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Tidwell J, Nguyen MTT, Forouhar F, Stewart CL, Bath R. A Case of Herpes Simplex Virus Colitis in an Immunosuppressed Patient. Cureus 2023; 15:e51409. [PMID: 38292955 PMCID: PMC10827282 DOI: 10.7759/cureus.51409] [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] [Accepted: 12/30/2023] [Indexed: 02/01/2024] Open
Abstract
Herpes simplex virus (HSV) can cause severe disseminated infections in immunocompromised patients. Gastrointestinal tract involvement seldom includes the colon. We present a rare case of disseminated cutaneous HSV infection with concomitant colonic involvement in an immunosuppressed patient. The patient's clinical presentation and computerized tomography (CT) findings were concerning for colitis. She failed to improve on antibiotic therapy and subsequently underwent flexible sigmoidoscopy. Gross findings and histopathology were consistent with herpes simplex virus colitis. It is essential to recognize this pathology in immunocompromised patients to evaluate the need to hold immunosuppressive therapy and ensure successful treatment to prevent fatal outcomes.
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Affiliation(s)
- Jasmine Tidwell
- Internal Medicine, University of Connecticut Health, Hartford, USA
| | - Minh Thu T Nguyen
- Gastroenterology and Hepatology, University of Connecticut, Farmington, USA
| | | | | | - Roopjeet Bath
- Gastroenterology and Hepatology, University of Connecticut Health, Farmington, USA
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Cathomas M, Rosenberg R, Burri E, Javier-Gonzalez M, Weber A, Filipowicz Sinnreich M, Cathomas G, Galli R. Herpes simplex virus colitis mimicking acute severe ulcerative colitis: a case report and review of the literature. J Surg Case Rep 2023; 2023:rjad225. [PMID: 37124571 PMCID: PMC10139777 DOI: 10.1093/jscr/rjad225] [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: 03/13/2023] [Accepted: 04/04/2023] [Indexed: 05/02/2023] Open
Abstract
A 60-year-old female patient with longstanding left-sided ulcerative colitis presented with symptoms mimicking an acute flare and developed a colonic perforation shortly after starting steroid treatment. Following left hemicolectomy and Hartmann's procedure, rescue treatment with infliximab was started. Within a few days, the patient developed hepatic failure. Histology and immunohistochemistry of the specimen revealed extensive necrotizing herpes simplex virus colitis, and liver biopsy demonstrated herpes simplex virus hepatitis. Sixteen days after admission, the patient died from multiorgan failure. This compelling case of severe herpes simplex virus colitis raises awareness of a rare but potentially detrimental infection in patients with inflammatory bowel disease.
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Affiliation(s)
- Marionna Cathomas
- Correspondence address. Department of Surgery, Cantonal Hospital Baselland, 4410 Liestal, Switzerland. Tel: +41-925-32-00; E-mail:
| | - Robert Rosenberg
- Department of Surgery, Cantonal Hospital Baselland, Liestal, Switzerland
| | - Emanuel Burri
- Department of Gastroenterology and Hepatology, Medical University Clinic, Cantonal Hospital Baselland, Liestal, Switzerland
| | | | - Achim Weber
- Department of Pathology and Molecular Pathology, Institute of Molecular Cancer Research, University Hospital Zurich, Zurich, Switzerland
| | - Magdalena Filipowicz Sinnreich
- Department of Gastroenterology and Hepatology, Medical University Clinic, Cantonal Hospital Baselland, Liestal, Switzerland
| | - Gieri Cathomas
- Department of Pathology, Cantonal Hospital Baselland, Liestal, Switzerland
- Institute of Tissue Medicine and Pathology, University Bern, Bern, Switzerland
| | - Raffaele Galli
- Department of Surgery, Cantonal Hospital Baselland, Liestal, Switzerland
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Muacevic A, Adler JR. Hypertrophic Perianal Herpes Mimicking Squamous Cell Cancer: A Case Report and a Review of the Literature. Cureus 2022; 14:e30649. [PMID: 36439566 PMCID: PMC9684622 DOI: 10.7759/cureus.30649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2022] [Indexed: 12/03/2022] Open
Abstract
Clinical practice frequently involves the discovery of perineal lesions. The human papillomavirus, molluscum contagiosum, and herpes simplex virus are to blame for the majority of these anogenital lesions. In the majority of cases, these lesions may be identified by their distinctive appearance. It is challenging to make a clinical diagnosis in immunocompromised people since these lesions might be large and have uncommon appearances. Verrucous perianal herpes is a rare type of herpes that resembles squamous cell carcinoma in gross appearance. We present a case of a 71-year-old man on azathioprine, an immunosuppressive drug for autoimmune pancreatitis, who developed a perianal lesion resembling squamous cell carcinoma. Excisional biopsy revealed a benign ulcerative lesion with herpetic inclusions. The patient received antiviral treatment, and the perianal wound completely healed. He developed a similar lesion in the perineum at one year follow up, which was successfully treated with oral and topical antivirals.
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Franceschini E, Cozzi-Lepri A, Santoro A, Bacca E, Lancellotti G, Menozzi M, Gennari W, Meschiari M, Bedini A, Orlando G, Puzzolante C, Digaetano M, Milic J, Codeluppi M, Pecorari M, Carli F, Cuomo G, Alfano G, Corradi L, Tonelli R, De Maria N, Busani S, Biagioni E, Coloretti I, Guaraldi G, Sarti M, Luppi M, Clini E, Girardis M, Gyssens IC, Mussini C. Herpes Simplex Virus Re-Activation in Patients with SARS-CoV-2 Pneumonia: A Prospective, Observational Study. Microorganisms 2021; 9:microorganisms9091896. [PMID: 34576791 PMCID: PMC8465957 DOI: 10.3390/microorganisms9091896] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 09/02/2021] [Accepted: 09/03/2021] [Indexed: 12/15/2022] Open
Abstract
Background: Herpes simplex 1 co-infections in patients with COVID-19 are considered relatively uncommon; some reports on re-activations in patients in intensive-care units were published. The aim of the study was to analyze herpetic re-activations and their clinical manifestations in hospitalized COVID-19 patients, performing HSV-1 PCR on plasma twice a week. Methods: we conducted a prospective, observational, single-center study involving 70 consecutive patients with severe/critical SARS-CoV-2 pneumonia tested for HSV-1 hospitalized at Azienda Ospedaliero-Universitaria of Modena. Results: of these 70 patients, 21 (30.0%) showed detectable viremia and 13 (62%) had clinically relevant manifestations of HSV-1 infection corresponding to 15 events (4 pneumonia, 5 herpes labialis, 3 gingivostomatitis, one encephalitis and two hepatitis). HSV-1 positive patients were more frequently treated with steroids than HSV-1 negative patients (76.2% vs. 49.0%, p = 0.036) and more often underwent mechanical ventilation (IMV) (57.1% vs. 22.4%, p = 0.005). In the unadjusted logistic regression analysis, steroid treatment, IMV, and higher LDH were significantly associated with an increased risk of HSV1 re-activation (odds ratio 3.33, 4.61, and 16.9, respectively). The association with the use of steroids was even stronger after controlling for previous use of both tocilizumab and IMV (OR = 5.13, 95% CI:1.36–19.32, p = 0.016). The effect size was larger when restricting to participants who were treated with high doses of steroids while there was no evidence to support an association with the use of tocilizumab Conclusions: our study shows a high incidence of HSV-1 re-activation both virologically and clinically in patients with SARS-CoV-2 severe pneumonia, especially in those treated with steroids.
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Affiliation(s)
- Erica Franceschini
- Infectious Diseases Unit, Azienda Ospedaliero-Universitaria Policlinico, 41124 Modena, Italy; (A.S.); (M.M.); (M.M.); (A.B.); (G.O.); (C.P.); (M.D.); (F.C.); (G.C.); (L.C.)
- Correspondence: (E.F.); (C.M.)
| | - Alessandro Cozzi-Lepri
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, London NW3 2PF, UK;
| | - Antonella Santoro
- Infectious Diseases Unit, Azienda Ospedaliero-Universitaria Policlinico, 41124 Modena, Italy; (A.S.); (M.M.); (M.M.); (A.B.); (G.O.); (C.P.); (M.D.); (F.C.); (G.C.); (L.C.)
| | - Erica Bacca
- Department of Infectious Diseases, University of Modena and Reggio Emilia, 41124 Modena, Italy; (E.B.); (G.L.); (J.M.); (G.G.)
| | - Guido Lancellotti
- Department of Infectious Diseases, University of Modena and Reggio Emilia, 41124 Modena, Italy; (E.B.); (G.L.); (J.M.); (G.G.)
| | - Marianna Menozzi
- Infectious Diseases Unit, Azienda Ospedaliero-Universitaria Policlinico, 41124 Modena, Italy; (A.S.); (M.M.); (M.M.); (A.B.); (G.O.); (C.P.); (M.D.); (F.C.); (G.C.); (L.C.)
| | - William Gennari
- Microbiology and Virology Unit, Azienda Ospedaliero-Universitaria Policlinico, 41124 Modena, Italy; (W.G.); (M.P.); (M.S.)
| | - Marianna Meschiari
- Infectious Diseases Unit, Azienda Ospedaliero-Universitaria Policlinico, 41124 Modena, Italy; (A.S.); (M.M.); (M.M.); (A.B.); (G.O.); (C.P.); (M.D.); (F.C.); (G.C.); (L.C.)
| | - Andrea Bedini
- Infectious Diseases Unit, Azienda Ospedaliero-Universitaria Policlinico, 41124 Modena, Italy; (A.S.); (M.M.); (M.M.); (A.B.); (G.O.); (C.P.); (M.D.); (F.C.); (G.C.); (L.C.)
| | - Gabriella Orlando
- Infectious Diseases Unit, Azienda Ospedaliero-Universitaria Policlinico, 41124 Modena, Italy; (A.S.); (M.M.); (M.M.); (A.B.); (G.O.); (C.P.); (M.D.); (F.C.); (G.C.); (L.C.)
| | - Cinzia Puzzolante
- Infectious Diseases Unit, Azienda Ospedaliero-Universitaria Policlinico, 41124 Modena, Italy; (A.S.); (M.M.); (M.M.); (A.B.); (G.O.); (C.P.); (M.D.); (F.C.); (G.C.); (L.C.)
| | - Margherita Digaetano
- Infectious Diseases Unit, Azienda Ospedaliero-Universitaria Policlinico, 41124 Modena, Italy; (A.S.); (M.M.); (M.M.); (A.B.); (G.O.); (C.P.); (M.D.); (F.C.); (G.C.); (L.C.)
| | - Jovana Milic
- Department of Infectious Diseases, University of Modena and Reggio Emilia, 41124 Modena, Italy; (E.B.); (G.L.); (J.M.); (G.G.)
| | - Mauro Codeluppi
- Infectious Diseases Unit, G. da Saliceto Hospital, 29121 Piacenza, Italy;
| | - Monica Pecorari
- Microbiology and Virology Unit, Azienda Ospedaliero-Universitaria Policlinico, 41124 Modena, Italy; (W.G.); (M.P.); (M.S.)
| | - Federica Carli
- Infectious Diseases Unit, Azienda Ospedaliero-Universitaria Policlinico, 41124 Modena, Italy; (A.S.); (M.M.); (M.M.); (A.B.); (G.O.); (C.P.); (M.D.); (F.C.); (G.C.); (L.C.)
| | - Gianluca Cuomo
- Infectious Diseases Unit, Azienda Ospedaliero-Universitaria Policlinico, 41124 Modena, Italy; (A.S.); (M.M.); (M.M.); (A.B.); (G.O.); (C.P.); (M.D.); (F.C.); (G.C.); (L.C.)
| | - Gaetano Alfano
- Nephrology, Dialysis and Transplant Unit, Azienda Ospedaliero-Universitaria Policlinico, 41124 Modena, Italy;
| | - Luca Corradi
- Infectious Diseases Unit, Azienda Ospedaliero-Universitaria Policlinico, 41124 Modena, Italy; (A.S.); (M.M.); (M.M.); (A.B.); (G.O.); (C.P.); (M.D.); (F.C.); (G.C.); (L.C.)
| | - Roberto Tonelli
- Respiratory Diseases Unit, University of Modena and Reggio Emilia, 41124 Modena, Italy; (R.T.); (E.C.)
| | - Nicola De Maria
- Gastroenterology Unit, Azienda Ospedaliero-Universitaria Policlinico, 41124 Modena, Italy;
| | - Stefano Busani
- Intensive Care Unit, Department of Anaesthesia, Azienda Ospedaliero-Universitaria Policlinico, 41124 Modena, Italy; (S.B.); (E.B.); (I.C.); (M.G.)
| | - Emanuela Biagioni
- Intensive Care Unit, Department of Anaesthesia, Azienda Ospedaliero-Universitaria Policlinico, 41124 Modena, Italy; (S.B.); (E.B.); (I.C.); (M.G.)
| | - Irene Coloretti
- Intensive Care Unit, Department of Anaesthesia, Azienda Ospedaliero-Universitaria Policlinico, 41124 Modena, Italy; (S.B.); (E.B.); (I.C.); (M.G.)
| | - Giovanni Guaraldi
- Department of Infectious Diseases, University of Modena and Reggio Emilia, 41124 Modena, Italy; (E.B.); (G.L.); (J.M.); (G.G.)
| | - Mario Sarti
- Microbiology and Virology Unit, Azienda Ospedaliero-Universitaria Policlinico, 41124 Modena, Italy; (W.G.); (M.P.); (M.S.)
| | - Mario Luppi
- Hematology Unit, University of Modena and Reggio Emilia, 41124 Modena, Italy;
| | - Enrico Clini
- Respiratory Diseases Unit, University of Modena and Reggio Emilia, 41124 Modena, Italy; (R.T.); (E.C.)
| | - Massimo Girardis
- Intensive Care Unit, Department of Anaesthesia, Azienda Ospedaliero-Universitaria Policlinico, 41124 Modena, Italy; (S.B.); (E.B.); (I.C.); (M.G.)
| | - Inge C. Gyssens
- Radboud Center for Infectious Diseases, Department of Internal Medicine, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands;
- Faculty of Medicine and Life Sciences, Hasselt University, 3500 Hasselt, Belgium
| | - Cristina Mussini
- Infectious Diseases Unit, Azienda Ospedaliero-Universitaria Policlinico, 41124 Modena, Italy; (A.S.); (M.M.); (M.M.); (A.B.); (G.O.); (C.P.); (M.D.); (F.C.); (G.C.); (L.C.)
- Department of Infectious Diseases, University of Modena and Reggio Emilia, 41124 Modena, Italy; (E.B.); (G.L.); (J.M.); (G.G.)
- Correspondence: (E.F.); (C.M.)
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Craviotto V, Furfaro F, Loy L, Zilli A, Peyrin-Biroulet L, Fiorino G, Danese S, Allocca M. Viral infections in inflammatory bowel disease: Tips and tricks for correct management. World J Gastroenterol 2021; 27:4276-4297. [PMID: 34366605 PMCID: PMC8316900 DOI: 10.3748/wjg.v27.i27.4276] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 04/01/2021] [Accepted: 05/15/2021] [Indexed: 02/06/2023] Open
Abstract
Over the past decades, the treatment of inflammatory bowel diseases (IBD) has become more targeted, anticipating the use of immune-modifying therapies at an earlier stage. This top-down approach has been correlated with favorable short and long-term outcomes, but it has also brought with it concerns regarding potential infectious complications. This large IBD population treated with immune-modifying therapies, especially if combined, has an increased risk of severe infections, including opportunistic infections that are sustained by viral, bacterial, parasitic, and fungal agents. Viral infections have emerged as a focal safety concern in patients with IBD, representing a challenge for the clinician: they are often difficult to diagnose and are associated with significant morbidity and mortality. The first step is to improve effective preventive strategies, such as applying vaccination protocols, adopt adequate prophylaxis and educate patients about potential risk factors. Since viral infections in immunosuppressed patients may present atypical signs and symptoms, the challenges for the gastroenterologist are to suspect, recognize and diagnose such complications. Appropriate treatment of common viral infections allows us to minimize their impact on disease outcomes and patients’ lives. This practical review supports this standard of care to improve knowledge in this subject area.
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Affiliation(s)
- Vincenzo Craviotto
- Humanitas Clinical and Research Center, IRCCS, Rozzano 20089, Milano, Italy
| | - Federica Furfaro
- Humanitas Clinical and Research Center, IRCCS, Rozzano 20089, Milano, Italy
| | - Laura Loy
- Humanitas Clinical and Research Center, IRCCS, Rozzano 20089, Milano, Italy
| | - Alessandra Zilli
- Humanitas Clinical and Research Center, IRCCS, Rozzano 20089, Milano, Italy
| | - Laurent Peyrin-Biroulet
- Department of Hepato-Gastroenterology and Inserm U954, University Hospital of Nancy, Lorraine University, Nancy 54511, France
| | - Gionata Fiorino
- Humanitas Clinical and Research Center, IRCCS, Rozzano 20089, Milano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele 20090, Milano, Italy
| | - Silvio Danese
- Humanitas Clinical and Research Center, IRCCS, Rozzano 20089, Milano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele 20090, Milano, Italy
| | - Mariangela Allocca
- Humanitas Clinical and Research Center, IRCCS, Rozzano 20089, Milano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele 20090, Milano, Italy
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Herpes Simplex Virus Pneumonia in an Immunocompetent Child on Corticosteroids for Acute Wheezing. Pediatr Emerg Care 2020; 36:e735-e736. [PMID: 29794958 DOI: 10.1097/pec.0000000000001519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Herpes simplex virus (HSV) is rarely the cause of pneumonia in immunocompetent patients. We describe a previously healthy child, with no evidence of an immunodeficiency, who presented to the emergency department with severe pneumonia, wheezing, and pleural effusions with a history of orolabial HSV infection. On admission, he was started on antibiotics and systemic corticosteroids but continued to deteriorate. Oral lesions, blood, and pleural fluid tested positive for HSV, and improvement was achieved only after the addition of acyclovir and discontinuation of steroids. We suggest that steroids should be used with caution in patients presenting with lower respiratory tract symptoms and herpetic oral lesions.
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Li TH, Lai CC, Wang WH, Chen WS, Tsao YP, Tsai CY, Chang YS. Risk of severe herpes simplex virus infection in systemic lupus erythematosus: analysis of epidemiology and risk factors analysis in Taiwan. Ann Rheum Dis 2019; 78:941-946. [PMID: 30954968 DOI: 10.1136/annrheumdis-2018-214844] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 03/12/2019] [Accepted: 03/13/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Patients with systemic lupus erythematosus (SLE) are susceptible to herpes simplex virus (HSV) infection, which occasionally leads to severe complications including meningoencephalitis and keratitis. However, few attempts to analyse the associated incidence and risk factors have been made. METHODS We enrolled patients with SLE recorded between 1997 and 2012 and compared the incidence rate (IR) of severe HSV infection, including meningoencephalitis, septicaemia, ocular and visceral involvement, and other specific complications demanding hospitalisation, with that of a non-SLE cohort. A Cox multivariate proportional hazards model was applied to analyse the risk factors of severe HSV infection in patients with SLE. RESULTS A total of 122 520 subjects (24 504 patients with SLE and 98 016 age-matched and sex-matched non-SLE controls) were included, and a higher IR of severe HSV infection was revealed in the SLE group (IR ratio=3.93, p<0.001). In patients with SLE, previous oral and genital infection (HR=2.29, p=0.049), intravenous steroid pulse therapy (HR=5.32, p<0.001) and daily oral dose of over 7.5 mg of prednisolone (HR=1.59, p=0.024) were independent risk factors for severe HSV infection, whereas age of ≤18 (HR=0.45, p=0.029) was a protective factor. CONCLUSIONS Patients with SLE are at higher risk of severe HSV infection, and related risk factors include being older than 18 years, having a history of HSV mucocutaneous infection, recent receipt of steroid pulse therapy and a daily oral dose of steroid over 7.5 mg prednisolone.
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Affiliation(s)
- Tzu-Hao Li
- Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Chiayi Branch, Taichung Veterans General Hospital, Chiayi City, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei City, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei City, Taiwan
| | - Chien-Chih Lai
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei City, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei City, Taiwan.,Divisionof Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wen-Hsiu Wang
- Division of Allergy, Immunology and Rheumatology, Mackay Memorial Hospital, Taipei, Taiwan.,Medicine, Mackay Medical College, Sanzhi, Taiwan
| | - Wei-Sheng Chen
- Divisionof Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yen-Po Tsao
- Divisionof Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chang-Youh Tsai
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei City, Taiwan.,Divisionof Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yu-Sheng Chang
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taipei Medical University Shuang Ho Hospital, New Taipei City, Taiwan .,Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan.,Institute of Biomedical Informatics, National Yang-Ming University, Taipei, Taiwan
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Jiang HY, Wang SY, Deng M, Li YC, Ling ZX, Shao L, Ruan B. Immune response to hepatitis B vaccination among people with inflammatory bowel diseases: A systematic review and meta-analysis. Vaccine 2017; 35:2633-2641. [PMID: 28404358 DOI: 10.1016/j.vaccine.2017.03.080] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 03/27/2017] [Accepted: 03/29/2017] [Indexed: 12/17/2022]
Abstract
INTRODUCTION The response rate to hepatitis B virus (HBV) vaccination in patients with inflammatory bowel disease (IBD) is low and varies markedly. We performed a systematic review and meta-analysis to determine the response rate to HBV vaccination and identified the factors predictive of an immune response. METHODS We searched PubMed, Cochrane Library, and Embase databases, and reviewed the titles and abstracts of studies on the efficacy of HBV vaccination in IBD patients performed through July 2016. Anti-HBs levels>10IU/L was considered to be an effective immune response. The primary outcome measure was the response rate to HBV vaccination after series completion, and the secondary outcome was identification of factors at baseline predictive of an immune response. RESULTS Thirteen studies including 1688 patients were eligible for inclusion. Based on a random-effects model, the pooled rate of a response to HBV vaccination among patients with IBD was 61% (95% confidence interval [CI]: 53-69). Young age (mean difference [MD]: -5.7; 95% CI: -8.46, -2.95) and vaccination during disease remission (relative risk [RR]: 1.62; 95% CI: 1.15-2.29) were associated with a positive response to HBV vaccination. In addition, no immunosuppressive therapy was predictive of an immune response compared to immunomodulatory (RR: 1.33; 95% CI: 1.08-1.63) or anti-tumor necrosis factor-α (anti-TNF-α) (RR: 1.57; 95% CI: 1.19-2.08) therapy. CONCLUSIONS Based on this meta-analysis, only three of five IBD patients will show a serological response to HBV vaccination. Vaccination should be performed at the time of IBD diagnosis, during disease remission, or before starting immunosuppressive therapy.
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Affiliation(s)
- Hai-Yin Jiang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Hangzhou, Zhejiang 310003, China
| | - Shu-Yin Wang
- Department of Nosocomial Infection Management, Hangzhou First People's Hospital, Hangzhou 310006, China
| | - Min Deng
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Hangzhou, Zhejiang 310003, China
| | - Yu-Chuan Li
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Hangzhou, Zhejiang 310003, China
| | - Zong-Xin Ling
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Hangzhou, Zhejiang 310003, China
| | - Li Shao
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Hangzhou, Zhejiang 310003, China
| | - Bing Ruan
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Hangzhou, Zhejiang 310003, China.
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Phadke VK, Friedman-Moraco RJ, Quigley BC, Farris AB, Norvell JP. Concomitant herpes simplex virus colitis and hepatitis in a man with ulcerative colitis: Case report and review of the literature. Medicine (Baltimore) 2016; 95:e5082. [PMID: 27759636 PMCID: PMC5079320 DOI: 10.1097/md.0000000000005082] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Herpesvirus infections often complicate the clinical course of patients with inflammatory bowel disease; however, invasive disease due to herpes simplex virus is distinctly uncommon. METHODS We present a case of herpes simplex virus colitis and hepatitis, review all the previously published cases of herpes simplex virus colitis, and discuss common clinical features and outcomes. We also discuss the epidemiology, clinical manifestations, diagnosis, and management of herpes simplex virus infections, focusing specifically on patients with inflammatory bowel disease. RESULTS A 43-year-old man with ulcerative colitis, previously controlled with an oral 5-aminosalicylic agent, developed symptoms of a colitis flare that did not respond to treatment with systemic corticosteroid therapy. One week later he developed orolabial ulcers and progressive hepatic dysfunction, with markedly elevated transaminases and coagulopathy. He underwent emergent total colectomy when imaging suggested bowel micro-perforation. Pathology from both the colon and liver was consistent with herpes simplex virus infection, and a viral culture of his orolabial lesions and a serum polymerase chain reaction assay also identified herpes simplex virus. He was treated with systemic antiviral therapy and made a complete recovery. CONCLUSIONS Disseminated herpes simplex virus infection with concomitant involvement of the colon and liver has been reported only 3 times in the published literature, and to our knowledge this is the first such case in a patient with inflammatory bowel disease. The risk of invasive herpes simplex virus infections increases with some, but not all immunomodulatory therapies. Optimal management of herpes simplex virus in patients with inflammatory bowel disease includes targeted prophylactic therapy for patients with evidence of latent infection, and timely initiation of antiviral therapy for those patients suspected to have invasive disease.
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MESH Headings
- Adult
- Colitis/complications
- Colitis/diagnosis
- Colitis/virology
- Colitis, Ulcerative/complications
- Colitis, Ulcerative/diagnosis
- Colonoscopy
- DNA, Viral/analysis
- Hepatitis, Viral, Human/complications
- Hepatitis, Viral, Human/diagnosis
- Hepatitis, Viral, Human/virology
- Herpes Simplex/complications
- Herpes Simplex/diagnosis
- Herpes Simplex/virology
- Humans
- Male
- Simplexvirus/genetics
- Tomography, X-Ray Computed
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Affiliation(s)
- Varun K. Phadke
- Division of Infectious Diseases, Emory University School of Medicine
- Correspondence: Varun K. Phadke, 49 Jesse Hill Jr. Drive, Atlanta 30303, GA (e-mail: )
| | | | - Brian C. Quigley
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Emory University Hospital
| | - Alton B. Farris
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Emory University Hospital
| | - J. P. Norvell
- Division of Digestive Diseases, Emory University School of Medicine
- Emory Transplant Center, Atlanta, GA
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10
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Muhvić-Urek M, Tomac-Stojmenović M, Mijandrušić-Sinčić B. Oral pathology in inflammatory bowel disease. World J Gastroenterol 2016; 22:5655-5667. [PMID: 27433081 PMCID: PMC4932203 DOI: 10.3748/wjg.v22.i25.5655] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 05/27/2016] [Accepted: 06/15/2016] [Indexed: 02/06/2023] Open
Abstract
The incidence of inflammatory bowel diseases (IBD) - Crohn’s disease (CD) and ulcerative colitis (UC) - has been increasing on a global scale, and progressively, more gastroenterologists will be included in the diagnosis and treatment of IBD. Although IBD primarily affects the intestinal tract, extraintestinal manifestations of the disease are often apparent, including in the oral cavity, especially in CD. Specific oral manifestations in patients with CD are as follows: indurate mucosal tags, cobblestoning and mucogingivitis, deep linear ulcerations and lip swelling with vertical fissures. The most common non-specific manifestations, such as aphthous stomatitis and angular cheilitis, occur in both diseases, while pyostomatitis vegetans is more pronounced in patients with UC. Non-specific lesions in the oral cavity can also be the result of malnutrition and drugs. Malnutrition, followed by anemia and mineral and vitamin deficiency, affects the oral cavity and teeth. Furthermore, all of the drug classes that are applied to the treatment of inflammatory bowel diseases can lead to alterations in the oral cavity due to the direct toxic effects of the drugs on oral tissues, as well as indirect immunosuppressive effects with a risk of developing opportunistic infections or bone marrow suppression. There is a higher occurrence of malignant diseases in patients with IBD, which is related to the disease itself and to the IBD-related therapy with a possible oral pathology. Treatment of oral lesions includes treatment of the alterations in the oral cavity according to the etiology together with treatment of the primary intestinal disease, which requires adequate knowledge and a strong cooperation between gastroenterologists and specialists in oral medicine.
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11
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Haag LM, Hofmann J, Kredel LI, Holzem C, Kühl AA, Taube ET, Schubert S, Siegmund B, Epple HJ. Herpes Simplex Virus Sepsis in a Young Woman with Crohn's Disease. J Crohns Colitis 2015; 9:1169-73. [PMID: 26351382 DOI: 10.1093/ecco-jcc/jjv149] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 07/21/2015] [Indexed: 12/22/2022]
Abstract
We present the case of a herpes simplex virus-1 [HSV-1] sepsis with severe herpes hepatitis in a young female treated with triple immunosuppressive therapy [adalimumab, azathioprine, prednisolone] for refractory Crohn's disease [CD]. The patient presented with high fever, generalised abdominal tenderness, strongly elevated transaminases, coagulopathy, and pancytopenia. Comprehensive diagnostics including blood HSV-1 polymerase chain reaction [PCR], liver biopsy, and immunohistochemistry revealed the diagnosis of fulminant herpes hepatitis. HSV-1 positivity of cutaneous lesions proved the disseminated nature of the infection. Early treatment with intravenous acyclovir led to a rapid improvement of the patient's condition and resulted in a full recovery of her liver function. This is the first reported case of HSV-sepsis in a patient with CD. Physicians treating inflammatory bowel disease [IBD] patients with combined immunosuppressive therapy should be aware of the possibility of herpes hepatitis, and early empirical antiviral therapy should be considered in immunosuppressed patients presenting with fever and severe anicteric hepatitis.
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Affiliation(s)
- Lea-Maxie Haag
- Medical Department 1, Charité Universitätsmedizin Berlin, Berlin
| | - Jörg Hofmann
- Institute of Virology, Campus Charité Mitte, Charité Universitätsmedizin Berlin, Berlin
| | | | - Christina Holzem
- Medical Department 1, Charité Universitätsmedizin Berlin, Berlin
| | - Anja A Kühl
- Medical Department 1, Charité Universitätsmedizin Berlin, Berlin
| | - Eliane T Taube
- Institute of Pathology, Campus Charité Mitte, Charité Universitätsmedizin Berlin, Berlin
| | | | - Britta Siegmund
- Medical Department 1, Charité Universitätsmedizin Berlin, Berlin
| | - Hans-Jörg Epple
- Medical Department 1, Charité Universitätsmedizin Berlin, Berlin
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12
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Erdmann N, Hewitt BA, Atkinson TP, Van Wagoner N. Disseminated Primary Herpes Simplex Virus Type 2 Infection in a 22-Year-Old male. Open Forum Infect Dis 2015; 2:ofv092. [PMID: 26180838 PMCID: PMC4499671 DOI: 10.1093/ofid/ofv092] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Accepted: 06/10/2015] [Indexed: 12/13/2022] Open
Abstract
We present a case of primary disseminated herpes simplex virus type 2 (HSV-2) cutaneous disease in a 22-year-old male. We discuss the immune response to HSV-2 infection as well as the extragenital manifestations of HSV-2 observed in immune-competent and immune-suppressed persons.
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