HERPES-SIMPLEX VIRUS-INFECTION - A RARE CAUSE OF PROLONGED CROUP

Pediatric acute subglottic croup is generally of limited duration (usu ally 2 to 7 days) and caused by influenza or parainfluenza viruses. Pr olonged infections may involve other pathogens. To date and to our kno wledge, there has been but a single case report of herpes simplex viru s type 1 (HSV-1) infection prolonging croup attributed to prolonged us e of corticosteroids. Other authors have reported a wide range of HSV- 1 infections of the upper and lower respiratory tracts in all age grou ps that are usually associated with immunocompromise. Two immunocompet ent toddlers with prolonged croup associated with HSV-1-positive subgl ottic lesions are described herein. In one case the culture was obtain ed 11 days after just three doses of dexamethasone treatment. In the s econd case the culture was obtained after 10 days of prednisone therap y; the infection cleared quickly following treatment with acyclovir an d rapid taper of the prednisone dose. These cases suggest that prolong ed crouplike symptoms warrant thorough airway evaluation. Herpes simpl ex virus type 1 should be a suspected pathogen in cases of prolonged o r atypical croup. Herpes simplex virus type 1 croup is not necessarily associated with immunocompromise or prolonged corticosteroid therapy. Acyclovir seems to be effective in treating other airway HSV infectio ns, and by analogy it is the treatment of choice in recalcitrant herpe tic croup. It is unknown whether HSV-1 represents a primary or seconda ry pathogen in prolonged croup.