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Observational Study
. 2025 Feb;53(1):449-455.
doi: 10.1007/s15010-024-02351-5. Epub 2024 Jul 20.

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

Christina Bahrs  1   2 , Christian Schönherr  3 , Marcus Panning  4 , Norman Rose  5 , Theo Dähne  4 , Stefan Hagel  5 , Sebastian Weis  5   6 , Jan Rupp  7   8   9 , Gernot Rohde  9   10   11 , Martin Witzenrath  12 , Mathias W Pletz  5   9 ; CAPNETZ Study Group
Affiliations
Observational Study

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

Christina Bahrs et al. Infection. 2025 Feb.

Abstract

Purpose: This study assessed the frequency, clinical significance, and risk factors for Herpes simplex virus (HSV) reactivation in immunocompetent patients with community-acquired pneumonia (CAP).

Methods: 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).

Results: 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.

Conclusion: 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.

Keywords: CRB-65 score; Community-acquired pneumonia; Herpes simplex virus; Hospital recovery scale; Oxygen therapy.

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Conflict of interest statement

Declarations. Conflict of interest: All authors declare no conflicts of interest that are relevant to the content of this article. Ethics declarations: Research was conducted in accordance with the Declaration of Helsinki and national and institutional standards. The study protocol was approved by the local ethics committees of all participating centres (number of leading ethics committee Medical Faculty of Otto-von-Guericke-University Magdeburg: 104/01; see acknowledgment or www.capnetz.de for participating centres). Consent to participate and consent to publish: Prior to study enrolment, all patients provided written informed consent. As only anonymised data were analysed, additional consent to publish was not required.

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