Detection and diagnosis of herpes simplex virus infection in adults with acute liver failure.

Published

Journal Article

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.

Full Text

Cited Authors

  • Levitsky, J; Duddempudi, AT; Lakeman, FD; Whitley, RJ; Luby, JP; Lee, WM; Fontana, RJ; Blei, AT; Ison, MG; US Acute Liver Failure Study Group,

Published Date

  • October 2008

Published In

Volume / Issue

  • 14 / 10

Start / End Page

  • 1498 - 1504

PubMed ID

  • 18825709

Pubmed Central ID

  • 18825709

Electronic International Standard Serial Number (EISSN)

  • 1527-6473

International Standard Serial Number (ISSN)

  • 1527-6465

Digital Object Identifier (DOI)

  • 10.1002/lt.21567

Language

  • eng