1
|
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.
Collapse
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
| |
Collapse
|
2
|
Marshall C, Khatoon N, Lynch E. Disseminated Herpes Simplex Virus in an Immunocompetent Patient Without Presence of Epidermal or Mucosal Lesions. Am J Forensic Med Pathol 2021; 42:e13-e15. [PMID: 33346975 DOI: 10.1097/paf.0000000000000652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Herpes simplex virus (HSV) is a disease usually characterized by lesions within the epidermis or mucosa of children and adults. However, this infection can also cause complications to many systems of the body, including the peripheral and central nervous system, respiratory system, and hepatobiliary system. In this case, we present a 43-year-old man with a history of substance abuse, who presented with fever, cough, and headache, and within days, progressed into fulminant hepatitis and hypoxic failure. Bacterial and fungal cultures were negative, as well as the workup for human immunodeficiency virus. However, the presence of HSV was detected in a bronchial lavage culture after the patients had expired. This result, along with the findings at autopsy, including viral cytopathic effect in the lung and liver, which were confirmed with immunohistochemical stains for HSV, strongly suggest that the cause of death is from disseminated herpes virus infection with hepatitis and viral pneumonitis. This disseminated infection occurred in an immunocompetent host without any evidence of mucocutaneous lesions.
Collapse
Affiliation(s)
- Cody Marshall
- From the Allegheny Health Network Pathology and Laboratory Medicine, Allegheny General Hospital, Pittsburgh, PA
| | | | | |
Collapse
|
3
|
Bowers EMR, Esianor BI, Kimura K, Lewis JS, Topf MC. Disseminated Herpes Simplex Infection Presenting as Acute Supraglottitis in an Adult. Head Neck Pathol 2020; 15:1074-1081. [PMID: 33372241 PMCID: PMC8385039 DOI: 10.1007/s12105-020-01255-8] [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: 10/20/2020] [Accepted: 11/18/2020] [Indexed: 11/30/2022]
Abstract
Supraglottitis is a life-threatening, predominantly bacterial disease that is rarely caused by viral etiologies. Herpes Simplex Virus (HSV) supraglottitis has been infrequently reported, but its presentation can mimic that of bacterial supraglottitis or pharyngitis which may lead to delayed diagnosis and increased morbidity. We present a case of supraglottitis in an immunocompetent man initially thought to have bacterial epiglottitis. After receiving a tracheostomy due to impending airway compromise and failing to improve on antibiotic therapy, biopsy of the upper airway tissue revealed infection with HSV type 2. The patient improved after multiple weeks of systemic antivirals. HSV supraglottitis remains an unusual but important diagnostic consideration in patients with dysphonia, dysphagia, ulcerative supraglottal lesions, and acute supraglottic inflammation unresponsive to antibiotics.
Collapse
Affiliation(s)
| | - Brandon I. Esianor
- Vanderbilt University Department of Otolaryngology—Head and Neck Surgery, Vanderbilt University Medical Center, 1215 21st Ave. S. Suite 7209, Nashville, TN 37232 USA
| | - Kyle Kimura
- Vanderbilt University Department of Otolaryngology—Head and Neck Surgery, Vanderbilt University Medical Center, 1215 21st Ave. S. Suite 7209, Nashville, TN 37232 USA
| | - James S. Lewis
- Vanderbilt University Department of Otolaryngology—Head and Neck Surgery, Vanderbilt University Medical Center, 1215 21st Ave. S. Suite 7209, Nashville, TN 37232 USA ,Vanderbilt University Department of Pathology, Microbiology, and Immunology, Nashville, USA
| | - Michael C. Topf
- Vanderbilt University Department of Otolaryngology—Head and Neck Surgery, Vanderbilt University Medical Center, 1215 21st Ave. S. Suite 7209, Nashville, TN 37232 USA
| |
Collapse
|
4
|
Abu-Raya B, Michalski C, Sadarangani M, Lavoie PM. Maternal Immunological Adaptation During Normal Pregnancy. Front Immunol 2020; 11:575197. [PMID: 33133091 PMCID: PMC7579415 DOI: 10.3389/fimmu.2020.575197] [Citation(s) in RCA: 233] [Impact Index Per Article: 58.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 09/18/2020] [Indexed: 12/25/2022] Open
Abstract
The risk and severity of specific infections are increased during pregnancy due to a combination of physiological and immunological changes. Characterizing the maternal immune system during pregnancy is important to understand how the maternal immune system maintains tolerance towards the allogeneic fetus. This may also inform strategies to prevent maternal fatalities due to infections and optimize maternal vaccination to best protect the mother-fetus dyad and the infant after birth. In this review, we describe what is known about the immunological changes that occur during a normal pregnancy.
Collapse
Affiliation(s)
- Bahaa Abu-Raya
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, BC, Canada.,BC Children's Hospital Research Institute, Vancouver, BC, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.,Experimental Medicine Program, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Christina Michalski
- BC Children's Hospital Research Institute, Vancouver, BC, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.,Experimental Medicine Program, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Manish Sadarangani
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, BC, Canada.,BC Children's Hospital Research Institute, Vancouver, BC, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.,Experimental Medicine Program, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Pascal M Lavoie
- BC Children's Hospital Research Institute, Vancouver, BC, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.,Experimental Medicine Program, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
5
|
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.
Collapse
|
6
|
Liew JW, Jones BL, Hunter AJ. Disseminated Herpes Simplex Masquerading as Hemophagocytic Lymphohistiocytosis: A Case Report. Perm J 2019; 23:18-202. [PMID: 31167703 DOI: 10.7812/tpp/18-202] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Marked elevation in serum ferritin levels may be seen in disseminated infection or severe organ failure states, but it is also present in hemophagocytic lymphohistiocytosis (HLH). Herpes simplex virus (HSV) hepatitis has a high mortality rate, even in immunocompetent individuals, in whom it is rarely reported. We present a case of hyperferritinemia with features initially suggestive of a diagnosis of HLH but that ultimately proved to be fulminant HSV hepatitis. CASE PRESENTATION A 56-year-old man with an indolent undiagnosed brain mass presented with progressive neurologic deficits and was found to have fevers, cytopenias, transaminitis, and hyperferritinemia. Initially, HLH was suspected; however, the ultimate diagnosis was HSV hepatitis with dissemination. Although the patient was treated with intravenous acyclovir, multiorgan failure developed, and he died. DISCUSSION This case highlights the importance of considering alternative causes for a rise in ferritin levels when HLH is on the differential. Additionally, we discuss the diagnostic and therapeutic implications of HSV hepatitis, and we review the literature for cases presenting in immunocompetent hosts.
Collapse
Affiliation(s)
- Jean W Liew
- Division of Rheumatology, Department of Medicine, University of Washington, Seattle
| | - Brian L Jones
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Alan J Hunter
- Division of Hospital Medicine, Department of Medicine, Oregon Health and Science University, Portland
| |
Collapse
|
7
|
González-Puga C, Palomeque-Jiménez A, García-Saura PL, García-Rubio J, Jiménez-Ríos JA. [Fulminant hepatitis due to herpes simplex virus in an immunocompetent patient. Differential diagnosis with acute cholecystitis]. GASTROENTEROLOGIA Y HEPATOLOGIA 2014; 37:414-416. [PMID: 24447891 DOI: 10.1016/j.gastrohep.2013.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 12/02/2013] [Accepted: 12/04/2013] [Indexed: 06/03/2023]
Affiliation(s)
- Cristina González-Puga
- Hospital Universitario San Cecilio, Servicio de Cirugía General y Aparato Digestivo, Granada, España
| | - Antonio Palomeque-Jiménez
- Hospital Universitario San Cecilio, Servicio de Cirugía General y Aparato Digestivo, Granada, España.
| | - Pedro Luis García-Saura
- Hospital Universitario San Cecilio, Servicio de Cirugía General y Aparato Digestivo, Granada, España
| | - Jesús García-Rubio
- Hospital Universitario San Cecilio, Servicio de Cirugía General y Aparato Digestivo, Granada, España
| | - José Antonio Jiménez-Ríos
- Hospital Universitario San Cecilio, Servicio de Cirugía General y Aparato Digestivo, Granada, España
| |
Collapse
|
8
|
Affiliation(s)
- Athena P Kourtis
- From the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta (A.P.K., D.J.J.); and the Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco (J.S.R.)
| | | | | |
Collapse
|
9
|
Sappenfield E, Jamieson DJ, Kourtis AP. Pregnancy and susceptibility to infectious diseases. Infect Dis Obstet Gynecol 2013; 2013:752852. [PMID: 23935259 PMCID: PMC3723080 DOI: 10.1155/2013/752852] [Citation(s) in RCA: 139] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Accepted: 06/17/2013] [Indexed: 11/18/2022] Open
Abstract
To summarize the literature regarding susceptibility of pregnant women to infectious diseases and severity of resulting disease, we conducted a review using a PubMed search and other strategies. Studies were included if they reported information on infection risk or disease outcome in pregnant women. In all, 1454 abstracts were reviewed, and a total of 85 studies were included. Data were extracted regarding number of cases in pregnant women, rates of infection, risk factors for disease severity or complications, and maternal outcomes. The evidence indicates that pregnancy is associated with increased severity of some infectious diseases, such as influenza, malaria, hepatitis E, and herpes simplex virus (HSV) infection (risk for dissemination/hepatitis); there is also some evidence for increased severity of measles and smallpox. Disease severity seems higher with advanced pregnancy. Pregnant women may be more susceptible to acquisition of malaria, HIV infection, and listeriosis, although the evidence is limited. These results reinforce the importance of infection prevention as well as of early identification and treatment of suspected influenza, malaria, hepatitis E, and HSV disease during pregnancy.
Collapse
Affiliation(s)
- Elisabeth Sappenfield
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | - Denise J. Jamieson
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | - Athena P. Kourtis
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| |
Collapse
|
10
|
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
| |
Collapse
|
11
|
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.
Collapse
|
12
|
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.
Collapse
Affiliation(s)
- C Riediger
- Department of Surgery, Technische Universität München, Ismaningerstr, Munich, Germany.
| | | | | | | | | | | |
Collapse
|
13
|
Abstract
Although the standard of care in febrile neutropenic patients includes the initiation of empirical antibacterial and antifungal therapy, many patients do not respond and need further diagnostic work up and treatment. Here, we report on an immunosuppressed neutropenic patient with a prolonged episode of fever unresponsive to empirical antibacterial therapy. Herpes polymerase chain reaction revealed systemic reactivation of herpes simplex virus type 1 (HSV-1) infection and treatment with acyclovir was associated with the prompt resolution of signs and symptoms of infection. Screening for HSV in persistently febrile neutropenic patients may discover HSV reactivation that can be treated successfully by acyclovir administration.
Collapse
|
14
|
Norvell JP, Blei AT, Jovanovic BD, Levitsky J. Herpes simplex virus hepatitis: an analysis of the published literature and institutional cases. Liver Transpl 2007; 13:1428-34. [PMID: 17902129 DOI: 10.1002/lt.21250] [Citation(s) in RCA: 162] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Hepatitis is a rare complication of herpes simplex virus (HSV), often leading to acute liver failure (ALF), liver transplantation (LT), and/or death. Our aim was to identify variables associated with either survival or progression (death/LT), based on an analysis of cases in the literature and our institution. A total of 137 cases (132 literature, 5 institutional) of HSV hepatitis were identified. The main features at clinical presentation were fever (98%), coagulopathy (84%), and encephalopathy (80%). Rash was seen in less than half of patients. Most cases (58%) were first diagnosed at autopsy and the diagnosis was suspected clinically prior to tissue confirmation in only 23%. Overall, 74% of cases progressed to death or LT, with 51% in acyclovir-treated patients as compared to 88% in the untreated subjects (P=0.03). Variables on presentation associated with death or need for LT compared to spontaneous survival: male gender, age>40 yr, immunocompromised state, ALT>5,000 U/L, platelet count<75x10(3)/L, coagulopathy, encephalopathy, and absence of antiviral therapy. In conclusion, HSV hepatitis has a high mortality and is often clinically unsuspected. Patients who are male, older, immunocompromised, and/or presenting with significant liver dysfunction are more likely to progress to death and should thus be evaluated for LT early. Based on the frequent delay in HSV diagnosis, low risk-benefit ratio, and significantly improved outcomes, empiric acyclovir therapy for patients presenting with ALF of unknown etiology is recommended until HSV hepatitis is excluded.
Collapse
Affiliation(s)
- John P Norvell
- Department of Internal Medicine, Division of Hepatology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | | | | | | |
Collapse
|
15
|
Kluger N, Boutboul D, Molinari E, Haroche J, Rozenberg F, Amoura Z, Francès C. Hépatite aiguë lors d’une primo-infection à Herpès simplex virus 2 chez un malade atteint d’un lupus érythémateux disséminé. Ann Dermatol Venereol 2007; 134:369-73. [PMID: 17483758 DOI: 10.1016/s0151-9638(07)89193-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Herpes simplex virus hepatitis is a rare complication associated with a poor prognosis and a high mortality rate. It mainly affects adults with impaired cell-mediated immunity. Mucocutaneous involvement is seen in only 57% to 70% of patients and the clinical aspects of the lesions may sometimes be misleading. Here we report a new case that developed during primary HSV-2 infection in a patient with systemic lupus erythematosus. CASE REPORT A 57 year-old man with systemic lupus erythematosus treated with oral prednisone presented a disseminated varicella-like eruption with acute liver failure related to primary genital HSV-2 infection. Type-specific HSV deoxyribonucleic acid amplification by polymerase chain reaction on serum and oral lesion samples revealed type 2 HSV. Dramatic improvement was observed with parenteral acyclovir. DISCUSSION Hepatitis due to HSV is a rare but potentially fatal disorder chiefly affecting adults with impaired immune systems. In this case, HSV affects the liver during primary or recurrent infection. If initiated quickly, parenteral acyclovir can cure hepatitis, which means that this diagnosis must be considered in both immunocompromised and immunocompetent patients with high fever, leucopoenia and marked elevation of aminotransferase levels. Mucocutaneous signs are present in only 57 to 70% of cases. Careful physical examination to detect herpes lesions should be done in all cases of acute liver failure. HSV viremia testing may confirm the diagnosis by non-invasive means. Patients with systemic lupus erythematosus are at increased risk for infection due to immunosuppressive drugs, but also to numerous intrinsic immunologic abnormalities such as a recently reported deficit in NK cells and plasmacytoid dendritic cells.
Collapse
Affiliation(s)
- N Kluger
- Université Montpellier I, Service de Dermatologie, Hôpital Saint Eloi, CHU Montpellier.
| | | | | | | | | | | | | |
Collapse
|
16
|
Janeiro M, Veiga A, Orduña MJ, Corredoira JC. Insuficiencia hepática fulminante por virus herpes simple en un adulto inmunocompetente. Med Clin (Barc) 2007; 128:638-9. [PMID: 17524324 DOI: 10.1157/13101748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
17
|
Czartoski T, Liu C, Koelle DM, Schmechel S, Kalus A, Wald A. Fulminant, acyclovir-resistant, herpes simplex virus type 2 hepatitis in an immunocompetent woman. J Clin Microbiol 2006; 44:1584-6. [PMID: 16597901 PMCID: PMC1448683 DOI: 10.1128/jcm.44.4.1584-1586.2006] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
We report an immunocompetent woman with multisystem organ failure following herpes simplex virus type 2 (HSV-2) hepatitis. After she initially responded to intravenous acyclovir, she was switched to oral valacyclovir. She developed respiratory failure and opportunistic infections and died. Autopsy confirmed disseminated HSV infection, and lung tissue grew acyclovir-resistant HSV-2.
Collapse
Affiliation(s)
- Todd Czartoski
- Molecular Virology Laboratory, University of Washington, 960 Republican St., Seattle, WA 98195, USA
| | | | | | | | | | | |
Collapse
|
18
|
Duckro AN, Sha BE, Jakate S, Hayden MK, Simon DM, Saltzberg SN, Arai S, Kessler HA. Herpes simplex virus hepatitis: expanding the spectrum of disease. Transpl Infect Dis 2006; 8:171-6. [PMID: 16913977 DOI: 10.1111/j.1399-3062.2006.00133.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
We describe 2 transplant patients with herpes simplex virus (HSV) hepatitis who were minimally symptomatic throughout their illness. The spectrum of disease caused by HSV hepatitis is more variable than previously reported in this population. HSV hepatitis should be considered in immunocompromised hosts with elevated transaminases without evidence of fulminant hepatic necrosis.
Collapse
Affiliation(s)
- A N Duckro
- Department of Medicine, Section of Infectious Diseases, Rush University Medical Center, 600 S. Paulina, Chicago, IL 60612, USA
| | | | | | | | | | | | | | | |
Collapse
|
19
|
Fulminant Hepatic Failure due to Herpes Simplex Virus in a Previously Healthy Woman. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2006. [DOI: 10.1097/01.idc.0000222618.10533.8b] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
20
|
Campsen J, Hendrickson R, Bak T, Wachs M, Kam I, Nash R, Russ P, Levi M. Herpes simplex in a liver transplant recipient. Liver Transpl 2006; 12:1171-3. [PMID: 16799938 DOI: 10.1002/lt.20823] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Jeffrey Campsen
- Department of Surgery, University of Colorado Health Sciences Center, Denver, CO 80262, USA
| | | | | | | | | | | | | | | |
Collapse
|
21
|
|
22
|
Montalbano M, Slapak-Green GI, Neff GW. Fulminant Hepatic Failure from Herpes Simplex Virus: Post Liver Transplantation Acyclovir Therapy and Literature Review. Transplant Proc 2005; 37:4393-6. [PMID: 16387129 DOI: 10.1016/j.transproceed.2005.10.031] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2004] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Herpes simplex virus (HSV) is seen throughout the world and can be treated with acyclovir. We present a case of fulminant hepatic failure (FHF) as a result of disseminated HSV infection in a pregnant patient during the second trimester. METHODS The medical records of a patient suffering from HSV-related fulminant hepatic failure were collected. A review of the literature was collected and reported. RESULTS A previously healthy female presented with fulminant hepatic failure at a local emergency room complaining of a 5-day history of fever, nausea, vomiting, and right side abdominal pain that radiated to the back. She was diagnosed with fulminant hepatic failure and progressed into a coma. The patient underwent orthotopic liver transplantation (OLT) prior to the diagnosis of HSV and then treated successfully with acyclovir. CONCLUSION Treatment of HSV fulminant hepatitis is dependent up on early suspicion and prompt intervention. In addition, antiviral therapy may need to be lifelong.
Collapse
Affiliation(s)
- M Montalbano
- University of Cincinnati, Division for Digestive Diseases, Cincinnati, Ohio, USA
| | | | | |
Collapse
|
23
|
Ichai P, Roque Afonso AM, Sebagh M, Gonzalez ME, Codés L, Azoulay D, Saliba F, Karam V, Dussaix E, Guettier C, Castaing D, Samuel D. Herpes simplex virus-associated acute liver failure: a difficult diagnosis with a poor prognosis. Liver Transpl 2005; 11:1550-5. [PMID: 16315311 DOI: 10.1002/lt.20545] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
We report 5 cases of acute liver failure related to herpes simplex (HSV) infection in 1 immunocompetent and 4 immunosuppressed patients. One patient was too ill for liver transplantation indication. Three patients, among the 4 listed, underwent liver transplantation. Three patients died 11 days to 1 year after transplantation and 2 patients died 2 to 3 days after admission. All presented with fever and none with skin lesions. The diagnosis of HSV-related hepatitis was made antemortem in only 2 patients on the basis of positive blood cultures and/or immunohistochemic findings. In the remaining patients, HSV diagnosis was made retrospectively on further histologic and virologic investigations. Primary HSV infection was certain or likely in all cases, including an HSV2 superinfection of an anti-HSV1-positive patient and two HSV superinfections of hepatitis B virus (HBV)-related chronic liver disease. In these latter patients, HSV diagnosis was totally unsuspected, despite fever. HSV superinfection has significantly contributed to liver dysfunction aggravation and death. In conclusion, the diagnosis of HSV hepatitis is difficult to establish in the absence of specific clinical signs. This may suggest the need for early administration of acyclovir in patients with suspected HSV hepatitis, without waiting for virologic confirmation. Diagnosis methods providing fast results (real-time polymerase chain reaction [PCR]) should be implemented.
Collapse
Affiliation(s)
- Philippe Ichai
- Centre Hépatobiliaire, Assistance Publique-Hôpitaux de Paris, Université Paris Sud, Hôpital Paul Brousse, 12 Avenue Paul Vaillant Couturier, 94800 Villejuif Cedex, France.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Allen RH, Tuomala RE. Herpes Simplex Virus Hepatitis Causing Acute Liver Dysfunction and Thrombocytopenia in Pregnancy. Obstet Gynecol 2005; 106:1187-9. [PMID: 16260566 DOI: 10.1097/01.aog.0000160481.11517.a0] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Herpes simplex virus (HSV) hepatitis in pregnant women is a rare condition. We report a case confirmed by liver biopsy and successfully treated with empiric intravenous acyclovir. CASE A 25-year-old primigravida at 34 weeks of gestation presented with fever, thrombocytopenia, and markedly elevated liver enzymes. The patient was treated empirically and was delivered by cesarean. After delivery failed to correct her condition, a liver biopsy revealed HSV hepatitis. The fetus was unaffected and the patient recovered with an extended course of acyclovir. CONCLUSION Pregnant women are susceptible to disseminated HSV causing hepatitis. A high index of suspicion is necessary to diagnose HSV hepatitis and begin appropriate treatment with acyclovir. Herpes simplex virus hepatitis should be included in the differential diagnosis for liver failure during pregnancy.
Collapse
Affiliation(s)
- Rebecca H Allen
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
| | | |
Collapse
|
25
|
Herget GW, Riede UN, Schmitt-Gräff A, Lübbert M, Neumann-Haefelin D, Köhler G. Generalized herpes simplex virus infection in an immunocompromised patient – report of a case and review of the literature. Pathol Res Pract 2005; 201:123-9. [PMID: 15901133 DOI: 10.1016/j.prp.2004.12.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Patients with immunodeficiency or treatment-related immunosuppression are at an increased risk of developing severe herpes simplex virus (HSV) infection. We present a fatal case of a generalized HSV-1 infection in a 22-year-old female afflicted by acute lymphoblastic leukemia who was treated with polychemotherapy. The terminal clinical course was characterized by abdominal pain, progressive hepatic failure, and disseminated intravascular coagulation. Autopsy revealed non-perioral herpetic skin lesions and mucosal ulceration of the esophagus and colon. Punctuated areas of yellow-tan necrosis with hyperemic rims were detected in the liver, spleen, and lung. Numerous petechiae were observed on the mucosal surface of the esophagus, jejunum, ileum, and colon. Microscopically, lesions demonstrated the cellular changes characteristic of herpetic infection. Immunohistochemistry for identification of the virus using monoclonal antibodies against HSV-1 and HSV-2 showed positive staining for HSV-1. Polymerase chain reaction and sequencing confirmed HSV-1 positivity. Emphasis must be placed on clinical awareness of a generalized HSV infection in immunocompromised patients. Absence of orofacial or genital lesions does not rule out the possibility of active HSV infection.
Collapse
Affiliation(s)
- Georg Werner Herget
- Department of Orthopedics and Traumatology, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg i. Br., Germany
| | | | | | | | | | | |
Collapse
|
26
|
Abstract
Herpes simplex hepatitis is a treatable cause of acute hepatitis with a high mortality (41% to 79%). We present 4 adult patients who died of herpes simplex hepatitis and review another 70 patients (including pregnant women) from the literature to illustrate that herpes simplex hepatitis was only considered in the differential diagnosis in 26% to 33% of patients even though muco-cutaneous involvement was present in at least 70% of these patients. The presence of muco-cutaneous lesions in a patient with clinical symptoms and biochemical findings of acute hepatitis should raise the suspicion of herpes simplex hepatitis. Prompt treatment with acyclovir can be initiated within hours of admission in an attempt to prevent further hepatocellular damage in this potentially life-threatening infection.
Collapse
Affiliation(s)
- Shobha Sharma
- Emory University Hospital, Department of Pathology, Atlanta, Georgia 30322, USA.
| | | |
Collapse
|
27
|
Mortelé KJ, Barish MA, Yucel KE. Fulminant herpes hepatitis in an immunocompetent pregnant woman: CT imaging features. ACTA ACUST UNITED AC 2004; 29:682-4. [PMID: 15185020 DOI: 10.1007/s00261-004-0199-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2003] [Accepted: 02/11/2004] [Indexed: 12/21/2022]
Abstract
Fulminant hepatitis due to herpes simplex virus (HSV) is rare in immunocompetent adults. Most reported cases have clearly established pregnancy as a condition that can predispose to disseminated HSV infection. We report a case of a 25-year-old previously healthy pregnant woman who presented with fatigue, fever, and anicteric hepatitis. Triphasic contrast-enhanced computed tomography demonstrated a miliary pattern of multiple, hypovascular, subcentimeter lesions scattered throughout the liver. Familiarity with the clinical findings and computed tomographic appearance may prompt early recognition of fulminant HSV hepatitis and allow differentiation from other hepatic disease during pregnancy.
Collapse
Affiliation(s)
- K J Mortelé
- Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
| | | | | |
Collapse
|
28
|
Tischendorf JJW, Grosse V, Flik J, Verhagen W, Manns MP, Trautwein C. Fulminant course of herpes simplex virus reactivation in an apparently immunocompetent woman. Int J Infect Dis 2003; 7:160-2. [PMID: 12839720 DOI: 10.1016/s1201-9712(03)90014-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
29
|
Abstract
Lesions of the pancreas induced by viral infection have drawn relatively little attention because of their low incidence, and the histopathologic features of viral pancreatitis have not been fully elucidated. We report the autopsy findings of 2 patients, a 59-year-old woman with allergic granulomatous angiitis and a 73-year-old man with invasive pulmonary aspergillosis who had a disseminated visceral herpes simplex virus (HSV) infection. In both cases, the liver was the organ most severely affected by the viral infection. The pancreas showed multiple small foci of hemorrhagic necrosis, which were not accompanied by fat necrosis of the surrounding adipose tissue. Histopathologically, Cowdry type A intranuclear inclusions and a ground-glass appearance of the nuclei were found in many degenerated acinar cells around the necrotic foci. The gross appearance and histopathologic features of HSV pancreatitis were characteristic and, in particular, distinct from those of the more common acute hemorrhagic pancreatitis. Immunohistochemistry using an anti-HSV antibody revealed immunoreactivity in the intranuclear inclusions and ground-glass nuclei, and polymerase chain reaction analysis disclosed that the causative virus in these 2 cases was HSV-1. Herpes simplex virus pancreatitis constitutes a rare, but distinct pathologic entity among a group of acute pancreatitis diseases with diverse etiopathogenesis.
Collapse
|
30
|
Abstract
The human herpesviruses can produce a wide variety of disease in the liver (Table 7). The immunocompromised host is particularly susceptible to hepatic manifestations of herpesvirus disease. CMV is the most common opportunistic pathogen in the immunocompromised patient. The clinical presentation of hepatic herpesvirus infection is often nonspecific. A high index of suspicion and rapid progression to liver biopsy to document viral replication (alpha- and betaherpesviruses) or outgrowth of virus-infected cells (gammaherpesviruses) can lead to lifesaving therapeutic interventions.
Collapse
Affiliation(s)
- J D Fingeroth
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.
| |
Collapse
|
31
|
Barton LL, Weaver-Woodard S, Gutierrez JA, Lee DM. Herpes simplex virus hepatitis in a child: case report and review. Pediatr Infect Dis J 1999; 18:1026-8. [PMID: 10571448 DOI: 10.1097/00006454-199911000-00023] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- L L Barton
- Department of Pediatrics and the Steele Memorial Children's Research Center, University of Arizona, Tucson, USA.
| | | | | | | |
Collapse
|
32
|
Kang AH, Graves CR. Herpes simplex hepatitis in pregnancy: a case report and review of the literature. Obstet Gynecol Surv 1999; 54:463-8. [PMID: 10394584 DOI: 10.1097/00006254-199907000-00026] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Fulminant hepatic dysfunction in the third trimester of pregnancy accompanied by fever may result from disseminated herpes simplex virus. Since 1969, 24 cases of herpes simplex hepatitis, including the current case, have been reported. Mucocutaneous lesions are present in only half of cases; therefore, suspicion for diagnosis of this disease is low. Twenty-five percent of cases were not diagnosed until autopsy. Maternal and perinatal mortality are high, approaching 39 percent for both mother and fetus. Early recognition with initiation of antiviral therapy appears to be most important in maximizing survival.
Collapse
MESH Headings
- Acyclovir/therapeutic use
- Adult
- Antiviral Agents/therapeutic use
- Female
- Hepatitis, Viral, Human/drug therapy
- Hepatitis, Viral, Human/epidemiology
- Hepatitis, Viral, Human/virology
- Herpes Simplex/diagnosis
- Herpes Simplex/drug therapy
- Herpes Simplex/epidemiology
- Herpesvirus 1, Human/isolation & purification
- Herpesvirus 2, Human/isolation & purification
- Humans
- Pregnancy
- Pregnancy Complications, Infectious/drug therapy
- Pregnancy Complications, Infectious/epidemiology
- Pregnancy Complications, Infectious/virology
Collapse
Affiliation(s)
- A H Kang
- Department of Obstetrics and Gynecology, Vanderbilt University, Nashville, Tennessee 37232, USA
| | | |
Collapse
|
33
|
Chung AB, Fas N. Successful Acyclovir Treatment of Herpes Simplex Type 2 Hepatitis in a Patient with Systemic Lupus Erythematosus: A Case Report and Meta Analysis. Am J Med Sci 1998. [DOI: 10.1016/s0002-9629(15)40453-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
34
|
Chung AB, Fas N. Successful acyclovir treatment of herpes simplex type 2 hepatitis in a patient with systemic lupus erythematosus: a case report and meta analysis. Am J Med Sci 1998; 316:404-7. [PMID: 9856697 DOI: 10.1097/00000441-199812000-00010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Herpes simplex virus (HSV) hepatitis is a rare complication of HSV infection with a high reported mortality rate in untreated patients. The authors present a case of HSV hepatitis in a 26-year-old female with focal proliferative lupus nephropathy who was status post one cycle of pulse high-dose (1 gm/ m2) cyclophosphamide. Treatment with parenteral acyclovir was successful. A meta analysis of well-documented cases of HSV hepatitis treated with acyclovir, excluding those that omit initial serum concentrations of hepatic transaminases, suggests that the early administration of parenteral acyclovir may have been instrumental in the achievement of a successful outcome, and that a patient's serum levels of hepatic transaminases at the time of treatment initiation may predict outcome. This is the first reported case of successful parenteral acyclovir treatment of HSV hepatitis in a patient with lupus nephritis who has recently undergone cyclophosphamide immunosuppression, and includes a meta analysis to examine the hypothesis that initial markers of hepatic injury may predict outcome of acyclovir treatment.
Collapse
Affiliation(s)
- A B Chung
- Department of Medicine, Emory University, Atlanta, GA 30322, USA.
| | | |
Collapse
|
35
|
Knobil K, Wiener C, Zenilman J. Herpes Simplex Infections in the Critical Care Setting. J Intensive Care Med 1997. [DOI: 10.1177/088506669701200204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Infections caused by herpes simplex virus (HSV) types 1 and 2 are widely prevalent and usually asymptomatic. In the immunocompromised or severely ill patient, however, HSV can cause a variety of mucosal and systemic syndromes. Organ systems most susceptible include the gastrointestinal tract, lungs, and the central nervous system. Systemic disseminated disease may also occur. With the exception of herpes encephalitis, clinical diagnosis of serious HSV infections is difficult, because it occurs in hosts who are susceptible to a wide range of infectious and metabolic problems. We review the presenting syndromes of HSV infection in the critically ill patient, and outline current concepts for diagnosis and treatment.
Collapse
|
36
|
Abstract
Primary cultures of trigeminal ganglion (TG) cells from herpes simplex virus type 1 (HSV-1) latently infected mice were used to study reactivation. Expression of HSV-1 latency-associated transcripts was noted in TG cell cultures. Infectious virus appeared in 75% of culture supernatants within 120 h after heat stress. Likewise, HSV-1 lytic-phase mRNA and proteins were detectable 24 h after heat stress. HSV-1 antigen first appeared in neurons after heat stress, indicating the neurons were the source of reactivation. The effect of heat stress duration on reactivation was determined. Reactivation occurred in 0, 40, or 67% of cultures after a 1-, 2-, or 3-h heat stress, respectively. However, 72-kDa heat shock protein expression was induced regardless of heat stress duration. Thus, reactivation was not a direct result of inducing the heat shock response. The capacities of several drugs to induce reactivation were also evaluated. While neither epinephrine, forskolin, nor a membrane-permeable cyclic AMP analog induced reactivation, dexamethasone did so in a dose-dependent manner. Furthermore, dexamethasone pretreatment enhanced the kinetics of heat stress-induced reactivation from TG cells. Collectively, the results indicate that TG cell cultures mimic important aspects of in vivo latency and reactivation. Therefore, this model may be useful for studying signalling pathways that lead to HSV-1 reactivation.
Collapse
Affiliation(s)
- W P Halford
- Department of Microbiology and Immunology, Louisiana State University Medical Center, New Orleans 70112, USA
| | | | | |
Collapse
|
37
|
Glorioso DV, Molloy PJ, Van Thiel DH, Kania RJ. Successful empiric treatment of HSV hepatitis in pregnancy. Case report and review of the literature. Dig Dis Sci 1996; 41:1273-5. [PMID: 8654163 DOI: 10.1007/bf02088248] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- D V Glorioso
- Western Pennsylvania Hospital, Division of Gastroenterology, Pittsburgh, USA
| | | | | | | |
Collapse
|
38
|
Abstract
Fever is common in the solid organ transplant patient and may be produced by a variety of processes. The approach to the febrile transplant patient must include an extensive search for infection, which may be aided by considering the organ transplanted, time after transplantation, and the patient's immunosuppressed state. In addition, a number of noninfectious causes of fever exist in this population, including allograft rejection, drug fever, and thromboembolic disease. A review of the pathogens commonly noted in posttransplant patients is presented, emphasizing risk factors for disease, typical time of presentation, and particular organ groups affected. In addition, the authors review the noninfectious causes of fever in the solid organ transplant patient.
Collapse
Affiliation(s)
- S A Fischer
- Rush Medical College, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois, USA
| | | | | |
Collapse
|
39
|
Sasadeusz JJ, Sacks SL. Herpes latency, meningitis, radiculomyelopathy and disseminated infection. Genitourin Med 1994; 70:369-77. [PMID: 7705852 PMCID: PMC1195300 DOI: 10.1136/sti.70.6.369] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- J J Sasadeusz
- Department of Medicine, University of British Columbia Faculty of Medicine, Vancouver, Canada
| | | |
Collapse
|
40
|
Abstract
A 36 year old primigravid woman presented with a "flu-like" illness and premature labour, followed by severe pneumonitis and hepatitis in the late second trimester of pregnancy. Progressive deterioration obliged an elective delivery of twins, stillborn at 25 weeks of gestation. Herpes virus isolated from one placenta, but not from any fetal tissue, was the only indication of a systemic herpes simplex infection in which there were no mucocutaneous lesions seen before or during the illness. There was no history of herpes simplex infection and antibody studies were not helpful initially for a diagnosis that was confirmed in retrospect. Double staining for viral DNA and antigen showed that the virus was present in host monocytes.
Collapse
Affiliation(s)
- C G Fink
- Department of Clinical Virology, John Radcliffe Hospital, Headington, Oxford
| | | | | | | | | | | |
Collapse
|
41
|
Kolomiets AG, Duboiskaya GP, Gasich EL, Kolomiets ND, Votyakov VI. Peculiarities of thymus pathology in regional and generalized herpetic infections. Bull Exp Biol Med 1993. [DOI: 10.1007/bf00791177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
42
|
|
43
|
Takebe N, Yokoyama A, Akasaka Y, Ishii H, Miyaguchi S, Sata T, Hibi T, Oda M, Hata J, Tsuchiya M. Fatal herpes simplex hepatitis type 2 in a post-thymectomized adult. GASTROENTEROLOGIA JAPONICA 1993; 28:304-11. [PMID: 8486219 DOI: 10.1007/bf02779235] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The authors report an unusual case of herpes simplex type 2 (HSV) hepatitis which presented as part of a systemic HSV infection accompanied by disseminated intravascular coagulation (DIC). The patient was a 49-year-old Japanese male who three months prior to admission underwent surgical resection of his thymus for an invasive thymoma. Postoperatively, he received a course of chemotherapy which included prednisone, cyclophosphamide, vincristine, and pinorubicin. After discharge from the hospital, he was put on a maintenance dosage of prednisone and cyclophosphamide. Two weeks prior to this admission, the patient developed rhinorrhea, chills and general fatigue. Routine follow-up laboratory tests revealed markedly elevated liver enzymes which led to his immediate hospitalization. The tentative diagnosis on admission was fulminant hepatitis with DIC. The patient's condition steadily worsened during his hospitalization and acyclovir was initiated on the 4th hospital day due to the possibility of HSV hepatitis. He died on the same day. Histopathology performed on the liver at autopsy revealed hepatic inclusion bodies of HSV with positive immunohistochemical detection of the HSV type 2 antigen. Our case is the first report of HSV hepatitis associated with the removal of the thymus secondary to thymoma. It supports previous observations of disseminated HSV infection being prevalent in those patients with disorders of cell mediated immunity.
Collapse
Affiliation(s)
- N Takebe
- Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Japan
| | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
|
45
|
Abstract
Herpes simplex virus (HSV) hepatitis is rare in adults, usually occurring in immunocompromised individuals and in otherwise healthy women in the third trimester of pregnancy. Three cases of HSV hepatitis occurring in pregnant women were diagnosed at our institution between 1981 and 1990. This diagnosis was not suspected clinically, and in each case was made on the basis of histology, immunoperoxidase studies, and viral cultures of liver tissue. Clinically, the patients had severe anicteric liver failure with markedly elevated serum aspartate aminotransferase and alanine aminotransferase levels; two of the three patients died. None had mucocutaneous lesions at the time of diagnosis. Histologically, two distinct patterns of necrosis and inflammation were seen. Two of the cases had well-demarcated foci of necrosis scattered randomly throughout the lobules with neutrophilic infiltration, giving the impression of abscess formation. Hepatocytes at the periphery of these areas of necrosis had enlarged nuclei with "ground-glass" inclusions; however, no Cowdry type A inclusions were seen. Rare multinucleated cells were present. Immunoperoxidase staining using antibodies to HSV was positive primarily in the hepatocytes with inclusions. The third case had diffuse, almost total hepatic necrosis with no viral inclusions and virtually no inflammatory response. This histologic pattern is similar to that seen in neonates with HSV infection. Immunoperoxidase studies in this case were negative; however, viral cultures were positive. While HSV hepatitis may be suspected or diagnosed on the basis of histology alone, viral cultures are an important adjunct since viral inclusions may be absent. Prompt diagnosis is important since antiviral therapy is now available.
Collapse
Affiliation(s)
- S M Jacques
- Department of Pathology, Hutzel Hospital, Detroit, MI 48201
| | | |
Collapse
|
46
|
Miyazaki Y, Akizuki S, Sakaoka H, Yamamoto S, Terao H. Disseminated infection of herpes simplex virus with fulminant hepatitis in a healthy adult. A case report. APMIS 1991; 99:1001-7. [PMID: 1659835 DOI: 10.1111/j.1699-0463.1991.tb01292.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
An autopsy case of fulminant hepatitis caused by herpes simplex virus type 1 in a healthy adult is presented. The clinical course was characterized by hepatic failure, disseminated intravascular coagulation and acute renal failure. Many small ulcerations were present in the tongue and tonsils, and there were foci of hemorrhagic necrosis in the liver. Herpes simplex viral antigen was identified in the liver, tonsils, spleen, tongue, pharynx, larynx, esophagus, stomach, intestine, adrenal glands, and lymph nodes with immunohistochemical staining using antibodies to herpes simplex virus type 1. The electron microscopic examination revealed many virions in the hepatocytes. Herpes simplex virus was isolated from the liver, and viral DNA, which had some distinctive features of herpes simplex virus type 1, was examined. We discuss possible reasons for this opportunistic infection occurring in a healthy adult.
Collapse
Affiliation(s)
- Y Miyazaki
- Department of Pathology, Medical College of Oita, Japan
| | | | | | | | | |
Collapse
|
47
|
Kusne S, Schwartz M, Breinig MK, Dummer JS, Lee RE, Selby R, Starzl TE, Simmons RL, Ho M. Herpes simplex virus hepatitis after solid organ transplantation in adults. J Infect Dis 1991; 163:1001-7. [PMID: 1850439 PMCID: PMC2956417 DOI: 10.1093/infdis/163.5.1001] [Citation(s) in RCA: 84] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Twelve patients developed herpes simplex (HSV) hepatitis a median of 18 days after solid organ transplantation. This is earlier than cytomegalovirus hepatitis, which usually occurs 30-40 days after transplantation. Eight recipients (67%) died, and in seven, the diagnosis was made at autopsy or less than 48 h before death. Clinical manifestations associated with mortality were hypotension, disseminated intravascular coagulation (DIC), metabolic acidosis, gastrointestinal bleeding, and bacteremia. Laboratory abnormalities at diagnosis associated with mortality were high creatinine, low platelet counts, prolonged partial thromboplastin time, and a high percentage of band forms on the blood smear. Disseminated HSV disease was noted in four of six patients who had an autopsy and included involvement of lungs in three and the gastrointestinal tract in three. Five recipients developed DIC and all died. Pathologically, HSV hepatitis has two forms, focal and diffuse. All three patients with diffuse liver pathology died. However, three of seven with focal liver pathology survived with antiviral therapy, which suggests that early diagnosis and treatment may be lifesaving. None of these patients had received prophylactic acyclovir. It is possible that acyclovir prophylaxis may be able to prevent this disease.
Collapse
Affiliation(s)
- S Kusne
- Department of Medicine, Graduate School of Public Health, University of Pittsburgh, Pennsylvania 15261
| | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Generalized experimental herpes developing in guinea pigs after retrobulbar infection. Bull Exp Biol Med 1990. [DOI: 10.1007/bf00840050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
49
|
McMinn PC, Lim IS, McKenzie PE, van Deth AG, Simmons A. Disseminated herpes simplex virus infection in an apparently immunocompetent woman. Med J Aust 1989; 151:588-90, 592, 594. [PMID: 2687652 DOI: 10.5694/j.1326-5377.1989.tb101292.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
A young, previously healthy woman developed bilateral exudative tonsillitis that was associated with severe systemic symptoms. This was followed by evidence of multisystem disease with acute abdominal pain, raised liver enzyme levels, respiratory difficulty, increasing drowsiness and multiple vesicular skin lesions. Herpes simplex virus type-1 was isolated from skin lesions and a throat swab and herpes simplex virus type-1 antigen was detected in a liver biopsy sample. She recovered rapidly without any sequelae after treatment with intravenously administered acyclovir.
Collapse
Affiliation(s)
- P C McMinn
- Institute of Medical and Veterinary Science, Adelaide, SA
| | | | | | | | | |
Collapse
|
50
|
Gäbel H, Flamholc L, Ahlfors K. Herpes simplex virus hepatitis in a renal transplant recipient: successful treatment with acyclovir. SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES 1988; 20:435-8. [PMID: 3057619 DOI: 10.3109/00365548809032482] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Herpes simplex virus (HSV) hepatitis in adults is a rare and severe disease usually occurring in immunocompromised patients or pregnant women. We report on a case of primary HSV type I hepatitis in a 48-year-old male renal transplant recipient with successful outcome after acyclovir treatment.
Collapse
Affiliation(s)
- H Gäbel
- Department of Surgery, Malmö General Hospital, Sweden
| | | | | |
Collapse
|