Fischer M, Wohlrab J, Radke J, Marsch W C, Soukup J
Universitätsklinik und Poliklinik für Dermatologie und Venerologie, Martin-Luther-Universität Halle-Wittenberg, Germany.
Anaesthesist. 2002 Nov;51(11):925-8. doi: 10.1007/s00101-002-0394-6.
Herpes simplex infections are potentially a life-threatening situation for immunocompromised as well as critically ill patients. The correct diagnosis is made more difficult in comatose patients by the fact that the characteristic symptom of extreme pain cannot be registered. The clinical dermatological findings (polycyclic configuration, easily bleeding ulcers) are thus especially important in patients under intensive care conditions. As examples, the cases of 3 critically ill patients (subarachnoid bleeding or head injury) developing therapy-resistant, flat sacral or perioral skin ulcers with peripheral blisters are presented. Herpes simplex virus was confirmed immunohistologically and in the smear test. All patients subsequently died. These cases emphasize that patients in the intensive care unit are in danger of developing a chronic persistent Herpes simplex infection due to latent immunosuppression. Chronic persistent Herpes infections may be underrated in intensive therapy, and must always be ruled out in case of therapy-resistant erosions or ulcerations.
单纯疱疹感染对于免疫功能低下以及重症患者来说，可能是一种危及生命的情况。对于昏迷患者而言，由于无法记录极度疼痛这一特征性症状，使得正确诊断变得更加困难。因此，在重症监护条件下，临床皮肤科表现（多环形态、易出血性溃疡）对患者尤为重要。本文列举了3例重症患者（蛛网膜下腔出血或头部受伤）的病例，这些患者出现了对治疗耐药的、扁平的骶部或口周皮肤溃疡，并伴有外周水疱。通过免疫组织化学和涂片检查确诊为单纯疱疹病毒感染。所有患者随后均死亡。这些病例强调，重症监护病房的患者因潜在的免疫抑制而有发生慢性持续性单纯疱疹感染的风险。在强化治疗中，慢性持续性疱疹感染可能被低估，对于治疗耐药的糜烂或溃疡病例，必须始终排除该感染。
