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Zjačić Puljiz D, Vrkić I, Jeličić I, Borić Škaro D, Delić Jukić IK, Vicelić Čutura L, Pavičić Ivelja M. Late-Onset HSV-2 Encephalitis in a Kidney Transplant Recipient: A Rare Case Report. Life (Basel) 2025; 15:152. [PMID: 40003561 PMCID: PMC11856058 DOI: 10.3390/life15020152] [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: 01/06/2025] [Revised: 01/20/2025] [Accepted: 01/21/2025] [Indexed: 02/27/2025] Open
Abstract
Infections are an important cause of morbidity and mortality in renal transplant recipients. Among the viral pathogens encountered in this population, herpes simplex virus (HSV), a member of the Alphaherpesvirinae subfamily, has an important place. HSV type 2 infections in this immunosuppressed population are primarily due to viral reactivation. While HSV-2 frequently presents as genital herpes or remains asymptomatic, in rare cases, it can lead to severe neurological manifestations, such as encephalitis, particularly in the early post-transplant period with a reported mortality rate of up to 40%. We present the case of a 49-year-old male who, three years after kidney transplantation, developed acute neurological symptoms, including aphasia and disorientation. Polymerase chain reaction (PCR) analysis of cerebrospinal fluid (CSF) identified HSV-2 as the causative pathogen, enabling a swift and accurate diagnosis. The patient was promptly treated with intravenous acyclovir, adjusted for renal function, resulting in complete neurological recovery and subsequent negative follow-up CSF PCR results. This case emphasizes the vital role of PCR diagnostics as the gold standard for confirming viral encephalitis, particularly in immunosuppressed patients, where atypical presentations can complicate diagnosis. It also highlights the importance of considering HSV-2 encephalitis in the differential diagnosis even beyond the immediate post-transplant period. Early recognition and management, facilitated by the multidisciplinary approach, are critical for improving outcomes in this vulnerable patient population.
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Affiliation(s)
- Danijela Zjačić Puljiz
- Clinic of Internal Medicine, Department of Nephrology, Dialysis and Hypertension, University Hospital Split, 21000 Split, Croatia
- School of Medicine, University of Split, 21000 Split, Croatia
| | - Ivana Vrkić
- Department of Infectious Disease, University Hospital Split, 21000 Split, Croatia
| | - Ivo Jeličić
- Clinic of Internal Medicine, Department of Nephrology, Dialysis and Hypertension, University Hospital Split, 21000 Split, Croatia
- School of Medicine, University of Split, 21000 Split, Croatia
| | - Dijana Borić Škaro
- Clinic of Internal Medicine, Department of Nephrology, Dialysis and Hypertension, University Hospital Split, 21000 Split, Croatia
- School of Medicine, University of Split, 21000 Split, Croatia
| | - Ivana Kristina Delić Jukić
- Clinic of Internal Medicine, Department of Nephrology, Dialysis and Hypertension, University Hospital Split, 21000 Split, Croatia
| | - Lučana Vicelić Čutura
- School of Medicine, University of Split, 21000 Split, Croatia
- Clinic of Internal Medicine, Department of Hematology, University Hospital Split, 21000 Split, Croatia
| | - Mirela Pavičić Ivelja
- School of Medicine, University of Split, 21000 Split, Croatia
- Department of Infectious Disease, University Hospital Split, 21000 Split, Croatia
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Wang B, Grand A, Schub M, Singh H, Ortiz Melo DI, Howell DN. Renal biopsy in systemic infections: expect the unexpected. Ultrastruct Pathol 2023; 47:22-29. [PMID: 36602913 DOI: 10.1080/01913123.2022.2164099] [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: 01/06/2023]
Abstract
Infection-related glomerulonephritis is well recognized in patients with ongoing infections. It can be missed, however, if the infection is unusual or undetected. We present three cases where the renal biopsy findings prompted the identification or treatment of systemic infections.Case 1: A 84-year-old male presented with acute kidney injury (AKI) and IgA vasculitis on skin biopsy. A renal biopsy showed active glomerulonephritis with abundant neutrophils and predominantly mesangial immune complex deposits containing IgA. The findings prompted an infectious workup which was positive for COVID-19, suggesting exacerbation of IgA nephropathy by recent COVID-19 infection. Case 2: A 31-year-old female status post kidney transplant for granulomatosis with polyangiitis (GPA) had recent pregnancy with preterm delivery, disseminated herpes simplex virus (HSV) infection with HSV hepatitis, E. coli on urine culture, and AKI. A renal biopsy showed proliferative glomerulonephritis with subendothelial and mesangial immune complex deposits containing IgG and C3. The findings were most consistent with infection-related immune complex glomerulonephritis, most likely HSV-related. Case 3: A 78-year-old female presented with AKI, proteinuria, hematuria, and positive p-ANCA. Clinically, ANCA vasculitis was suspected, and renal biopsy did show focal, segmental, necrotizing glomerulonephritis. However, immunofluorescence and electron microscopy showed IgM-rich deposits in the mesangium. The unusual presentation prompted an infectious workup including a Bartonella antibody panel which showed very high titers, suggesting Bartonella endocarditis.Infection-related glomerulonephritis has a wide variety of presentations histologically and clinically. The three cases we present here emphasize the importance of recognizing these entities to help guide treatment and improve patient care.
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Affiliation(s)
- Bangchen Wang
- Department of Pathology, Duke University Health Systems, Durham, NC, USA
| | - Alexandra Grand
- Department of Medicine, Duke University Health Systems, Durham, NC, USA
| | - Micah Schub
- Department of Medicine, Duke University Health Systems, Durham, NC, USA
| | - Harpreet Singh
- Department of Medicine, Duke University Health Systems, Durham, NC, USA
| | | | - David N Howell
- Department of Pathology, Duke University Health Systems, Durham, NC, USA
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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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A Rare Case of Cytomegalovirus and Herpes Simplex Virus Coinfection Gastritis and Colitis in a Person Living With HIV/AIDS. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2021. [DOI: 10.1097/ipc.0000000000001077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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5
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Filippidis P, Vionnet J, Manuel O, Mombelli M. Prevention of viral infections in solid organ transplant recipients in the era of COVID-19: a narrative review. Expert Rev Anti Infect Ther 2021; 20:663-680. [PMID: 34854329 DOI: 10.1080/14787210.2022.2013808] [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: 10/19/2022]
Abstract
INTRODUCTION In solid organ transplant (SOT) recipients, viral infections are associated with direct morbidity and mortality and may influence long-term allograft outcomes. Prevention of viral infections by vaccination, antiviral prophylaxis, and behavioral measures is therefore of paramount importance. AREAS COVERED We searched Pubmed to select publications to review current preventive strategies against the most important viral infections in SOT recipients, including SARS-CoV-2, influenza, CMV, and other herpesvirus, viral hepatitis, measles, mumps, rubella, and BK virus. EXPERT OPINION The clinical significance of the reduced humoral response following mRNA SARS-CoV-2 vaccines in SOT recipients still needs to be better clarified, in particular with regard to the vaccines' efficacy in preventing severe disease. Although a third dose improves immunogenicity and is already integrated into routine practice in several countries, further research is still needed to explore additional interventions. In the upcoming years, further data are expected to better delineate the role of virus-specific cell mediated immune monitoring for the prevention of CMV and potentially other viral diseases, and the role of the letermovir in the prevention of CMV in SOT recipients. Future studies including clinical endpoints will hopefully facilitate the integration of successful new influenza vaccination strategies into clinical practice.
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Affiliation(s)
| | - Julien Vionnet
- Transplantation Center, Lausanne University Hospital, Lausanne, Switzerland.,Service of Gastroenterology and Hepatology, Lausanne University Hospital, Lausanne, Switzerland
| | - Oriol Manuel
- Service of Infectious Diseases, Lausanne University Hospital, Lausanne, Switzerland.,Transplantation Center, Lausanne University Hospital, Lausanne, Switzerland
| | - Matteo Mombelli
- Service of Infectious Diseases, Lausanne University Hospital, Lausanne, Switzerland.,Transplantation Center, Lausanne University Hospital, Lausanne, Switzerland.,Service of Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland
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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: 0.8] [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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7
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Lee DH, Zuckerman RA. Herpes simplex virus infections in solid organ transplantation: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant 2019; 33:e13526. [PMID: 30859647 DOI: 10.1111/ctr.13526] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 02/27/2019] [Indexed: 12/19/2022]
Abstract
These updated guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation review the diagnosis, prevention, and management of HSV in the pre- and post-transplant period. A majority of transplant recipients are seropositive for HSV-1 or 2. Compared with immunocompetent persons, SOT recipients shed HSV more frequently, have more severe clinical manifestations, and are slower to respond to therapy. Most HSV infection is diagnosed on clinical grounds, but patients may present with atypical lesions and/or other clinical manifestations. Acquisition from the donor is rare. Polymerase chain reaction is the preferred diagnostic test unless culture is needed for resistance testing. For limited mucocutaneous lesions, oral therapy can be used; however, in severe, disseminated, visceral or CNS involvement, acyclovir doses of up to 10 mg/kg every 8 hours intravenously should be initiated. Acyclovir-resistant HSV is less common in SOT patients than in HSCT and can be treated with foscarnet, though other novel therapies are currently under investigation. HSV-specific prophylaxis should be considered for all HSV-1 and HSV-2-seropositive organ recipients who are not receiving antiviral medication for CMV prevention that has activity against HSV.
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Affiliation(s)
- Dong H Lee
- Division of Infectious Diseases and HIV Medicine, College of Medicine, Drexel University, Philadelphia, Pennsylvania
| | - Richard A Zuckerman
- Infectious Disease Service for Transplant and Immunocompromised Hosts, Section of Infectious Disease and International Health, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
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Nikolic D, Kohn D, Yen-Lieberman B, Procop GW. Detection of Herpes Simplex Virus and Varicella-Zoster Virus by Traditional and Multiplex Molecular Methods. Am J Clin Pathol 2019; 151:122-126. [PMID: 30239569 DOI: 10.1093/ajcp/aqy111] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objectives To compare multiplex nucleic acid amplification tests (NAATs) that detect and differentiate herpes simplex virus (HSV) and varicella-zoster virus (VZV) with traditional virologic assays. Methods The HSV ELVIS Test System (Quidel, San Diego, CA) and/or Light Diagnostics VZV direct fluorescent antibody (DFA) kit (Millipore Sigma, Billerica, MA), as well as an ARIES HSV 1&2/VZV assay (Luminex, Austin, TX) and the Solana HSV1 + 2/VZV Assay (Quidel), were performed on non-cerebrospinal fluid specimens. Results The sensitivities/specificities for the ELVIS, Aries, and Solana assays for HSV were 71.1%/93.2%, 94.9%/93.2%, and 94.7%/100%, respectively. The sensitivities/specificities for the DFA, Aries, and Solana assays for VZV were 71.4%/100%, 100%/96.0%, and 95.3%/100%, respectively. HSV and VZV were detected but clinically unsuspected in 5.4% and 4.2% of the specimens, respectively. Conclusions Both NAAT assays were comparable and more sensitive than traditional methods. The recovery of unsuspected HSV and VZV from clinical specimens supports the implementation of a combined HSV/VZV assay.
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Affiliation(s)
- Dejan Nikolic
- Department of Pathology, Cooper University Health Care, Camden, NJ
- Department of Laboratory Medicine, Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH
| | - Debra Kohn
- Department of Laboratory Medicine, Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH
| | - Belinda Yen-Lieberman
- Department of Laboratory Medicine, Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH
| | - Gary W Procop
- Department of Laboratory Medicine, Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH
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Abstract
The α herpes viruses HSV-1, HSV-2, and VZV often reactivate in the setting of immune suppression after solid organ transplantation. Oral or genital mucocutaneous disease is the most common clinical manifestation of HSV disease while VZV manifests as varicella (or chickenpox) or reactivation herpes zoster, characterized by a diffuse rash, or a painful unilateral vesicular eruption in a dermatomal distribution, respectively. The diagnosis of HSV and VZV is primarily based on history and clinical presentation, although diagnostic tests may be necessary for atypical presentations of disease. Treatment usually involves oral or intravenous antiviral therapy, depending on severity of illness.
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Affiliation(s)
- Cybele Lara Abad
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Raymund R Razonable
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, MN; The William J. Von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN.
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Macesic N, Abbott IJ, Kaye M, Druce J, Glanville AR, Gow PJ, Hughes PD, Korman TM, Mulley WR, O'Connell PJ, Opdam H, Paraskeva M, Pitman MC, Setyapranata S, Rawlinson WD, Johnson PDR. Herpes simplex virus-2 transmission following solid organ transplantation: Donor-derived infection and transplantation from prior organ recipients. Transpl Infect Dis 2017; 19. [PMID: 28618165 DOI: 10.1111/tid.12739] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 03/24/2017] [Accepted: 04/02/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Owing to limited availability of donor organs, previous solid organ transplant (SOT) recipients are increasingly considered as potential organ donors. We report donor-derived transmission of herpes simplex virus type-2 (HSV-2) to two clusters of SOT recipients with transmission from the original donor and an HSV-2-infected recipient who subsequently became a donor. METHODS We reviewed medical records of the donors and recipients in both clusters. Pre-transplant serology and virological features of HSV-2 were characterized. Genotyping of HSV-2 isolates to determine potential for donor transmission of HSV-2 through transplantation of organs from prior organ recipients was performed. RESULTS A kidney-pancreas recipient died day 9 post transplant. Following confirmation of brain death, the lungs and recently transplanted kidney were donated to two further recipients. The liver was not retrieved, but biopsy confirmed HSV-2 infection. Testing on the original donor showed negative HSV-2 polymerase chain reaction and HSV immunoglobulin (Ig)M, but positive HSV-2 IgG. The liver recipient from the original donor developed HSV-2 hepatitis and cutaneous infection that responded to treatment with intravenous acyclovir. In the second cluster, lung and kidney recipients both developed HSV-2 viremia that was successfully treated with antiviral therapy. Genotyping of all HSV-2-positive samples showed 100% sequence homology for three recipients. CONCLUSIONS Donor-derived HSV infection affected two clusters of recipients because of transplantation of organs from a prior organ recipient. HSV should be considered as a possible cause of illness in febrile SOT recipients in the immediate post-transplant period and may cause disseminated disease and re-infection in HSV-2-seropositive recipients. Testing of HSV serology and prophylaxis may be considered in SOT recipients not receiving cytomegalovirus prophylaxis.
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Affiliation(s)
- Nenad Macesic
- Department of Infectious Diseases, Austin Health, Melbourne, VIC, Australia.,Division of Infectious Diseases, Columbia University Medical Center, New York City, NY, USA
| | - Iain J Abbott
- Victorian Infectious Diseases Reference Laboratory, Doherty Institute, Melbourne, VIC, Australia
| | - Matthew Kaye
- Victorian Infectious Diseases Reference Laboratory, Doherty Institute, Melbourne, VIC, Australia
| | - Julian Druce
- Victorian Infectious Diseases Reference Laboratory, Doherty Institute, Melbourne, VIC, Australia
| | - Allan R Glanville
- Department of Thoracic Medicine, St. Vincent's Hospital, Sydney, NSW, Australia
| | - Paul J Gow
- Liver Transplant Unit, Austin Health, Melbourne, VIC, Australia.,Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Peter D Hughes
- Department of Nephrology, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Tony M Korman
- Monash Infectious Diseases, Monash University, Monash Health, Melbourne, VIC, Australia
| | - William R Mulley
- Department of Medicine, Monash University, Melbourne, VIC, Australia.,Department of Nephrology, Monash Health, Melbourne, VIC, Australia
| | - Phillip J O'Connell
- National Pancreas Transplant Unit, Westmead Hospital, Sydney, NSW, Australia
| | | | - Miranda Paraskeva
- Department of Allergy, Immunology and Respiratory Medicine, Alfred Hospital, Melbourne, VIC, Australia
| | - Matthew C Pitman
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Stella Setyapranata
- Department of Nephrology, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - William D Rawlinson
- Serology and Virology Division (SAViD), South Eastern Area Laboratory Services, University of NSW, Sydney, NSW, Australia
| | - Paul D R Johnson
- Department of Infectious Diseases, Austin Health, Melbourne, VIC, Australia.,Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
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Hirschi S, Biondini D, Ohana M, Solis M, D'Urso A, Rosner V, Kessler R. Herpes simplex virus 2 hepatitis in a lung transplant recipient: a diagnostic challenge. Transpl Infect Dis 2015; 17:904-8. [DOI: 10.1111/tid.12459] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 08/18/2015] [Indexed: 01/31/2023]
Affiliation(s)
- S. Hirschi
- Department of Respiratory Medicine; Strasbourg University Hospital; Strasbourg France
| | - D. Biondini
- Department of Cardiological, Thoracic and Vascular Sciences; University of Padova; Padova Italy
| | - M. Ohana
- Department of Radiology; Strasbourg University Hospital; Strasbourg France
| | - M. Solis
- Department of Virology; Strasbourg University Hospital; Strasbourg France
| | - A. D'Urso
- Institut Hospitalo-Universitaire (IHU); Institute for Minimally Hybrid Invasive Image-Guided Surgery; Strasbourg University Hospital; Strasbourg France
| | - V. Rosner
- Department of Respiratory Medicine; Strasbourg University Hospital; Strasbourg France
| | - R. Kessler
- Department of Respiratory Medicine; Strasbourg University Hospital; Strasbourg France
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12
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Côté-Daigneault J, Carrier F, Toledano K, Wartelle-Bladu C, Willems B. Herpes simplex hepatitis after liver transplantation: case report and literature review. Transpl Infect Dis 2014; 16:130-4. [DOI: 10.1111/tid.12178] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Revised: 05/08/2013] [Accepted: 09/22/2013] [Indexed: 12/20/2022]
Affiliation(s)
- J. Côté-Daigneault
- Hepatology Service; Department of Medicine; Saint-Luc Hospital; CHUM; University of Montreal; Montreal Quebec Canada
| | - F.M. Carrier
- Intensive Care Service; Department of Medicine; Saint-Luc Hospital; CHUM; University of Montreal; Montreal Quebec Canada
- Department of Anaesthesiology; Saint-Luc Hospital; CHUM; University of Montreal; Montreal Quebec Canada
| | - K. Toledano
- Intensive Care Service; Department of Medicine; Saint-Luc Hospital; CHUM; University of Montreal; Montreal Quebec Canada
| | - C. Wartelle-Bladu
- Hepatology Service; Department of Medicine; Saint-Luc Hospital; CHUM; University of Montreal; Montreal Quebec Canada
| | - B. Willems
- Hepatology Service; Department of Medicine; Saint-Luc Hospital; CHUM; University of Montreal; Montreal Quebec Canada
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13
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Netchiporouk E, Tchervenkov J, Paraskevas S, Sasseville D, Billick R. Evaluation of Herpes Simplex Virus Infection Morbidity and Mortality in Pancreas and Kidney-Pancreas Transplant Recipients. Transplant Proc 2013; 45:3343-7. [DOI: 10.1016/j.transproceed.2013.05.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Accepted: 05/09/2013] [Indexed: 10/26/2022]
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14
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Pietrucha-Dilanchian P, Tanawuttiwat T, Abbo L, Regatieri A, Chaparro S, Ruiz P, Morris M. Fatal herpes simplex virus type 2 hepatitis in a heart transplant recipient: a case report and review of the literature. Transpl Infect Dis 2013; 15:E87-96. [DOI: 10.1111/tid.12077] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Revised: 12/13/2012] [Accepted: 12/23/2012] [Indexed: 11/30/2022]
Affiliation(s)
| | - T. Tanawuttiwat
- Division of Cardiology; Jackson Memorial Hospital; University of Miami; Miami; Florida; USA
| | - L. Abbo
- Division of Infectious Diseases; Jackson Memorial Hospital/University of Miami Miller School of Medicine; Miami; Florida; USA
| | - A. Regatieri
- Division of Infectious Diseases; Jackson Memorial Hospital/University of Miami Miller School of Medicine; Miami; Florida; USA
| | - S. Chaparro
- Division of Cardiology; Jackson Memorial Hospital; University of Miami; Miami; Florida; USA
| | - P. Ruiz
- Division of Transplantation; Department of Surgery; University of Miami; Miami; Florida; USA
| | - M.I. Morris
- Division of Infectious Diseases; Jackson Memorial Hospital/University of Miami Miller School of Medicine; Miami; Florida; USA
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15
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Wilck MB, Zuckerman RA. Herpes simplex virus in solid organ transplantation. Am J Transplant 2013; 13 Suppl 4:121-7. [PMID: 23465005 DOI: 10.1111/ajt.12105] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- M B Wilck
- Division of Infectious Diseases, Hospital of University of Pennsylvania, Philadelphia, PA, USA
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16
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Zuckerman RA, Limaye AP. Varicella zoster virus (VZV) and herpes simplex virus (HSV) in solid organ transplant patients. Am J Transplant 2013; 13 Suppl 3:55-66; quiz 66. [PMID: 23347214 DOI: 10.1111/ajt.12003] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Revised: 09/06/2012] [Accepted: 09/07/2012] [Indexed: 01/25/2023]
Abstract
Varicella zoster virus (VZV) and the two herpes simplex viruses (HSV) are human α-herpesviruses that establish life-long latency in neural ganglia after initial primary infection. In the solid organ transplant (SOT) population, manifestations of VZV or HSV may be seen in up to 70% of recipients if no prophylaxis is used, some of them life and organ threatening. While there are effective vaccines to prevent VZV primary infection and reactivation in immunocompetent adults, these vaccines are contraindicated after SOT because they are live-virus vaccines. For HSV, prevention has focused primarily on antiviral strategies because the immunologic correlates of protection and control are different from VZV, making vaccine development more challenging. Current antiviral therapy remains effective for the majority of clinical VZV and HSV infections.
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Affiliation(s)
- R A Zuckerman
- Department of Medicine, Section of Infectious Disease and International Health, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
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Abstract
HSV infections are prevalent worldwide. A vaccine to prevent genital herpes would have a significant impact on this disease. Several vaccines have shown promise in animal models; however, so far these have not been successful in human clinical studies. Prophylactic HSV vaccines to prevent HSV infection or disease have focused primarily on eliciting antibody responses. Potent antibody responses are needed to result in sufficiently high levels of virus-specific antibody in the genital tract. Therapeutic vaccines that reduce recurrences need to induce potent T-cell responses at the site of infection. With the increasing incidence of HSV-1 genital herpes, an effective herpes vaccine should protect against both HSV-1 and HSV-2. Novel HSV vaccines, such as replication-defective or attenuated viruses, have elicited humoral and cellular immune responses in preclinical studies. These vaccines and others hold promise in future clinical studies.
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Affiliation(s)
- Lesia K Dropulic
- Medical Virology Section, Laboratory of Infectious Diseases, National Institute of Allergy & Infectious Diseases, National Institutes of Health, Bethesda, MD, USA.
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Yoshida K, Miyahira Y, Ishida M, Iwai M, Kagotani A, Arita N, Iwamoto N, Takikita M, Kojima F, Okabe H. Ascitic fluid due to type II herpes simplex virus infection: report of a case with immunocytochemical confirmation. Diagn Cytopathol 2012; 41:354-9. [PMID: 22282082 DOI: 10.1002/dc.21775] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Revised: 05/29/2011] [Accepted: 05/31/2011] [Indexed: 11/06/2022]
Abstract
Herpes simplex virus (HSV) infection is usually observed in the oral cavity and external genitals, and HSV peritonitis is extremely rare. Herein, we report a case of type II HSV peritonitis successfully diagnosed by ascitic cytology. A 66-year-old Japanese man, who had been treated with steroid inhalation for 5 years due to chronic obstructive pulmonary disease, was suspected to have acute cholecystitis. Laparoscopic cholecystectomy and intraoperative cytological examination of ascitic fluid were performed. Cytological study of ascitic fluid revealed that abundant granular cell debris, degenerative cells and apoptotic bodies were present, as well as some single or multinucleated cells with ground glass nuclei. However, vivid mesothelial cells were rarely seen. Immunocytochemical staining for type II HSV was positive in single or multinucleated cells with ground glass nuclei. Therefore, a diagnosis of type II HSV peritonitis was made. This is the first reported case of type II HSV peritonitis successfully diagnosed by ascitic cytology. This report highlights that the presence of abundant cell debris, degenerative cells and apoptotic bodies, and the absence of vivid mesothelial cells are the key cytological findings to suspect HSV peritonitis, and the diagnosis can be confirmed by careful surveillance for characteristic nuclear findings of single or multinucleated cells. The frequency of opportunistic infection is increased because of the increased numbers of iatrogenic immunocompromised patients as seen in this case, therefore, cytological examination is a useful method for early detection of the causative agent of peritonitis including HSV.
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Affiliation(s)
- Keiko Yoshida
- Division of Diagnostic Pathology, Shiga University of Medical Science, Shiga, Japan
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19
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Ambrosioni J, Kaiser L, Giostra E, Meylan P, Mentha G, Toso C, Genevay-Infante M, Rubbia-Brandt L, van Delden C. Herpes simplex virus load to monitor antiviral treatment after liver transplantation for acute herpetic hepatitis. Antivir Ther 2011; 17:401-4. [PMID: 22290285 DOI: 10.3851/imp1922] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2011] [Indexed: 10/16/2022]
Abstract
Herpes simplex virus (HSV) hepatitis is an uncommon cause of acute liver failure (ALF), primarily affecting immunocompromised patients. So far, 148 cases have been published, of which 9 underwent liver transplantation (LT). The reported post-transplant survival is poor, with over 60% dying in the first year. Dosing and duration of antiviral therapy after LT are not established. Concerns include both the risk of hepatic recurrence after LT and emergence of viral resistance during prolonged therapy. HSV DNA plasma levels might be helpful to monitor therapeutic response and guide duration of therapy. We present a case of ALF complicating a primary HSV-1 infection in an immunocompetent host, who required emergency LT. We further discuss the value of measuring serial HSV DNA plasma loads to monitor antiviral therapy.
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Affiliation(s)
- Juan Ambrosioni
- Service of Infectious Diseases, Department of Medical Specialities, University Hospitals of Geneva, Geneva, Switzerland
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20
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Rizza V, Coletti G, Grimaldi A, Clemente K, Di Cocco P, D'Angelo M, Delreno F, Famulari A, Pisani F. A rare case of herpes simplex type 1 bronchopneumonia associated with cardiomegaly in renal transplantation. Transplant Proc 2011; 43:1210-1212. [PMID: 21620091 DOI: 10.1016/j.transproceed.2011.01.152] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION We report a rare case of herpes simplex virus (HSV) type 1B in patient with kidney transplant as a possible cause of patient death. CASE REPORT A 32-year-old renal transplanted Caucasian man was referred for asthenia, fever, anemia, chest pain, cough, dyspnea, myalgias, peripheral edema, acute renal failure, diffuse cutaneus and mucous vesicles, and acute weight gain. The home therapy consisted of tacrolimus, sodic mycophenolate, and steroids. Laboratory data, bronchoscopy, and bronchial mucosal biopsy revealed HSV1B. We administered antiviral and antibiotic agents and reduced tacrolimus with clinical resolution. But after 10 days from discharge, the patient was admitted for acute cardiomegaly. So using ex adiuvantibus criteria we administered antiviral therapy with complete clinical improvement. CONCLUSION According to the literature, posttransplant HSV1B infection is a rare but severe complication of kidney transplantation associated with poor graft survival and a high mortality. Only an early, accurate diagnosis with efficient treatment permitted resolution of the problem. Our report stresses the difficulty of HSV2B clinical diagnosis and treatment.
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Affiliation(s)
- V Rizza
- Kidney Transplant Unit, Department of Surgery, University of L'Aquila, San Salvatore Hospital, L'Aquila, Italy.
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21
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Herpes viruses in transplant recipients: HSV, VZV, human herpes viruses, and EBV. Hematol Oncol Clin North Am 2011; 25:171-91. [PMID: 21236397 DOI: 10.1016/j.hoc.2010.11.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The herpes viruses are responsible for a wide range of diseases in patients following transplant, resulting from direct viral effects and indirect effects, including tumor promotion. Effective treatments and prophylaxis exist for the neurotropic herpes viruses HSV-1, HSV-2, varicella zoster virus, and possibly HHV-6. Antivirals seem to be less effective at prevention of the tumor-promoting effects of Epstein-Barr virus and HHV-8. Reduction in immunosuppression is the cornerstone to treatment of many diseases associated with herpes virus infections.
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22
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Bohn K, Zell R, Schacke M, Wutzler P, Sauerbrei A. Gene polymorphism of thymidine kinase and DNA polymerase in clinical strains of herpes simplex virus. Antivir Ther 2011; 16:989-97. [DOI: 10.3851/imp1852] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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23
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Watanabe D, Kuhara T, Ishida N, Takeo T, Tamada Y, Matsumoto Y. Disseminated mucocutaneous herpes simplex virus infection in an immunocompetent woman. Int J STD AIDS 2010; 21:213-4. [PMID: 20215631 DOI: 10.1258/ijsa.2009.009017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Disseminated mucocutaneous herpes simplex virus (HSV) infection in an immunocompetent person is quite rare. A 19-year-old healthy Japanese woman presented with painful, umbilicated vesicles and pustules on her genital region, both nipples and on the forearm 10 days after the last sexual contact with her partner who had cold sore at that time. Tzanck test and biopsy confirmed the diagnosis of disseminated mucocutaneous HSV infection. She did not have any visceral HSV disease. Skin lesions improved after treatment with acyclovir and erythromycin for seven days. We propose that like herpes gladiatorum, HSV dissemination in this case was acquired by close body contact.
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Affiliation(s)
- D Watanabe
- Department of Dermatology, Aichi Medical University, Nagakute, Aichi 480-1195, Japan.
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24
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Shiley K, Blumberg E. Herpes Viruses in Transplant Recipients: HSV, VZV, Human Herpes Viruses, and EBV. Infect Dis Clin North Am 2010; 24:373-93. [DOI: 10.1016/j.idc.2010.01.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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25
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Zuckerman R, Wald A. Herpes simplex virus infections in solid organ transplant recipients. Am J Transplant 2009; 9 Suppl 4:S104-7. [PMID: 20070669 DOI: 10.1111/j.1600-6143.2009.02900.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- R Zuckerman
- Department of Medicine, Section of Infectious Disease and International Health, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
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