Clinical Report: Fatal Reactivation of HSV-1 Detected by Sequential mNGS

Overview

This case study details the rare occurrence of fatal reactivation of HSV-1 in a 91-year-old patient following ARDS induced by intestinal obstruction. Sequential metagenomic next-generation sequencing (mNGS) was utilized to monitor pathogen evolution.

Background

Herpes simplex virus type 1 (HSV-1) is a common pathogen that can reactivate under stress or immunosuppression, potentially leading to severe respiratory complications. This case presents the diagnostic challenges of HSV-1 in the context of ARDS.

Data Highlights

Key Findings

• HSV-1 reactivation can occur in elderly patients following acute stress, such as intestinal obstruction.
• Sequential mNGS testing provides monitoring of pathogen evolution in critically ill patients.
• Conventional microbiological testing may fail to detect HSV-1 in cases of severe respiratory distress.
• Broad-spectrum treatments may not reverse refractory hypoxemia in such cases.

Clinical Implications

Healthcare professionals should consider the potential for HSV-1 reactivation in elderly patients presenting with ARDS following acute stressors.

Conclusion

This case illustrates the challenges of diagnosing and managing HSV-1 reactivation in elderly patients with ARDS.

Related Resources & Content

1. Hagel et al., Infection, 2024 -- Prevalence and Clinical Implications of Herpes Simplex Virus Types 1 and 2 Reactivation in Adults with Mild to Moderate Community-Acquired Pneumonia
2. Frontiers in Medicine, 2026 -- Case Report: Beyond conventional diagnostics: mNGS support in a complex immunocompromised patient diagnosis
3. Intensive Care Medicine, 2024 -- Herpes Simplex Virus and Cytomegalovirus in the Lungs of COVID-19 Patients with Acute Respiratory Distress Syndrome
4. Intensive Care Medicine — The Impact of Cytomegalovirus Reactivation on Mortality in Acute Respiratory Distress Syndrome Patients
5. Pulmonary herpes simplex virus and cytomegalovirus in patients with acute respiratory distress syndrome related to COVID-19 | Intensive Care Medicine | Springer Nature Link
6. IDSA/ASM 2024 Guide to Utilization of the Microbiology Laboratory for Diagnosis of Infectious Diseases
7. Sexually Transmitted Infections Treatment Guidelines, 2021 | MMWR