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Review
. 2011 Dec;40(12 Pt 2):e561-8.
doi: 10.1016/j.lpm.2011.05.027. Epub 2011 Nov 16.

Virus-induced acute respiratory distress syndrome: epidemiology, management and outcome

Charles-Édouard Luyt  1 , Alain Combes, Jean-Louis Trouillet, Ania Nieszkowska, Jean Chastre
Affiliations
Review

Virus-induced acute respiratory distress syndrome: epidemiology, management and outcome

Charles-Édouard Luyt et al. Presse Med. 2011 Dec.

Abstract

The acute respiratory distress syndrome (ARDS) can be induced by viral diseases, with two virus types being responsible: respiratory viruses that cause community-acquired viral pneumonia and Herpesviridae that cause nosocomial viral pneumonia. Among the respiratory viruses that can affect the lung and cause ARDS, pandemic viruses head the list, with influenza viruses H5N1 and H1N1 2009 being the most recently identified. However, other viruses can cause severe ARDS. Notably, a novel coronavirus was responsible for the severe acute respiratory syndrome outbreak in 2003. Apart from these pandemic viruses, respiratory viruses are rarely responsible for viral pneumonia and ARDS. Other than antiviral drug (mainly oseltamivir) administration and avoidance of corticosteroids, management of ARDS due to these viruses does not differ from that for ARDS caused by other diseases. Among Herpesviridae, herpes simplex virus (HSV) and cytomegalovirus (CMV) are the two viruses causing nosocomial viral pneumonia that can evolve into ARDS. HSV is frequently recovered in the respiratory tract of mechanically ventilated patients and can sometimes be responsible for HSV bronchopneumonitis. Although not evaluated for this indication, acyclovir can be a therapeutic option for patients with HSV bronchopneumonitis and ARDS. CMV pneumonia can also occur in mechanically ventilated patients, but is difficult to diagnose because virus recovery does not necessarily mean viral disease. Ganciclovir can be considered for patients with ARDS and histology- or cytology-proven CMV pneumonia.

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Figures

Figure 1
Figure 1
Chest radiograph of a patient successfully treated with extracorporeal membrane oxygenation (ECMO) for confirmed 2009 Influenza A (H1N1)
Figure 2
Figure 2
Herpes simplex virus oral-labial lesion
Figure 3
Figure 3
Herpes simplex virus-specific nuclear inclusion in cell recovered in bronchoalveolar lavage fluid
Figure 4
Figure 4
Cytomegalovirus-specific cytoplasmic inclusion in cell recovered in bronchoalveolar lavage fluid
See this image and copyright information in PMC

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