Respiratory Tract Herpesvirus Reactivation in Critically Ill Patients: An Underrecognized Clinical Concern

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Harbiye et al. linked pulmonary HSV reactivation in persistent acute respiratory failure with less favorable outcomes and a localized alveolar inflammatory response.
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Elevated pulmonary HSV burden was associated with a distinct inflammatory phenotype, but its relationship to acute respiratory failure subphenotypes remains unconfirmed.
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The authors call for evaluating HSV reactivation across acute respiratory failure subphenotypes and stratifying analyses by immune status, sepsis, and molecular profiles.
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Upper respiratory tract HSV burden and timing of artificial airway placement warrant assessment because HSV may spread to the lower respiratory tract in ventilated patients.
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The authors recommend standardizing HSV PCR results in IU/mL, investigating interactions with other airway pathogens, and testing antiviral therapy in randomized trials.

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