21.9%) and cytomegalovirus antigenemia (18.8%). Majority of the subjects (90.6%, n=29) with HSV infection were lymphopenic (absolute lymphocyte count <1 x 109/L) which could indicate underlying impairment in cell-mediated immunity related to malnutrition, hematological disorders, use of immunosuppressants. Similar proportion in the surviving group received anti-viral treatment as compared to the mortality group (53.8% versus 66.7%, respectively), implicating that treatment with anti-viral medication might not have important impact on mortality rate. Conclusion The awareness of significance of HSV reactivation in lower respiratory tract is highly variable. Lymphopenic patients are at high risk of HSV reactivation or HSV pnemonitis. The presence of lymphopenia, or other immunocompromised state should prompt the physicians to perform a thorough work-up for HSV infection even in the absence of macroscopic lesions.
 
dc.description.naturepublished_or_final_version
 
dc.descriptionThesis (P. Dip.)--University of Hong Kong, 2012.
 
dc.description"This work is submitted to Faculty of Medicine of the University of Hong Kong in partial fulfillment of the requirements for the Postgraduate Diploma in Infectious Diseases, PDipID (HK)."
 
dc.descriptionIncludes bibliographical references (p. 21-26).
 
dc.description.thesisdisciplineMicrobiology
 
dc.description.thesislevelPostgraduate diploma
 
dc.description.thesisnamePostgraduate Diploma in Infectious Diseases
 
dc.identifier.hkulb4832019
 
dc.identifier.urihttp://hdl.handle.net/10722/173733
 
dc.languageeng
 
dc.publisherThe University of Hong Kong (Pokfulam, Hong Kong)
 
dc.rightsCreative Commons: Attribution 3.0 Hong Kong License
 
dc.rightsThe author retains all proprietary rights, (such as patent rights) and the right to use in future works.
 
dc.subject.lcshHerpes simplex virus.
 
dc.subject.lcshRespiratory infections.
 
dc.titleHerpes simplex virus infection of respiratory tract in intensive care unit
 
dc.typePG_Thesis
 
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<item><contributor.author>Lui, Mei-sze</contributor.author>
<contributor.author>&#38647;&#32654;&#35433;</contributor.author>
<date.accessioned>2012-11-01T02:50:30Z</date.accessioned>
<date.available>2012-11-01T02:50:30Z</date.available>
<date.issued>2012</date.issued>
<identifier.uri>http://hdl.handle.net/10722/173733</identifier.uri>
<description>Thesis (P. Dip.)--University of Hong Kong, 2012.</description>
<description>&quot;This work is submitted to Faculty of Medicine of the University of Hong Kong in partial fulfillment of the requirements for the Postgraduate Diploma in Infectious Diseases, PDipID (HK).&quot;</description>
<description>Includes bibliographical references (p. 21-26).</description>
<description.abstract>Background
Herpes Simplex virus (HSV) is commonly isolated from the specimen of
respiratory tract in hospitalized patients. It can indicate asymptomatic shedding
from respiratory epithelium, viral reactivation with macroscopic airway lesion, or
even pneumonia. There are significant differences in the awareness, interpretation
and management strategies of the condition among departments and hospitals.
Objective
A retrospective case review of clinical features, management and outcomes of
hospitalized subjects from whom HSV is detected in the bronchoalveolar lavage
specimen
Method
The medical records of all the patients with pneumonia and bronchoalveolar
lavage (BAL) being positive for HSV culture, who were admitted between 2004 and
2011 to Queen Mary Hospital, were retrieved from the clinical management system or
record folders. Their demographic data, laboratory results, progress and outcomes
were recorded.
Results
A total of 32 patients were identified over the period of seven years. 81.3% of
them were emergency admission while 18.8% were elective admission. Most of
them (90.6%) required admission to the Adult Intensive Care Unit. 59.3% (n=19)
required intubation and mechanical ventilation during hospitalization. The mean age
was 57.1 (SD 13.8) year old. 71.9% were male patients. No patients with HSV
detected in BAL had macroscopic lesion on bronchoscopy. No cytological
examination on the BAL was performed. HSV reactivation is commonly associated
other opportunistic pathogens such as Pneumocystis jivoreci (21.9%) and
cytomegalovirus antigenemia (18.8%). Majority of the subjects (90.6%, n=29) with
HSV infection were lymphopenic (absolute lymphocyte count &lt;1 x 109/L) which
could indicate underlying impairment in cell-mediated immunity related to
malnutrition, hematological disorders, use of immunosuppressants. Similar
proportion in the surviving group received anti-viral treatment as compared to the
mortality group (53.8% versus 66.7%, respectively), implicating that treatment with
anti-viral medication might not have important impact on mortality rate.
Conclusion
The awareness of significance of HSV reactivation in lower respiratory tract is
highly variable. Lymphopenic patients are at high risk of HSV reactivation or HSV
pnemonitis. The presence of lymphopenia, or other immunocompromised state
should prompt the physicians to perform a thorough work-up for HSV infection even
in the absence of macroscopic lesions.</description.abstract>
<language>eng</language>
<publisher>The University of Hong Kong (Pokfulam, Hong Kong)</publisher>
<rights>Creative Commons: Attribution 3.0 Hong Kong License</rights>
<rights>The author retains all proprietary rights, (such as patent rights) and the right to use in future works.</rights>
<subject.lcsh>Herpes simplex virus.</subject.lcsh>
<subject.lcsh>Respiratory infections.</subject.lcsh>
<title>Herpes simplex virus infection of respiratory tract in intensive care unit</title>
<type>PG_Thesis</type>
<identifier.hkul>b4832019</identifier.hkul>
<description.thesisname>Postgraduate Diploma in Infectious Diseases</description.thesisname>
<description.thesislevel>Postgraduate diploma</description.thesislevel>
<description.thesisdiscipline>Microbiology</description.thesisdiscipline>
<description.nature>published_or_final_version</description.nature>
<bitstream.url>http://hub.hku.hk/bitstream/10722/173733/1/FullText.pdf</bitstream.url>
</item>