PIP: Herpes-simplex virus 1 (HSV1) and 2 can cause recurrent infection in man and in nonhuman species localized on a specific area of the body, such as face, cornea, or genitals. The origin of the virus responsible for a recurrent infection is not usually apparent. Some possible sources of virus can be exogenous infection, endogenous infection from another site of the body, chronic, continuous viral multiplication around the site of involvement, and persistence of the virus at the site of the recurrent infection. No definite information is yet available regarding the mechanism by which HSV1 or HSV2 persists and it is triggered to multiply, or regarding the cells that harbor the virus. It is possible that frequent or constant antigenic stimulation occurs in at least some cases of recurrent herpetic infections. The role of antibodies and of interferon in host resistance to HSV remains to be elucidated. Several recent studies have shown the association of more than a dozen herpes viruses with cancer in man and various animals; for example with limphoma, and with squamous cell carcinoma of the lip and cancer of the cervix. Genital HSV infections and cervical cancer were first linked when it was noted that women with genital herpes had a high frequency of cervical dysplasia and cancer. The results of new seroepidemiologic studies on this subject are still difficult to evaluate. Inocculation of HSV2 in laboratory animals has resulted in sarcomas, but it has never been possible to prove that the virus caused the tumors, since no HSV antigens could be detected in the tumors. However, herpesvirus antigens have been demonstrated by immunofluorescent technics in exfoliated cervical cells obtained from women with dysplasia, carcinoma in situ, and invasive carcinoma. In the absence of other kinds of data, it is difficult to rule out the possibility that the presence of HSV2 or of antigens is not an independent event unrelated to the cancer.

Infection with herpes-simplex viruses 1 and 2. II.

In a prospective study of all patients with Pseudomonas pseudomallei infections admitted to a large provincial hospital in northeastern Thailand, 63 cases of septicemic melioidosis and 206 patients with other community-acquired septicemias were documented during a 1-y period. Apart from P. pseudomallei, the spectrum of bacteria isolated from blood cultures and the overall mortality (32%) were similar to those previously reported elsewhere. Death from septicemia was associated with failure to develop a leukocytosis or pyrexia over 38 degrees C, azotemia, hypoglycemia, and jaundice. Septicemic melioidosis presented mainly in the rainy season, occurred predominantly in rice farmers or their families, and was significantly associated with preexisting diabetes mellitus or renal failure (P = .03). Blood-borne pneumonia and visceral abscesses were common and the mortality was high (68%; P less than .001). The response to appropriate treatment was slow (median fever clearance time 5.5 d) and the median duration of hospital stay was 4 w. Septicemic melioidosis is a major cause of morbidity and mortality in northeast Thailand.

Melioidosis: A Major Cause of Community-Acquired Septicemia in

Imaging and clinical manifestations of viral pneumonia are protean and not reliably predictive of its origin; although definitive diagnosis cannot be made on the basis of imaging features alone, the use of a combination of clinical and radiographic findings can substantially improve the accuracy of diagnosis in this disease.

https://pubs.rsna.org/doi/pdf/10.1148/radiol.11092149

Imaging of Pulmonary Viral Pneumonia

Numerous viruses, including influenza virus, measles virus, Hantavirus, adenovirus, herpesviruses, varicella-zoster virus, cytomegalovirus, and Epstein-Barr virus, can cause lower respiratory tract infection in adults. Viral pneumonia in adults can be classified into two clinical groups: so-called atypical pneumonia in otherwise healthy hosts and viral pneumonia in immunocompromised hosts. Influenza virus types A and B cause most cases of viral pneumonia in immunocompetent adults. Immunocompromised hosts are susceptible to pneumonias caused by cytomegalovirus, herpesviruses, measles virus, and adenovirus. The radiographic findings, which consist mainly of patchy or diffuse ground-glass opacity with or without consolidation and reticular areas of increased opacity, are variable and overlapping. Computed tomographic findings, which are also overlapping, consist of poorly defined centrilobular nodules, ground-glass attenuation with a lobular distribution, segmental consolidation, or diffuse ground-glass attenuation with thickened interlobular septa. The radiologic findings reflect the variable extents of the histopathologic features: diffuse alveolar damage (intraalveolar edema, fibrin, and variable cellular infiltrates with a hyaline membrane), intraalveolar hemorrhage, and interstitial (intrapulmonary or airway) inflammatory cell infiltration. Clinical information such as patient age, immune status, community outbreaks, symptom onset and duration, and presence of a rash remain important aids in diagnosis of viral causes.

https://pubs.rsna.org/doi/pdf/10.1148/radiographics.22.suppl_1.g02oc15s137

Viral Pneumonias in Adults: Radiologic and Pathologic Findings

Herpesvirus infection of the esophagus and other visceral organs in adults: Incidence and clinical significance

Fifteen cases of herpetic infection of the middle and lower respiratory tract are presented and discussed. All of the cases were documented histologically, two were confirmed by culture of Herpesvirus hominis and a third by electron microscopic observation of virions consistent with the Herpesvirus group within tracheal epithelial cells. The diagnosis was not made clinically in any of these cases. Six cases were discovered at necropsy and nine additional cases were found in a retrospective study of autopsy files. As the lesions were often focal or severely altered by superimposed infection, careful microscopic study was necessary for recognition of the diagnostic changes. Bacterial and fungal superinfection were found in 12 of the patients and represented potentially life-threatening sequelae.

Herpetic infection of the middle and lower respiratory tract.

The pathologic findings and interpretations of 335 autopsies performed on patients who died of extensive cutaneous burns during the period 1960 to 1967 are presented. The information accumulated during this period is unique in that the burn wounds were systematically examined postmortem, the patients studied were young, and the number with preexisting disease was negligible. Comparison of the major fatal complications prior and subsequent to topical antibacterial therapy confirms the marked decline in sepsis due to invasive bacterial infection of the burn wound that has been reported previously. There has been an increase in fungal colonization and infection of the burn wound coincident with the use of the topical antibacterial agent, Sulfamylon. Sepsis, although reduced in magnitude due to control of one of its major sources, continues to be the single most frequent fatal complication of burns. Infective and respiratory complications together account for two-thirds of deaths in patients who survive the initial phase of thermal injury. The infected cannulated vein now rivals infection of the burn wound as a source of sepsis in burned patients. The increase in deaths attributed to respiratory complications has occurred only in patients with extensive burns and may be an apparent rather than a real increase.

The burn autopsy. Fatal complications of burns.

Melioidosis is a disease caused by the Gram-negative bacillus Pseudomonas pseudomallei . It is endemic in Southeast Asia, but is being seen with increasing frequency in the United States as more military personnel return from Vietnam. We have recently autopsied four patients with relatively minor burns who died with the acute systemic form of melioidosis. The clinical course was that of a fulminating septicemia. Grossly visible lesions were present in three patients, whereas microscopic lesions were present in all. The lungs, liver, spleen, and bone marrow were characteristically involved. The morphogenesis of a t3rpical pulmonary lesion was traced. The grossly visible lesions had a zonal architecture. Necrotic centers were surrounded by degenerative histiocytes. Peripherally, there was a mixed infiltrate of neutrophils and viable histiocytes. The entire lesion was surrounded by a hemorrhagic border. The causative organism was easily seen, using modified Giemsa or Gram stains. Early treatment in one case appeared to sterilize the lesion.

Acute systemic melioidosis. Autopsy findings in four patients.

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Herpetic infection of the middle and lower respiratory tract.

The burn autopsy. Fatal complications of burns.

Acute systemic melioidosis. Autopsy findings in four patients.