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Clementi N, Ghosh S, De Santis M, Castelli M, Criscuolo E, Zanoni I, Clementi M, Mancini N. Viral Respiratory Pathogens and Lung Injury. Clin Microbiol Rev 2021; 34:e00103-20. [PMID: 33789928 PMCID: PMC8142519 DOI: 10.1128/cmr.00103-20] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Several viruses target the human respiratory tract, causing different clinical manifestations spanning from mild upper airway involvement to life-threatening acute respiratory distress syndrome (ARDS). As dramatically evident in the ongoing SARS-CoV-2 pandemic, the clinical picture is not always easily predictable due to the combined effect of direct viral and indirect patient-specific immune-mediated damage. In this review, we discuss the main RNA (orthomyxoviruses, paramyxoviruses, and coronaviruses) and DNA (adenoviruses, herpesviruses, and bocaviruses) viruses with respiratory tropism and their mechanisms of direct and indirect cell damage. We analyze the thin line existing between a protective immune response, capable of limiting viral replication, and an unbalanced, dysregulated immune activation often leading to the most severe complication. Our comprehension of the molecular mechanisms involved is increasing and this should pave the way for the development and clinical use of new tailored immune-based antiviral strategies.
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Affiliation(s)
- Nicola Clementi
- Laboratory of Microbiology and Virology, Vita-Salute San Raffaele University, Milan, Italy
- Laboratory of Microbiology and Virology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Sreya Ghosh
- Harvard Medical School, Boston Children's Hospital, Division of Immunology, Boston, Massachusetts, USA
| | - Maria De Santis
- Department of Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center-IRCCS, Rozzano, Italy
| | - Matteo Castelli
- Laboratory of Microbiology and Virology, Vita-Salute San Raffaele University, Milan, Italy
| | - Elena Criscuolo
- Laboratory of Microbiology and Virology, Vita-Salute San Raffaele University, Milan, Italy
| | - Ivan Zanoni
- Harvard Medical School, Boston Children's Hospital, Division of Immunology, Boston, Massachusetts, USA
- Harvard Medical School, Boston Children's Hospital, Division of Gastroenterology, Boston, Massachusetts, USA
| | - Massimo Clementi
- Laboratory of Microbiology and Virology, Vita-Salute San Raffaele University, Milan, Italy
- Laboratory of Microbiology and Virology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Nicasio Mancini
- Laboratory of Microbiology and Virology, Vita-Salute San Raffaele University, Milan, Italy
- Laboratory of Microbiology and Virology, IRCCS San Raffaele Scientific Institute, Milan, Italy
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2
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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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3
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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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Prevalence of Herpes Simplex Virus Infection in Patients With Relapsing-Remitting Multiple Sclerosis: A Case-Control Study in the North of Iran. ARCHIVES OF CLINICAL INFECTIOUS DISEASES 2016. [DOI: 10.5812/archcid.36576] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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5
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Clementi N, Criscuolo E, Cappelletti F, Burioni R, Clementi M, Mancini N. Novel therapeutic investigational strategies to treat severe and disseminated HSV infections suggested by a deeper understanding of in vitro virus entry processes. Drug Discov Today 2016; 21:682-91. [PMID: 26976690 DOI: 10.1016/j.drudis.2016.03.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 02/11/2016] [Accepted: 03/04/2016] [Indexed: 01/28/2023]
Abstract
The global burden of herpes simplex virus (HSV) legitimates the critical need to develop new prevention strategies, such as drugs and vaccines that are able to fight either primary HSV infections or reactivations. Moreover, the ever-growing number of patients receiving transplants increases the number of severe HSV infections that are unresponsive to current therapies. Finally, the high global incidence of genital HSV-2 infection increases the risk of perinatal transmission to newborns, in which disseminated infection or central nervous system (CNS) involvement is frequent, with associated high morbidity and mortality rates. There are several key features shared by novel anti-HSV drugs, from currently available optimized drugs to small molecules able to interfere with various virus replication steps. However, several virological aspects of the disease and associated clinical needs highlight why an ideal anti-HSV drug has yet to be developed.
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Affiliation(s)
- Nicola Clementi
- Microbiology and Virology Unit, 'Vita-Salute San Raffaele' University, 20132 Milan, Italy.
| | - Elena Criscuolo
- Microbiology and Virology Unit, 'Vita-Salute San Raffaele' University, 20132 Milan, Italy
| | - Francesca Cappelletti
- Microbiology and Virology Unit, 'Vita-Salute San Raffaele' University, 20132 Milan, Italy
| | - Roberto Burioni
- Microbiology and Virology Unit, 'Vita-Salute San Raffaele' University, 20132 Milan, Italy
| | - Massimo Clementi
- Microbiology and Virology Unit, 'Vita-Salute San Raffaele' University, 20132 Milan, Italy
| | - Nicasio Mancini
- Microbiology and Virology Unit, 'Vita-Salute San Raffaele' University, 20132 Milan, Italy
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Abuhasna SD, Shihab ZM, Al Niyadi SM, Tatari HM, Al Jundi AH, Atwa KH. Neonatal herpes simplex fulminant hepatitis successfully treated with acyclovir. J Clin Neonatol 2013; 1:87-90. [PMID: 24027697 PMCID: PMC3743148 DOI: 10.4103/2249-4847.96761] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Disseminated neonatal herpes simplex virus (HSV) infection is characterized by progressive multiple organ failure and high mortality rates up to 85% for untreated neonates. It can result from infection with either HSV-1 or HSV-2. We report the first known case of disseminated neonatal herpes associated with fulminant liver failure caused by HSV-2 who survived without liver transplant.
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Affiliation(s)
- Said D Abuhasna
- Department of Critical Care Medicine, Tawam Hospital, P. O. Box 15258, Al Ain, United Arab Emirates
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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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Shanmugam NP, Bansal S, Greenough A, Verma A, Dhawan A. Neonatal liver failure: aetiologies and management--state of the art. Eur J Pediatr 2011; 170:573-81. [PMID: 20886352 DOI: 10.1007/s00431-010-1309-1] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2010] [Accepted: 09/15/2010] [Indexed: 12/19/2022]
Abstract
Acute liver failure in neonates is rare, but carries a high mortality. Neonatal liver failure can be defined as "failure of the synthetic function of liver within 4 weeks of birth". Encephalopathy is not essential for the diagnosis. Acute liver failure in neonates differs from children with regard to aetiology and outcome. Common causes of neonatal liver failure are neonatal hemochromatosis, haematological malignancies, viral infections and liver-based metabolic defects. Early diagnosis and referral to a paediatric liver centre is recommended as liver transplantation is the only definitive treatment when supportive or a disease-specific treatment fails.
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Affiliation(s)
- Naresh P Shanmugam
- Paediatric Liver, GI & Nutrition Centre, King's College Hospital, London, UK
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Gunson R, Jackson A, Aitken C. A case of neonatal sepsis with acute liver failure. J Clin Virol 2011; 50:266-9. [DOI: 10.1016/j.jcv.2010.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2010] [Revised: 11/26/2010] [Accepted: 12/01/2010] [Indexed: 11/30/2022]
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Juhl D, Mosel C, Nawroth F, Funke AM, Dadgar SM, Hagenström H, Kirchner H, Hennig H. Detection of herpes simplex virus DNA in plasma of patients with primary but not with recurrent infection: implications for transfusion medicine? Transfus Med 2010; 20:38-47. [DOI: 10.1111/j.1365-3148.2009.00951.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Levitsky J, Duddempudi AT, Lakeman FD, Whitley RJ, Luby JP, Lee WM, Fontana RJ, Blei AT, Ison MG. Detection and diagnosis of herpes simplex virus infection in adults with acute liver failure. Liver Transpl 2008; 14:1498-504. [PMID: 18825709 PMCID: PMC3618973 DOI: 10.1002/lt.21567] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Disseminated herpes simplex virus (HSV) infection may lead to acute liver failure (ALF) and the need for emergency liver transplantation (LT). The primary aim of this study was to determine the utility of HSV serological testing and HSV DNA testing by polymerase chain reaction (PCR) in the diagnosis and management of indeterminate, pregnancy-related, and known HSV-related ALF. Stored sera obtained on study day 1 or 2 from patients enrolled in the United States ALF Study Group with indeterminate (n = 51), pregnancy-related (n = 12), and HSV-related (n = 4) ALF were screened for HSV DNA by PCR and serology. While 7 of the indeterminate and pregnant patients had positive anti-HSV immunoglobulin M, none had detectable HSV DNA. The 4 known HSV cases all had high-titer HSV DNA on presentation (range: 3.5 to 36 x 10(8) copies/mL). Two HSV patients underwent LT but developed posttransplant extrahepatic HSV infection despite suppression of HSV DNA with acyclovir treatment, and one of them eventually died. The 2 other fulminant HSV patients died within 48 hours of presentation. In conclusion, serum HSV DNA indicative of occult HSV infection was not detected in 51 indeterminate and 12 pregnancy-related ALF patients. The 4 patients with known HSV-related ALF all had high HSV DNA levels at presentation, and despite the rapid use of antiviral therapy and emergency LT, substantial morbidity and mortality were encountered, highlighting the poor prognosis with severe disseminated HSV infection.
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Affiliation(s)
- Josh Levitsky
- Northwestern Memorial Hospital/Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Fred D. Lakeman
- University of Alabama at Birmingham Health System, Birmingham, AL
| | | | - James P. Luby
- University of Texas Southwestern Medical Center, Dallas, TX
| | - William M. Lee
- University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Andres T. Blei
- Northwestern Memorial Hospital/Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Michael G. Ison
- Northwestern Memorial Hospital/Northwestern University Feinberg School of Medicine, Chicago, IL
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Verma A, Dhawan A, Zuckerman M, Hadzic N, Baker AJ, Mieli-Vergani G. Neonatal herpes simplex virus infection presenting as acute liver failure: prevalent role of herpes simplex virus type I. J Pediatr Gastroenterol Nutr 2006; 42:282-6. [PMID: 16540797 DOI: 10.1097/01.mpg.0000214156.58659.4c] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND Acute liver failure (ALF) in neonates is rare but carries a high mortality without liver transplantation. Herpes simplex virus (HSV) is one of the microbes that more commonly causes ALF and is potentially treatable; hence, early diagnosis and treatment are important to avoid progression to liver failure. PATIENTS AND RESULTS We have analysed retrospectively the case notes of 11 patients with HSV-induced ALF. A history of possible herpes infection was elicited in 5 parents, but HSV had not been suspected clinically. All patients were asymptomatic when discharged from postnatal units and were presented with nonspecific symptoms of poor feeding and lethargy within 2 weeks from birth. Seven of the 11 patients had HSV-1 infection, 4 HSV-2. Only 2 patients who received early treatment with intravenous acyclovir survived. CONCLUSIONS HSV-related ALF in the neonatal period carries high morbidity and mortality and needs a high index of suspicion so that life-saving treatment can be started promptly. Both HSV-1 and HSV-2 can cause severe neonatal infection. It is important to recognise HSV infection in women of childbearing age and their sexual partners.
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MESH Headings
- Acyclovir/therapeutic use
- Antiviral Agents/therapeutic use
- Female
- Herpes Genitalis/complications
- Herpes Genitalis/drug therapy
- Herpes Genitalis/mortality
- Herpes Simplex/complications
- Herpes Simplex/drug therapy
- Herpes Simplex/mortality
- Herpesvirus 1, Human/drug effects
- Herpesvirus 1, Human/isolation & purification
- Herpesvirus 1, Human/pathogenicity
- Herpesvirus 2, Human/drug effects
- Herpesvirus 2, Human/isolation & purification
- Herpesvirus 2, Human/pathogenicity
- Humans
- Infant, Newborn
- Infectious Disease Transmission, Vertical
- Liver Failure, Acute/drug therapy
- Liver Failure, Acute/mortality
- Liver Failure, Acute/virology
- Male
- Pregnancy
- Pregnancy Complications, Infectious/drug therapy
- Pregnancy Complications, Infectious/mortality
- Pregnancy Complications, Infectious/virology
- Retrospective Studies
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Affiliation(s)
- Anita Verma
- Department of Medical Microbiology and Virology, Health Protection Agency, London, King's College Hospital, London, UK.
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Meerbach A, Sauerbrei A, Meerbach W, Bittrich HJ, Wutzler P. Fatal outcome of herpes simplex virus type 1-induced necrotic hepatitis in a neonate. Med Microbiol Immunol 2006; 195:101-5. [PMID: 16404606 DOI: 10.1007/s00430-005-0009-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2005] [Indexed: 10/25/2022]
Abstract
In neonates, herpes simplex virus (HSV) infections can lead to severe diseases associated with high mortality. We report a 6-day-old girl who developed clinical signs of fulminant hepatic failure accompanied by infectious-toxic shock and disseminated coagulopathy secondary to HSV type 1 (HSV-1) infection. The diagnosis was performed postmortem by demonstration of HSV-1 DNA in liver tissue as well as by retrospective detection of HSV-specific antibodies.
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MESH Headings
- Antibodies, Viral/blood
- Disseminated Intravascular Coagulation
- Fatal Outcome
- Female
- Hepatitis, Viral, Human/mortality
- Hepatitis, Viral, Human/pathology
- Hepatitis, Viral, Human/virology
- Herpes Simplex/complications
- Herpes Simplex/mortality
- Herpes Simplex/virology
- Herpesvirus 1, Human
- Humans
- Infant, Newborn
- Liver/pathology
- Liver/virology
- Liver Failure, Acute
- Necrosis
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Affiliation(s)
- Astrid Meerbach
- Institute of Virology and Antiviral Therapy, Friedrich-Schiller University of Jena, Hans-Knöll-Street 2, 07745 Jena, Germany.
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Abstract
Acute liver failure (ALF) in neonates is a rare but often fatal event. Though in adults and older children, a main symptom of ALF is hepatic encephalopathy, this is very difficult to diagnose and prove in infants. Causes of ALF in neonates encompass metabolic, infectious and haematological disorders, congenital vascular/heart abnormalities, and drugs. Infants with ALF should only be treated in specialised paediatric hepatology centres with facilities for liver transplantation, since for many liver transplant, with a long term survival of over 60%, is the only therapeutic option.
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Affiliation(s)
- Anil Dhawan
- Paediatric Liver Centre, Institute of Liver Studies, Variety Club Children's Hospital, King's College School of Medicine at King's College Hospital, Denmark Hill, London SE5 9RS, UK
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