Introduction
Herpes simplex virus (HSV), Cytomegalovirus (CMV), and severe acute respiratory syndrome-associated coronavirus 2 (SAS-CoV-2) are three well-established causes of viral pneumonia. While there are variable responses to evolving treatments of COVID-19, established effective treatment options for HSV and CMV exist. Therefore, the identification of herpesvirus-family infections superimposed on COVID-19 infections is critical in management and ultimate outcome of these patients. The purpose of this study is to highlight the importance of searching for and identifying HSV and CMV infections in individuals infected with COVID-19.
Materials and Methods
Broncho-alveolar lavage (BAL) specimens, viral PCR databases, and patient medical records from our institution were searched from March 2020 to September 2020. The findings in each BAL were interpreted by a cytopathologist and reported promptly to the clinical teams.
Results
Four patients with COVID-19 coinfected with HSV and/or CMV were identified. Each BAL demonstrated a few cells with characteristic nuclear features of HSV or CMV infection. Immunohistochemical staining was utilized to confirm the presence of HSV in one of the patients. Three of the four cases had molecular confirmation of the diagnosis, and each patient received antiviral therapy following cytologic diagnosis.
Conclusions
All four patients had clinical management altered based on their cytological diagnoses. Herpesvirus-family co-infections in COVID-19 positive patients should be considered, especially since both HSV and CMV have effective treatment options which can greatly reduce morbidity and mortality. We present this series to demonstrate the occurrence of coinfections with herpesviruses in COVID-19 and highlight the important role of cytopathologic diagnosis in the management of these patients.
PST020