Herpes simplex virus sepsis and acute liver failure

Abstract

Acute liver failure is a life threatening disease mostly triggered by drug-induced or toxic liver damage or viral hepatitis. Herpes Simplex virus (HSV) hepatitis is rare and accounts for only 1% of all acute liver failures. The importance of HSV-induced acute liver failure is based on its extremely severe clinical course with lethality rates of almost 75%. HSV hepatitis is just one of several clinical manifestations of HSV sepsis leading more frequently to encephalitis, pneumonia and esophagitis. Local herpes infection or recurrence of dermal lesions (herpes labialis, herpes genitalis), however, is common and account for the high prevalence of HSV-1 or HSV-2 infection in adults. Another rare entity is visual dissemination, which mostly affects immunocompromised patients. Compromised cellular immunity is a major risk factor for HSV sepsis because of either primary infection or reactivation of occult chronic HSV infection. Delayed diagnosis without antiviral therapy significantly contributes to the unfavorable outcome. Typically, anicteric hepatitis is seen in patients with HSV hepatitis. Because of its low incidence, however, and the lack of dermal manifestations, HSV hepatitis is rarely considered in the context of acute liver failure. In addition, diagnostic tests might not always be available. Therefore, it is a generally accepted consensus to begin antiviral therapy pre-emptively with acyclovir in cases of acute liver failure of unknown origin, in which high urgency (HU) liver transplantation remains the only therapeutical option. Even in the case of early specific therapy, sepsis may prevail and the indication for HU transplantation must be evaluated carefully. The outcome after liver transplantation for HSV-induced liver failure with reported survival rates of more than 40% is good. Because of the risk of recurrence, lifelong prophylaxis with acyclovir is recommended.

Functional Genomics Reveals an Essential and Specific Role for Stat1 in Protection of the Central Nervous System following Herpes Simplex Virus Corneal Infection

“…Herpes simplex virus type 1 (HSV-1) is a ubiquitous, neurotropic human pathogen that causes mostly self-limiting diseases in immunocompetent hosts but can cause encephalitis, meningitis, and hepatitis in immune-suppressed hosts (36,42). Herpes simplex encephalitis (HSE) is the most common form of viral sporadic encephalitis (25) and, when left untreated, has a mortality rate of 70% (3,22).…”

Acute liver failure in the setting of herpes simplex virus and coexistent acute fatty liver of pregnancy

“…HSV infection is endemic with an estimated 80% of adults likely to contract HSV throughout their lifetime [1] . Although HSV infection may present with mild nonspecific viral symptoms, most HSV infections are asymptomatic.…”

“…Of these cases, the mortality rate approaches 90% [1,3,5,8] . Data support the use of acyclovir to treat HSV hepatitis, and early initiation of treatment is vital to transplantfree survival [7] .…”

“…fold) occurs in the setting of relatively normal or low bilirubin levels [1,3,5,7,8] . This pattern is often associated with a marked elevation of AST greater than ALT.…”

Practical Applications in Immunohistochemistry: Evaluation of Rejection and Infection in Organ Transplantation

“…Herpes simplex virus and varicellazoster virus can also rarely cause severe, systemic infection, including encephalitis, esophagitis, pneumonia, keratoconjunctivitis, or hepatitis, which are associated with significant mortality. [137][138][139][140][141] Immunosuppressed patients with systemic disease may not have characteristic mucocutaneous lesions.…”