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Villar LM, da Silva LL, do Lago BV, Pereira JG, Guimarães ACS, Mello FCDA, de Paula VS. Could Herpesviridae be the cause of severe acute hepatitis of unknown origin in children? Expert Rev Anti Infect Ther 2024; 22:5-17. [PMID: 38224018 DOI: 10.1080/14787210.2024.2304637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 01/09/2024] [Indexed: 01/16/2024]
Abstract
INTRODUCTION Severe acute hepatitis (SAH) is defined by a severe inflammation of hepatocytes in the liver parenchyma which can lead to an acute liver failure, a clinical condition with high mortality rate that can be triggered by several factors but is usually associated to hepatotropic viruses' infection. In 2022, cases of children with severe acute hepatitis of unknown origin hospitalized in Glasgow, Scotland, were reported. Possible causes of this condition include, but are not limited to, undiagnosed viral (and non-viral) infections, autoimmune hepatitis, drug and/or chemical toxicity, mitochondrial chain respiratory and metabolic disorders. AREAS COVERED Herpesviruses can cause severe acute hepatitis, but little is known about the role and the mechanisms of herpesviruses as a causative agent of this type of hepatitis. We review the role of herpesviruses as causative agent of SAH in children and other possible mechanisms involved in this disease. EXPERT OPINION Differential diagnosis for herpesvirus in SAH should be implemented in all settings. Alternative fluids, such as saliva and dried blood, could be used in the diagnosis to overwhelm the availability of biological specimens at sufficient volume. In the future, genetic studies could also be added to increase the knowledge about severe acute hepatitis in children.
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Affiliation(s)
- Livia Melo Villar
- Viral Hepatitis Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Lucas Lima da Silva
- Viral Hepatitis Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Barbara Vieira do Lago
- Viral Hepatitis Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Jessica Gonçalves Pereira
- Laboratory of Molecular Virology and Parasitology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Ana Carolina Silva Guimarães
- Laboratory of Molecular Virology and Parasitology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | | | - Vanessa Salete de Paula
- Laboratory of Molecular Virology and Parasitology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
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Echenique JVZ, Gris AH, Camargo LJ, De Lorenzo C, Bertolini M, Barbosa FMS, Ansolch M, Canal CW, Panziera W, Pavarini SP, Sonne L. Fatal Simplexvirus humanalpha1 infection in howler-monkeys (Alouatta sp.) under human care: Clinical, molecular, and pathological findings. J Med Primatol 2023; 52:392-399. [PMID: 37602976 DOI: 10.1111/jmp.12670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/03/2023] [Accepted: 08/07/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND Simplexvirus humanalpha1 (HuAHV-1) are common anthropozoonosis reported in marmosets but rare in howler monkeys (Alouatta sp.). METHODS Necropsy of two brown-howler monkeys (A. caraya) and one red-howler monkey (A. guariba clamitans) from different zoo collections were performed. Fragments of all organs were examined through microscopy. Samples were submitted to IHC for Simplexvirus humanalpha 2 (HuAHV-2) [sin. Herpesvirus simplex type 2] and PCR. RESULTS Grossly, only the A. guariba showed liver lesions characterized by multifocal, pinpoint white areas corresponding microscopically as random necrotizing herpetic hepatitis and ulcerative glossitis. Both A. caraya showed necrotizing meningoencephalitis with Cowdry A-type body inclusions within neurons and astrocytes. Immunolabeling for HuAHV-1/2 was observed in the tongue, liver, and brain. HuAHV-1 was confirmed in all samples by PCR, Sanger sequencing, and phylogenetic analyses. CONCLUSION Necrotizing meningoencephalitis was appreciated in 2/3 of animals, and it is associated with neurologic signs. Along with ulcerative glossitis, a hallmark lesion in marmosets, it was present in one animal. Regarding herpetic hepatitis, it is not frequent in monkeys and occurs mainly in immunocompromised animals. HuAHV-1 infection was confirmed corroborating with a human source. This is the second report on captive black-howler monkeys and the first gross, histologic, immunohistochemical, and molecular description of herpetic hepatitis and ulcerative glossitis in red-howler monkeys (A. guariba).
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Affiliation(s)
- Joanna V Z Echenique
- Setor de Patologia Veterinária, Departamento de Patologia Clínica Veterinária, Faculdade de Veterinária, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Anderson H Gris
- Setor de Patologia Veterinária, Departamento de Patologia Clínica Veterinária, Faculdade de Veterinária, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Laura J Camargo
- Laboratório de Virologia Veterinária, Faculdade de Veterinária, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Cíntia De Lorenzo
- Setor de Patologia Veterinária, Departamento de Patologia Clínica Veterinária, Faculdade de Veterinária, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Marianna Bertolini
- Setor de Patologia Veterinária, Departamento de Patologia Clínica Veterinária, Faculdade de Veterinária, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Franscisca M S Barbosa
- Setor de Patologia Veterinária, Departamento de Patologia Clínica Veterinária, Faculdade de Veterinária, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Moira Ansolch
- Mantenedor de Fauna Arca de Noé (MFAN), Morro Reuter, Brazil
| | - Cláudio W Canal
- Laboratório de Virologia Veterinária, Faculdade de Veterinária, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Welden Panziera
- Setor de Patologia Veterinária, Departamento de Patologia Clínica Veterinária, Faculdade de Veterinária, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Saulo P Pavarini
- Setor de Patologia Veterinária, Departamento de Patologia Clínica Veterinária, Faculdade de Veterinária, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Luciana Sonne
- Setor de Patologia Veterinária, Departamento de Patologia Clínica Veterinária, Faculdade de Veterinária, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Ebrahim MA, Zaher EA, Patel P, Alvi MS. Cause or Coincidence: A Case of Necrotizing Pancreatitis in the Setting of Herpes Simplex Virus Infection. Cureus 2023; 15:e51028. [PMID: 38264395 PMCID: PMC10805061 DOI: 10.7759/cureus.51028] [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: 12/23/2023] [Indexed: 01/25/2024] Open
Abstract
This study explores a rare occurrence of acute pancreatitis induced by herpes simplex virus (HSV) in an immunocompetent adult. The patient, initially diagnosed with pancreatitis presumed to be gallstone-related, exhibited persistent symptoms and elevated lipase levels. Endoscopic ultrasound revealed necrotizing pancreatitis without stones, prompting suspicion of an atypical cause. Subsequent serology confirmed acute HSV infection. This case underscores the importance of considering viral etiologies in atypical pancreatitis cases, especially when hepatitis coexists. The study contributes to the limited literature on HSV-induced pancreatitis in immunocompetent individuals, emphasizing the significance of early recognition and appropriate management in the absence of typical risk factors.
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Affiliation(s)
| | - Eli A Zaher
- Internal Medicine, Ascension Saint Joseph Hospital, Chicago, USA
| | - Parth Patel
- Internal Medicine, Ascension Saint Joseph Hospital, Chicago, USA
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Frapard T, Amaddeo G, Decavele M, Abback PS, Gaillet A, Bouzbib C, Vanlemmens C, Younan R, Canet E, Moreau AS, Neuville M, Azoulay E, Sitbon A, Mokart D, Radenne S, Abergel A, Guichon C, Roux O, Bonadona A, Mekontso Dessap A, De Jong A, Dumortier J, de Prost N. Herpes Simplex Virus Hepatitis in Patients Requiring Intensive Care Unit Admission: A Retrospective, Multicenter, Observational Study. Open Forum Infect Dis 2023; 10:ofad484. [PMID: 37942463 PMCID: PMC10629341 DOI: 10.1093/ofid/ofad484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 09/27/2023] [Indexed: 11/10/2023] Open
Abstract
The clinical features and short-term prognosis of patients admitted to the intensive care unit for herpes hepatitis are lacking. Of 33 patients admitted between 2006 and 2022, 22 were immunocompromised, 4 were pregnant women, and 23 died. Sixteen patients developed a hemophagocytic syndrome. Acyclovir was initiated a median (interquartile range) of 1 (0-3) day after admission.
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Affiliation(s)
- Thomas Frapard
- Assistance Publique—Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, DHU ATVB, Service de Médecine Intensive Réanimation,Créteil, France
- Université Paris Est Créteil, Faculté de Médecine de Créteil, Institut Mondor de Recherche Biomédicale—Groupe de Recherche Clinique CARMAS,Créteil, France
| | - Giuliana Amaddeo
- Assistance Publique—Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, Service d’Hépatologie,Créteil, France
| | - Maxens Decavele
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique,Paris, France
- Groupe Hospitalier Universitaire APHP-Sorbonne Université, Site Pitié-Salpêtrière, Service de Médecine Intensive et Réanimation (Département R3S),Paris, France
| | - Paer-Selim Abback
- Département Anesthésie Réanimation, Université de Tours, CHU de Tours, Tours, France
| | - Antoine Gaillet
- Assistance Publique—Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, DHU ATVB, Service de Médecine Intensive Réanimation,Créteil, France
- Université Paris Est Créteil, Faculté de Médecine de Créteil, Institut Mondor de Recherche Biomédicale—Groupe de Recherche Clinique CARMAS,Créteil, France
| | - Charlotte Bouzbib
- Assistance Publique—Hôpitaux de Paris, Hôpitaux Universitaires Pitié Salpêtrière, Service d’Hépatologie,Paris, France
| | - Claire Vanlemmens
- Centre Hospitalier Universitaire Jean Minjoz, Service d’Hépatologie et Soins Intensifs Digestifs,Besançon, France
| | - Romy Younan
- Assistance Publique—Hôpitaux de Paris, Hôpital Universitaire Saint Louis, Service de Médecine Intensive Réanimation,Paris, France
| | - Emmanuel Canet
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, France
- Université de Nantes, Nantes, France
| | - Anne Sophie Moreau
- Centre Hospitalier Universitaire de Lille, Service de Réanimation Médicale,Lille, France
| | | | - Elie Azoulay
- Assistance Publique—Hôpitaux de Paris, Hôpital Universitaire Saint Louis, Service de Médecine Intensive Réanimation,Paris, France
| | - Alexandre Sitbon
- Assistance Publique—Hôpitaux de Paris, Hôpitaux Universitaires Pitié Salpêtrière, Service de Réanimation Chirurgicale,Paris, France
| | - Djamel Mokart
- Institut Paoli-Calmettes, Service de Réanimation Polyvalente,Marseille, France
| | - Sylvie Radenne
- Hospices Civils de Lyon, Hôpital de la Croix-Rousse, Service d’Hépato-Gastroentérologie,Lyon, France
| | - Armand Abergel
- Centre Hospitalier Universitaire de Clermont-Ferrand, Service d’Hépato-Gastroentérologie,Clermont-Ferrand, France
| | - Céline Guichon
- Hospices Civils de Lyon, Hôpital de la Croix-Rousse, Service d’Anesthésie-Réanimation,Lyon, France
| | - Olivier Roux
- Assistance Publique—Hôpitaux de Paris, Hôpital Beaujon, Service d’Hépatologie,Clichy, France
| | - Agnes Bonadona
- Service d’Hépatologie et Greffe, Pôle Digidune, CHU Grenoble Alpes,La Tronche, France
| | - Armand Mekontso Dessap
- Assistance Publique—Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, DHU ATVB, Service de Médecine Intensive Réanimation,Créteil, France
- Université Paris Est Créteil, Faculté de Médecine de Créteil, Institut Mondor de Recherche Biomédicale—Groupe de Recherche Clinique CARMAS,Créteil, France
| | - Audrey De Jong
- PhyMedExp, Montpellier University, INSERM, CNRS, CHU de Montpellier, Montpellier, France
- Department of Anesthesia and Intensive Care Unit, St-Eloi Hospital, Montpellier, France
| | - Jerome Dumortier
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service d’Hépato-Gastroentérologie,Lyon, France
- Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Nicolas de Prost
- Assistance Publique—Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, DHU ATVB, Service de Médecine Intensive Réanimation,Créteil, France
- Université Paris Est Créteil, Faculté de Médecine de Créteil, Institut Mondor de Recherche Biomédicale—Groupe de Recherche Clinique CARMAS,Créteil, France
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Shionoya K, Kako M, Masuda S, Makazu M, Koizumi K. Acute liver failure due to herpes simplex viral hepatitis diagnosed by skin lesions and blood tests: a case report. J Med Case Rep 2023; 17:338. [PMID: 37559160 PMCID: PMC10413703 DOI: 10.1186/s13256-023-04083-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 07/16/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND The incidence of acute liver failure from herpes simplex virus is rare. CASE PRESENTATION A 71-year-old Japanese man was diagnosed with acute liver failure and was transferred to our hospital. Steroid therapy, plasma exchange, and hemodiafiltration were started for liver failure, and antimicrobial therapy was initiated for pneumonia. Staphylococcus epidermidis was detected in blood culture. Skin rash appeared; a positive anti-herpes simplex virus result led to the diagnosis of acute liver failure from herpes simplex virus. Hence, acyclovir was started. After blood tests improved, treatments for acute liver failure were discontinued. Antimicrobial therapy was continued; however, he died. In this case, persistent bacteremia and drug-induced liver damage due to acyclovir may have contributed to his death. CONCLUSIONS Acute liver failure can lead to complications and death. Thus, careful observation is crucial, even if the patient has shown some improvements.
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Affiliation(s)
- Kento Shionoya
- Shonan Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Okamoto 1370-1, Kamakura-Shi, Kanagawa, 247-8533, Japan.
| | - Makoto Kako
- Shonan Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Okamoto 1370-1, Kamakura-Shi, Kanagawa, 247-8533, Japan
| | - Sakue Masuda
- Shonan Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Okamoto 1370-1, Kamakura-Shi, Kanagawa, 247-8533, Japan
| | - Makomo Makazu
- Shonan Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Okamoto 1370-1, Kamakura-Shi, Kanagawa, 247-8533, Japan
| | - Kazuya Koizumi
- Shonan Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Okamoto 1370-1, Kamakura-Shi, Kanagawa, 247-8533, Japan
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Azeem A, Baartman B, Conrady CD, Meier JL, El-Herte R. Herpes simplex virus dissemination with necrotizing hepatitis following Descemet membrane endothelial keratoplasty. BMC Infect Dis 2023; 23:465. [PMID: 37438705 DOI: 10.1186/s12879-023-08414-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 06/21/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Corneal transplants are the most common type of transplant and increasing in frequency. Donor cornea tissues are a rare source of herpes simplex virus (HSV) transmission and not routinely tested for presence of HSV. Donor graft-to-recipient transmission typically causes graft failure and anterior uveitis, and extra-ocular HSV disease has not been previously reported. We present a case of HSV transmission from donor cornea tissue that nearly cost the corneal transplant recipient his life. CASE REPORT An elderly immunocompetent man developed an acute illness 10 days after having donor corneal tissue implanted in a Descemet membrane endothelial keratoplasty (DMEK). He was found to have HSV necrotizing hepatitis per liver biopsy, trilineage cytopenia, rhabdomyolysis, acute kidney failure, altered mental status, early-stage hemophagocytic lymphohistiocytosis (HLH), and donor corneal tissue implant infection resulting in graft failure and anterior uveitis. HSV DNA was detected in cerebral spinal fluid, peripheral blood, explanted donor corneal tissue, and anterior chamber fluid (220 million HSV DNA copies per mL). HSV-1 seroconversion denoted a primary HSV infection, and the patient had no other risk factor for HSV acquisition. Early recognition of HSV dissemination prompting treatment with intravenous acyclovir, as well as a short course of HLH-directed therapy, resolved the systemic illness. Vision was restored to near normal by replacement of the infected corneal graft with new donor DMEK tissue in conjunction with intravitreal foscarnet treatment. CONCLUSION Awareness of the potential risk of donor cornea tissue transmitting HSV and leading to life-threatening HSV disease is paramount to early diagnosis and treatment. The role of donor cornea tissue in HSV transmission and disease merits additional attention and investigation.
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Affiliation(s)
- Ahad Azeem
- Department of Medicine, Creighton University School of Medicine and CHI Health, Omaha, NE, 68105, USA
| | | | - Christopher D Conrady
- Departments of Ophthalmology, Pathology, and Microbiology, Medical Center, University of Nebraska, Omaha, NE, 68198, USA
| | - Jeffery L Meier
- Iowa City Veterans Affairs Health Care System, Iowa City, IA, 52246, USA.
- Division of Infectious Diseases, Department of Internal Medicine, Department of Epidemiology, College of Public Health, University of Iowa Carver College of Medicine, Iowa City, IA, 52242, USA.
| | - Rima El-Herte
- Division of Infectious Diseases, Department of Medicine, Creighton University School of Medicine and CHI Health, Omaha, NE, 68124, USA.
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Herpes Simplex Virus and Varicella Zoster Virus Infections in Cancer Patients. Viruses 2023; 15:v15020439. [PMID: 36851652 PMCID: PMC9961783 DOI: 10.3390/v15020439] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 01/28/2023] [Accepted: 02/03/2023] [Indexed: 02/08/2023] Open
Abstract
Herpes simplex virus (HSV) and varicella zoster virus (VZV) are alpha herpesviruses that establish life-long latent infection in neuronal ganglia after primary infection. Periodic reactivation of these viruses results in recurrent infections that can have significant impact on patients' quality of life. HSV commonly causes oral and genital mucocutaneous infections whereas VZV is responsible for varicella/chickenpox and herpes zoster/shingles, but cancer patients are at particularly higher risk of complications including disseminated and visceral infections due to impaired cell-mediated immunity. While diagnosis of more common HSV and/or VZV infections is frequently clinically based, immunocompromised hosts may have atypical skin presentation or visceral involvement. Thus, diagnostic confirmation using virus-specific tests such as polymerase chain reaction or immunohistochemical staining is crucial in some cases. Oral acyclovir, valacyclovir and famciclovir are usually used for mild to moderate infections and intravenous acyclovir is the drug of choice for severe or disseminated infections. Foscarnet can be used when acyclovir-resistance is confirmed or suspected. Pharmaceutical prophylaxis against HSV and/or VZV should be considered in high-risk cancers patients. Currently, there is no commercially available vaccine against HSV, but VZV vaccines are available to prevent varicella and zoster.
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8
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[(Rare) infectious hepatitis as an important differential diagnosis of unclear hepatopathy]. PATHOLOGIE (HEIDELBERG, GERMANY) 2023; 44:53-62. [PMID: 36456751 PMCID: PMC9877095 DOI: 10.1007/s00292-022-01167-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/02/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND Liver biopsies to determine the cause of unclear hepatopathy and acute liver failure represent a diagnostic hallmark and require close cooperation between clinicians and pathologists. The commonly acute presentation of hepatic dysfunction warrants a rapid diagnosis. Infectious causes of hepatitis may be identified by the pathologist, supporting further diagnostic and therapeutic steps. OBJECTIVES Rare infectious causes of hepatic dysfunction with distinct histomorphological features are presented. MATERIALS AND METHODS Retrospective cases of liver biopsies for evaluation of hepatic dysfunction with infection confirmed by laboratory tests were selected from the archive of the institute of pathology of TUM and evaluated for morphologic diagnostic criteria. RESULTS AND CONCLUSIONS Infections with adenovirus, Herpes simplex virus, Hepatitis A virus, and coxiella burnettii are rare findings in liver core biopsies but able to cause hepatic dysfunction that present with distinct histomorphologic alterations that can contribute to the identification of the causative agent. Rare infectious causes should be considered in any patient presenting with hepatic dysfunction of unknown etiology. Knowledge of the histomorphologic criteria by the pathologist is crucial to initiate further diagnostic testing and treatment.
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9
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Kim M, Jalal A, Rubio-Gomez H, Bromberg R. A case report of severe systemic herpes simplex virus-1 (HSV-1) infection with multi-organ involvement after a course of oral corticosteroid treatment. BMC Infect Dis 2022; 22:817. [DOI: 10.1186/s12879-022-07815-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 10/26/2022] [Indexed: 11/06/2022] Open
Abstract
Abstract
Background
Herpes simplex virus (HSV) rarely causes organ-invasive infection. Diagnosis and treatment for such infections are often delayed, and mortality is high. We present the first reported case of disseminated HSV-1 infection in an adult causing liver failure, myocarditis, and encephalitis in a patient who recovered after receiving parenteral acyclovir treatment.
Case presentation
A 46-year-old female presented with fever, chills, and malaise after 2 weeks of oral corticosteroid treatment for uveitis. She was diagnosed with disseminated HSV-1 infection with multi-organ involvement causing hepatitis, encephalitis, and myocarditis. Diagnosis was made timely using serum polymerase chain reaction (PCR) for HSV DNA and the patient was given intravenous acyclovir treatment promptly, which led to her survival without significant morbidity.
Conclusions
Clinicians should have a low threshold for suspecting HSV infection and ordering HSV PCR to decrease morbidity and mortality when there is a high clinical suspicion of systemic HSV infection with multi-organ involvement. Serum PCR for HSV DNA is an excellent modality for an initial diagnostic approach. Further research is warranted to elucidate causality between a course of corticosteroid therapy and systemic HSV-1 infection without major immunosuppressive comorbidities or treatments.
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Ledgerwood C, Villgran V, Mardirossian N, Dumont T, DiSilvio B. Acute Liver Failure. Crit Care Nurs Q 2022; 45:248-257. [PMID: 35617091 DOI: 10.1097/cnq.0000000000000409] [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: 11/26/2022]
Abstract
Acute liver failure (ALF) is a rare but life-threatening disease process that can result in rapidly progressive encephalopathy, elevated intracranial pressure, and multiorgan failure. In the United States, the 2 most common causes of ALF in the intensive care unit (ICU) are acetaminophen overdose and hypoxic-ischemic hepatopathy. Less common causes of ALF include alcoholic hepatitis, nonacetaminophen drug-induced liver injury, acute viral hepatitis, Wilson's disease, autoimmune hepatitis, and acute fatty liver of pregnancy. Unfortunately, there are many cases in which the cause of liver failure is indeterminate. ALF is an ICU emergency that requires close monitoring, extensive workup to determine etiology, frequent support of hemodynamic, respiratory, and renal function, administration of targeted therapies depending on the cause, utilization of N-acetylcysteine if appropriate, and consideration for liver transplant in select cases. The primary objective of this article is to define, diagnose, and detail the management of ALF in an ICU setting.
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Affiliation(s)
- Chelsea Ledgerwood
- Division of Pulmonary and Critical Care Medicine, Allegheny Health Network, Pittsburgh, Pennsylvania (Drs Ledgerwood, Villgran, Dumont, and DiSilvio); and Department of Nursing, Allegheny Health Network, Allegheny General Hospital, Pittsburgh, Pennsylvania (Mr Mardirossian)
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11
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Hoornaert E, Yombi JC, Coubeau L, Baldin P, Dahlqvist G, Yildiz H. Liver hypodense infectious lesions: Is it only bacteria, parasites or fungi? Clin Res Hepatol Gastroenterol 2022; 46:101872. [PMID: 35131509 DOI: 10.1016/j.clinre.2022.101872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/26/2022] [Accepted: 01/28/2022] [Indexed: 02/04/2023]
Affiliation(s)
- E Hoornaert
- Department of Internal Medicine and Infectious Diseases, Cliniques Universitaires Saint-Luc, 10 Avenue Hippocrate 1200 Woluwe Saint Lambert, Brussels, Belgium.
| | - J C Yombi
- Department of Internal Medicine and Infectious Diseases, Cliniques Universitaires Saint-Luc, 10 Avenue Hippocrate 1200 Woluwe Saint Lambert, Brussels, Belgium
| | - L Coubeau
- Department of Surgery and Abdominal Organ Transplantation, Cliniques Universitaires Saint-Luc, 10 Avenue Hippocrate 1200 Woluwe Saint Lambert, Brussels, Belgium
| | - P Baldin
- Department of Pathology, Cliniques Universitaires Saint-Luc, 10 Avenue Hippocrate 1200 Woluwe Saint Lambert, Brussels, Belgium
| | - G Dahlqvist
- Department of Hepatology, Cliniques Universitaires Saint-Luc, 10 Avenue Hippocrate 1200 Woluwe Saint Lambert, Brussels, Belgium
| | - H Yildiz
- Department of Internal Medicine and Infectious Diseases, Cliniques Universitaires Saint-Luc, 10 Avenue Hippocrate 1200 Woluwe Saint Lambert, Brussels, Belgium
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12
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Liou JW, Mani H, Yen JH. Viral Hepatitis, Cholesterol Metabolism, and Cholesterol-Lowering Natural Compounds. Int J Mol Sci 2022; 23:ijms23073897. [PMID: 35409259 PMCID: PMC8999150 DOI: 10.3390/ijms23073897] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 03/27/2022] [Accepted: 03/30/2022] [Indexed: 11/24/2022] Open
Abstract
Hepatitis is defined as inflammation of the liver; it can be acute or chronic. In chronic cases, the prolonged inflammation gradually damages the liver, resulting in liver fibrosis, cirrhosis, and sometimes liver failure or cancer. Hepatitis is often caused by viral infections. The most common causes of viral hepatitis are the five hepatitis viruses—hepatitis A virus (HAV), hepatitis B virus (HBV), hepatitis C virus (HCV), hepatitis D virus (HDV), and hepatitis E virus (HEV). While HAV and HEV rarely (or do not) cause chronic hepatitis, a considerable proportion of acute hepatitis cases caused by HBV (sometimes co-infected with HDV) and HCV infections become chronic. Thus, many medical researchers have focused on the treatment of HBV and HCV. It has been documented that host lipid metabolism, particularly cholesterol metabolism, is required for the hepatitis viral infection and life cycle. Thus, manipulating host cholesterol metabolism-related genes and proteins is a strategy used in fighting the viral infections. Efforts have been made to evaluate the efficacy of cholesterol-lowering drugs, particularly 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors, in the treatment of hepatitis viral infections; promising results have been obtained. This review provides information on the relationships between hepatitis viruses and host cholesterol metabolism/homeostasis, as well as the discovery/development of cholesterol-lowering natural phytochemicals that could potentially be applied in the treatment of viral hepatitis.
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Affiliation(s)
- Je-Wen Liou
- Department of Biochemistry, School of Medicine, Tzu Chi University, Hualien 97004, Taiwan;
- Institute of Medical Sciences, Tzu Chi University, Hualien 97004, Taiwan;
| | - Hemalatha Mani
- Institute of Medical Sciences, Tzu Chi University, Hualien 97004, Taiwan;
| | - Jui-Hung Yen
- Institute of Medical Sciences, Tzu Chi University, Hualien 97004, Taiwan;
- Department of Molecular Biology and Human Genetics, Tzu Chi University, Hualien 97004, Taiwan
- Correspondence: or ; Tel.: +886-3-856-5301 (ext. 2683)
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13
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Gupta M, Manek G, Dombrowski K, Maiwall R. Newer developments in viral hepatitis: Looking beyond hepatotropic viruses. World J Meta-Anal 2021; 9:522-542. [DOI: 10.13105/wjma.v9.i6.522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 09/09/2021] [Accepted: 12/08/2021] [Indexed: 02/06/2023] Open
Abstract
Viral hepatitis in the entirety of its clinical spectrum is vast and most discussion are often restricted to hepatotropic viral infections, including hepatitis virus (A to E). With the advent of more advanced diagnostic techniques, it has now become possible to diagnose patients with non-hepatotropic viral infection in patients with hepatitis. Majority of these viruses belong to the Herpes family, with characteristic feature of latency. With the increase in the rate of liver transplantation globally, especially for the indication of acute hepatitis, it becomes even more relevant to identify non hepatotropic viral infection as the primary hepatic insult. Immunosuppression post-transplant is an established cause of reactivation of a number of viral infections that could then indirectly cause hepatic injury. Antiviral agents may be utilized for treatment of most of these infections, although data supporting their role is derived primarily from case reports. There are no current guidelines to manage patients suspected to have viral hepatitis secondary to non-hepatotropic viral infection, a gap that needs to be addressed. In this review article, the authors analyze the common non hepatotropic viral infections contributing to viral hepatitis, with emphasis on recent advances on diagnosis, management and role of liver transplantation.
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Affiliation(s)
- Manasvi Gupta
- Department of Internal Medicine, University of Connecticut, Farmington, CT 06030, United States
| | - Gaurav Manek
- Department of Pulmonology and Critical Care, Cleveland Clinic, Cleveland, OH 44195, United States
| | - Kaitlyn Dombrowski
- Department of Internal Medicine, University of Connecticut, Farmington, CT 06030, United States
| | - Rakhi Maiwall
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi 110070, India
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14
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Ehwarieme R, Agarwal AN, Alkhateb R, Bowling JE, Anstead GM. A Surprising Cause of Liver Abscesses in a Post-Chemotherapy Patient: Herpes Simplex Virus. Cureus 2021; 13:e17744. [PMID: 34659957 PMCID: PMC8491800 DOI: 10.7759/cureus.17744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2021] [Indexed: 11/15/2022] Open
Abstract
Herpes simplex virus (HSV) hepatitis is a rare complication of HSV infection, and a rare cause of hepatitis. It is often fatal, especially if the diagnosis and treatment are delayed. Herein, we describe the case of a 31-year-old female with a history of receiving cytotoxic cancer chemotherapy five months prior who presented with a one-week history of worsening abdominal pain and fever. She was noted to have an outbreak of genital herpes at the time of presentation. Computed tomography (CT) scan of the abdomen showed innumerable hypodensities compatible with hepatic micro-abscesses. A specimen from a subsequent liver biopsy revealed HSV-type cytopathic changes and nuclear staining with an anti-HSV immunohistochemical stain. She was initially started on high-dose oral valacyclovir for genital herpes and was noted to have rapid clinical improvement prior to the histopathologic diagnosis of HSV hepatitis. She achieved full recovery while on oral valacyclovir. This is the first reported case of HSV hepatitis treated with oral valacyclovir and the third reported case of HSV hepatitis mimicking pyogenic abscesses on abdominal imaging. With the high mortality rate associated with HSV hepatitis, one should consider the diagnosis in all patients with multifocal liver lesions of unknown etiology, especially if genital herpes is present at the time of presentation, or in patients who are immunocompromised.
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Affiliation(s)
- Rukevwe Ehwarieme
- Medicine/Infectious Diseases, University of Texas Health, San Antonio, San Antonio, USA
| | - Apeksha N Agarwal
- Pathology, University of Texas Health, San Antonio, San Antonio, USA
| | - Rahaf Alkhateb
- Pathology, University of Texas Health, San Antonio, San Antonio, USA
| | - Jason E Bowling
- Medicine/Infectious Diseases, University of Texas Health, San Antonio, San Antonio, USA
| | - Gregory M Anstead
- Medicine/Infectious Diseases, South Texas Veterans Healthcare System, San Antonio, USA.,Medicine/Infectious Diseases, University of Texas Health, San Antonio, San Antonio, USA
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15
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Chávez SM, Poniachik JM, Urzua ÁM, Roblero JP, Cattaneo MJ, Jimenez AP, Carreño LE, Cornejo RA. Acute liver failure due to herpes simplex virus: diagnostic clues and potential role of plasmapheresis: A case report. Medicine (Baltimore) 2021; 100:e27139. [PMID: 34477166 PMCID: PMC8416005 DOI: 10.1097/md.0000000000027139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 08/03/2021] [Accepted: 08/18/2021] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Acute liver failure (ALF) is a life-threatening condition that remains challenging for physicians despite several advances in supportive care. Etiologies vary worldwide, with herpes simplex virus (HSV) hepatitis representing less than 1% of cases. Despite its low incidence, ALF is a lethal cause of acute necrotizing hepatitis and has a high mortality. Early antiviral treatment is beneficial for survival and decreased liver transplantation necessity. However, plasmapheresis, despite its theoretical potential benefit, is scarcely reported. PATIENT CONCERNS A 25-year-old woman with no known disease presented with painful pharynx ulcers, increased transaminases and impaired liver function. DIAGNOSIS ALF due to a disseminated HSV-2 primary infection was diagnosed with a positive polymerase chain reaction for HSV-2 in the biopsied liver tissue and blood. INTERVENTIONS Empiric antiviral treatment was initiated. After clinical deterioration, plasmapheresis was also initiated. OUTCOMES After 6 cycles of plasmapheresis and supportive care, the patient's condition improved without undergoing liver transplantation. CONCLUSIONS ALF is a life-threatening condition, and HSV as an etiology must be suspected based on background, clinical manifestation, and laboratory information. The potential role of plasmapheresis in HSV hepatitis should be considered.
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Affiliation(s)
- Sebastián M. Chávez
- Unidad de Pacientes Críticos, Departamento de Medicina, Hospital Clínico Universidad de Chile. Santiago, Chile
| | - Jaime M. Poniachik
- Sección Gastroenterología, Departamento de Medicina, Hospital Clínico Universidad de Chile. Santiago, Chile
| | - Álvaro M. Urzua
- Sección Gastroenterología, Departamento de Medicina, Hospital Clínico Universidad de Chile. Santiago, Chile
| | - Juan P. Roblero
- Sección Gastroenterología, Departamento de Medicina, Hospital Clínico Universidad de Chile. Santiago, Chile
| | - Máximo J. Cattaneo
- Sección Gastroenterología, Departamento de Medicina, Hospital Clínico Universidad de Chile. Santiago, Chile
| | - Andrea P. Jimenez
- Sección Gastroenterología, Departamento de Medicina, Hospital Clínico Universidad de Chile. Santiago, Chile
| | - Laura E. Carreño
- Departamento de Anatomía patológica, Hospital Clínico Universidad de Chile. Santiago, Chile
| | - Rodrigo A. Cornejo
- Unidad de Pacientes Críticos, Departamento de Medicina, Hospital Clínico Universidad de Chile. Santiago, Chile
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16
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Ali S, Prakash S, Murali AR. Hepatic Manifestations of Nonhepatotropic Infectious Agents Including Severe Acute Respiratory Syndrome Coronavirus-2, Adenovirus, Herpes Simplex Virus, and Coxiella burnetii. Gastroenterol Clin North Am 2021; 50:383-402. [PMID: 34024447 DOI: 10.1016/j.gtc.2021.02.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Nonhepatotropic viruses such as adenovirus, herpes simplex virus, flaviviruses, filoviruses, and human herpes virus, and bacteria such as Coxiella burnetii, can cause liver injury mimicking acute hepatitis. Most of these organisms cause a self-limited infection. However, in immunocompromised patients, they can cause severe hepatitis or in some cases fulminant hepatic failure requiring an urgent liver transplant. Hepatic dysfunction is also commonly seen in patients with severe acute respiratory syndrome coronavirus-2 infection. Patients with preexisting liver diseases are likely at risk for severe coronavirus disease 2019 (COVID-19) and may be associated with poor outcomes.
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Affiliation(s)
- Saeed Ali
- Department of Internal Medicine, University of Iowa Healthcare, 200 Hawkins Drive, SE 636 GH, Iowa City, IA 52242, USA
| | - Sameer Prakash
- Department of Internal Medicine, University of Iowa Healthcare, 200 Hawkins Drive, SE 636 GH, Iowa City, IA 52242, USA
| | - Arvind R Murali
- Division of Gastroenterology-Hepatology, Department of Internal Medicine, University of Iowa Carver College of Medicine, University of Iowa, 200 Hawkins Drive, 4553 JCP, Iowa City, IA 52242, USA.
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17
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Goldberg E, Edwards B, Krill K. Atypical case of syphilitic hepatitis. BMJ Case Rep 2021; 14:14/3/e237851. [PMID: 33731401 PMCID: PMC7978060 DOI: 10.1136/bcr-2020-237851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 31-year-old immunocompetent, heterosexual man with no relevant medical history presented with 1 week of jaundice, abdominal pain, cough and headache. Examination revealed scleral icterus, right upper quadrant tenderness and hepatomegaly. Initial investigations revealed hyperbilirubinaemia and elevated transaminases. Serum studies were positive for antinuclear antibodies, antimitochondrial antibodies, and herpes simplex virus IgM. Despite being started on intravenous acyclovir, his bilirubin and transaminase levels continued to rise. He was subsequently tested for syphilis given his maculopapular rash on the soles of his feet and it returned positive. He improved clinically with the initiation of penicillin. In this case, we will discuss the presentation, diagnosis and treatment of syphilitic hepatitis.
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Affiliation(s)
- Elliott Goldberg
- Internal Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Bathai Edwards
- Internal Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Kaleigh Krill
- Internal Medicine, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, USA
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18
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Zeidan JH, Casingal V, Hippen B, Ahrens W, Lamm K, Gerber DA, Schmeltzer PA, Gajurel K. Donor-derived herpes simplex virus hepatitis in a kidney transplant recipient and review of the literature. Transpl Infect Dis 2021; 23:e13562. [PMID: 33432726 DOI: 10.1111/tid.13562] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/31/2020] [Accepted: 12/29/2020] [Indexed: 11/26/2022]
Abstract
Donor-derived (DD) herpes simplex virus (HSV) hepatitis in solid organ transplant (SOT) recipients is extremely uncommon but carries a high mortality rate. The diagnosis is challenging due to the non-specific presentation and lack of clinical suspicion. We report a case of DDHSV hepatitis in a HSV2 pre-transplant seronegative kidney recipient who received the organ from a HSV2 seropositive donor. The case is highlighted by a few unusual features, namely severe thrombocytopenia and the development of cutaneous, oral and esophageal HSV lesions several weeks after symptom onset while recovering on appropriate treatment. A review of nine proven and probable DDHSV hepatitis cases (including eight previously published ones) showed that fever is a common presenting feature while gastrointestinal symptoms and cutaneous manifestations are uncommon. The symptoms almost always occurred within 2 weeks of transplant. Six out of the nine DDHSV hepatitis patients, including five patients who were on appropriate treatment, died within a month after transplant.
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Affiliation(s)
- Joseph H Zeidan
- Division of Gastroenterology, Carolinas Medical Center, Atrium Health, Charlotte, NC, USA
| | - Vincent Casingal
- Department of Surgery, Carolinas Medical Center, Atrium Health, Charlotte, NC, USA
| | | | | | - Kevin Lamm
- Center for Liver Diseases and Liver transplantation, Carolinas Medical Center, Atrium Health, Charlotte, NC, USA
| | - David A Gerber
- Department of Surgery, University of North Carolina, Chapel Hill, NC, USA
| | - Paul A Schmeltzer
- Center for Liver Diseases and Liver transplantation, Carolinas Medical Center, Atrium Health, Charlotte, NC, USA
| | - Kiran Gajurel
- Division of Infectious Diseases, Carolinas Medical Center, Atrium Health, Charlotte, NC, USA
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19
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Abstract
BACKGROUND Herpes simplex virus (HSV) causes only 2-4% of all acute hepatitis but has high morbidity and mortality. Pregnancy is a risk factor for HSV hepatitis. We describe a case of gestational HSV hepatitis. CASE A 32-year old woman, gravida 2 para 1, presented at 38 2/7 weeks of gestation with back pain and fetal tachycardia. She became febrile after admission, had spontaneous rupture of membranes, and was delivered by cesarean for malpresentation. Postpartum, she became persistently febrile and developed transaminitis, symptomatic hypotension, and pancytopenia despite antibiotics. Imaging revealed acute liver injury, splenomegaly, pleural effusions, and cardiomyopathy. Serum polymerase chain reaction (PCR) screening identified HSV-1 infection. The patient recovered on acyclovir. There was no evidence of neonatal seroconversion. CONCLUSION Herpes simplex virus hepatitis causes significant morbidity, and pregnant women are susceptible to severe infections. Pregnant or peripartum women with acute febrile hepatitis require prompt evaluation for HSV with serum PCR screening.
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20
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Cook G, Patel S, Williams R, Hodge J, Ingram W, Gayed R. Severe Coagulopathy Secondary to Fulminant Herpes Simplex Virus Hepatitis in a Severely Burned Patient: A Case Report and Review of the Literature. J Burn Care Res 2020; 39:1071-1076. [PMID: 29931338 DOI: 10.1093/jbcr/irx046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Fulminant hepatic failure secondary to herpes simplex virus (HSV) is a rare complication that is associated with high mortality. Here, we describe the case of a critically ill patient with severe burns and inhalation injury who developed severe coagulopathy during her hospital stay, which was later found to be caused by HSV hepatitis. In addition, we review the current literature on HSV hepatitis. Only three prior reports document liver involvement of HSV in patients with burn. Clinical symptoms, diagnostic factors, and management of HSV hepatitis in patients with burn are presented. Because of severe immunosuppression and potentially fatal nature of this infection, clinicians should have a heightened suspicion for HSV hepatitis in burn patients with HSV mucocutaneous involvement, unexplained liver dysfunction, and severe coagulopathy, and it should prompt immediate initiation of intravenous acyclovir.
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Affiliation(s)
- Gregory Cook
- Department of Pharmacy and Clinical Nutrition, Grady Health System, Atlanta, GA
| | - Sonali Patel
- Department of Pharmacy and Clinical Nutrition, Grady Health System, Atlanta, GA
| | | | - Juvonda Hodge
- Department of Surgery, Emory University, Atlanta, GA
| | - Walter Ingram
- Department of Surgery, Emory University, Atlanta, GA
| | - Rita Gayed
- Department of Pharmacy and Clinical Nutrition, Grady Health System, Atlanta, GA
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21
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Herpes Simplex Virus-2 Hepatitis: A Case Report and Review of the Literature. Case Rep Med 2020; 2020:8613840. [PMID: 32148514 PMCID: PMC7054783 DOI: 10.1155/2020/8613840] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 01/08/2020] [Indexed: 01/05/2023] Open
Abstract
Herpes simplex virus (HSV) is a rare cause of hepatitis in pregnancy and the chronically immunosuppressed, with a high propensity to progress to acute liver failure (ALF) and death. Patients typically present with a nonspecific clinical picture that often delays diagnosis and treatment, contributing to the high mortality rate. We present a case of a young female on chronic prednisone and hydroxychloroquine for systemic lupus erythematosus (SLE) who was diagnosed with HSV-2 hepatitis after presenting with right-sided chest and abdominal discomfort. Despite early clinical deterioration, prompt initiation of therapy with intravenous acyclovir and methylprednisolone led to rapid improvement.
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22
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Ikuta K, Roychoudhury P, Xie H, Mcclurkan CL, Walkiewicz M, Makhsous N, Huang ML, Beru Y, Alam M, Shepherd A, Lamotte ED, Patel K, Morris A, Ҫoruh B, Yu L, Bhattacharya R, Cheng R, Walter RB, Limaye AP, Lockwood CM, Holland SM, Rakita RM, Koelle DM, Greninger AL. Trillions and Trillions: Herpes Simplex Virus-1 Hepatitis in an Immunocompetent Adult. Open Forum Infect Dis 2019; 6:ofz465. [PMID: 31777756 PMCID: PMC6868424 DOI: 10.1093/ofid/ofz465] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 10/23/2019] [Indexed: 11/14/2022] Open
Abstract
We describe a case of acute liver failure and myopericarditis due to herpes simplex virus-1 (HSV-1) in an immunocompetent adult. We estimate that, at the height of viremia, the patient contained a quantity of HSV-1 virions approaching that of human cells. The patient recovered with acyclovir that was dose-adjusted for neurotoxicity and developed a vigorous anti-HSV-1 T-cell response.
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Affiliation(s)
- Kevin Ikuta
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Pavitra Roychoudhury
- Department of Laboratory Medicine, University of Washington, Seattle, Washington, USA
| | - Hong Xie
- Department of Laboratory Medicine, University of Washington, Seattle, Washington, USA
| | - Christopher L Mcclurkan
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Magdalena Walkiewicz
- Immunopathogenesis Section, National Institute of Allergy and Infectious Disease, Bethesda, Maryland, USA
| | - Negar Makhsous
- Department of Laboratory Medicine, University of Washington, Seattle, Washington, USA
| | - Meei-Li Huang
- Department of Laboratory Medicine, University of Washington, Seattle, Washington, USA
| | - Yodit Beru
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Mariam Alam
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Amanda Shepherd
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Eric D Lamotte
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Kevin Patel
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Amy Morris
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Başak Ҫoruh
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Lei Yu
- Division of Gastroenterology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Renuka Bhattacharya
- Division of Gastroenterology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Rex Cheng
- Division of Gastroenterology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Roland B Walter
- Clinical Research Division, Fred Hutchinson Cancer Research Center Seattle, Washington, USA
| | - Ajit P Limaye
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Christina M Lockwood
- Department of Laboratory Medicine, University of Washington, Seattle, Washington, USA
| | - Steven M Holland
- Immunopathogenesis Section, National Institute of Allergy and Infectious Disease, Bethesda, Maryland, USA
| | - Robert M Rakita
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - David M Koelle
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA.,Department of Laboratory Medicine, University of Washington, Seattle, Washington, USA.,Department of Global Health, University of Washington, Seattle, Washington, USA.,Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.,Benaroya Research Institute, Seattle, Washington, USA
| | - Alexander L Greninger
- Department of Laboratory Medicine, University of Washington, Seattle, Washington, USA.,Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
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23
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Goel K, Bunker M, Balog A, Silverman JF. Fulminant Herpes Simplex Hepatitis Secondary to Adalimumab in Crohn's Disease: A Case Report. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2019; 12:1179547619858979. [PMID: 31320810 PMCID: PMC6610429 DOI: 10.1177/1179547619858979] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 05/29/2019] [Indexed: 12/18/2022]
Abstract
Herpes simplex virus (HSV) hepatitis is an uncommon cause of fulminant hepatic
failure, seen mostly in immunocompromised patients. Conventional treatment
modalities for inflammatory bowel disease (IBD), such as steroids and
azathioprine, have been known to cause HSV hepatitis. However, the reported
incidence of HSV hepatitis in IBD patients undergoing tumor necrosis factor
(TNF)-α inhibitor therapy is very rare. In this case report, we describe a rare
case of fulminant HSV hepatitis that developed in a patient with Crohn’s disease
after treatment with the TNF-α inhibitor, adalimumab.
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Affiliation(s)
- Kanika Goel
- Department of Pathology, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PA, USA
| | - Mark Bunker
- Department of Pathology, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PA, USA
| | - Anna Balog
- Department of Pathology, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PA, USA
| | - Jan F Silverman
- Department of Pathology, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PA, USA
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24
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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.
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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
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25
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Then EO, Gayam V, Are VS, Sunkara T, Gaduputi V. Herpes Simplex Virus Hepatitis: A Brief Review of an Oft-overlooked Pathology. Cureus 2019; 11:e4313. [PMID: 31183293 PMCID: PMC6538099 DOI: 10.7759/cureus.4313] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Herpes simplex virus (HSV) is a rarely reported cause of viral hepatitis. Aggressive in nature, most cases of HSV hepatitis rapidly progress to fulminant hepatic failure. Present day, its pathogenesis is yet to be elucidated, but its complications and associated high mortality rate are clear. Clinically, its symptoms mimic those of other causes of acute hepatic failure thus making the diagnosis of HSV hepatitis a precarious task. Although treatment in the form of acyclovir is readily available, most cases have a poor prognosis due to late initiation of therapy. This makes the early identification of HSV essential in improving outcomes and potentially preventing mortality.
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Affiliation(s)
- Eric O Then
- Internal Medicine, St. Barnabas Hospital Health System, Bronx, USA
| | - Vijay Gayam
- Internal Medicine, Interfaith Medical Center, Brooklyn, USA
| | - Vijay S Are
- Internal Medicine, Stormont Vail Health System, Lawrence, USA
| | - Tagore Sunkara
- Internal Medicine, Mercy Medical Center, Des Moines, USA
| | - Vinaya Gaduputi
- Internal Medicine, St. Barnabas Hospital Health System, Bronx, USA
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26
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Yiu D, Ballabio M, Fornoni G, Maggi U. Unusual oral presentation of HSV-1 lesions in an adult liver transplant recipient. BMJ Case Rep 2019; 12:12/3/e227492. [PMID: 30852500 DOI: 10.1136/bcr-2018-227492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Herpes Simplex Virus (HSV) hepatitis in liver transplant patients is a rarely reported infective complication of HSV with severe consequences, often leading to fulminant hepatitis if left untreated. The clinical signs are often atypical, leading to under-reporting in the literature and potential delays in treatment. Our case report describes such atypical mucocutaneous lesions in a liver transplant recipient. We highlight the need for further reports, especially those with images, in order to aid the diagnosis of HSV infection, and to allow prompt treatment to prevent complications such as HSV hepatitis.
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Affiliation(s)
- Daniel Yiu
- General Surgery, Frimley Health NHS Foundation Trust, Slough, UK
| | - Michele Ballabio
- UO Chirurgia Generale e Trapianti di Fegato, Ospedale Maggiore Policlinico, Milano, Italy
| | - Gianluca Fornoni
- UO Chirurgia Generale e Trapianti di Fegato, Ospedale Maggiore Policlinico, Milano, Italy
| | - Umberto Maggi
- HPB and Liver Transplant Unit, Osped Maggiore Policlin Milano, Milano, Italy
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27
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Yunce M, Bhat P, Jaganathan D, Bahrain M. Herpes hepatitis as a complication of total abdominal hysterectomy; an unusual complication of abdominal instrumentation. Clin Case Rep 2019; 7:11-14. [PMID: 30655998 PMCID: PMC6332770 DOI: 10.1002/ccr3.1890] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 08/25/2018] [Accepted: 10/01/2018] [Indexed: 11/25/2022] Open
Abstract
Herpes simplex virus hepatitis is a rare but potentially fatal disease without early intervention. Impaired immunity is a major predisposing risk factor but infection in immunocompetent individuals is not unheard of. Diagnosis is complicated by its rarity and nonspecific signs and symptoms on presentation. Identification by liver biopsy is often limited due to concurrent coagulopathy. Early and aggressive treatment is centered on antiviral therapy with acyclovir. We present a case of herpes hepatitis in an immunocompetent woman following abdominal instrumentation.
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Affiliation(s)
- Muharrem Yunce
- Department of MedicineMedStar Franklin Square Medical CenterBaltimoreMaryland
| | - Pavan Bhat
- Department of MedicineMedStar Franklin Square Medical CenterBaltimoreMaryland
| | - Daisy Jaganathan
- Department of MedicineMedStar Franklin Square Medical CenterBaltimoreMaryland
| | - Michelle Bahrain
- Department of Infectious DiseaseMedStar Franklin Square Medical CenterBaltimoreMaryland
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Inthasot V, Goushchi A, Lazzaroni S, Papaleo A, Galdon MG, Chochrad D. Fatal Septic Shock Associated with Herpes Simplex Virus Hepatitis: A Case Report. Eur J Case Rep Intern Med 2018; 5:000982. [PMID: 30755997 PMCID: PMC6346974 DOI: 10.12890/2018_000982] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Accepted: 11/09/2018] [Indexed: 11/05/2022] Open
Abstract
Herpes simplex viruses are endemic worldwide, with an estimated seroprevalence of approximately 70% in developed countries. However, it is less well known that they are one of the viral causes of fulminant hepatitis (<2%) and constitute <1% of all causes of acute liver failure. We describe the case of an 89-year-old man who developed sepsis caused by a urinary tract infection due to drug-sensitive Escherichia coli. After empirical treatment with piperacillin-tazobactam was initiated, the patient’s condition worsened with shock, acute liver and renal failure, encephalopathy and persistent fever, that led to admission to the intensive care unit. The emergence of an acute abdomen prompted exploratory laparotomy but the patient died soon after surgery from abdominal haemorrhage. Immunohistochemical analysis of a liver biopsy specimen identified herpes simplex virus (HSV) hepatitis. The authors emphasize the need for better understanding of this rare condition in order to more precisely identify patients at risk who need more aggressive evaluation and empirical treatment, especially patients presenting with marked hepatic cytolysis with a rapidly worsening clinical evolution.
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Affiliation(s)
| | - Adonis Goushchi
- Internal Medicine Department, Iris South Hospitals, Brussels, Belgium
| | - Silvia Lazzaroni
- Internal Medicine Department, Iris South Hospitals, Brussels, Belgium
| | - Alberto Papaleo
- Internal Medicine Department, Iris South Hospitals, Brussels, Belgium
| | - Maria Gomez Galdon
- Anatomical Pathology Department Institut Jules Bordet, Brussels, Belgium
| | - Didier Chochrad
- Intensive Care Unit, Iris South Hospitals, Brussels, Belgium
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Safdar A, Pouch SM, Scully B. Infections in Allogeneic Stem Cell Transplantation. PRINCIPLES AND PRACTICE OF TRANSPLANT INFECTIOUS DISEASES 2018. [PMCID: PMC7121717 DOI: 10.1007/978-1-4939-9034-4_11] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) has become a widely used modality of therapy for a variety of malignant and nonmalignant diseases. Despite advances in pharmacotherapy and transplantation techniques, infection remains one of the most severe and frequently encountered complications of allo-HSCT. This chapter will address the risk factors for development of infection following allo-HSCT, including those related to the host, the conditioning regimen, and the graft, as well as the timing of opportunistic infections after allo-HSCT. The most common bacterial, viral, fungal, and parasitic infections, as well as issues surrounding their diagnostics and treatment, will be discussed. Finally, this chapter will address vaccination and other preventative strategies to be utilized when caring for patients undergoing allo-HSCT.
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Affiliation(s)
- Amar Safdar
- grid.416992.10000 0001 2179 3554Clinical Associate Professor of Medicine, Texas Tech University Health Sciences Center El Paso, Paul L. Foster School of Medicine, El Paso, TX USA
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Foo SS, Chen W, Chan Y, Lee WS, Lee SA, Cheng G, Nielsen-Saines K, Brasil P, Jung JU. Biomarkers and immunoprofiles associated with fetal abnormalities of ZIKV-positive pregnancies. JCI Insight 2018; 3:124152. [PMID: 30385728 PMCID: PMC6238739 DOI: 10.1172/jci.insight.124152] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 09/19/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND An intricate fetal-maternal immune crosstalk during pregnancy is essential for a healthy birth. Hence, the infection-induced alterations of maternal immunity often lead to adverse outcomes for mother and/or child. The emergence of Zika virus (ZIKV) infection in pregnant women has been associated with more than 3,000 cases of microcephaly and nervous system malformations. METHODS To explore the potential correlation of ZIKV-induced alteration of maternal immunity with fetal abnormalities, we performed extensive sera immunoprofiling of 74 pregnant women: 30 symptomatic ZIKV+ pregnant patients and 30 healthy pregnant controls in ZIKV-endemic Rio de Janeiro, along with 14 healthy pregnant controls in non-endemic Los Angeles. RESULTS Extensive multiplexing analysis of 69 cytokines revealed that CXCL10, CCL2, and CCL8 chemokines were specifically associated with symptomatic ZIKV+ infection during pregnancy, and distinct immunoprofiles were detected at different trimesters in ZIKV-infected pregnant women. Intriguingly, the high CCL2 level and its inverse correlation with CD163, TNFRSF1A, and CCL22 levels was apparently associated with ZIKV-induced abnormal birth. CONCLUSION Our findings provide insights into the alteration of ZIKV-elicited maternal immunity, serving as a potential clinical biomarker platform. FUNDING NIH (CA200422, CA180779, DE023926, AI073099, AI116585, AI129496, AI140705, AI069120, AI056154, AI078389, AI28697, AI40718 and AI129534-01), Hastings Foundation, Fletcher Jones Foundation, Departamento de Ciência e Tecnologia (DECIT/25000.072811/2016-17) do Ministério da Saúde do Brasil, and Coordenação de Aperfeiçoamento de Pessoal de Nivel Superior CAPES/88887.116627/2016-01.
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Affiliation(s)
- Suan-Sin Foo
- Department of Molecular Microbiology and Immunology and
| | - Weiqiang Chen
- Department of Molecular Microbiology and Immunology and
| | - Yen Chan
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Zilkha Neurogenetic Institute, Los Angeles, California, USA
| | - Wai-Suet Lee
- Department of Molecular Microbiology and Immunology and
- Institute for Glycomics, Griffith University, Gold Coast, Southport, Queensland, Australia
| | - Shin-Ae Lee
- Department of Molecular Microbiology and Immunology and
| | - Genhong Cheng
- Department of Microbiology and Molecular Genetics and
| | - Karin Nielsen-Saines
- Division of Pediatric Infectious Diseases, David Geffen School of Medicine, UCLA, Marion Davies Children’s Health Center, Los Angeles, California, USA
| | - Patrícia Brasil
- Laboratório de Pesquisa Clínica em Doenças Febris Agudas, Instituto Nacional de Infectologia Evandro Chagas, Fondação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Jae U. Jung
- Department of Molecular Microbiology and Immunology and
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Magawa S, Tanaka H, Furuhashi F, Maki S, Nii M, Toriyabe K, Ikeda T. A literature review of herpes simplex virus hepatitis in pregnancy. J Matern Fetal Neonatal Med 2018; 33:1774-1779. [PMID: 30235956 DOI: 10.1080/14767058.2018.1527311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Purpose: Hepatitis due to herpes simplex virus (HSV) during pregnancy is rare, it is often not included in the differential disease. However, hepatitis leads to maternal death; hence, early diagnosis is necessary. Hepatic enzyme elevation in late pregnancy is often associated with obstetric-related diseases, such as acute gestational fatty liver and HELLP syndrome (hemolytic anemia, elevated liver enzymes, low platelet count). These pregnancy-related diseases often improve maternal condition after completion of pregnancy, but in patients with HSV hepatitis, invasive treatment, such as cesarean section, may lead to deterioration of maternal condition after completion of pregnancy. A systematic review was conducted to extract necessary factors to avoid maternal death caused by herpetic hepatitis.Methods: In 24 cases reported since 1991, age, onset gestational weeks, initial symptoms, days from onset of symptoms to consultation, diagnosis method, treatment method, maximum liver escape enzyme value during hospitalization, bilirubin value, international normalized ratio value, and fetal/neonatal prognosis were extracted, and the relationship between maternal death group (n = 6) and maternal alive group (n = 18) was statistically analyzed.Results: Fever as an initial symptom was observed in all cases. Maternal death did not occur in patients administered with acyclovir (ACV) as empiric therapy. No difference was found between the two groups in other factors.Conclusion: Early diagnosis and treatment of herpetic hepatitis during pregnancy are important, as well as administration of empiric ACV concurrently with noninvasive diagnosis when a pregnant woman has elevated liver enzyme accompanied by fever in late pregnancy.
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Affiliation(s)
- Shoichi Magawa
- Department of Obstetrics and Gynecology, Mie University Faculty Medicine, Tsu, Japan
| | - Hiroaki Tanaka
- Department of Obstetrics and Gynecology, Mie University Faculty Medicine, Tsu, Japan
| | - Fumi Furuhashi
- Department of Obstetrics and Gynecology, Mie University Faculty Medicine, Tsu, Japan
| | - Shintaro Maki
- Department of Obstetrics and Gynecology, Mie University Faculty Medicine, Tsu, Japan
| | - Masafumi Nii
- Department of Obstetrics and Gynecology, Mie University Faculty Medicine, Tsu, Japan
| | - Kuniaki Toriyabe
- Department of Obstetrics and Gynecology, Mie University Faculty Medicine, Tsu, Japan
| | - Tomoaki Ikeda
- Department of Obstetrics and Gynecology, Mie University Faculty Medicine, Tsu, Japan
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32
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Lin GL, McGinley JP, Drysdale SB, Pollard AJ. Epidemiology and Immune Pathogenesis of Viral Sepsis. Front Immunol 2018; 9:2147. [PMID: 30319615 PMCID: PMC6170629 DOI: 10.3389/fimmu.2018.02147] [Citation(s) in RCA: 167] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 08/30/2018] [Indexed: 12/11/2022] Open
Abstract
Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. Sepsis can be caused by a broad range of pathogens; however, bacterial infections represent the majority of sepsis cases. Up to 42% of sepsis presentations are culture negative, suggesting a non-bacterial cause. Despite this, diagnosis of viral sepsis remains very rare. Almost any virus can cause sepsis in vulnerable patients (e.g., neonates, infants, and other immunosuppressed groups). The prevalence of viral sepsis is not known, nor is there enough information to make an accurate estimate. The initial standard of care for all cases of sepsis, even those that are subsequently proven to be culture negative, is the immediate use of broad-spectrum antibiotics. In the absence of definite diagnostic criteria for viral sepsis, or at least to exclude bacterial sepsis, this inevitably leads to unnecessary antimicrobial use, with associated consequences for antimicrobial resistance, effects on the host microbiome and excess healthcare costs. It is important to understand non-bacterial causes of sepsis so that inappropriate treatment can be minimised, and appropriate treatments can be developed to improve outcomes. In this review, we summarise what is known about viral sepsis, its most common causes, and how the immune responses to severe viral infections can contribute to sepsis. We also discuss strategies to improve our understanding of viral sepsis, and ways we can integrate this new information into effective treatment.
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Affiliation(s)
- Gu-Lung Lin
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom.,National Institute for Health Research, Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Joseph P McGinley
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom.,National Institute for Health Research, Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Simon B Drysdale
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom.,National Institute for Health Research, Oxford Biomedical Research Centre, Oxford, United Kingdom.,Department of Paediatrics, St George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Andrew J Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom.,National Institute for Health Research, Oxford Biomedical Research Centre, Oxford, United Kingdom
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33
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Noor A, Panwala A, Forouhar F, Wu GY. Hepatitis caused by herpes viruses: A review. J Dig Dis 2018; 19:446-455. [PMID: 29923691 DOI: 10.1111/1751-2980.12640] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 05/30/2018] [Accepted: 06/17/2018] [Indexed: 12/11/2022]
Abstract
Herpes virus hepatitis varies in presentation, ranging from asymptomatic to acute liver failure, in both immunocompetent and immunocompromised individuals. Hepatitis caused by the Herpesviridae family is uncommon and usually results in mild disease. It is also often self-limiting, although in certain populations especially immunosuppressed patients, it can cause severe infections, leading to acute to fulminant hepatic failure. In addition, some isolated cases of fulminant disease in immunocompetent individuals have been reported. As the presentation is frequently non-specific, it is important to maintain a high level of suspicion for these viral etiologies and start empiric therapy with antiviral agents as soon as possible. Liver transplantation is the last resort. Mortality remains high in fulminant hepatic failure caused by Herpesviridae without liver transplantation. Here we review the literatures on hepatitis caused by three members of the Herpesviridae family, cytomegalovirus, Epstein-Barr virus and herpes simplex virus to discuss the epidemiology, diagnostic methods, clinical features and current management, and also to determine which aspects need to be investigated in further detail. Herpesviridae-mediated acute liver failure is rare but is associated with a poor prognosis, even after early treatment.
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Affiliation(s)
- Arish Noor
- Department of Medicine, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Amruta Panwala
- Department of Medicine, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Faripour Forouhar
- Department of Pathology, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - George Y Wu
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Connecticut Health Center, Farmington, Connecticut, USA
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34
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Gupta A, Jain P. Leucopenia: A Rare Extrahepatic Manifestation of Acute Hepatitis A. J Clin Exp Hepatol 2018; 8:215-216. [PMID: 29892189 PMCID: PMC5992310 DOI: 10.1016/j.jceh.2017.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Indexed: 12/12/2022] Open
Affiliation(s)
- Ankur Gupta
- Address for correspondence: Ankur Gupta, Department of Gastroenterology Max Super Speciality Hospital, Mussoorie Diversion Road, Malsi, Dehradun, Uttarakhand 248001, India. Tel.: +91 9450274612.
| | - Priyanka Jain
- Department of Pathology and Transfusion Medicine, Max Super Speciality Hospital, Mussoorie Diversion Road, Malsi, Dehradun, Uttarakhand 248001, India
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35
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Faqih NA, Alfaqih MA, Salami K, Herron B, Sultan I, Al-Hussaini M. Empirical treatment with parenteral acyclovir in a child with herpes simplex virus hepatitis and acute lymphoblastic leukemia. IDCases 2018; 12:10-12. [PMID: 29850402 PMCID: PMC5966627 DOI: 10.1016/j.idcr.2018.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Revised: 02/19/2018] [Accepted: 02/19/2018] [Indexed: 11/07/2022] Open
Abstract
Introduction Hepatitis secondary to Herpes Simplex Virus (HSV) infection is a complication that often leads to fatal hepatic failure. Early treatment with the anti-viral drug, acyclovir, is life-saving. In view of the non-specific nature of the signs and symptoms associated with HSV hepatitis, diagnosis is often made late during the course of the disease; a factor that largely contributes to the high mortality rate of this treatable disease complication. There is thus a growing consensus in the field to initiate empirical treatment with acyclovir once suspicion of HSV hepatitis is raised even before reaching a conclusive diagnosis. Presentation of case We present clinical evidence on the benefit of starting empirical acyclovir treatment on the outcome of patients suffering from HSV hepatitis. We report two cases of HSV hepatitis in children with cancer. One case presented with fulminant hepatitis which was fatal and the diagnosis was only reached post mortem. In the second case, there was enough suspicion of HSV hepatitis to start early empirical acyclovir therapy. The diagnosis was confirmed 48 hours following the initiation of treatment and the early intervention with anti-virals proved to be life-saving. Discussion In both cases above, the following symptoms were shared; fever, elevated transaminase levels and mucositis without clear cutaneous lesions. HSV hepatitis should thus be considered in the differential diagnosis of immuonocomprimised patients exhibiting the above symptoms. Conclusion Due to the frequent delay in HSV diagnosis and the safety of acyclovir, we recommend empirically administering acyclovir in patients suspected of HSV hepatitis.
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Affiliation(s)
- Nesreen A Faqih
- Departments of Pediatrics, King Hussein Cancer Center, Queen Rania Street, Amman, Jordan
| | - Mahmoud A Alfaqih
- Department of Physiology Biochemistry, Jordan University of Science Technology, Irbid, Jordan
| | - Khadra Salami
- Departments of Pediatrics, King Hussein Cancer Center, Queen Rania Street, Amman, Jordan
| | - Brian Herron
- Department of Pathology, Royal Victoria Hospital, Belfast, Northern Ireland, UK
| | - Iyad Sultan
- Departments of Pediatrics, King Hussein Cancer Center, Queen Rania Street, Amman, Jordan
| | - Maysa Al-Hussaini
- Departments of Pathology, King Hussein Cancer Center, Queen Rania Street, Amman, Jordan
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Yokoi Y, Kaneko T, Sawayanagi T, Takano Y, Watahiki Y. Fatal fulminant herpes simplex hepatitis following surgery in an adult. World J Clin Cases 2018; 6:11-19. [PMID: 29468167 PMCID: PMC5807890 DOI: 10.12998/wjcc.v6.i2.11] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 12/15/2017] [Accepted: 01/16/2018] [Indexed: 02/05/2023] Open
Abstract
We present a case of a healthy 72-year-old man with herpes simplex hepatitis (HSVH) development soon after ordinary surgery for biliary stones. A sudden onset of hepatitis associated with high fever and leukopenia emerged on postoperative day 5, followed by a rapid and lethal course (died on day 9), despite an acyclovir therapy on day 8. Postmortem liver biopsy revealed positive immunostaining for herpes simplex virus (HSV) type-1. The serum tests (available after the death) were negative for anti-HSV immunogloblulins, but positive for HSV DNA. A review of 15 cases of postsurgical HSVH along with 42 cases of non-surgical HSH showed that (1): A wide spectrum of surgical procedures was involved; and (2): High mortality (87%) associated with lower rates of ante-mortem diagnosis (20%) and acyclovir treatment (20%). Due to the difficulty in diagnosis and lethal nature, an early clinical suspension and prompt empirical anti-viral intervention are imperative for postsurgical hepatitis with undetermined etiology, characterized by fever and leucopenia.
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Affiliation(s)
- Yoshihiro Yokoi
- Youichi Watahiki, Department of Surgery, Shinshiro Municipal Hospital, Shinshiro 441-1387, Japan
| | - Takeshi Kaneko
- Youichi Watahiki, Department of Surgery, Shinshiro Municipal Hospital, Shinshiro 441-1387, Japan
| | - Tomoki Sawayanagi
- Youichi Watahiki, Department of Surgery, Shinshiro Municipal Hospital, Shinshiro 441-1387, Japan
| | - Yasuo Takano
- Department of Pathology, Shinshiro Municipal Hospital, Shinshiro 441-1387, Japan
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Liver Disease Associated With Systemic Viral Infection. ZAKIM AND BOYER'S HEPATOLOGY 2018. [PMCID: PMC7099665 DOI: 10.1016/b978-0-323-37591-7.00038-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Ramirez-Fort MK, Zeng J, Feily A, Ramirez-Pacheco LA, Jenrette JM, Mayhew DL, Syed T, Cooper SL, Linden C, Graybill WS, French LE, Lange CS. Radiotherapy-induced reactivation of neurotrophic human herpes viruses: Overview and management. J Clin Virol 2017; 98:18-27. [PMID: 29197712 DOI: 10.1016/j.jcv.2017.11.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 10/20/2017] [Accepted: 11/11/2017] [Indexed: 12/11/2022]
Abstract
PURPOSE Infection by Human Herpes Viruses (HHV) types 1-3, are prevalent throughout the world. It is known that radiotherapy can reactivate HHVs, but it is unclear how and to what extent reactivations can interact with or affect radiotherapeutic efficacy, patient outcomes and mortality risk. Herein, we aim to summarize what is known about Herpes Simplex Virus (HSV)-1,2 and Varicella Zoster Virus (VZV) pathophysiology as it relates to tumor biology, radiotherapy, chemo-radiotherapy, diagnosis and management so as to optimize cancer treatment in the setting of active HHV infection. Our secondary aim is to emphasize the need for further research to elucidate the potential adverse effects of active HHV infection in irradiated tumor tissue and to design optimal management strategies to incorporate into cancer management guidelines. MATERIALS AND METHODS The literature regarding herpetic infection, herpetic reactivation, and recurrence occurring during radiotherapy and that regarding treatment guidelines for herpetic infections are reviewed. We aim to provide the oncologist with a reference for the infectious dangers of herpetic reactivation in patients under their care and well established methods for prevention, diagnosis, and treatment of such infections. Pain management is also considered. CONCLUSIONS In the radiotherapeutic setting, serologic assays for HSV-1 and HSV-2 are feasible and can alert the clinician to patients at risk for viral reactivation. RT-PCR is specific in identifying the exact viral culprit and is the preferred diagnostic method to measure interventional efficacy. It can also differentiate between herpetic infection and radionecrosis. The MicroTrak® HSV1/HSV2/VZV staining kit has high sensitivity and specificity in acute lesions, is also the most rapid means to confirm diagnosis. Herpetic reactivation and recurrences during radiotherapy can cause interruptions, cessations, or prolongations of the radiotherapeutic course, thus decreasing the biologically effective dose, to sub-therapeutic levels. Active HHV infection within the treatment volume results in increased tumor radio-resistance and potentially sub-therapeutic care if left untreated. Visceral reactivations may result in fatality and therefore, a high index of suspicion is important to identify these active infections. The fact that such infections may be mistaken for acute and/or late radiation effects, leading to less than optimal treatment decisions, makes knowledge of this problem even more relevant. To minimize the risk of these sequelae, prompt anti-viral therapy is recommended, lasting the course of radiotherapy.
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Affiliation(s)
- Marigdalia K Ramirez-Fort
- Radiation Oncology, Medical University of South Carolina, Charleston, SC, United States; Urological Oncology, Weill Cornell Medical College, New York, NY, United States
| | - Jianying Zeng
- Pathology, State University of New York Downstate Medical Center, Brooklyn, NY, United States
| | - Amir Feily
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Joseph M Jenrette
- Radiation Oncology, Medical University of South Carolina, Charleston, SC, United States
| | - David L Mayhew
- Radiation Oncology, Tufts Medical Center, Boston, MA, United States; Medicine, Dana Farber Cancer Institute, Boston, MA, United States
| | - Talal Syed
- Radiation Oncology, State University of New York Downstate Medical Center, Brooklyn, NY, United States
| | - S Lewis Cooper
- Radiation Oncology, Medical University of South Carolina, Charleston, SC, United States
| | - Craig Linden
- Radiology, State University of New York Downstate Medical Center, Brooklyn, NY, United States
| | - Witney S Graybill
- Gynecology Oncology, Medical University of South Carolina, Charleston, SC, United States
| | - Lars E French
- Dermatology, Zurich University Hospital, Zurich, Switzerland
| | - Christopher S Lange
- Radiation Oncology, State University of New York Downstate Medical Center, Brooklyn, NY, United States.
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Picone O. [Genital herpes and pregnancy: Epidemiology, clinical manifestations, prevention and screening. Guidelines for clinical practice from the French College of Gynecologists and Obstetrician (CNGOF)]. ACTA ACUST UNITED AC 2017; 45:642-654. [PMID: 29146286 DOI: 10.1016/j.gofs.2017.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To analyze the consequences of genital herpes infections in pregnant women. METHODS The PubMed database and the recommendations from the French and foreign obstetrical societies or colleges have been consulted. RESULTS The symptomatology of herpes genital rash is often atypical (NP2) and not different during pregnancy (Professional consensus). It is most often due to HSV2 (NP2). Seventy percent of pregnant patients have a history of infection with Herpes simplex virus, without reference to genital or labial localization, and this is in most cases type 1 (NP2). The prevalence of clinical herpes lesions at birth in the event of recurrence is about 16% compared with 36% in the case of initial infection (NP4). In HSV+ patients, asymptomatic herpetic excretion is 4 to 10%. The rate of excretion increases in HIV+ patients (20 to 30%) (NP2). The risk of HSV seroconversion during pregnancy is 1 to 5% (NP2), but can reach 20% in case of sero-discordant couple (NP2). Questioning is not always sufficient to determine the history of herpes infection of a patient and her partner (NP2) and the clinical examination is not always reliable (NP2). Herpetic hepatitis and encephalitis are rare and potentially severe (NP4). These diagnoses should be discussed during pregnancy and antiviral therapy should be started as soon as possible (Professional consensus). There is no established link between herpes infection and miscarriages (NP3). There appears to be an association between untreated herpes infection and premature delivery (NP3) but not in the case of treated infections (NP4). Herpetic fetopathies are exceptional (NP4). There is no argument for recommending specific prenatal diagnosis for herpes infection during pregnancy (Professional consensus). Condom use reduces the risk of initial infection in women who are not pregnant (NP3). There is no evidence to justify routine screening during pregnancy (Professional consensus). CONCLUSION There is a strong discrepancy between the prevalence of herpetic excretion at the time of delivery and the scarcity of neonatal infections. There is a lack of data on the impact of herpes infections during pregnancy in France. Fetal and maternal consequences are potentially serious but rare.
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Affiliation(s)
- O Picone
- Department of Gynaecology and Obstetrics, hôpital Louis-Mourier, hôpitaux universitaires Paris Nord, 147, rue des Renouillets, 92700 Colombes, France.
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Sananès N. [Management of pregnant women with first episode of genital herpes. Guidelines for clinical practice from the French college of gynecologists and obstetricians (CNGOF)]. ACTA ACUST UNITED AC 2017; 45:664-676. [PMID: 29132767 DOI: 10.1016/j.gofs.2017.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To provide guidelines for the management of first episode genital herpes during pregnancy and in the immediate postpartum period. METHODS MedLine and Cochrane Library databases search and review of the main foreign guidelines. RESULTS In case of first episode genital herpes during pregnancy, antiviral treatment with acyclovir (200mg 5 times daily) or valacyclovir (1000mg twice daily) for 5 to 10 days is recommended (grade C). The patient should be tested for HIV if not previously done (grade B). Daily suppressive antiviral treatment with acyclovir (400mg 3 times daily) or valacyclovir (500mg twice daily) is recommended from 36 weeks for women who have had a first episode genital herpes during pregnancy (grade B). A cesarean section should be performed in case of suspicion of first episode genital herpes at the onset of labor (grade B) or premature rupture of the membranes at term (professional consensus), or in case of first episode genital herpes less than 6 weeks before delivery (professional consensus). In the event of first episode genital herpes highlighted in the postpartum period, the neonatologist should be informed (professional consensus). The patient may be treated according the scheme described above. CONCLUSION A cesarean section should be performed in case of first episode genital herpes less than 6 weeks before delivery.
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Affiliation(s)
- N Sananès
- Service de gynécologie obstétrique, hôpitaux universitaires de Strasbourg, avenue Molière, BP 426, 67091 Strasbourg cedex, France; Unité Inserm UMR-S 1121 « Biomatériaux et Bioingénierie », 11, rue Humann, 67000 Strasbourg, France.
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Gonzales-Gustavson E, Timoneda N, Fernandez-Cassi X, Caballero A, Abril JF, Buti M, Rodriguez-Frias F, Girones R. Identification of sapovirus GV.2, astrovirus VA3 and novel anelloviruses in serum from patients with acute hepatitis of unknown aetiology. PLoS One 2017; 12:e0185911. [PMID: 28982120 PMCID: PMC5628893 DOI: 10.1371/journal.pone.0185911] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 09/21/2017] [Indexed: 12/14/2022] Open
Abstract
Hepatitis is a general term meaning inflammation of the liver, which can be caused by a variety of viruses. However, a substantial number of cases remain with unknown aetiology. We analysed the serum of patients with clinical signs of hepatitis using a metagenomics approach to characterize their viral species composition. Four pools of patients with hepatitis without identified aetiological agents were evaluated. Additionally, one pool of patients with hepatitis E (HEV) and pools of healthy volunteers were included as controls. A high diversity of anelloviruses, including novel sequences, was found in pools from patients with hepatitis of unknown aetiology. Moreover, viruses recently associated with gastroenteritis as sapovirus GV.2 and astrovirus VA3 were also detected only in those pools. Besides, most of the HEV genome was recovered from the HEV pool. Finally, GB virus C and human endogenous retrovirus were found in the HEV and healthy pools. Our study provides an overview of the virome in serum from hepatitis patients suggesting a potential role of these viruses not previously described in cases of hepatitis. However, further epidemiologic studies are necessary to confirm their contribution to the development of hepatitis.
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Affiliation(s)
- Eloy Gonzales-Gustavson
- Laboratory of Virus Contaminants of Water and Food, Department of Genetics, Microbiology and Statistics, Faculty of Biology, University of Barcelona, Barcelona, Catalonia, Spain
| | - N. Timoneda
- Laboratory of Virus Contaminants of Water and Food, Department of Genetics, Microbiology and Statistics, Faculty of Biology, University of Barcelona, Barcelona, Catalonia, Spain
- Computational Genomics Lab, Department of Genetics, Microbiology and Statistics, Faculty of Biology, University of Barcelona, Barcelona, Catalonia, Spain
- Institut de Biomedicina de la Universitat de Barcelona (IBUB), Barcelona, Catalonia, Spain
| | - X. Fernandez-Cassi
- Laboratory of Virus Contaminants of Water and Food, Department of Genetics, Microbiology and Statistics, Faculty of Biology, University of Barcelona, Barcelona, Catalonia, Spain
| | - A. Caballero
- Hospital Universitari Vall d’Hebron and CIBEREHD del Instituto Carlos III, Barcelona, Catalonia, Spain
| | - J. F. Abril
- Computational Genomics Lab, Department of Genetics, Microbiology and Statistics, Faculty of Biology, University of Barcelona, Barcelona, Catalonia, Spain
- Institut de Biomedicina de la Universitat de Barcelona (IBUB), Barcelona, Catalonia, Spain
| | - M. Buti
- Hospital Universitari Vall d’Hebron and CIBEREHD del Instituto Carlos III, Barcelona, Catalonia, Spain
| | - F. Rodriguez-Frias
- Hospital Universitari Vall d’Hebron and CIBEREHD del Instituto Carlos III, Barcelona, Catalonia, Spain
| | - R. Girones
- Laboratory of Virus Contaminants of Water and Food, Department of Genetics, Microbiology and Statistics, Faculty of Biology, University of Barcelona, Barcelona, Catalonia, Spain
- * E-mail:
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Herpes Simplex Virus Hepatitis: A Presentation of Multi-Institutional Cases to Promote Early Diagnosis and Management of the Disease. Case Reports Hepatol 2017; 2017:3180984. [PMID: 28835860 PMCID: PMC5556611 DOI: 10.1155/2017/3180984] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Accepted: 07/02/2017] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE To compare three cases of Herpes simplex virus (HSV) hepatitis to increase early diagnosis of the disease. Case 1. A 23-year-old man with Crohn's disease and oral HSV. HSV hepatitis was diagnosed clinically and he improved with acyclovir. Case 2. An 18-year-old G1P0 woman with transaminitis. Despite early empiric acyclovir therapy, she died due to fulminant liver failure. Case 3. A 65-year-old woman who developed transaminitis after liver transplant. Diagnosis was confirmed by biopsy and she had resolution of acute liver failure with acyclovir. CONCLUSION It is imperative that clinicians be aware of patients at high risk for developing HSV hepatitis to increase timely diagnosis and prevent morbidity and fatality.
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Masadeh M, Shen H, Lee Y, Gunderson A, Brown K, Bellizzi A, Tanaka T. A fatal case of herpes simplex virus hepatitis in a pregnant patient. Intractable Rare Dis Res 2017; 6:124-127. [PMID: 28580213 PMCID: PMC5451744 DOI: 10.5582/irdr.2017.01013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
We present a middle aged pregnant woman who developed signs and symptoms of acute liver failure and was found to have herpes simplex virus hepatitis. Patient had an emergent delivery and was started on antiviral therapy, but unfortunately due to the severity of her liver failure, she passed away. The importance of reporting this case is to emphasize on the importance of considering herpes simplex infection in pregnant women who present with acute liver failure, and the importance of early administration of antiviral therapy.
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Affiliation(s)
- Maen Masadeh
- Division of Gastroenterology and Hepatology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Huafeng Shen
- Division of Gastroenterology and Hepatology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Yejin Lee
- Division of Gastroenterology and Hepatology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Alan Gunderson
- Division of Gastroenterology and Hepatology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Kyle Brown
- Division of Gastroenterology and Hepatology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Andrew Bellizzi
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Tomohiro Tanaka
- Division of Gastroenterology and Hepatology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
- Address correspondence to: Dr. Tomohiro Tanaka, Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52241, USA. E-mail:
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Honsig C, Beinhardt S, Tomasits J, Dienes HP. Haemophagocytic lymphohistiocytosis associated with fulminant hepatitis and multiorgan failure following primary Epstein-Barr virus and herpes simplex virus type 1 infection. BMJ Case Rep 2017; 2017:bcr-2016-218310. [PMID: 28356254 PMCID: PMC5372189 DOI: 10.1136/bcr-2016-218310] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
We present a case of severe fatal hepatitis in a young patient presumably triggered by two ubiquitous viral diseases which occurred in close succession. This case is unusual because of the exceptional chronological sequence of primary Epstein–Barr virus and herpes simplex virus type 1 infection causing systemic immune dysregulation associated with rapidly developing liver failure and consecutive multiorgan failure. Clinical, laboratory and histopathological findings indicated the development of secondary haemophagocytic lymphohistiocytosis triggered by these closely succeeding viral primary infections.
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Affiliation(s)
- Claudia Honsig
- Division of Clinical Virology, Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Sandra Beinhardt
- Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | | | - Hans Peter Dienes
- Medical University of Vienna, Institute of Clinical Pathology, Vienna, Austria
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Acute Liver Failure from Herpes Simplex Virus in an Immunocompetent Patient Due to Direct Inoculation of the Peritoneum. ACG Case Rep J 2017; 4:e23. [PMID: 28286789 PMCID: PMC5340723 DOI: 10.14309/crj.2017.23] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 11/28/2016] [Indexed: 02/08/2023] Open
Abstract
Herpes simplex virus (HSV) hepatitis is a rare cause of acute liver failure (ALF). It carries a mortality rate of 80% if untreated, thus early identification and treatment are critical. Without high clinical suspicion, HSV hepatitis is difficult to diagnose. A 48-year-old Hispanic female presented with a 4-day history of abdominal pain and a vaginal cuff tear requiring laparoscopic repair. She subsequently developed postsurgical disseminated HSV, resulting in ALF. Acyclovir was initiated, but she was resistant to treatment. She was given additional foscarnet and responded without requiring a liver transplant.
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46
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Lawrence SJ. Febrile Transaminitis of Viral Etiology. Infect Dis (Lond) 2017. [DOI: 10.1016/b978-0-7020-6285-8.00207-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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47
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Ma CKK, Clancy L, Deo S, Blyth E, Micklethwaite KP, Gottlieb DJ. Herpes simplex virus type 1 (HSV-1) specific T-cell generation from HLA-A1- and HLA-A2-positive donors for adoptive immunotherapy. Cytotherapy 2016; 19:107-118. [PMID: 27793552 DOI: 10.1016/j.jcyt.2016.09.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 09/28/2016] [Accepted: 09/29/2016] [Indexed: 01/15/2023]
Abstract
BACKGROUND AIMS Herpes simplex virus (HSV) reactivation and infection is common in patients undergoing hematopoietic stem cell transplant (HSCT) and requires routine antiviral prophylaxis. Drug-resistant strains are increasingly common, and effective alternative therapy is currently unavailable. We generated and characterized HSV-1-specific T cells for use in adoptive cellular immunotherapy following allogeneic stem cell transplantation. METHODS Peripheral blood mononuclear cells from HLA-A1 and HLA-A2 HSV-seropositive hereditary hemochromatosis donors were used as the antigen source. Three HLA-A1 and four HLA-A2 specific epitopes were used for stimulation of T cells. Cells were stimulated with antigen-pulsed dendritic cells and cultured for 21 days in medium with interleukin (IL)-2. Cultured cells were phenotyped and tested for cytokine production, proliferation and cytotoxicity. RESULTS There was a 5.3-fold expansion in total cell numbers over 21 days of culture, with 35% of T cells being CD8 positive. Thirty-five percent, 21% and 5% of CD8 cells secreted interferon-γ, tumor necrosis factor-α and IL-2 upon HSV antigen re-stimulation. More than 50% of antigen-specific T cells secreted multiple cytokines. Cultured T cells proliferated upon antigen re-stimulation and lysed HSV-1 peptide and virus-infected targets. CONCLUSIONS It is feasible to generate functional HSV-1 specific T cells from the blood of HLA-A1 and HLA-A2 HSV-seropositive donors using specific peptides. The utility of these cells in preventing and treating HSV-1 reactivation in allogeneic HSCT will need to be tested clinically.
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Affiliation(s)
- Chun K K Ma
- The Westmead Institute for Medical Research, Australia; Blood and Marrow Transplant Unit, Australia
| | - Leighton Clancy
- The Westmead Institute for Medical Research, Australia; Blood and Marrow Transplant Unit, Australia; Sydney Cell and Gene Therapy Laboratory, Westmead Hospital, The University of Sydney, Sydney, Australia
| | - Shivashni Deo
- The Westmead Institute for Medical Research, Australia; Blood and Marrow Transplant Unit, Australia
| | - Emily Blyth
- The Westmead Institute for Medical Research, Australia; Blood and Marrow Transplant Unit, Australia; Sydney Cell and Gene Therapy Laboratory, Westmead Hospital, The University of Sydney, Sydney, Australia
| | - Kenneth P Micklethwaite
- The Westmead Institute for Medical Research, Australia; Blood and Marrow Transplant Unit, Australia; Sydney Cell and Gene Therapy Laboratory, Westmead Hospital, The University of Sydney, Sydney, Australia
| | - David J Gottlieb
- The Westmead Institute for Medical Research, Australia; Blood and Marrow Transplant Unit, Australia; Sydney Cell and Gene Therapy Laboratory, Westmead Hospital, The University of Sydney, Sydney, Australia.
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Shahani L. Fulminant hepatic failure secondary to acyclovir-resistant herpes simplex virus. BMJ Case Rep 2016; 2016:bcr-2016-216322. [PMID: 27754940 DOI: 10.1136/bcr-2016-216322] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Liver failure is a frequent and serious complication that causes morbidity and mortality in haematopoietic stem cell transplantation (HCT) recipients. Liver dysfunction in these patients can be related to infectious causes, most common viral hepatitis. We report a case of disseminated acyclovir-resistant herpes simplex virus (HSV) infection following HCT that led to acute liver failure and death. Although rare, HSV hepatitis leads to high morbidity and mortality and should be considered in the differential diagnosis of HCT recipients with marked elevation of hepatic transaminase. Acyclovir is a first-line therapy for HSV infection; however, acyclovir-resistant viral strains should be considered and alternative HSV therapies given in HCT recipients whose HSV infection does not improve on acyclovir therapy.
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Affiliation(s)
- Lokesh Shahani
- McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
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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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Feugeas J, Mory S, Jeulin H, Velay A, Pertek JP, Ladriere M, Losser MR. Herpes simplex virus type 1 hepatitis due to primary infection in a pancreas-kidney transplant recipient. J Clin Virol 2016; 80:57-9. [DOI: 10.1016/j.jcv.2016.04.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 04/22/2016] [Accepted: 04/23/2016] [Indexed: 11/24/2022]
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