RESUMO
IMPORTANCE: Herpes simplex virus (HSV) hepatitis is a rare condition with a high mortality rate. Immunocompromised individuals, including pregnant women, are the most susceptible. When primary infection occurs during pregnancy, risk for disseminated HSV is greatly increased. Disseminated HSV can manifest in the form of HSV hepatitis. OBJECTIVE: We aim to review the literature and summarize what is known about HSV hepatitis in pregnancy to aid in the diagnosis and treatment of this condition. EVIDENCE ACQUISITION: A literature search of PubMed and Web of Science was performed. A total of 237 citations were found. All citations were independently reviewed. Thirty-eight full-text articles were identified and included in this review. Additional data from 1 unpublished case from our institution was included. RESULTS: Fifty-six cases were included with average gestational age at diagnosis of 30 weeks. Patients presented with a wide variety of gastrointestinal, respiratory, neurologic, and urogenital symptoms. The most common examination findings were fever and abdominal tenderness. Only 18.2% of patients had a vesicular rash. All patients had a transaminitis, and 85% had positive viral cultures. A multitude of treatments were used with the majority of favorable outcomes occurring after treatment with acyclovir. CONCLUSIONS AND RELEVANCE: Although HSV hepatitis is rare, it carries a mortality rate of up to 39% for mothers and neonates. Therefore, it is crucial that HSV hepatitis be included on the differential diagnosis when a patient presents with fever and transaminitis. When HSV hepatitis is suspected, empiric therapy with acyclovir can be initiated with no additional risk to the fetus.
Assuntos
Herpes Simples/virologia , Complicações Infecciosas na Gravidez/virologia , Simplexvirus , Aciclovir/uso terapêutico , Adulto , Antivirais/uso terapêutico , Feminino , Herpes Simples/tratamento farmacológico , Herpes Simples/mortalidade , Humanos , Recém-Nascido , Gravidez , Complicações Infecciosas na Gravidez/tratamento farmacológico , Complicações Infecciosas na Gravidez/mortalidade , Resultado da GravidezRESUMO
This retrospective study characterized the clinical course of 13 neonates who died with herpes simplex virus infection from 2001 to 2011, representing a 26% case-fatality rate. Fatal disease developed at ≤ 48 hours of age in one-third of infants, was mostly disseminated disease, and occurred despite early administration of high-dose acyclovir therapy.
Assuntos
Herpes Simples/mortalidade , Complicações Infecciosas na Gravidez/mortalidade , Feminino , Herpes Simples/diagnóstico , Humanos , Recém-Nascido , Masculino , Complicações Infecciosas na Gravidez/diagnóstico , Estudos RetrospectivosAssuntos
Encéfalo/virologia , Callithrix/virologia , Herpes Simples/transmissão , Herpesvirus Humano 1/crescimento & desenvolvimento , Zoonoses/transmissão , Animais , Animais Selvagens/virologia , Encéfalo/patologia , Brasil , Reservatórios de Doenças , Herpes Simples/epidemiologia , Herpes Simples/mortalidade , Herpes Simples/patologia , Herpes Simples/veterinária , Herpes Simples/virologia , Humanos , Imuno-Histoquímica , Taxa de Sobrevida , Zoonoses/epidemiologia , Zoonoses/virologiaRESUMO
OBJECTIVE: To better characterize the clinical outcomes of infants with herpes simplex virus (HSV) infection and identify useful correlates of disease severity. STUDY DESIGN: Infants aged ≤6 months with HSV infection treated between 1999 and 2009 were identified. In patients with concurrent hepatitis, laboratory and clinical variables were examined to identify predictors of specific outcomes, including death or the need for liver transplantation and the need for intensive care. RESULTS: Of the 15 patients enrolled, 4 (27%) had fatal disease and 2 (13%) required liver transplantation. Infants who lacked skin lesions (P = .04), had a positive HSV polymerase chain reaction result (P = .01), had more severe thrombocytopenia (P = .001), or had other organ system dysfunction (P = .002) were more likely to require intensive care. A higher International Normalized Ratio value (P = .001) and peak total bilirubin level (P = .0002) were predictive of death or the need for liver transplantation. Peak direct bilirubin level was predictive of the need for intensive care and of death or the need for liver transplantation (P = .04 and .009, respectively). CONCLUSIONS: HSV hepatitis represents a broad spectrum of disease from mild aminotransferase elevation to fulminant liver failure and death. HSV DNA detected by polymerase chain reaction, a lack of skin lesions, and the degree of coagulopathy, thrombocytopenia, and cholestasis portend unfavorable outcomes.
Assuntos
Hepatite Viral Humana/mortalidade , Herpes Simples/mortalidade , Índice de Gravidade de Doença , Bilirrubina/sangue , DNA Viral/análise , Feminino , Hepatite Viral Humana/cirurgia , Hepatite Viral Humana/virologia , Humanos , Lactente , Recém-Nascido , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Unidades de Terapia Intensiva Pediátrica/estatística & dados numéricos , Coeficiente Internacional Normatizado , Transplante de Fígado/estatística & dados numéricos , Masculino , Reação em Cadeia da Polimerase , Simplexvirus/genética , Dermatopatias Virais/epidemiologia , Dermatopatias Virais/patologia , Trombocitopenia/epidemiologiaRESUMO
Ascorbate is an important antioxidant. However, in the presence of transition metals such as Cu(II) or Fe(III), it also has pro-oxidant capabilities. The effect of ascorbate-Cu(II) in the in vitro infection of herpes simplex virus type 2 (HSV-2) and its protecting effect in a murine model was investigated. HSV-2 was treated with different concentrations of ascorbate in the presence of Cu(II). A group of CF-1 mice were treated with the inactivated virus and other treated with maintenance medium containing only ascorbate-Cu(II). Weeks later, mice were challenged intranasally with infectious viruses. HSV-2 was completely inactivated by 2mM ascorbate plus 1mM Cu(II). Ascorbate or Cu(II) alone did not inactivate the virus. Compared with the control group, 60% of the immunized animals did not show any sign of encephalitis and survived the herpes virus infection, while a 7% survival rate was observed in the control group (P = 0.056). We concluded that the in vitro treatment of HSV-2 with ascorbate-Cu(II) is not only able to inactivate the virus, but also suggested that the viral particles induced a protective response against herpes encephalitis. This inactivation may provide an alternative method to develop new agents therapeutics.