1
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Sehrawat SS, Premkumar M. Critical care management of acute liver failure. Indian J Gastroenterol 2024; 43:361-376. [PMID: 38578565 DOI: 10.1007/s12664-024-01556-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 02/12/2024] [Indexed: 04/06/2024]
Abstract
The management of acute liver failure (ALF) in modern hepatology intensive care units (ICU) has improved patient outcomes. Critical care management of hepatic encephalopathy, cerebral edema, fluid and electrolytes; prevention of infections and organ support are central to improved outcomes of ALF. In particular, the pathogenesis of encephalopathy is multifactorial, with ammonia, elevated intra-cranial pressure and systemic inflammation playing a central role. Although ALF remains associated with high mortality, the availability of supportive care, including organ failure support such as plasma exchange, timely mechanical ventilation or continuous renal replacement therapy, either conservatively manages patients with ALF or offers bridging therapy until liver transplantation. Thus, appropriate critical care management has improved the likelihood of patient recovery in ALF. ICU care interventions such as monitoring of cerebral edema, fluid status assessment and interventions for sepsis prevention, nutritional support and management of electrolytes can salvage a substantial proportion of patients. In this review, we discuss the key aspects of critical care management of ALF.
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Affiliation(s)
- Surender Singh Sehrawat
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Madhumita Premkumar
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India.
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2
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Martinot M, Gravier S, Mohseni-Zadeh M, Fabien N, Casanova JL, Puel A, Goncalves D. Severe acute herpes virus type 2 primo-infection and its association with anti-type 1 interferon autoantibodies. Eur J Clin Microbiol Infect Dis 2023; 42:1531-1535. [PMID: 37870714 DOI: 10.1007/s10096-023-04688-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 10/16/2023] [Indexed: 10/24/2023]
Abstract
Herpes simplex virus type 2 (HSV-2) is a common cause of infection, which is usually self-limited and asymptomatic. A 71-year-old patient with HSV-2 primo-infection developed acute hepatitis and secondary hemophagocytic lymphohistiocytosis. The patient had high levels of autoantibodies against type I interferon (IFN) (> 1000 ng/mL), neutralizing high concentration (10 ng/mL) of both IFN-α and IFN-ω but not IFN-β. Anti-IFN-I auto-antibodies are rarely observed in healthy individuals; however, their prevalence increases in individuals over 70 years of age and have been identified as a cause of some severe viral diseases, including critical COVID-19. Considering the function of IFN-I in innate immunity, the pathological role of these autoantibodies in severe viral diseases following primo-infections in elderly patient appears crucial.
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Affiliation(s)
- Martin Martinot
- Infectious Diseases Department, Hôpitaux Civils de Colmar, 39 Avenue de La Liberté 68024, CEDEX, Colmar, France.
| | - Simon Gravier
- Infectious Diseases Department, Hôpitaux Civils de Colmar, 39 Avenue de La Liberté 68024, CEDEX, Colmar, France
| | - Mahsa Mohseni-Zadeh
- Infectious Diseases Department, Hôpitaux Civils de Colmar, 39 Avenue de La Liberté 68024, CEDEX, Colmar, France
| | - Nicole Fabien
- Immunology Department, Lyon Sud Hospital Hospices Civils de Lyon, Pierre-Bénite, Lyon, France
| | - Jean-Laurent Casanova
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM U1163, Necker Hospital for Sick Children, Paris, France
- University Paris Cité, Imagine Institute, Paris, France
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY, USA
- Howard Hughes Medical Institute, New York, NY, USA
- Department of Pediatrics, Necker Hospital for Sick Children, APHP, Paris, France
| | - Anne Puel
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM U1163, Necker Hospital for Sick Children, Paris, France
- University Paris Cité, Imagine Institute, Paris, France
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY, USA
| | - David Goncalves
- Immunology Department, Lyon Sud Hospital Hospices Civils de Lyon, Pierre-Bénite, Lyon, France
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3
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Frapard T, Amaddeo G, Decavele M, Abback PS, Gaillet A, Bouzbib C, Vanlemmens C, Younan R, Canet E, Moreau AS, Neuville M, Azoulay E, Sitbon A, Mokart D, Radenne S, Abergel A, Guichon C, Roux O, Bonadona A, Mekontso Dessap A, De Jong A, Dumortier J, de Prost N. Herpes Simplex Virus Hepatitis in Patients Requiring Intensive Care Unit Admission: A Retrospective, Multicenter, Observational Study. Open Forum Infect Dis 2023; 10:ofad484. [PMID: 37942463 PMCID: PMC10629341 DOI: 10.1093/ofid/ofad484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 09/27/2023] [Indexed: 11/10/2023] Open
Abstract
The clinical features and short-term prognosis of patients admitted to the intensive care unit for herpes hepatitis are lacking. Of 33 patients admitted between 2006 and 2022, 22 were immunocompromised, 4 were pregnant women, and 23 died. Sixteen patients developed a hemophagocytic syndrome. Acyclovir was initiated a median (interquartile range) of 1 (0-3) day after admission.
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Affiliation(s)
- Thomas Frapard
- Assistance Publique—Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, DHU ATVB, Service de Médecine Intensive Réanimation,Créteil, France
- Université Paris Est Créteil, Faculté de Médecine de Créteil, Institut Mondor de Recherche Biomédicale—Groupe de Recherche Clinique CARMAS,Créteil, France
| | - Giuliana Amaddeo
- Assistance Publique—Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, Service d’Hépatologie,Créteil, France
| | - Maxens Decavele
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique,Paris, France
- Groupe Hospitalier Universitaire APHP-Sorbonne Université, Site Pitié-Salpêtrière, Service de Médecine Intensive et Réanimation (Département R3S),Paris, France
| | - Paer-Selim Abback
- Département Anesthésie Réanimation, Université de Tours, CHU de Tours, Tours, France
| | - Antoine Gaillet
- Assistance Publique—Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, DHU ATVB, Service de Médecine Intensive Réanimation,Créteil, France
- Université Paris Est Créteil, Faculté de Médecine de Créteil, Institut Mondor de Recherche Biomédicale—Groupe de Recherche Clinique CARMAS,Créteil, France
| | - Charlotte Bouzbib
- Assistance Publique—Hôpitaux de Paris, Hôpitaux Universitaires Pitié Salpêtrière, Service d’Hépatologie,Paris, France
| | - Claire Vanlemmens
- Centre Hospitalier Universitaire Jean Minjoz, Service d’Hépatologie et Soins Intensifs Digestifs,Besançon, France
| | - Romy Younan
- Assistance Publique—Hôpitaux de Paris, Hôpital Universitaire Saint Louis, Service de Médecine Intensive Réanimation,Paris, France
| | - Emmanuel Canet
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, France
- Université de Nantes, Nantes, France
| | - Anne Sophie Moreau
- Centre Hospitalier Universitaire de Lille, Service de Réanimation Médicale,Lille, France
| | | | - Elie Azoulay
- Assistance Publique—Hôpitaux de Paris, Hôpital Universitaire Saint Louis, Service de Médecine Intensive Réanimation,Paris, France
| | - Alexandre Sitbon
- Assistance Publique—Hôpitaux de Paris, Hôpitaux Universitaires Pitié Salpêtrière, Service de Réanimation Chirurgicale,Paris, France
| | - Djamel Mokart
- Institut Paoli-Calmettes, Service de Réanimation Polyvalente,Marseille, France
| | - Sylvie Radenne
- Hospices Civils de Lyon, Hôpital de la Croix-Rousse, Service d’Hépato-Gastroentérologie,Lyon, France
| | - Armand Abergel
- Centre Hospitalier Universitaire de Clermont-Ferrand, Service d’Hépato-Gastroentérologie,Clermont-Ferrand, France
| | - Céline Guichon
- Hospices Civils de Lyon, Hôpital de la Croix-Rousse, Service d’Anesthésie-Réanimation,Lyon, France
| | - Olivier Roux
- Assistance Publique—Hôpitaux de Paris, Hôpital Beaujon, Service d’Hépatologie,Clichy, France
| | - Agnes Bonadona
- Service d’Hépatologie et Greffe, Pôle Digidune, CHU Grenoble Alpes,La Tronche, France
| | - Armand Mekontso Dessap
- Assistance Publique—Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, DHU ATVB, Service de Médecine Intensive Réanimation,Créteil, France
- Université Paris Est Créteil, Faculté de Médecine de Créteil, Institut Mondor de Recherche Biomédicale—Groupe de Recherche Clinique CARMAS,Créteil, France
| | - Audrey De Jong
- PhyMedExp, Montpellier University, INSERM, CNRS, CHU de Montpellier, Montpellier, France
- Department of Anesthesia and Intensive Care Unit, St-Eloi Hospital, Montpellier, France
| | - Jerome Dumortier
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service d’Hépato-Gastroentérologie,Lyon, France
- Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Nicolas de Prost
- Assistance Publique—Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, DHU ATVB, Service de Médecine Intensive Réanimation,Créteil, France
- Université Paris Est Créteil, Faculté de Médecine de Créteil, Institut Mondor de Recherche Biomédicale—Groupe de Recherche Clinique CARMAS,Créteil, France
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Bhatti TK, Singal AK, Kwo PY. Viral Hepatitis and Acute-on-Chronic Liver Failure. Clin Liver Dis 2023; 27:617-630. [PMID: 37380286 DOI: 10.1016/j.cld.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
Acute-on-chronic liver failure (ACLF) is a potentially reversible syndrome that develops in patients with cirrhosis or with underlying chronic liver disease (CLD) and is characterized by acute decompensation, organ failure, and high short-term mortality. Hepatitis A and hepatitis E are major causes of ACLF. Hepatitis B may also cause ACLF through a flare of hepatitis B, acute infection, or reactivation. Besides supportive care, nucleoside/nucleotide analog therapy should also be initiated in this setting. Nonhepatotropic viruses may rarely also cause ACLF with the severe acute respiratory syndrome coronavirus 2 virus recently being identified with poorer outcomes in those with underlying CLD.
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Affiliation(s)
| | - Ashwani K Singal
- University of SD Sanford School of Medicine, Sioux Falls, SD, USA
| | - Paul Y Kwo
- Stanford University School of Medicine, Palo Alto, CA, USA.
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5
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Hepatic Microabscesses: A Unique Presentation of Herpes Simplex Virus Hepatitis. ACG Case Rep J 2021. [DOI: 10.14309/crj.0000000000000697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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6
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Srinivasan D, Kaul CM, Buttar AB, Nottingham FI, Greene JB. Disseminated Herpes Simplex Virus-2 (HSV-2) as a Cause of Viral Hepatitis in an Immunocompetent Host. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e932474. [PMID: 34341324 PMCID: PMC8349572 DOI: 10.12659/ajcr.932474] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Patient: Male, 57-year-old Final Diagnosis: Hepatitis • herpes Symptoms: Fever Medication: — Clinical Procedure: — Specialty: General and Internal Medicine
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Affiliation(s)
- Dushyanth Srinivasan
- Division of Hospital Medicine, Department of Medicine, New York University (NYU) Grossman School of Medicine, New York City, NY, USA
| | - Christina M Kaul
- Division of Infectious Diseases and Immunology, Department of Medicine, New York University (NYU) Grossman School of Medicine, New York City, NY, USA
| | - Amna B Buttar
- Division of Geriatric Medicine, Department of Medicine, New York University (NYU) Grossman School of Medicine, New York City, NY, USA
| | - Fatima I Nottingham
- Division of Hospital Medicine, Department of Medicine, New York University (NYU) Grossman School of Medicine, New York City, NY, USA
| | - Jeffrey B Greene
- Division of Infectious Diseases and Immunology, Department of Medicine, New York University (NYU) Grossman School of Medicine, New York City, NY, USA
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7
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Human Herpesviruses Increase the Severity of Hepatitis. BIOLOGY 2021; 10:biology10060483. [PMID: 34072365 PMCID: PMC8227862 DOI: 10.3390/biology10060483] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/21/2021] [Accepted: 05/27/2021] [Indexed: 02/07/2023]
Abstract
Simple Summary More than 300 million people worldwide suffer from hepatitis B or hepatitis C and more than 1 million people die each year from cirrhosis and liver cancer. In some cases, the nature of hepatitis remains unclear. The purpose of this research was to assess the prevalence of human herpesviruses (cytomegalovirus, Epstein–Barr virus, and herpesvirus type 6) in patients with hepatitis, and to examine their effect on the disease severity. In the clinical materials of 377 patients with acute or chronic hepatitis, DNA of these three herpesviruses was detected in the blood in 13.5% of patients with viral hepatitis B or C and in 10.1% of patients with hepatitis of unspecified etiology. The cirrhosis was diagnosed in patients with herpesviruses 3 times more often than in patients without them. In patients with hepatitis C, the incidence of herpesviruses was higher in the tissue samples of liver biopsies (38.7%) than in the blood. Clinical and virological indicators of hepatitis were considerably higher in the patients with coinfection. Since in patients with hepatitis the presence of herpesviruses is associated with a more severe course of the disease, the detection, and herpesvirus DNA monitoring will help to adjust the course of therapy. Abstract Acute and chronic liver diseases are a major global public health problem; nevertheless, the etiology of 12–30% of cases remains obscure. The purpose of this research was to study the incidence of human herpesviruses (HHVs) cytomegalovirus, Epstein–Barr virus (EBV), and HHV-6 in patients with hepatitis and to examine the effect of HHV on the disease severity. We studied the clinical materials of 259 patients with hepatitis treated in Infectious Clinic n.1 (Moscow) and the archived materials of 118 patients with hepatitis C. HHV DNA was detected in the whole blood in 13.5% of patients with hepatitis B or C and in 10.1% of patients with hepatitis of unspecified etiology. EBV demonstrated the highest incidence (58.1%). Cirrhosis was diagnosed in 50% of patients with HHV and in 15.6% of patients without HHV. In patients with hepatitis C, the frequency of HHV was higher in liver biopsy (38.7%) compared to blood. The clinical and virological indicators of hepatitis were considerably higher in patients with coinfection. Conclusion: HHV detected in patients with viral hepatitis has been associated with a significant effect on the severity of the disease, and we suggest monitoring HHV DNA in patients with severe hepatitis and/or poor response to antiviral drugs.
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8
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Anand AC, Nandi B, Acharya SK, Arora A, Babu S, Batra Y, Chawla YK, Chowdhury A, Chaoudhuri A, Eapen EC, Devarbhavi H, Dhiman RK, Datta Gupta S, Duseja A, Jothimani D, Kapoor D, Kar P, Khuroo MS, Kumar A, Madan K, Mallick B, Maiwall R, Mohan N, Nagral A, Nath P, Panigrahi SC, Pawar A, Philips CA, Prahraj D, Puri P, Rastogi A, Saraswat VA, Saigal S, Shalimar, Shukla A, Singh SP, Verghese T, Wadhawan M. Indian National Association for the Study of Liver Consensus Statement on Acute Liver Failure (Part-2): Management of Acute Liver Failure. J Clin Exp Hepatol 2020; 10:477-517. [PMID: 33029057 PMCID: PMC7527855 DOI: 10.1016/j.jceh.2020.04.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 04/12/2020] [Indexed: 12/12/2022] Open
Abstract
Acute liver failure (ALF) is not an uncommon complication of a common disease such as acute hepatitis. Viral hepatitis followed by antituberculosis drug-induced hepatotoxicity are the commonest causes of ALF in India. Clinically, such patients present with appearance of jaundice, encephalopathy, and coagulopathy. Hepatic encephalopathy (HE) and cerebral edema are central and most important clinical event in the course of ALF, followed by superadded infections, and determine the outcome in these patients. The pathogenesis of encephalopathy and cerebral edema in ALF is unique and multifactorial. Ammonia plays a crucial role in the pathogenesis, and several therapies aim to correct this abnormality. The role of newer ammonia-lowering agents is still evolving. These patients are best managed at a tertiary care hospital with facility for liver transplantation (LT). Aggressive intensive medical management has been documented to salvage a substantial proportion of patients. In those with poor prognostic factors, LT is the only effective therapy that has been shown to improve survival. However, recognizing suitable patients with poor prognosis has remained a challenge. Close monitoring, early identification and treatment of complications, and couseling for transplant form the first-line approach to manage such patients. Recent research shows that use of dynamic prognostic models is better for selecting patients undergoing liver transplantation and timely transplant can save life of patients with ALF with poor prognostic factors.
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Key Words
- ACLF, Acute on Chronic liver Failure
- AKI, Acute kidney injury
- ALF, Acute Liver Failure
- ALFED score
- ALT, alanine transaminase
- AST, aspartate transaminase
- CNS, central nervous system
- CT, Computerized tomography
- HELLP, Hemolysis, elevated liver enzymes, and low platelets
- ICH, Intracrainial hypertension
- ICP, Intracrainial Pressure
- ICU, Intensive care unit
- INR, International normalised ratio
- LAD, Liver assist device
- LDLT, Living donor liver transplantation
- LT, Liver transplantation
- MAP, Mean arterial pressure
- MELD, model for end-stage liver disease
- MLD, Metabolic liver disease
- NAC, N-acetyl cysteine
- PALF, Pediatric ALF
- WD, Wilson's Disease
- acute liver failure
- artificial liver support
- liver transplantation
- plasmapheresis
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Affiliation(s)
- Anil C. Anand
- Department of Gastroenterology, Kaliga Institute of Medical Sciences, Bhubaneswar, 751024, India
| | - Bhaskar Nandi
- Department of Gastroenterology, Sarvodaya Hospital and Research Centre, Faridababd, Haryana, India
| | - Subrat K. Acharya
- Department of Gastroenterology and Hepatology, KIIT University, Patia, Bhubaneswar, Odisha, 751 024, India
| | - Anil Arora
- Institute of Liver Gastroenterology & Pancreatico Biliary Sciences, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, 110 060, India
| | - Sethu Babu
- Department of Gastroenterology, Krishna Institute of Medical Sciences, Hyderabad, 500003, India
| | - Yogesh Batra
- Department of Gastroenterology, Indraprastha Apollo Hospital, SaritaVihar, New Delhi, 110 076, India
| | - Yogesh K. Chawla
- Department of Gastroenterology, Kalinga Institute of Medical Sciences (KIMS), Kushabhadra Campus (KIIT Campus-5), Patia, Bhubaneswar, Odisha, 751 024, India
| | - Abhijit Chowdhury
- Department of Hepatology, School of Digestive and Liver Diseases, Institute of Post Graduate Medical Education & Research, Kolkata, 700020, India
| | - Ashok Chaoudhuri
- Hepatology and Liver Transplant, Institute of Liver & Biliary Sciences, D-1 Vasant Kunj, New Delhi, India
| | - Eapen C. Eapen
- Department of Hepatology, Christian Medical College, Vellore, India
| | - Harshad Devarbhavi
- Department of Gastroenterology and Hepatology, St. John's Medical College Hospital, Bangalore, 560034, India
| | - Radha K. Dhiman
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Siddhartha Datta Gupta
- Department of Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India
| | - Ajay Duseja
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Dinesh Jothimani
- Institute of Liver Disease and Transplantation, Dr Rela Institute and Medical Centre, Chrompet, Chennai, 600044, India
| | | | - Premashish Kar
- Department of Gastroenterology and Hepatology, Max Super Speciality Hospital, Vaishali, Ghaziabad, Uttar Pradesh, 201 012, India
| | - Mohamad S. Khuroo
- Department of Gastroenterology, Dr Khuroo’ s Medical Clinic, Srinagar, Kashmir, India
| | - Ashish Kumar
- Institute of Liver Gastroenterology & Pancreatico Biliary Sciences, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, 110 060, India
| | - Kaushal Madan
- Gastroenterology and Hepatology, Max Smart Super Specialty Hospital, Saket, New Delhi, India
| | - Bipadabhanjan Mallick
- Department of Gastroenterology, Kalinga Institute of Medical Sciences, Bhubaneswar, 751024, India
| | - Rakhi Maiwall
- Hepatology Incharge Liver Intensive Care, Institute of Liver & Biliary Sciences, D-1 Vasant Kunj, New Delhi, India
| | - Neelam Mohan
- Department of Pediatric Gastroenterology, Hepatology & Liver Transplantation, Medanta – the MedicityHospital, Sector – 38, Gurgaon, Haryana, India
| | - Aabha Nagral
- Department of Gastroenterology, Apollo and Jaslok Hospital & Research Centre, 15, Dr Deshmukh Marg, Pedder Road, Mumbai, Maharashtra, 400 026, India
| | - Preetam Nath
- Department of Gastroenterology, Kaliga Institute of Medical Sciences, Bhubaneswar, 751024, India
| | - Sarat C. Panigrahi
- Department of Gastroenterology, Kaliga Institute of Medical Sciences, Bhubaneswar, 751024, India
| | - Ankush Pawar
- Liver & Digestive Diseases Institute, Fortis Escorts Hospital, Okhla Road, New Delhi, 110 025, India
| | - Cyriac A. Philips
- The Liver Unit and Monarch Liver Lab, Cochin Gastroenterology Group, Ernakulam Medical Centre, Kochi 682028, Kerala, India
| | - Dibyalochan Prahraj
- Department of Gastroenterology, Kaliga Institute of Medical Sciences, Bhubaneswar, 751024, India
| | - Pankaj Puri
- Department of Hepatology and Gastroenterology, Fortis Escorts Liver & Digestive Diseases Institute (FELDI), Fortis Escorts Hospital, Delhi, India
| | - Amit Rastogi
- Department of Liver Transplantation, Medanta – the MedicityHospital, Sector – 38, Gurgaon, Haryana, India
| | - Vivek A. Saraswat
- Department of Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raibareli Road, Lucknow, Uttar Pradesh, 226 014, India
| | - Sanjiv Saigal
- Department of Hepatology, Department of Liver Transplantation, India
| | - Shalimar
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, 29, India
| | - Akash Shukla
- Department of Gastroenterology, LTM Medical College & Sion Hospital, India
| | - Shivaram P. Singh
- Department of Gastroenterology, SCB Medical College, Dock Road, Manglabag, Cuttack, Odisha, 753 007, India
| | - Thomas Verghese
- Department of Gastroenterology, Government Medical College, Kozikhode, India
| | - Manav Wadhawan
- Institute of Liver & Digestive Diseases and Head of Hepatology & Liver Transplant (Medicine), BLK Super Speciality Hospital, Delhi, India
| | - The INASL Task-Force on Acute Liver Failure
- Department of Gastroenterology, Kaliga Institute of Medical Sciences, Bhubaneswar, 751024, India
- Department of Gastroenterology, Sarvodaya Hospital and Research Centre, Faridababd, Haryana, India
- Department of Gastroenterology and Hepatology, KIIT University, Patia, Bhubaneswar, Odisha, 751 024, India
- Institute of Liver Gastroenterology & Pancreatico Biliary Sciences, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, 110 060, India
- Department of Gastroenterology, Krishna Institute of Medical Sciences, Hyderabad, 500003, India
- Department of Gastroenterology, Indraprastha Apollo Hospital, SaritaVihar, New Delhi, 110 076, India
- Department of Gastroenterology, Kalinga Institute of Medical Sciences (KIMS), Kushabhadra Campus (KIIT Campus-5), Patia, Bhubaneswar, Odisha, 751 024, India
- Department of Hepatology, School of Digestive and Liver Diseases, Institute of Post Graduate Medical Education & Research, Kolkata, 700020, India
- Hepatology and Liver Transplant, Institute of Liver & Biliary Sciences, D-1 Vasant Kunj, New Delhi, India
- Department of Hepatology, Christian Medical College, Vellore, India
- Department of Gastroenterology and Hepatology, St. John's Medical College Hospital, Bangalore, 560034, India
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
- Department of Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India
- Institute of Liver Disease and Transplantation, Dr Rela Institute and Medical Centre, Chrompet, Chennai, 600044, India
- Gleneagles Global Hospitals, Hyderabad, Telangana, India
- Department of Gastroenterology and Hepatology, Max Super Speciality Hospital, Vaishali, Ghaziabad, Uttar Pradesh, 201 012, India
- Department of Gastroenterology, Dr Khuroo’ s Medical Clinic, Srinagar, Kashmir, India
- Gastroenterology and Hepatology, Max Smart Super Specialty Hospital, Saket, New Delhi, India
- Department of Gastroenterology, Kalinga Institute of Medical Sciences, Bhubaneswar, 751024, India
- Hepatology Incharge Liver Intensive Care, Institute of Liver & Biliary Sciences, D-1 Vasant Kunj, New Delhi, India
- Department of Pediatric Gastroenterology, Hepatology & Liver Transplantation, Medanta – the MedicityHospital, Sector – 38, Gurgaon, Haryana, India
- Department of Gastroenterology, Apollo and Jaslok Hospital & Research Centre, 15, Dr Deshmukh Marg, Pedder Road, Mumbai, Maharashtra, 400 026, India
- Liver & Digestive Diseases Institute, Fortis Escorts Hospital, Okhla Road, New Delhi, 110 025, India
- The Liver Unit and Monarch Liver Lab, Cochin Gastroenterology Group, Ernakulam Medical Centre, Kochi 682028, Kerala, India
- Department of Hepatology and Gastroenterology, Fortis Escorts Liver & Digestive Diseases Institute (FELDI), Fortis Escorts Hospital, Delhi, India
- Department of Liver Transplantation, Medanta – the MedicityHospital, Sector – 38, Gurgaon, Haryana, India
- Department of Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raibareli Road, Lucknow, Uttar Pradesh, 226 014, India
- Department of Hepatology, Department of Liver Transplantation, India
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, 29, India
- Department of Gastroenterology, LTM Medical College & Sion Hospital, India
- Department of Gastroenterology, SCB Medical College, Dock Road, Manglabag, Cuttack, Odisha, 753 007, India
- Department of Gastroenterology, Government Medical College, Kozikhode, India
- Institute of Liver & Digestive Diseases and Head of Hepatology & Liver Transplant (Medicine), BLK Super Speciality Hospital, Delhi, India
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9
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Abstract
BACKGROUND Herpes simplex virus (HSV) causes only 2-4% of all acute hepatitis but has high morbidity and mortality. Pregnancy is a risk factor for HSV hepatitis. We describe a case of gestational HSV hepatitis. CASE A 32-year old woman, gravida 2 para 1, presented at 38 2/7 weeks of gestation with back pain and fetal tachycardia. She became febrile after admission, had spontaneous rupture of membranes, and was delivered by cesarean for malpresentation. Postpartum, she became persistently febrile and developed transaminitis, symptomatic hypotension, and pancytopenia despite antibiotics. Imaging revealed acute liver injury, splenomegaly, pleural effusions, and cardiomyopathy. Serum polymerase chain reaction (PCR) screening identified HSV-1 infection. The patient recovered on acyclovir. There was no evidence of neonatal seroconversion. CONCLUSION Herpes simplex virus hepatitis causes significant morbidity, and pregnant women are susceptible to severe infections. Pregnant or peripartum women with acute febrile hepatitis require prompt evaluation for HSV with serum PCR screening.
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10
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Choi S, Lee JH, Park MS. Successful Treatment of Neonatal Herpes Simplex Infection Presenting as Fulminant Hepatitis with Acyclovir and Peritoneal Dialysis. NEONATAL MEDICINE 2019. [DOI: 10.5385/nm.2019.26.4.229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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11
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Tio SY, Nickless D, McCracken J, Nedumannil R, Stewart J, Aboltins C. A Man With Tonsillitis and Hepatitis. Clin Infect Dis 2019; 67:1303-1305. [PMID: 30265322 DOI: 10.1093/cid/ciy107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Shio Yen Tio
- Department of Infectious Diseases, University of Melbourne, Victoria, Australia
| | - David Nickless
- Department of Pathology, University of Melbourne, Victoria, Australia
| | - James McCracken
- Department of Oncology, The Northern Hospital, University of Melbourne, Victoria, Australia
| | - Rithin Nedumannil
- Department of Oncology, The Northern Hospital, University of Melbourne, Victoria, Australia
| | - Josephine Stewart
- Department of Oncology, The Northern Hospital, University of Melbourne, Victoria, Australia
| | - Craig Aboltins
- Department of Infectious Diseases, University of Melbourne, Victoria, Australia.,Northern Clinical School, University of Melbourne, Victoria, Australia
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12
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Abstract
Acute liver failure is a rare and severe consequence of abrupt hepatocyte injury, and can evolve over days or weeks to a lethal outcome. A variety of insults to liver cells result in a consistent pattern of rapid-onset elevation of aminotransferases, altered mentation, and disturbed coagulation. The absence of existing liver disease distinguishes acute liver failure from decompensated cirrhosis or acute-on-chronic liver failure. Causes of acute liver failure include paracetamol toxicity, hepatic ischaemia, viral and autoimmune hepatitis, and drug-induced liver injury from prescription drugs, and herbal and dietary supplements. Diagnosis requires careful review of medications taken, and serological testing for possible viral exposure. Because of its rarity, acute liver failure has not been studied in large, randomised trials, and most treatment recommendations represent expert opinion. Improvements in management have resulted in lower mortality, although liver transplantation, used in nearly 30% of patients with acute liver failure, still provides a life-saving alternative to medical management.
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Affiliation(s)
- R Todd Stravitz
- Hume-Lee Transplant Center of Virginia Commonwealth University, Richmond, VA, USA
| | - William M Lee
- Digestive and Liver Diseases Division, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA.
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13
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Yiu D, Ballabio M, Fornoni G, Maggi U. Unusual oral presentation of HSV-1 lesions in an adult liver transplant recipient. BMJ Case Rep 2019; 12:12/3/e227492. [PMID: 30852500 DOI: 10.1136/bcr-2018-227492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Herpes Simplex Virus (HSV) hepatitis in liver transplant patients is a rarely reported infective complication of HSV with severe consequences, often leading to fulminant hepatitis if left untreated. The clinical signs are often atypical, leading to under-reporting in the literature and potential delays in treatment. Our case report describes such atypical mucocutaneous lesions in a liver transplant recipient. We highlight the need for further reports, especially those with images, in order to aid the diagnosis of HSV infection, and to allow prompt treatment to prevent complications such as HSV hepatitis.
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Affiliation(s)
- Daniel Yiu
- General Surgery, Frimley Health NHS Foundation Trust, Slough, UK
| | - Michele Ballabio
- UO Chirurgia Generale e Trapianti di Fegato, Ospedale Maggiore Policlinico, Milano, Italy
| | - Gianluca Fornoni
- UO Chirurgia Generale e Trapianti di Fegato, Ospedale Maggiore Policlinico, Milano, Italy
| | - Umberto Maggi
- HPB and Liver Transplant Unit, Osped Maggiore Policlin Milano, Milano, Italy
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14
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Yunce M, Bhat P, Jaganathan D, Bahrain M. Herpes hepatitis as a complication of total abdominal hysterectomy; an unusual complication of abdominal instrumentation. Clin Case Rep 2019; 7:11-14. [PMID: 30655998 PMCID: PMC6332770 DOI: 10.1002/ccr3.1890] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 08/25/2018] [Accepted: 10/01/2018] [Indexed: 11/25/2022] Open
Abstract
Herpes simplex virus hepatitis is a rare but potentially fatal disease without early intervention. Impaired immunity is a major predisposing risk factor but infection in immunocompetent individuals is not unheard of. Diagnosis is complicated by its rarity and nonspecific signs and symptoms on presentation. Identification by liver biopsy is often limited due to concurrent coagulopathy. Early and aggressive treatment is centered on antiviral therapy with acyclovir. We present a case of herpes hepatitis in an immunocompetent woman following abdominal instrumentation.
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Affiliation(s)
- Muharrem Yunce
- Department of MedicineMedStar Franklin Square Medical CenterBaltimoreMaryland
| | - Pavan Bhat
- Department of MedicineMedStar Franklin Square Medical CenterBaltimoreMaryland
| | - Daisy Jaganathan
- Department of MedicineMedStar Franklin Square Medical CenterBaltimoreMaryland
| | - Michelle Bahrain
- Department of Infectious DiseaseMedStar Franklin Square Medical CenterBaltimoreMaryland
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15
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Inthasot V, Goushchi A, Lazzaroni S, Papaleo A, Galdon MG, Chochrad D. Fatal Septic Shock Associated with Herpes Simplex Virus Hepatitis: A Case Report. Eur J Case Rep Intern Med 2018; 5:000982. [PMID: 30755997 PMCID: PMC6346974 DOI: 10.12890/2018_000982] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Accepted: 11/09/2018] [Indexed: 11/05/2022] Open
Abstract
Herpes simplex viruses are endemic worldwide, with an estimated seroprevalence of approximately 70% in developed countries. However, it is less well known that they are one of the viral causes of fulminant hepatitis (<2%) and constitute <1% of all causes of acute liver failure. We describe the case of an 89-year-old man who developed sepsis caused by a urinary tract infection due to drug-sensitive Escherichia coli. After empirical treatment with piperacillin-tazobactam was initiated, the patient’s condition worsened with shock, acute liver and renal failure, encephalopathy and persistent fever, that led to admission to the intensive care unit. The emergence of an acute abdomen prompted exploratory laparotomy but the patient died soon after surgery from abdominal haemorrhage. Immunohistochemical analysis of a liver biopsy specimen identified herpes simplex virus (HSV) hepatitis. The authors emphasize the need for better understanding of this rare condition in order to more precisely identify patients at risk who need more aggressive evaluation and empirical treatment, especially patients presenting with marked hepatic cytolysis with a rapidly worsening clinical evolution.
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Affiliation(s)
| | - Adonis Goushchi
- Internal Medicine Department, Iris South Hospitals, Brussels, Belgium
| | - Silvia Lazzaroni
- Internal Medicine Department, Iris South Hospitals, Brussels, Belgium
| | - Alberto Papaleo
- Internal Medicine Department, Iris South Hospitals, Brussels, Belgium
| | - Maria Gomez Galdon
- Anatomical Pathology Department Institut Jules Bordet, Brussels, Belgium
| | - Didier Chochrad
- Intensive Care Unit, Iris South Hospitals, Brussels, Belgium
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16
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Motorna N, Rybalko S, Kvitnitskaya-Ryzhova T, Starosyla D, Strokina I, Kaminsky R, Savosko S, Sokurenko L, Chaikovsky Y. Ultrastructural changes in murine liver following HSV infection and stroke. CURRENT ISSUES IN PHARMACY AND MEDICAL SCIENCES 2018. [DOI: 10.1515/cipms-2018-0002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
The study of herpetic infection is a topical problem. Although the peculiarities and consequences of acute HSV-I infection in the brain are quite well-studied, little is known about the damage to other organs which are not a source of latent HSV-I infection, the liver in particular. The current study is aimed at determining the ultrastructural changes in murine liver following HSV infection and stroke. Liver samples obtained from four groups of animals were studied: 1) intact mice; 2) mice with stroke; 3) mice infected with HSV-I; 4) mice aflicted with HSV-I and subsequently simulated stroke. The study showed the reproduction of the virus in hepatic endotheliocytes, although no virions were detected in the hepatocytes. Therefore, the described changes were considered the consequences of the infectious process. Pathological changes of hepatocytes consisted of deformation and fragmentation of the nuclei, as well as accumulation of osmiophilic granules, lysosomes and lamellary bodies. Latent HSV-I infection may reactivate in liver after the stroke, potentially causing the complications of the underlying disease.
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Affiliation(s)
- Natalia Motorna
- O.O. Bogomolets National Medical University , Department of Histology and Embryology , T. Shevchenko Blvd 13, 01601 Kyiv , Ukraine
| | - Svetlana Rybalko
- Gromashevsky L.V. Institute of Epidemiology and Infection Diseases of NAMS of Ukraine , Kyiv , Ukraine
| | | | - Daria Starosyla
- Gromashevsky L.V. Institute of Epidemiology and Infection Diseases of NAMS of Ukraine , Kyiv , Ukraine
| | - Iryna Strokina
- O.O. Bogomolets National Medical University , Department of Histology and Embryology , T. Shevchenko Blvd 13, 01601 Kyiv , Ukraine
| | - Rostyslav Kaminsky
- O.O. Bogomolets National Medical University , Department of Histology and Embryology , T. Shevchenko Blvd 13, 01601 Kyiv , Ukraine
| | - Sergey Savosko
- O.O. Bogomolets National Medical University , Department of Histology and Embryology , T. Shevchenko Blvd 13, 01601 Kyiv , Ukraine
| | - Liudmyla Sokurenko
- O.O. Bogomolets National Medical University , Department of Histology and Embryology , T. Shevchenko Blvd 13, 01601 Kyiv , Ukraine
| | - Yuri Chaikovsky
- O.O. Bogomolets National Medical University , Department of Histology and Embryology , T. Shevchenko Blvd 13, 01601 Kyiv , Ukraine
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17
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Yokoi Y, Kaneko T, Sawayanagi T, Takano Y, Watahiki Y. Fatal fulminant herpes simplex hepatitis following surgery in an adult. World J Clin Cases 2018; 6:11-19. [PMID: 29468167 PMCID: PMC5807890 DOI: 10.12998/wjcc.v6.i2.11] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 12/15/2017] [Accepted: 01/16/2018] [Indexed: 02/05/2023] Open
Abstract
We present a case of a healthy 72-year-old man with herpes simplex hepatitis (HSVH) development soon after ordinary surgery for biliary stones. A sudden onset of hepatitis associated with high fever and leukopenia emerged on postoperative day 5, followed by a rapid and lethal course (died on day 9), despite an acyclovir therapy on day 8. Postmortem liver biopsy revealed positive immunostaining for herpes simplex virus (HSV) type-1. The serum tests (available after the death) were negative for anti-HSV immunogloblulins, but positive for HSV DNA. A review of 15 cases of postsurgical HSVH along with 42 cases of non-surgical HSH showed that (1): A wide spectrum of surgical procedures was involved; and (2): High mortality (87%) associated with lower rates of ante-mortem diagnosis (20%) and acyclovir treatment (20%). Due to the difficulty in diagnosis and lethal nature, an early clinical suspension and prompt empirical anti-viral intervention are imperative for postsurgical hepatitis with undetermined etiology, characterized by fever and leucopenia.
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Affiliation(s)
- Yoshihiro Yokoi
- Youichi Watahiki, Department of Surgery, Shinshiro Municipal Hospital, Shinshiro 441-1387, Japan
| | - Takeshi Kaneko
- Youichi Watahiki, Department of Surgery, Shinshiro Municipal Hospital, Shinshiro 441-1387, Japan
| | - Tomoki Sawayanagi
- Youichi Watahiki, Department of Surgery, Shinshiro Municipal Hospital, Shinshiro 441-1387, Japan
| | - Yasuo Takano
- Department of Pathology, Shinshiro Municipal Hospital, Shinshiro 441-1387, Japan
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18
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Okamoto M, Takahagi S, Tanaka A, Ogawa A, Nobuki H, Hide M. A case of Kaposi varicelliform eruption progressing to herpes simplex virus hepatitis in an immunocompetent patient. Clin Exp Dermatol 2018; 43:636-638. [DOI: 10.1111/ced.13405] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2017] [Indexed: 01/31/2023]
Affiliation(s)
- M. Okamoto
- Department of Dermatology; Institute of Biomedical & Health Sciences; Hiroshima University; Hiroshima Japan
| | - S. Takahagi
- Department of Dermatology; Institute of Biomedical & Health Sciences; Hiroshima University; Hiroshima Japan
| | - A. Tanaka
- Department of Dermatology; Institute of Biomedical & Health Sciences; Hiroshima University; Hiroshima Japan
| | - A. Ogawa
- Department of Dermatology; Institute of Biomedical & Health Sciences; Hiroshima University; Hiroshima Japan
| | - H. Nobuki
- Department of Dermatology; Institute of Biomedical & Health Sciences; Hiroshima University; Hiroshima Japan
| | - M. Hide
- Department of Dermatology; Institute of Biomedical & Health Sciences; Hiroshima University; Hiroshima Japan
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19
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Retrospective Identification of Herpes Simplex 2 Virus-Associated Acute Liver Failure in an Immunocompetent Patient Detected Using Whole Transcriptome Shotgun Sequencing. Case Reports Hepatol 2017; 2017:4630621. [PMID: 29441209 PMCID: PMC5758846 DOI: 10.1155/2017/4630621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 12/04/2017] [Indexed: 01/06/2023] Open
Abstract
Acute liver failure (ALF) is a severe condition in which liver function rapidly deteriorates in individuals without prior history of liver disease. While most cases result from acetaminophen overdose or viral hepatitis, in up to a third of patients, no clear cause can be identified. Liver transplantation has greatly reduced mortality among these patients, but 40% of patients recover without liver transplantation. Therefore, there is an urgent need for rapid determination of the etiology of acute liver failure. In this case report, we present a case of herpes simplex 2 virus- (HSV-) associated ALF in an immunocompetent patient. The patient recovered without LT, but the presence of HSV was not suspected at the time, precluding more effective treatment with acyclovir. To determine the etiology, stored blood samples were analyzed using whole transcriptome shotgun sequencing followed by mapping to a panel of viral reference sequences. The presence of HSV-DNA in blood samples at the time of admission was confirmed using real-time polymerase chain reaction, and, at the time of discharge, HSV-DNA levels had decreased by a factor of 106. Conclusions. In ALF cases of undetermined etiology, uncommon causes should be considered, especially those for which an effective treatment is available.
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20
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Vincenzi R, Fonseca EA, Roda KMO, Porta G, Candido HL, Benavides MR, Leite KRM, Afonso RC, Turine-Neto P, Ribeiro CMF, Chapchap P, Seda-Neto J. Living donor liver transplantation for neonatal fulminant hepatitis due to herpes simplex virus infection. Pediatr Transplant 2017; 21. [PMID: 28736976 DOI: 10.1111/petr.13021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/08/2017] [Indexed: 11/28/2022]
Abstract
Although rare, ALF caused by disseminated HSV infection is associated with high mortality in the neonatal population. This condition is often diagnosed relatively late due to the absence of specific signs. We present a case involving a neonate with ALF submitted to living donor liver transplantation without a prior diagnosis. The patient had no skin or mucosal lesions, and IgM serology was negative for HSV-1 and HSV-2. Immunohistochemical staining of the liver explant was positive for herpes virus infection, and the patient subsequently received antiviral drug treatment, with a good outcome. Due to organ shortages and the rarity of the aforementioned condition, LT has seldom been reported for the treatment of ALF caused by herpes virus infection; however, LT may be the only option for neonates with fulminant hepatitis. The use of living donors in an urgent scenario is well established in Eastern countries and safely applicable for pediatric patients with ALF.
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Affiliation(s)
- Rodrigo Vincenzi
- Hepatology and Liver Transplantation, Hospital Sirio-Libanes, Sao Paulo, SP, Brazil.,A.C. Camargo Cancer Center, Sao Paulo, SP, Brazil
| | - Eduardo A Fonseca
- Hepatology and Liver Transplantation, Hospital Sirio-Libanes, Sao Paulo, SP, Brazil.,A.C. Camargo Cancer Center, Sao Paulo, SP, Brazil
| | - Karina M O Roda
- Hepatology and Liver Transplantation, Hospital Sirio-Libanes, Sao Paulo, SP, Brazil.,A.C. Camargo Cancer Center, Sao Paulo, SP, Brazil
| | - Gilda Porta
- Hepatology and Liver Transplantation, Hospital Sirio-Libanes, Sao Paulo, SP, Brazil.,A.C. Camargo Cancer Center, Sao Paulo, SP, Brazil
| | - Helry L Candido
- Hepatology and Liver Transplantation, Hospital Sirio-Libanes, Sao Paulo, SP, Brazil.,A.C. Camargo Cancer Center, Sao Paulo, SP, Brazil
| | - Marcel R Benavides
- Hepatology and Liver Transplantation, Hospital Sirio-Libanes, Sao Paulo, SP, Brazil.,A.C. Camargo Cancer Center, Sao Paulo, SP, Brazil
| | - Katia R M Leite
- Department of Pathology, Hospital Sirio-Libanes, Sao Paulo, SP, Brazil
| | - Rogerio C Afonso
- Hepatology and Liver Transplantation, Hospital Sirio-Libanes, Sao Paulo, SP, Brazil.,A.C. Camargo Cancer Center, Sao Paulo, SP, Brazil
| | - Plinio Turine-Neto
- Hepatology and Liver Transplantation, Hospital Sirio-Libanes, Sao Paulo, SP, Brazil.,A.C. Camargo Cancer Center, Sao Paulo, SP, Brazil
| | | | - Paulo Chapchap
- Hepatology and Liver Transplantation, Hospital Sirio-Libanes, Sao Paulo, SP, Brazil
| | - João Seda-Neto
- Hepatology and Liver Transplantation, Hospital Sirio-Libanes, Sao Paulo, SP, Brazil.,A.C. Camargo Cancer Center, Sao Paulo, SP, Brazil
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21
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Abstract
Acute liver failure (ALF) is a life-threatening condition of heterogeneous etiology. Outcomes are better with early recognition and prompt initiation of etiology-specific therapy, intensive care protocols, and liver transplantation (LT). Prognostic scoring systems include the King's College Criteria and Model for End-stage Liver Disease score. Cerebral edema and intracranial hypertension are reasons for high morbidity and mortality; hypertonic saline is suggested for patients with a high risk for developing intracranial hypertension, and when it does, mannitol is recommended as first-line therapy. Extracorporeal liver support system may serve as a bridge to LT and may increase LT-free survival in select cases.
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Affiliation(s)
- Chalermrat Bunchorntavakul
- Division of Gastroenterology and Hepatology, Department of Medicine, Rajavithi Hospital, College of Medicine, Rangsit University, Rajavithi Road, Ratchathewi, Bangkok 10400, Thailand; Division of Gastroenterology and Hepatology, Department of Medicine, Hospital of the University of Pennsylvania, University of Pennsylvania, 2 Dulles, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - K Rajender Reddy
- Division of Gastroenterology and Hepatology, Department of Medicine, Hospital of the University of Pennsylvania, University of Pennsylvania, 2 Dulles, 3400 Spruce Street, Philadelphia, PA 19104, USA.
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22
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Hillaire S, Kahn JE, Picone O, Cazals-Hatem D. Rare cause of abdominal pain and fever in a pregnant woman. Gut 2017; 66:1911-1982. [PMID: 27888235 DOI: 10.1136/gutjnl-2016-313097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 11/04/2016] [Accepted: 11/08/2016] [Indexed: 12/08/2022]
Abstract
CLINICAL PRESENTATION A pregnant woman (third trimester) presented with intense abdominal pain, nausea and myalgia. The patient was obese (body mass index 38) and was being treated for high blood pressure, hyperuricemia and hypothyroidism. She had chronic renal deficiency related to focal segmental glomerular sclerosis requiring dialysis. The physical examination at admission revealed a fever of 39°C and an acute abdomen with abdominal guarding in the right upper quadrant without hepatomegaly or splenomegaly. There were no clinical signs of pre-eclampsia. Fetal ultrasound and a Doppler of the umbilical vessels were normal. Laboratory tests showed normal liver and liver function (total protein 95%, alanine transaminase (ALT), aspartate transaminase (AST), total bilirubin normal). The white cell count was 10×109/l (90% neutrophils), with a normal platelet count. Blood, urine and vaginal cultures were negative. Abdominal ultrasound revealed isolated thickening of the gallbladder wall without cholelithiasis. Empirical antibiotic treatment was begun with intravenous amoxicillin. Six days later, the patient's condition had worsened with increased abdominal pain, persistent fever and liver test abnormalities (AST-ALT 6N). However, bilirubin, hepatic synthesis tests, as well as leucocyte and platelet counts were still normal. A caesarean section followed by coelioscopy was decided. Coelioscopy revealed a liver with numerous necrotic spots (see figure 1).gutjnl;66/11/1911/GUTJNL2016313097F1F1GUTJNL2016313097F1Figure 1Diagnostic laparoscopy revealed a liver surface covered with numerous white necrotic spots. QUESTION What is the diagnosis?
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Affiliation(s)
| | | | - Olivier Picone
- Service de Gynécologie-Obstétrique, Hôpital Foch, Suresnes, France
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23
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Somasekar S, Lee D, Rule J, Naccache SN, Stone M, Busch MP, Sanders C, Lee WM, Chiu CY. Viral Surveillance in Serum Samples From Patients With Acute Liver Failure By Metagenomic Next-Generation Sequencing. Clin Infect Dis 2017; 65:1477-1485. [PMID: 29020199 PMCID: PMC5848299 DOI: 10.1093/cid/cix596] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 07/13/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Twelve percent of all acute liver failure (ALF) cases are of unknown origin, often termed indeterminate. A previously unrecognized hepatotropic virus has been suspected as a potential etiologic agent. METHODS We compared the performance of metagenomic next-generation sequencing (mNGS) with confirmatory nucleic acid testing (NAT) to routine clinical diagnostic testing in detection of known or novel viruses associated with ALF. Serum samples from 204 adult ALF patients collected from 1998 to 2010 as part of a nationwide registry were analyzed. One hundred eighty-seven patients (92%) were classified as indeterminate, while the remaining 17 patients (8%) served as controls, with infections by either hepatitis A virus or hepatitis B virus (HBV), or a noninfectious cause for their ALF. RESULTS Eight cases of infection from previously unrecognized viral pathogens were detected by mNGS (4 cases of herpes simplex virus type 1, including 1 case of coinfection with HBV, and 1 case each of HBV, parvovirus B19, cytomegalovirus, and human herpesvirus 7). Several missed dual or triple infections were also identified, and assembled viral genomes provided additional information on genotyping and drug resistance mutations. Importantly, no sequences corresponding to novel viruses were detected. CONCLUSIONS These results suggest that ALF patients should be screened for the presence of uncommon viruses and coinfections, and that most cases of indeterminate ALF in the United States do not appear to be caused by novel viral pathogens. In the future, mNGS testing may be useful for comprehensive diagnosis of viruses associated with ALF, or to exclude infectious etiologies.
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Affiliation(s)
- Sneha Somasekar
- Department of Laboratory Medicine, University of California San Francisco (UCSF) and
| | - Deanna Lee
- Department of Laboratory Medicine, University of California San Francisco (UCSF) and
| | - Jody Rule
- Department of Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas; and
| | - Samia N Naccache
- Department of Laboratory Medicine, University of California San Francisco (UCSF) and
| | - Mars Stone
- Blood Systems Research Institute, San Francisco, California
| | - Michael P Busch
- Department of Laboratory Medicine, University of California San Francisco (UCSF) and
- Blood Systems Research Institute, San Francisco, California
| | - Corron Sanders
- Department of Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas; and
| | - William M Lee
- Department of Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas; and
| | - Charles Y Chiu
- Department of Laboratory Medicine, University of California San Francisco (UCSF) and
- UCSF–Abbott Viral Diagnostics and Discovery Center and
- Department of Medicine, Division of Infectious Diseases, University of California San Francisco
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24
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Wendon, J, Cordoba J, Dhawan A, Larsen FS, Manns M, Samuel D, Simpson KJ, Yaron I, Bernardi M. EASL Clinical Practical Guidelines on the management of acute (fulminant) liver failure. J Hepatol 2017; 66:1047-1081. [PMID: 28417882 DOI: 10.1016/j.jhep.2016.12.003] [Citation(s) in RCA: 495] [Impact Index Per Article: 70.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 12/07/2016] [Indexed: 02/06/2023]
Abstract
The term acute liver failure (ALF) is frequently applied as a generic expression to describe patients presenting with or developing an acute episode of liver dysfunction. In the context of hepatological practice, however, ALF refers to a highly specific and rare syndrome, characterised by an acute abnormality of liver blood tests in an individual without underlying chronic liver disease. The disease process is associated with development of a coagulopathy of liver aetiology, and clinically apparent altered level of consciousness due to hepatic encephalopathy. Several important measures are immediately necessary when the patient presents for medical attention. These, as well as additional clinical procedures will be the subject of these clinical practice guidelines.
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25
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Herrine SK, Moayyedi P, Brown RS, Falck-Ytter YT. American Gastroenterological Association Institute Technical Review on Initial Testing and Management of Acute Liver Disease. Gastroenterology 2017; 152:648-664.e5. [PMID: 28061338 DOI: 10.1053/j.gastro.2016.12.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Steven K Herrine
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania.
| | | | - Robert S Brown
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York
| | - Yngve T Falck-Ytter
- Division of Gastroenterology and Hepatology, Department of Medicine, Case and VA Medical Center, Case Western Reserve University, Cleveland, Ohio
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26
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Lawrence SJ. Febrile Transaminitis of Viral Etiology. Infect Dis (Lond) 2017. [DOI: 10.1016/b978-0-7020-6285-8.00207-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Shahani L. Fulminant hepatic failure secondary to acyclovir-resistant herpes simplex virus. BMJ Case Rep 2016; 2016:bcr-2016-216322. [PMID: 27754940 DOI: 10.1136/bcr-2016-216322] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Liver failure is a frequent and serious complication that causes morbidity and mortality in haematopoietic stem cell transplantation (HCT) recipients. Liver dysfunction in these patients can be related to infectious causes, most common viral hepatitis. We report a case of disseminated acyclovir-resistant herpes simplex virus (HSV) infection following HCT that led to acute liver failure and death. Although rare, HSV hepatitis leads to high morbidity and mortality and should be considered in the differential diagnosis of HCT recipients with marked elevation of hepatic transaminase. Acyclovir is a first-line therapy for HSV infection; however, acyclovir-resistant viral strains should be considered and alternative HSV therapies given in HCT recipients whose HSV infection does not improve on acyclovir therapy.
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Affiliation(s)
- Lokesh Shahani
- McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
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28
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Fromentin M, Gauzit R, Gille B, Samama CM. First description of herpes simplex virus type 1 epididymo-orchitis: A new clinical form of herpes simplex virus infection during septic shock? IDCases 2016; 6:26-8. [PMID: 27672563 PMCID: PMC5035238 DOI: 10.1016/j.idcr.2016.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 09/06/2016] [Accepted: 09/10/2016] [Indexed: 11/18/2022] Open
Abstract
Genital herpes is increasingly caused by herpes simplex virus type 1 (HSV-1), but recurrences are less frequent than with HSV-2. Distinguishing between primary genital infection and reactivation can be difficult, but HSV-1 more often causes severe primary infections and fewer recurrences. However, as virus reactivation is common during septic shock, a severe form of HSV-1 reactivation can occur in locations other than the lungs, which remain the most common site. The case of a 79-year-old Caucasian man who presented with HSV-1 epididymo-orchitis after three episodes of severe sepsis or septic shock in the context of acute biliary necrotizing pancreatitis is described. This is the first reported case of HSV-1 epididymo-orchitis due to virus reactivation during sepsis.
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Affiliation(s)
- Mélanie Fromentin
- Department of Anesthesia and Intensive Care, Cochin University Hospital, Paris Descartes University, 27 Rue du Faubourg Saint Jacques, 75014 Paris, France
- Corresponding author.
| | - Remy Gauzit
- Department of Infectious Diseases, Cochin University Hospital, Paris Descartes University, 27 Rue du Faubourg Saint Jacques, 75014 Paris, France
| | - Benoit Gille
- Department of Anesthesia and Intensive Care, Cochin University Hospital, Paris Descartes University, 27 Rue du Faubourg Saint Jacques, 75014 Paris, France
| | - Charles Marc Samama
- Department of Anesthesia and Intensive Care, Cochin University Hospital, Paris Descartes University, 27 Rue du Faubourg Saint Jacques, 75014 Paris, France
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Feugeas J, Mory S, Jeulin H, Velay A, Pertek JP, Ladriere M, Losser MR. Herpes simplex virus type 1 hepatitis due to primary infection in a pancreas-kidney transplant recipient. J Clin Virol 2016; 80:57-9. [DOI: 10.1016/j.jcv.2016.04.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 04/22/2016] [Accepted: 04/23/2016] [Indexed: 11/24/2022]
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Hirschi S, Biondini D, Ohana M, Solis M, D'Urso A, Rosner V, Kessler R. Herpes simplex virus 2 hepatitis in a lung transplant recipient: a diagnostic challenge. Transpl Infect Dis 2015; 17:904-8. [DOI: 10.1111/tid.12459] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 08/18/2015] [Indexed: 01/31/2023]
Affiliation(s)
- S. Hirschi
- Department of Respiratory Medicine; Strasbourg University Hospital; Strasbourg France
| | - D. Biondini
- Department of Cardiological, Thoracic and Vascular Sciences; University of Padova; Padova Italy
| | - M. Ohana
- Department of Radiology; Strasbourg University Hospital; Strasbourg France
| | - M. Solis
- Department of Virology; Strasbourg University Hospital; Strasbourg France
| | - A. D'Urso
- Institut Hospitalo-Universitaire (IHU); Institute for Minimally Hybrid Invasive Image-Guided Surgery; Strasbourg University Hospital; Strasbourg France
| | - V. Rosner
- Department of Respiratory Medicine; Strasbourg University Hospital; Strasbourg France
| | - R. Kessler
- Department of Respiratory Medicine; Strasbourg University Hospital; Strasbourg France
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Affiliation(s)
- Zaw Min
- Division of Infectious Diseases, University of Alabama at Birmingham, 1900 University Boulevard, 229 THT, Birmingham, AL, 35294-0006, USA,
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32
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Denson JL, Maller A, Beckwith CA, Schwartz DR. A 25-year-old man with fulminant hepatic failure after treatment with corticosteroids. Chest 2014; 144:1717-1719. [PMID: 24189865 DOI: 10.1378/chest.13-1056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Joshua L Denson
- Internal Medicine Residency Program, Department of Medicine, NYU Langone Medical Center, New York, NY
| | - Abigail Maller
- Internal Medicine Residency Program, Department of Medicine, NYU Langone Medical Center, New York, NY
| | - Christine A Beckwith
- Internal Medicine Residency Program, Department of Medicine, NYU Langone Medical Center, New York, NY
| | - David R Schwartz
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, NYU Langone Medical Center, New York, NY.
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Côté-Daigneault J, Carrier F, Toledano K, Wartelle-Bladu C, Willems B. Herpes simplex hepatitis after liver transplantation: case report and literature review. Transpl Infect Dis 2014; 16:130-4. [DOI: 10.1111/tid.12178] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Revised: 05/08/2013] [Accepted: 09/22/2013] [Indexed: 12/20/2022]
Affiliation(s)
- J. Côté-Daigneault
- Hepatology Service; Department of Medicine; Saint-Luc Hospital; CHUM; University of Montreal; Montreal Quebec Canada
| | - F.M. Carrier
- Intensive Care Service; Department of Medicine; Saint-Luc Hospital; CHUM; University of Montreal; Montreal Quebec Canada
- Department of Anaesthesiology; Saint-Luc Hospital; CHUM; University of Montreal; Montreal Quebec Canada
| | - K. Toledano
- Intensive Care Service; Department of Medicine; Saint-Luc Hospital; CHUM; University of Montreal; Montreal Quebec Canada
| | - C. Wartelle-Bladu
- Hepatology Service; Department of Medicine; Saint-Luc Hospital; CHUM; University of Montreal; Montreal Quebec Canada
| | - B. Willems
- Hepatology Service; Department of Medicine; Saint-Luc Hospital; CHUM; University of Montreal; Montreal Quebec Canada
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34
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Barazzutti H, Savini H, Zandotti C, Geffroy Y, Roche C, Brardjanian S, Simon F. An unusual disseminated viral primary infection: Rash, hepatitis and polyserositis. J Clin Virol 2013; 58:601-4. [DOI: 10.1016/j.jcv.2013.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Revised: 03/26/2013] [Accepted: 04/07/2013] [Indexed: 11/15/2022]
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Acute Liver Failure Secondary to Herpes Simplex Virus Hepatitis in an Immunocompromised Patient With Human Immunodeficiency Virus. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2013. [DOI: 10.1097/ipc.0b013e31826e7f79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Pietrucha-Dilanchian P, Tanawuttiwat T, Abbo L, Regatieri A, Chaparro S, Ruiz P, Morris M. Fatal herpes simplex virus type 2 hepatitis in a heart transplant recipient: a case report and review of the literature. Transpl Infect Dis 2013; 15:E87-96. [DOI: 10.1111/tid.12077] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Revised: 12/13/2012] [Accepted: 12/23/2012] [Indexed: 11/30/2022]
Affiliation(s)
| | - T. Tanawuttiwat
- Division of Cardiology; Jackson Memorial Hospital; University of Miami; Miami; Florida; USA
| | - L. Abbo
- Division of Infectious Diseases; Jackson Memorial Hospital/University of Miami Miller School of Medicine; Miami; Florida; USA
| | - A. Regatieri
- Division of Infectious Diseases; Jackson Memorial Hospital/University of Miami Miller School of Medicine; Miami; Florida; USA
| | - S. Chaparro
- Division of Cardiology; Jackson Memorial Hospital; University of Miami; Miami; Florida; USA
| | - P. Ruiz
- Division of Transplantation; Department of Surgery; University of Miami; Miami; Florida; USA
| | - M.I. Morris
- Division of Infectious Diseases; Jackson Memorial Hospital/University of Miami Miller School of Medicine; Miami; Florida; USA
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Marcelin JR, Jones JM, Costello BA. 41-year-old woman with fever, neutropenia, and elevated transaminase levels. Mayo Clin Proc 2013; 88:113-6. [PMID: 23274024 DOI: 10.1016/j.mayocp.2012.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Revised: 06/03/2012] [Accepted: 06/07/2012] [Indexed: 11/28/2022]
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Chaillon A, Schnepf N, Jonas M, Mondon K, Orain I, Lioger B, Cottier JP, Hommet C, Goudeau A. Case report: benefits of quantitative polymerase chain reaction in the clinical management of herpes simplex virus 1 infection with prominent hepatitis and unusual secondary progression. J Med Virol 2012; 84:457-61. [PMID: 22246832 DOI: 10.1002/jmv.23230] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Herpes simplex virus (HSV) infection is rarely considered in the differential diagnosis of severe acute hepatitis and disseminated infection in immunocompetent adults. A case of disseminated HSV-1 infection in an 82-year-old woman initially presenting with neurological problems, signs of meningitis and prominent hepatitis was investigated. Initial diagnosis, monitoring, and follow-up were based on the application of molecular methods to cerebrospinal fluid, serum, and liver tissue samples from this patient. Following an initial full recovery, the patient presented delayed intracerebral haemorrhage and diffuse arthralgia. This atypical case, with delayed secondary progression, highlights the wide range of clinical features of HSV infection and the benefits of monitoring viral load by quantitative real-time polymerase chain reaction (PCR) during patient management.
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Affiliation(s)
- Antoine Chaillon
- Service de Bactériologie-Virologie, CHRU Bretonneau, Tours Cedex, France.
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39
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Poley RA, Snowdon JF, Howes DW. Herpes Simplex Virus Hepatitis in an Immunocompetent Adult: A Fatal Outcome due to Liver Failure. Case Rep Crit Care 2011; 2011:138341. [PMID: 24826316 PMCID: PMC4010022 DOI: 10.1155/2011/138341] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Accepted: 09/18/2011] [Indexed: 01/29/2023] Open
Abstract
Objective. To present a case of a healthy 41-year-old female who developed fulminant hepatic failure leading to death. The cause of hepatic failure identified on postmortem exam was herpes simplex virus hepatitis. Design. Observation of a single patient. Setting. Intensive care unit of a tertiary care university teaching hospital in Canada. Patient. 41-year-old previously healthy female presenting with a nonspecific viral illness and systemic inflammatory response syndrome. Intervention. The patient was treated with intravenous fluids and broad-spectrum antibiotics. On the second day of admission, she was found to have elevated transaminases, and, over 48 hours, she progressed to fulminant liver failure with disseminated intravascular coagulopathy, refractory lactic acidosis, and shock. She progressed to respiratory failure requiring intubation and mechanical ventilation. She was started on N-acetylcysteine, a bicarbonate infusion, hemodialysis, and multiple vasopressors and inotropes. Measurements and Main Results. Despite treatment, the patient died roughly 70 hours after her initial presentation to hospital. Her postmortem liver biopsy revealed herpes simplex virus hepatitis as her cause of death. Conclusions. Herpes simplex virus must be considered in all patients presenting with liver failure of unknown cause. If suspected, prompt treatment with acyclovir should be initiated.
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Affiliation(s)
- Rachel A. Poley
- Department of Emergency Medicine and Department of Critical Care Medicine, Kingston General Hospital, Queen's University, Kingston, ON, Canada K7L 2V7
| | - Jaime F. Snowdon
- Department of Pathology, Queen's University, Kingston, ON, Canada K7L 3N6
| | - Daniel W. Howes
- Department of Emergency Medicine and Department of Critical Care Medicine, Kingston General Hospital, Queen's University, Kingston, ON, Canada K7L 2V7
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40
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Herpes Simplex Virus Hepatitis in an Immunocompetent Adult: A Fatal Outcome due to Liver Failure. Case Rep Crit Care 2011. [PMID: 24826316 DOI: 10.1155/2011/138341.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective. To present a case of a healthy 41-year-old female who developed fulminant hepatic failure leading to death. The cause of hepatic failure identified on postmortem exam was herpes simplex virus hepatitis. Design. Observation of a single patient. Setting. Intensive care unit of a tertiary care university teaching hospital in Canada. Patient. 41-year-old previously healthy female presenting with a nonspecific viral illness and systemic inflammatory response syndrome. Intervention. The patient was treated with intravenous fluids and broad-spectrum antibiotics. On the second day of admission, she was found to have elevated transaminases, and, over 48 hours, she progressed to fulminant liver failure with disseminated intravascular coagulopathy, refractory lactic acidosis, and shock. She progressed to respiratory failure requiring intubation and mechanical ventilation. She was started on N-acetylcysteine, a bicarbonate infusion, hemodialysis, and multiple vasopressors and inotropes. Measurements and Main Results. Despite treatment, the patient died roughly 70 hours after her initial presentation to hospital. Her postmortem liver biopsy revealed herpes simplex virus hepatitis as her cause of death. Conclusions. Herpes simplex virus must be considered in all patients presenting with liver failure of unknown cause. If suspected, prompt treatment with acyclovir should be initiated.
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41
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Moldovan B, Mentha G, Majno P, Berney T, Morard I, Giostra E, Wildhaber BE, Van Delden C, Morel P, Toso C. Demographics and outcomes of severe herpes simplex virus hepatitis: a registry-based study. J Hepatol 2011; 55:1222-6. [PMID: 21703210 DOI: 10.1016/j.jhep.2011.02.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Revised: 02/21/2011] [Accepted: 02/23/2011] [Indexed: 01/09/2023]
Abstract
BACKGROUND & AIMS Herpes simplex virus hepatitis is a rare, but severe disease, thus far only documented by case reports and short series. The present study was based on the SRTR registry, and included all listed patients for liver transplantation from 1985 to 2009 with a diagnosis of HSV hepatitis. METHODS We assessed demographics and outcome of all listed patients, and further conducted a case-control study, matching each transplanted patient with 10 controls. Matching criteria included: transplant status, MELD score ±5, transplant date ±6 months, and age at transplant ±5 years. During the study period, 30 patients were listed for HSV hepatitis. Of the 30 listed patients, seven recovered spontaneously and five died, prior to transplantation. The remaining 10 children and eight adults were transplanted. RESULTS The chance of recovery was significantly higher in children than in adults (7/19 vs. 0/11, p=0.02). In children, survival was similar between HSV patients and the matched controls (5-year survival: 69% vs. 64%, p=0.89). Conversely, survival was poor in adult HSV (5-year survival: 38% vs. 65%, p=0.006), with 62% of them dying within the first 12 months. All three reported post-transplant deaths in children were independent from HSV. Among the seven adult post-transplant deaths, four were related to infection (bacterial, fungal, or viral). CONCLUSIONS Children listed for HSV hepatitis have a significantly better survival than adults both prior and after liver transplantation. While HSV fulminant hepatitis is an appropriate indication for liver transplantation in children, it should only be performed in selected adult patients in otherwise good condition.
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Affiliation(s)
- Bogdan Moldovan
- Transplantation Division, Department of Surgery, Geneva, Switzerland
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42
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Fulminant gestational hepatitis due to primary herpes simplex type 2 infection: use of serum HSV polymerase chain reaction for noninvasive diagnosis. Diagn Microbiol Infect Dis 2011; 72:181-4. [PMID: 22104186 DOI: 10.1016/j.diagmicrobio.2011.10.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Revised: 10/06/2011] [Accepted: 10/11/2011] [Indexed: 01/22/2023]
Abstract
Acute gestational hepatitis from herpes simplex virus (HSV) infection is a rare but potentially life-threatening condition. We present the first reported case of primary HSV type 2 hepatitis in a pregnant woman who was diagnosed by detection of HSV-2 viremia via real-time polymerase chain reaction. The patient was successfully treated with acyclovir and delivered a healthy infant.
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Ambrosioni J, Kaiser L, Giostra E, Meylan P, Mentha G, Toso C, Genevay-Infante M, Rubbia-Brandt L, van Delden C. Herpes simplex virus load to monitor antiviral treatment after liver transplantation for acute herpetic hepatitis. Antivir Ther 2011; 17:401-4. [PMID: 22290285 DOI: 10.3851/imp1922] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2011] [Indexed: 10/16/2022]
Abstract
Herpes simplex virus (HSV) hepatitis is an uncommon cause of acute liver failure (ALF), primarily affecting immunocompromised patients. So far, 148 cases have been published, of which 9 underwent liver transplantation (LT). The reported post-transplant survival is poor, with over 60% dying in the first year. Dosing and duration of antiviral therapy after LT are not established. Concerns include both the risk of hepatic recurrence after LT and emergence of viral resistance during prolonged therapy. HSV DNA plasma levels might be helpful to monitor therapeutic response and guide duration of therapy. We present a case of ALF complicating a primary HSV-1 infection in an immunocompetent host, who required emergency LT. We further discuss the value of measuring serial HSV DNA plasma loads to monitor antiviral therapy.
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Affiliation(s)
- Juan Ambrosioni
- Service of Infectious Diseases, Department of Medical Specialities, University Hospitals of Geneva, Geneva, Switzerland
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44
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McGoogan KE, Haafiz AB, González Peralta RP. Herpes simplex virus hepatitis in infants: clinical outcomes and correlates of disease severity. J Pediatr 2011; 159:608-11. [PMID: 21529822 DOI: 10.1016/j.jpeds.2011.03.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2010] [Revised: 02/16/2011] [Accepted: 03/09/2011] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To better characterize the clinical outcomes of infants with herpes simplex virus (HSV) infection and identify useful correlates of disease severity. STUDY DESIGN Infants aged ≤6 months with HSV infection treated between 1999 and 2009 were identified. In patients with concurrent hepatitis, laboratory and clinical variables were examined to identify predictors of specific outcomes, including death or the need for liver transplantation and the need for intensive care. RESULTS Of the 15 patients enrolled, 4 (27%) had fatal disease and 2 (13%) required liver transplantation. Infants who lacked skin lesions (P = .04), had a positive HSV polymerase chain reaction result (P = .01), had more severe thrombocytopenia (P = .001), or had other organ system dysfunction (P = .002) were more likely to require intensive care. A higher International Normalized Ratio value (P = .001) and peak total bilirubin level (P = .0002) were predictive of death or the need for liver transplantation. Peak direct bilirubin level was predictive of the need for intensive care and of death or the need for liver transplantation (P = .04 and .009, respectively). CONCLUSIONS HSV hepatitis represents a broad spectrum of disease from mild aminotransferase elevation to fulminant liver failure and death. HSV DNA detected by polymerase chain reaction, a lack of skin lesions, and the degree of coagulopathy, thrombocytopenia, and cholestasis portend unfavorable outcomes.
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Affiliation(s)
- Katherine E McGoogan
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of Florida College of Medicine and Shands Children's Hospital, Gainesville, FL 32610, USA.
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45
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Ichai P, Samuel D. Epidemiology of liver failure. Clin Res Hepatol Gastroenterol 2011; 35:610-7. [PMID: 21550329 DOI: 10.1016/j.clinre.2011.03.010] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2011] [Accepted: 03/31/2011] [Indexed: 02/04/2023]
Abstract
The etiology of fulminant hepatitis varies in different countries and at different times. The main causes of fulminant hepatitis are viruses, paracetamol, drugs (other than paracetamol), poisons and 15-30% remained of undetermined origin. The prevalence of these etiologies varies according to the geographic region and has changed over the past 10 years. Paracetamol has now overtaken viruses (particularly hepatitis B virus) as the leading cause of fulminant hepatitis. Establishing the cause of fulminant hepatitis is an important step in the management of acute liver failure, so that specific therapy can be initiated and any contraindications to liver transplantation be eliminated.
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Affiliation(s)
- Philippe Ichai
- Centre Hépato-Biliaire, hôpital Paul-Brousse, AP-HP, 94800 Villejuif, France
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46
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Beersma MF, Verjans GM, Metselaar HJ, Osterhaus AD, Berrington WR, van Doornum GJ. Quantification of viral DNA and liver enzymes in plasma improves early diagnosis and management of herpes simplex virus hepatitis. J Viral Hepat 2011; 18:e160-6. [PMID: 20704650 PMCID: PMC2992574 DOI: 10.1111/j.1365-2893.2010.01352.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Herpes simplex virus (HSV) hepatitis is a rare and potential life-threatening disease. The diagnosis of HSV hepatitis is hampered by its indifferent clinical presentation, which necessitates confirmatory laboratory data to identify HSV in the affected liver. However, liver biopsies are often contraindicated in the context of coagulopathy, are prone to sampling errors and have low sensitivity in mild HSV hepatitis cases. There is an unmet need for less invasive diagnostic tools. The diagnostic and therapeutic value of HSV DNA load and liver enzyme level kinetics was determined in five patients with HSV hepatitis and twenty disease controls with HSV-DNAemia without hepatitis. At time of hospitalization, patients with HSV hepatitis had a higher median (± interquartile range) HSV DNA load (6.0 × 10(6) ± 1.2 × 10(9)) compared to disease controls (171 ± 2845). Viral DNA load correlated with liver transaminase levels and disease severity. Antiviral treatment led to rapid decline of HSV DNA load and improvement of liver function of patients with HSV hepatitis. The data advocate the prompt and consecutive quantification of the HSV DNA load and liver enzyme levels in plasma of patients suspected of HSV hepatitis as well as those under antiviral treatment.
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Affiliation(s)
| | | | - Herold J. Metselaar
- Department of Gastroenterology & Hepatology, Erasmus Medical Center, Rotterdam, The Netherlands
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47
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Abstract
Acute liver failure is a rare disorder with high mortality and resource cost. In the developing world, viral causes predominate, with hepatitis E infection recognised as a common cause in many countries. In the USA and much of western Europe, the incidence of virally induced disease has declined substantially in the past few years, with most cases now arising from drug-induced liver injury, often from paracetamol. However, a large proportion of cases are of unknown origin. Acute liver failure can be associated with rapidly progressive multiorgan failure and devastating complications; however, outcomes have been improved by use of emergency liver transplantation. An evidence base for practice is emerging for supportive care, and a better understanding of the pathophysiology of the disorder, especially in relation to hepatic encephalopathy, will probably soon lead to further improvements in survival rates.
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MESH Headings
- Acetaminophen/adverse effects
- Ammonia/metabolism
- Analgesics, Non-Narcotic/adverse effects
- Chemical and Drug Induced Liver Injury/epidemiology
- Chemical and Drug Induced Liver Injury/etiology
- Emergency Treatment/methods
- Europe/epidemiology
- Global Health
- Hepatic Encephalopathy/epidemiology
- Hepatic Encephalopathy/etiology
- Hepatitis, Viral, Human/complications
- Hepatocytes/transplantation
- Humans
- Liver Failure, Acute/chemically induced
- Liver Failure, Acute/classification
- Liver Failure, Acute/epidemiology
- Liver Failure, Acute/etiology
- Liver Failure, Acute/mortality
- Liver Failure, Acute/physiopathology
- Liver Failure, Acute/surgery
- Liver Failure, Acute/virology
- Liver Transplantation
- Patient Selection
- Prognosis
- Severity of Illness Index
- Survival Rate
- Time Factors
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Affiliation(s)
- William Bernal
- Liver Intensive Therapy Unit, Institute of Liver Studies, King's College Hospital, London, UK.
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48
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Riediger C, Sauer P, Matevossian E, Müller MW, Büchler P, Friess H. Herpes simplex virus sepsis and acute liver failure. Clin Transplant 2010; 23 Suppl 21:37-41. [PMID: 19930315 DOI: 10.1111/j.1399-0012.2009.01108.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Acute liver failure is a life threatening disease mostly triggered by drug-induced or toxic liver damage or viral hepatitis. Herpes Simplex virus (HSV) hepatitis is rare and accounts for only 1% of all acute liver failures. The importance of HSV-induced acute liver failure is based on its extremely severe clinical course with lethality rates of almost 75%. HSV hepatitis is just one of several clinical manifestations of HSV sepsis leading more frequently to encephalitis, pneumonia and esophagitis. Local herpes infection or recurrence of dermal lesions (herpes labialis, herpes genitalis), however, is common and account for the high prevalence of HSV-1 or HSV-2 infection in adults. Another rare entity is visual dissemination, which mostly affects immunocompromised patients. Compromised cellular immunity is a major risk factor for HSV sepsis because of either primary infection or reactivation of occult chronic HSV infection. Delayed diagnosis without antiviral therapy significantly contributes to the unfavorable outcome. Typically, anicteric hepatitis is seen in patients with HSV hepatitis. Because of its low incidence, however, and the lack of dermal manifestations, HSV hepatitis is rarely considered in the context of acute liver failure. In addition, diagnostic tests might not always be available. Therefore, it is a generally accepted consensus to begin antiviral therapy pre-emptively with acyclovir in cases of acute liver failure of unknown origin, in which high urgency (HU) liver transplantation remains the only therapeutical option. Even in the case of early specific therapy, sepsis may prevail and the indication for HU transplantation must be evaluated carefully. The outcome after liver transplantation for HSV-induced liver failure with reported survival rates of more than 40% is good. Because of the risk of recurrence, lifelong prophylaxis with acyclovir is recommended.
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Affiliation(s)
- C Riediger
- Department of Surgery, Technische Universität München, Ismaningerstr, Munich, Germany.
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Craig DGN, Lee A, Hayes PC, Simpson KJ. Review article: the current management of acute liver failure. Aliment Pharmacol Ther 2010; 31:345-58. [PMID: 19845566 DOI: 10.1111/j.1365-2036.2009.04175.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Acute liver failure is a devastating clinical syndrome with a persistently high mortality rate despite critical care advances. Orthotopic liver transplantation (OLT) is a life-saving treatment in selected cases, but effective use of this limited resource requires accurate prognostication because of surgical risks and the requirement for subsequent life-long immunosuppression. AIM To review the aetiology of acute liver failure, discuss the evidence behind critical care management strategies and examine potential treatment alternatives to OLT. METHODS Literature review using Ovid, PubMed and recent conference abstracts. RESULTS Paracetamol remains the most common aetiology of acute liver failure in developed countries, whereas acute viral aetiologies predominate elsewhere. Cerebral oedema is a major cause of death, and its prevention and prompt recognition are vital components of critical care support, which strives to provide multiorgan support and 'buy time' to permit either organ regeneration or psychological and physical assessment prior to acquisition of a donor organ. Artificial liver support systems do not improve mortality in acute liver failure, whilst most other interventions have limited evidence bases to support their use. CONCLUSION Acute liver failure remains a truly challenging condition to manage, and requires early recognition and transfer of patients to specialist centres providing intensive, multidisciplinary input and, in some cases, OLT.
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Affiliation(s)
- D G N Craig
- Scottish Liver Transplantation Unit, Royal Infirmary of Edinburgh, Little France, Edinburgh EH16 4SA, UK
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Barreira ER, Bousso A, Shieh HH, Góes PF. Fulminant herpes simplex hepatitis following a short course of corticotherapy in a child. Clin Pediatr (Phila) 2010; 49:72-7. [PMID: 19671884 DOI: 10.1177/0009922809342583] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Eliane Roseli Barreira
- Division of Pediatrics of Hospital Universitário, University of São Paulo, São Paulo, Brazil.
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