Herpes simplex esophagitis from 1307 autopsy cases

Itoh, T; Takahashi, Takashi; Kusaka, K; Kawaura, Ken; Nakagawa, Yoshiaki; Yamakawa, J; Kanda, Tsugiyasu

doi:10.1046/j.1440-1746.2003.03166.x

Cited by 39 publications

(44 citation statements)

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“…A positive result is indicated by a specific size of PCR fragments: 120 bp (HSV1/2), 98 bp (VZV), 78 bp (CMV), 66 bp (HHV6), and 54 bp (EBV) (Figure 4). In routine diagnostics, PCR methods that are conducted on tissue specimens are well established [1,9] and superior to virus culture [9]. We have seen cases with double infection of fungi and HSV ( Figure 2) as well as with HSV and CMV or CMV and EBV (Figure 4).…”

Section: Histochemistry and Molecular Methodsmentioning

confidence: 95%

“…For the detection of HSV, biopsies should be taken from the edge of an ulcerated lesion. In contrast, CMV and EBV are better detected from the center of the ulcer base [3,5,9]. Since different viruses show variability concerning their best traceability, sampling should include…”

Section: Sequential Evaluation In Patients With Esophagitis Endoscopymentioning

confidence: 99%

“…Characteristic are cells with eosinophil intranuclear inclusions ("owl's eye"), a peripheral halo and prominent chromatin. Often there are associated multinucleated giant cells [9,10]. Whether EBV infection is a distinct disease entity or an "innocent bystander" remains controversial.…”

Section: Histologymentioning

confidence: 99%

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Practical Aspects in the Evaluation of Infectious Esophagitis

Otto¹

2012

Clin Microbial

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Section: Histochemistry and Molecular Methodsmentioning

confidence: 95%

Section: Sequential Evaluation In Patients With Esophagitis Endoscopymentioning

confidence: 99%

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Practical Aspects in the Evaluation of Infectious Esophagitis

Otto¹

2012

Clin Microbial

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“…HSV-1 esophagitis diagnosis is based on the endoscopic findings confirmed by histopathological examination of the esophagitis lesions (10,11,12,14,19). The place of the virological diagnosis in an HSV-1 esophagitis diagnosis remains unclear.…”

Section: Discussionmentioning

confidence: 99%

Virological Diagnosis of Herpes Simplex Virus 1 Esophagitis by Quantitative Real-Time PCR Assay

et al. 2012

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Herpes simplex virus 1 (HSV-1) esophagitis diagnosis is routinely based on the endoscopic findings confirmed by histopathological examination of the esophagitis lesions. Virological diagnosis is not systematically performed and restricted to viral culture or to qualitative PCR assay from esophagitis biopsy specimens. The aim of this study was to assess the interest of quantitative real-time PCR assay in HSV-1 esophagitis diagnosis by comparing the results obtained to those of histological examination associated with immunohistochemical staining, which is considered the "gold standard." From 53 esophagitis biopsy specimens, the PCR assay detected HSV-1 in 18 of 19 histologically proven to have herpetic esophagitis and in 9 of 34 that had esophagitis related to other causes, demonstrating sensitivity, specificity, positive predictive value, and negative predictive value of 94.7%, 73%, 66.7%, and 96%, respectively. Interestingly, HSV-1 was not detected in 16 specimens without the histological aspect of esophagitis. The viral loads normalized per g of total extracted DNA in each biopsy specimen detected positive by HSV PCR were then compared and appeared to be significantly higher in histopathologically positive herpetic esophagitis (median ‫؍‬ 2.9 ؋ 10 6 ؎ 1.1 ؋ 10 8 ) than in histopathologically negative herpetic esophagitis (median ‫؍‬ 3.1 ؋ 10 3 ؎ 6.2 ؋ 10 3 ) (P ‫؍‬ 0.0009). Moreover, a receiver operating characteristics analysis revealed that a viral load threshold greater than 2.5 ؋ 10 4 copies would allow an HSV-1 esophagitis diagnosis with a sensitivity and specificity of 83.3% and 100%, respectively. In conclusion, this work demonstrated that HSV quantitative PCR results for paraffin-embedded esophageal tissue was well correlated to histopathological findings for an HSV-1 esophagitis diagnosis and could be diagnostic through viral load assessment when histopathological results are missing or uncertain. Herpes simplex virus 1 (HSV-1) is the second most common infectious etiological cause of esophagitis after Candida albicans (15,18,22). HSV-1 esophagitis is well documented in immunocompromised patients, whereas this clinical entity is rare in immunocompetent patients (2,4,5,9). HSV-1 esophagitis may represent a primary infection in particular in the immunocompetent host but is commonly due to a reactivation of a latent infection in the immunocompromised host (7).Friable mucosa, numerous ulcers, and whitish exudates commonly involving the distal or the midesophagus are classical endoscopic aspects in HSV-1 esophagitis (10,11,14,19). These findings require confirmation by histological examination completed with immunohistochemical staining of the biopsy specimens from the ulcer edges, which still remains the "gold standard" for HSV-1 esophagitis diagnosis (13,14,19). Virological diagnosis has been reported to optimize the diagnostic sensitivity of HSV-1 esophagitis (2,16,19). However, it is not systematically performed and is restricted to viral culture or to qualitative PCR assay from esophageal biopsy speci...

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“…À l'image du cas pré-senté, cette hémorragie peut être grave et menacer ainsi le pronostic vital [10]. Endoscopiquement, l'atteinte intéresse le plus souvent l'oesophage distal et/ou moyen, mais parfois l'oesophage tout entier [1][2][3]11,12], la présence de lésions gastriques concomitantes est peu fréquente. L'aspect caractéristique est celui d'une muqueuse inflammée, friable avec de multiples ulcérations variables en taille, en profondeur et en type de regroupement [1].…”

Section: Discussionunclassified

Œsophagite herpétique révélée par une hémorragie digestive haute

et al. 2011

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L'oesophagite à Herpes simplex virus (HSV) est une affection opportuniste qui touche essentiellement les patients immunodéprimés mais peut survenir aussi chez l'immunocompétent. Le tableau clinique est non spécifique, fait essentiellement de douleur rétrosternale, d'odynophagie, voire de dysphagie. Quelques cas, apportés par la littérature, étaient révélés par une complication à type de perforation ou d'hémorragie. Nous rapportons le cas d'une oesophagite herpétique révélée par une hémorragie digestive haute (HDH) grave. Pour citer cette revue : Acta Endosc. 41 (2011). Mots clés OEsophagite herpétique · Anatomopathologie · Hémorragie digestive haute · ImmunosuppressionAbstract Herpes simplex esophagitis is well recognized as an opportunistic infection in immunodeficient patients, but can occur even in immunocompetent patients. Clinical symptoms such as chest pain, odynophagia and dysphagia are not specific. However, complications such as bleeding or perforation have been reported in a few cases in adults. We report a herpes simplex esophagitis case revealed by a serious upper gastrointestinal bleeding. To cite this journal: Acta Endosc. 41 (2011).

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Herpes simplex esophagitis from 1307 autopsy cases

Abstract: The present results suggest that the macroscopic and microscopic postmortem features of HSE may provide useful information for clinical diagnosis of HSE.

Cited by 39 publications

References 13 publications

Practical Aspects in the Evaluation of Infectious Esophagitis

Practical Aspects in the Evaluation of Infectious Esophagitis

Virological Diagnosis of Herpes Simplex Virus 1 Esophagitis by Quantitative Real-Time PCR Assay

Œsophagite herpétique révélée par une hémorragie digestive haute

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