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Reis AD, Mudinutti C, de Freitas Peigo M, Leon LL, Costallat LTL, Rossi CL, Costa SCB, Bonon SHA. Active human herpesvirus infections in adults with systemic lupus erythematosus and correlation with the SLEDAI score. Adv Rheumatol 2020; 60:42. [PMID: 32831149 DOI: 10.1186/s42358-020-00144-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 08/11/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Human herpesviruses (HHVs) are responsible for a significant number of clinical manifestations in systemic lupus erythematous (SLE) patients. The aim of this study was to determine the frequency of active HHV infections in SLE patients and correlating them with disease activity. METHODS Serum samples were collected from 71 SLE patients and their DNAs were extracted and analyzed to detect HHV-DNA viruses using the nucleic acid amplification technique. RESULTS Fifteen out of the 71 (21.1%) patients tested positive for the HHV-DNA virus. Of them, 11/15 HHV-DNA-positive patients (73.3%) had SLE activity index (SLEDAI - Systemic Lupus Erythematosus Disease Activity Index) ≥8 (p = 0.0001). Active HCMV infection was the mostly frequently observed infection, occurring in 6/15 patients (40%). The frequencies of other active viral infections were 22% for HSV-1, 16.7% for HHV-7, and 5.5% for HSV-2. Viral coinfection (two or more viruses detected in the same sample) occurred in three patients (16.7%). Active HHV infections in SLE patients are more frequent in those with active SLE (≥8), who is at high risk of HHV reactivation and HCMV disease. CONCLUSION Viral surveillance is important to identify active HHV infections that can cause clinical symptoms and other complication in SLE patients.
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Affiliation(s)
- Alex Domingos Reis
- Laboratory of Virology, School of Medical Sciences, State University of Campinas (UNICAMP), Rua Tessália Vieira de Camargo, 126, Campinas, SP, 13.083-887, Brazil
| | - Cristiane Mudinutti
- Laboratory of Virology, School of Medical Sciences, State University of Campinas (UNICAMP), Rua Tessália Vieira de Camargo, 126, Campinas, SP, 13.083-887, Brazil
| | - Murilo de Freitas Peigo
- Laboratory of Virology, School of Medical Sciences, State University of Campinas (UNICAMP), Rua Tessália Vieira de Camargo, 126, Campinas, SP, 13.083-887, Brazil
| | - Lucas Lopes Leon
- Laboratory of Virology, School of Medical Sciences, State University of Campinas (UNICAMP), Rua Tessália Vieira de Camargo, 126, Campinas, SP, 13.083-887, Brazil
| | - Lilian Tereza Lavras Costallat
- Department of Internal Medicine, Discipline of Rheumatology, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Claudio Lucio Rossi
- Department of Clinical Pathology, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Sandra Cecília Botelho Costa
- Laboratory of Virology, School of Medical Sciences, State University of Campinas (UNICAMP), Rua Tessália Vieira de Camargo, 126, Campinas, SP, 13.083-887, Brazil
| | - Sandra Helena Alves Bonon
- Laboratory of Virology, School of Medical Sciences, State University of Campinas (UNICAMP), Rua Tessália Vieira de Camargo, 126, Campinas, SP, 13.083-887, Brazil.
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Wang Y, Wang D, Tao X. Human herpesvirus 6B encephalitis in a liver transplant recipient: A case report and review of the literature. Transpl Infect Dis 2020; 23:e13403. [PMID: 32638491 PMCID: PMC7988578 DOI: 10.1111/tid.13403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 06/30/2020] [Accepted: 06/30/2020] [Indexed: 02/06/2023]
Abstract
Human herpesvirus 6B (HHV‐6B) encephalitis in a liver transplant recipient is rarely reported. In this report, we presented a case of HHV‐6B encephalitis in a liver transplant recipient and reviewed the relevant literature. A 56‐year‐old man was admitted to the intensive care unit (ICU) with an acute headache and intermittent convulsion 17 days after liver transplantation. Next‐generation sequencing (NGS) of the cerebrospinal fluid (CSF) revealed 30691 sequence reads of HHV‐6B and real‐time polymerase chain reaction (real‐time PCR) of the CSF detected HHV‐6B DNA at 12 000 copies/mL, so the patient was diagnosed with HHV‐6B encephalitis and received ganciclovir treatment promptly. The condition of the patient improved well and returned to the general ward with no neurologic deficits. This case indicated that adequate awareness, early diagnosis, and timely treatment are crucial to a good prognosis of HHV‐6B encephalitis after liver transplantation.
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Affiliation(s)
- Yinfeng Wang
- Department of Intensive Care Medicine, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230036, China
| | - Di Wang
- Department of Intensive Care Medicine, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230036, China
| | - Xiaogen Tao
- Department of Intensive Care Medicine, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230036, China
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Abstract
Human herpesvirus 6 (HHV-6A and HHV-6B) can cause primary infection or reactivate from latency in liver transplant recipients, which can result in a variety of clinical syndromes, including fever, hepatitis, encephalitis and higher rates of graft dysfunction as well as indirect effects including increased risks of mortality, CMV disease, hepatitis C progression and greater fibrosis scores. Although HHV-6 infection is currently diagnosed by quantifying viral DNA in plasma or blood, biopsy to demonstrate histopathological effects of HHV-6 remains the gold standard for diagnosis of end-organ disease. HHV-6 reactivation may be restricted to the infected organ with no evidence of active infection in the blood. HHV-6 infections in liver transplant patients are mostly asymptomatic, but clinically significant tissue-invasive infections have been treated successfully with ganciclovir, foscarnet or cidofovir. Inherited chromosomally integrated HHV-6 (ciHHV-6), in either the recipient or the donor organ, may create confusion about systemic HHV-6 infection. Recipients with inherited ciHHV-6 may have an increased risk of opportunistic infection and graft rejection. This article reviews the current scientific data on the clinical effects, risk factors, pathogenesis, diagnosis and treatment of HHV-6 infections in liver transplant recipients.
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Affiliation(s)
| | - Irmeli Lautenschlager
- Department of Virology, Helsinki University Hospital, Helsinki University, Helsinki, Finland
| | - Raymund R Razonable
- Division of Infectious Diseases, Department of Medicine and the William J von Liebig Center for Transplantation and Clinical Regeneration, College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Flor M Munoz
- Department of Pediatrics, Transplant Infectious Diseases, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
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Sultanova A, Cistjakovs M, Gravelsina S, Chapenko S, Roga S, Cunskis E, Nora-Krukle Z, Groma V, Ventina I, Murovska M. Association of active human herpesvirus-6 (HHV-6) infection with autoimmune thyroid gland diseases. Clin Microbiol Infect 2016; 23:50.e1-50.e5. [PMID: 27693656 DOI: 10.1016/j.cmi.2016.09.023] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 09/18/2016] [Accepted: 09/23/2016] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Viral infections frequently have been cited as important environmental factors implicated in the onset of autoimmune thyroiditis (AIT). The aim of this study was to determine the involvement of HHV-6 infection in the development of autoimmune thyroiditis. METHODS This study included 45 patients (42 female and 3 male; median age 47.00 IQR 38.50-57.00) with histologically, laboratory, and clinically confirmed autoimmune thyroiditis, as well as 30 autopsied subjects (26 female and 4 male; median age 58.50, IQR 51.50-67.00) without thyroid pathologies and 30 healthy blood donors (25 female and 5 male; median age 33.50, IQR 27.75-44.25) as controls. Results were obtained by applying molecular virology and immunohistochemistry techniques. RESULTS The presence of persistent HHV-6 infection in AIT patients was significantly higher (p 0.0058) than in the control group (44/45 (98%) vs. 23/30 (77%), respectively). Also, a significantly higher frequency of HHV-6 activation marker (U79/80 mRNA) was found in patients' thyroid gland tissue samples with AIT in comparison with the control group (18/44 (41%) vs. 1/17 (6%), respectively; p 0.0118). The median HHV-6 load was found to be higher in patients with active viral infection than in patients without it (2147, IQR 971-4188 vs. 551, IQR 145-1589 copies/1×106 cells; p 0.003). The presence of HHV-6 antigen expression was demonstrated in intrafollicular cellular clusters and immunohistochemistry indicated thyrocytes in the follicle wall. CONCLUSIONS These findings provide evidence of strong HHV-6 infection association with AIT development.
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Affiliation(s)
- A Sultanova
- Riga Stradiņš University, A. Kirchenstein Institute of Microbiology and Virology, Latvia.
| | - M Cistjakovs
- Riga Stradiņš University, A. Kirchenstein Institute of Microbiology and Virology, Latvia
| | - S Gravelsina
- Riga Stradiņš University, A. Kirchenstein Institute of Microbiology and Virology, Latvia
| | - S Chapenko
- Riga Stradiņš University, A. Kirchenstein Institute of Microbiology and Virology, Latvia
| | - S Roga
- Riga Stradiņš University, Study Department, Latvia
| | - E Cunskis
- Riga East Clinical University Hospital, Gailezers Clinic, Latvia
| | - Z Nora-Krukle
- Riga Stradiņš University, A. Kirchenstein Institute of Microbiology and Virology, Latvia
| | - V Groma
- Institute of Anatomy and Anthropology, Riga Stradiņš University, Riga, Latvia
| | - I Ventina
- Riga Stradiņš University, A. Kirchenstein Institute of Microbiology and Virology, Latvia
| | - M Murovska
- Riga Stradiņš University, A. Kirchenstein Institute of Microbiology and Virology, Latvia
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Thomasini RL, Pereira FSM. Impact of different types of herpesviral infections in the oral cavity. World J Stomatol 2016; 5:22-27. [DOI: 10.5321/wjs.v5.i2.22] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Revised: 11/28/2015] [Accepted: 03/23/2016] [Indexed: 02/06/2023] Open
Abstract
The herpesviruses are ubiquitous, doubled-stranded DNA viruses that can reactivate under conditions such as immunosuppressive therapy, acquired immunodeficiency syndrome, malnutrition, and immunosenescence. There are eight types of herpesviruses: Human herpesvirus simplex (HSV) type I (HSV-1) and HSV type II (HSV-2), varicella-zoster virus (VZV), epstein-Barr virus (EBV), cytomegalovirus, human herpesvirus (HHV)-6, HHV-7, and HHV-8 or Kaposi’s sarcoma herpesvirus. Some of these viruses can infect the oral cavity, leading to different types of lesions. Specifically, labial herpes (HSV-1 and less frequently HSV-2), zoster (VZV), infectious mononucleosis and oral hairy leukoplakia (EBV), and Kaposi’s Sarcoma (HHV-8) are the most common viruses infecting the oral cavity. Some of these viruses can act in synergy with other herpesviruses or as distinct infectious agents. Other herpesviruses may have indirect effects in periodontal disease. The diagnosis is frequently based on signs and symptoms and depends on the experience of the examiner. Cytopathologic and/or histopathologic examination as well as immunological methods such as ELISA could help to elucidate cases. In addition, molecular techniques which can be sensitive and specific have been reported in the literature. These methods require low amounts of sample and could offer results faster than other traditional methods.
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Kourí V, Correa C, Martínez PA, Sanchez L, Alvarez A, González G, Silverio CE, Hondal N, Florin J, Pérez L, Duran DP, Perez Y, Cazorla N, Gonzalez D, Jaime JC, Arencibia A, Sarduy S, Pérez L, Soto Y, González M, Alvarez I, Dorticós E, Marchena JJ, Solar L, Acosta B, Savón C, Hengge U. Prospective, comprehensive, and effective viral monitoring in Cuban children undergoing solid organ transplantation. SPRINGERPLUS 2014; 3:247. [PMID: 24877035 PMCID: PMC4035497 DOI: 10.1186/2193-1801-3-247] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Accepted: 05/07/2014] [Indexed: 12/30/2022]
Abstract
PURPOSE In Cuba, viral monitoring in the post-transplant period was not routinely performed. The aim of this research is to identify the most frequent viruses that affect transplanted Cuban children, by implementing a viral follow-up during the post-transplant period. METHODS The study population included all Cuban pediatric patients who underwent solid organ transplantation (SOT) between November 2009 and December 2012. A total of 34 transplanted pediatric patients of kidney (n = 11) and liver (n = 23) were prospectively monitored during a 34-week period for viral DNAemia and DNAuria by simultaneous detection of cytomegalovirus (CMV), Epstein-Barr virus, herpes simplex virus type 1 and 2, varicella zoster virus, human herpesvirus 6, human adenovirus, and polyomaviruses (BKV and JCV) using quantitative real-time polymerase chain reaction (qRT-PCR). RESULTS Viral genome of at least one virus was detected in 21 of 34 recipients, 18 patients excreted virus in urine while 12 presented DNAemia. CMV (41.2%) and BKV (35.3%) were the most frequent viruses detected during the follow-up. CMV was the virus mainly associated with clinical symptoms and DNAemia. Its excretion in urine (with cut off value of 219 copies/mL) was associated with detection in plasma (p < 0.001); furthermore, CMV viruria was predictive of CMV viremia (OR:8.4, CI:2.4-29.1, p = 0.001). There was no association between high viral load and clinical complications, due to the prompt initiation of preemptive ganciclovir. CONCLUSION This comprehensive viral monitoring program effectively prevents the development of critical viral disease, thus urge the implementation of qRT-PCR as routine for viral monitoring of transplanted Cuban organ recipients.
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Affiliation(s)
- Vivian Kourí
- Sexually Transmitted Diseases Laboratory, Virology Department, Institute of Tropical Medicine "Pedro Kourí", Havana City, Cuba ; Virology Department, Institute of Tropical Medicine ¨Pedro Kourí¨, Autopista Novia del Mediodia Km 6., La Lisa, Havana City, Cuba
| | - Consuelo Correa
- Sexually Transmitted Diseases Laboratory, Virology Department, Institute of Tropical Medicine "Pedro Kourí", Havana City, Cuba
| | - Pedro A Martínez
- Sexually Transmitted Diseases Laboratory, Virology Department, Institute of Tropical Medicine "Pedro Kourí", Havana City, Cuba
| | - Lizet Sanchez
- Epidemiology and Statistic Department, Institute of Tropical Medicine "Pedro Kourí", Havana City, Cuba
| | - Alina Alvarez
- Sexually Transmitted Diseases Laboratory, Virology Department, Institute of Tropical Medicine "Pedro Kourí", Havana City, Cuba
| | - Grehete González
- Respiratory Viruses Laboratory, Virology Department, Institute of Tropical Medicine "Pedro Kourí", Havana City, Cuba
| | - César E Silverio
- University Pediatric Hospital "William Soler", Havana City, Cuba
| | - Norma Hondal
- University Pediatric Hospital "William Soler", Havana City, Cuba
| | - Jose Florin
- University Pediatric Hospital of "Centro Habana", Havana City, Cuba
| | - Lourdes Pérez
- University Pediatric Hospital of "Centro Habana", Havana City, Cuba
| | - Diana P Duran
- University Pediatric Hospital of "Centro Habana", Havana City, Cuba
| | - Yardelis Perez
- University Pediatric Hospital of "Centro Habana", Havana City, Cuba
| | - Nancy Cazorla
- University Pediatric Hospital of "Centro Habana", Havana City, Cuba
| | | | - Juan C Jaime
- National Institute of Haematology and Immunology, Havana City, Cuba
| | | | - Sandra Sarduy
- National Institute of Haematology and Immunology, Havana City, Cuba
| | - Lissette Pérez
- Sexually Transmitted Diseases Laboratory, Virology Department, Institute of Tropical Medicine "Pedro Kourí", Havana City, Cuba
| | - Yudira Soto
- Sexually Transmitted Diseases Laboratory, Virology Department, Institute of Tropical Medicine "Pedro Kourí", Havana City, Cuba
| | - Mabel González
- University Pediatric Hospital "William Soler", Havana City, Cuba
| | - Iliana Alvarez
- University Pediatric Hospital "William Soler", Havana City, Cuba
| | - Elvira Dorticós
- National Institute of Haematology and Immunology, Havana City, Cuba
| | - Juan J Marchena
- University Pediatric Hospital of "Centro Habana", Havana City, Cuba
| | - Luis Solar
- University Pediatric Hospital of "Centro Habana", Havana City, Cuba
| | - Belsy Acosta
- Respiratory Viruses Laboratory, Virology Department, Institute of Tropical Medicine "Pedro Kourí", Havana City, Cuba
| | - Clara Savón
- Respiratory Viruses Laboratory, Virology Department, Institute of Tropical Medicine "Pedro Kourí", Havana City, Cuba
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Milan A, Sampaio AM, Guardia AC, Pavan CR, Andrade PD, Bonon SHA, Costa SCB, Ataíde EC, Boin IFSF, Stucchi RSB. Identification of bacterial infections and clinical manifestation associated with cytomegalovirus in liver transplantation patients. Transplant Proc 2013; 45:1130-2. [PMID: 23622644 DOI: 10.1016/j.transproceed.2013.02.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Liver transplantation has become the most effective therapy for the treatment of patients with end-stage liver disease. With new immunosuppressive agents the incidence of acute rejection has been significantly reduced, but infection has become a serious problem. OBJECTIVE Our objective was to correlate cytomegalovirus (CMV) positivity of antigenemia and polymerase chain reaction (PCR) with clinical manifestations and bacterial infections among patients undergoing liver transplantation. METHODS This prospective study included patients monitored for 6 months for early detection of CMV infection. Sample collections were performed at the time of surgery and weekly until the second month followed by fortnightly in the third month, and monthly in the fourth to sixth month. CMV infection was defined by positive antigenemia (>3 cells) or 2 positive PCR tests associated or not with clinical symptoms. The methodology for the diagnosis of bacterial infection was through biochemical tests and the automated VITEK/bioMérieux (identification and antibiogram) using samples of urine and blood cultures. Chi-square test was used for dicotomic variables with significant differences when P < .05. RESULTS Sixteen patients (32%) had CMV infections, including 13 (81%) with concomitant infections. Thirty-four patients (68%) did not have CMV infections and 8 of these (24%) had bacterial infection. There was a high correlation with bacterial infections among CMV-positive patients. CONCLUSION Bacterial infections after liver transplantation were associated with CMV infection.
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Affiliation(s)
- A Milan
- State University of Campinas, Campinas, Brazil
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HHV-6: Clinical and Laboratory Investigations and Correlations With Encephalitis in Liver Transplant Recipients. Transplant Proc 2013; 45:1997-9. [DOI: 10.1016/j.transproceed.2013.01.095] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Accepted: 01/24/2013] [Indexed: 11/30/2022]
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Abstract
BACKGROUND Human herpesvirus (HHV) 5 and 6 remain latent after primary infection and can be reactivated after immunosuppression for organ transplantation. An association between HHV-5 and HHV-6 has been reported in liver transplant patients. The coinfection is associated with clinical manifestations and graft dysfunction. OBJECTIVE The aim of this study was to monitor herpesviruses in liver transplant recipients to better understand issues involving coinfection with HHV-5/6 and correlations with acute cellular rejection episodes and bacterial infections. METHODS Forty-five adult liver transplant patients of median age 47 years (range, 18-66), gave blood samples and liver biopsies in the first 6 months after their surgeries. Viremia was detected with the use of nested PCR and antigenemia; the Banff classification was used to detect allograft rejection. RESULTS IgG positive for HHV-5 was observed in 94% of subjects whose main indication (67%) for transplantation was hepatitis C. Twenty-three (51.1%) displayed cytomeg virus (CMV) infections and 12 (26.7%) HHV-6 infection. There were 6 patients (13.3%) with HHV-5/6 coinfections. Eighteen of the 23 patients had CMV disease, showing a strong correlation between a positive test and CMV disease; 6 displayed an acute cellular rejection episode in the same period (χ(2) = 6.62; P < .03). Four out of 6 patients who displayed coinfections (HHV-5/6) had concomitant bacterial infections; 3/6 experienced graft rejection episodes. During follow-up, 1 patient had HHV-6 infection diagnosed as encephalitis followed by fever on the 24th day after surgery. The median 32 days for HHV-6 detection by nested PCR positivity was shorter than 38 days for HHV-5. CONCLUSIONS HHV-5/6-infected patients displayed more allograft rejection episodes, coinfections, and concomitant bacterial infections, besides an higher risk for CMV disease.
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Rocha-e-Silva M. Molecular and genetic aspects of oncology and infectology in Clinics. Clinics (Sao Paulo) 2012; 67:1353-6. [PMID: 23295585 PMCID: PMC3521794 DOI: 10.6061/clinics/2012(12)01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Abstract
One common sign of human cytomegalovirus infection is altered liver function. Murine cytomegalovirus strain v70 induces a rapid and severe hepatitis in immunocompetent mice that requires the presence of T cells in order to develop. v70 exhibits approximately 10-fold-greater virulence than the commonly used strain K181, resulting in a more severe, sustained, and lethal hepatitis but not dramatically higher viral replication levels. Hepatitis and death are markedly delayed in immunodeficient SCID compared to immunocompetent BALB/c mice. Transfer of BALB/c splenocytes to SCID mice conferred rapid disease following infection, and depletion of either CD4 or CD8 T cells in BALB/c mice reduced virus-induced hepatitis. The frequency of CD8 T cells producing gamma interferon and tumor necrosis factor in response to viral antigen was higher in settings where more severe disease occurred. Thus, virus-specific effector CD8 T cells appear to contribute to lethal virus-induced hepatitis, contrasting their protective role during sublethal infection. This study reveals how protection and disease during cytomegalovirus infection depend on viral strain and dose, as well as the quality of the T cell response.
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Human herpesvirus 6 in donor biopsies associated with the incidence of clinical cytomegalovirus disease and hepatitis C virus recurrence. Int J Infect Dis 2012; 16:e124-9. [DOI: 10.1016/j.ijid.2011.10.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2011] [Revised: 10/17/2011] [Accepted: 10/22/2011] [Indexed: 11/21/2022] Open
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