Document Detail

Detection and diagnosis of herpes simplex virus infection in adults with acute liver failure.
MedLine Citation:
PMID:  18825709     Owner:  NLM     Status:  MEDLINE    
Disseminated herpes simplex virus (HSV) infection may lead to acute liver failure (ALF) and the need for emergency liver transplantation (LT). The primary aim of this study was to determine the utility of HSV serological testing and HSV DNA testing by polymerase chain reaction (PCR) in the diagnosis and management of indeterminate, pregnancy-related, and known HSV-related ALF. Stored sera obtained on study day 1 or 2 from patients enrolled in the United States ALF Study Group with indeterminate (n = 51), pregnancy-related (n = 12), and HSV-related (n = 4) ALF were screened for HSV DNA by PCR and serology. While 7 of the indeterminate and pregnant patients had positive anti-HSV immunoglobulin M, none had detectable HSV DNA. The 4 known HSV cases all had high-titer HSV DNA on presentation (range: 3.5 to 36 x 10(8) copies/mL). Two HSV patients underwent LT but developed posttransplant extrahepatic HSV infection despite suppression of HSV DNA with acyclovir treatment, and one of them eventually died. The 2 other fulminant HSV patients died within 48 hours of presentation. In conclusion, serum HSV DNA indicative of occult HSV infection was not detected in 51 indeterminate and 12 pregnancy-related ALF patients. The 4 patients with known HSV-related ALF all had high HSV DNA levels at presentation, and despite the rapid use of antiviral therapy and emergency LT, substantial morbidity and mortality were encountered, highlighting the poor prognosis with severe disseminated HSV infection.
Josh Levitsky; Anupama T Duddempudi; Fred D Lakeman; Richard J Whitley; James P Luby; William M Lee; Robert J Fontana; Andres T Blei; Michael G Ison;
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society     Volume:  14     ISSN:  1527-6473     ISO Abbreviation:  Liver Transpl.     Publication Date:  2008 Oct 
Date Detail:
Created Date:  2008-10-06     Completed Date:  2009-01-27     Revised Date:  2013-06-05    
Medline Journal Info:
Nlm Unique ID:  100909185     Medline TA:  Liver Transpl     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1498-504     Citation Subset:  IM    
Copyright Information:
(c) 2008 AASLD.
Northwestern Memorial Hospital/Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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MeSH Terms
DNA, Viral / blood*
Herpes Simplex / blood,  complications,  diagnosis*
Liver Failure, Acute / virology*
Middle Aged
Polymerase Chain Reaction
Pregnancy Complications, Infectious / blood,  diagnosis*,  virology
Simplexvirus / isolation & purification*
Young Adult
Grant Support
Reg. No./Substance:
0/DNA, Viral

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