Cytologic features of nonfatal herpesvirus tracheobronchitis

Herpesvirus infections of the lower respiratory tract have most commonly been reported in patients with severe burns, immunosuppression or malignancies. Two patients without any of these underlying conditions developed severe herpetic tracheobronchitis, diagnosed by cytologic examination and confirmed by serologic studies. Serial examination of sputum, bronchial brushings and bronchial washings permitted observation of the evolution and progression of cellular changes found in herpesvirus infection of the lower respiratory tract. both patients recovered without specific antiviral therapy, but both developed superinfection with gram-negative organisms, requiring intensive antibiotic therapy. The distinctive features of herpesvirus infection in the tracheobronchial tree are similar to those recognized elsewhere in the body. Early findings include a variety of nonspecific changes in nuclear chromatin configurations; multinucleated cells may be common but do not often contain the central intranuclear inclusion bodies seen in later stages. These distinctive central intranuclear inclusions disappear in a few days, leaving only reparative changes in the surface epithelium. Herpesviruses are increasingly being reported in the literature as an etiologic agent of acute tracheobronchitis in otherwise healthy individuals.