Quantification of viral DNA and liver enzymes in plasma improves early diagnosis and management of herpes simplex virus hepatitis

Beersma, Matthias F. C.; Verjans, Georges M. G. M.; Metselaar, HJ; Osterhaus, A.D.M.E.; Berrington, William R.; Doornum, G J van

doi:10.1111/j.1365-2893.2010.01352.x

Cited by 27 publications

(25 citation statements)

References 26 publications

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“…Acyclovir should be started once HSV hepatitis is suspected, as the diagnosis is diffi cult to make and oft en delayed and as acyclovir has been shown to be safe and well-tolerated in pregnancy (92)(93)(94). As HSV hepatitis is associated with poor outcomes, even with appropriate acyclovir treatment initiation and availability of liver transplantation, there is little to lose in initiating acyclovir once HSV hepatitis is suspected as early treatment is associated with improvement in outcomes ( 89,95 ). On the other hand, empiric acyclovir is not recommended in all pregnant patients with hepatitis when HSV infection is not suspected ( 96 ).…”

Section: Recommendationsmentioning

confidence: 99%

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ACG Clinical Guideline: Liver Disease and Pregnancy

Tran

Ahn

Reau

2016

American Journal of Gastroenterology

235

257

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Consultation for liver disease in pregnant women is a common and oftentimes vexing clinical consultation for the gastroenterologist. The challenge lies in the need to consider the safety of both the expectant mother and the unborn fetus in the clinical management decisions. This practice guideline provides an evidence-based approach to common diagnostic and treatment challenges of liver disease in pregnant women. Am J Gastroenterol 2016; 111:176-194; doi: 10.1038/ajg.2015 Initial evaluation of pregnant patientA pregnant patient presenting with abnormal liver tests should undergo standard workup as with any non-pregnant individual (strong recommendation, very low level of evidence). Imaging in pregnancyUltrasound is safe and the preferred imaging modality used in assessment of abnormal liver tests suggestive of biliary tract disease (strong recommendation, low level of evidence).Magnetic resonance imaging without gadolinium can be used in the second and third trimester (conditional recommendation, low level of evidence).Computed tomography scans carry a risk of teratogenesis and childhood hematologic malignancies but may be used judiciously with minimized radiation protocols (2-5 rads; conditional recommendation, very low level of evidence). Endoscopy in pregnancyEndoscopy is safe in pregnancy but should be deferred until the second trimester if possible (strong recommendation, low level of evidence).Meperidine and propofol can be used for endoscopic sedation (strong recommendation, moderate level of evidence). Management of biliary disease in pregnancyERCP can be performed when indicated for pregnant women presenting with biliary disease that strongly necessitates intervention such as biliary pancreatitis, symptomatic choledocholithiasis, and/or cholangitis. Minimizing fetal exposure to fl uoroscopy is imperative (strong recommendation, low level of evidence).Symptomatic cholecystitis should be managed with early surgical intervention with laparoscopic cholecystectomy (strong recommendation, low level of evidence). Liver masses in pregnancyAsymptomatic hemangioma and focal nodular hyperplasia do not need routine imaging or surveillance during pregnancy (strong recommendation, very low level evidence).Hepatic adenomas should be monitored with ultrasound during pregnancy for growth. Patients with large adenomas (>5 cm) should be referred for resection prior to pregnancy (strong recommendation, low level of evidence). Hepatitis B in pregnancyActive-passive immunoprophylaxis with hepatitis B immunoglobulin and the HBV vaccination series should be administered to all infants born to HBV-infected mothers to prevent perinatal transmission (strong recommendation, low level of evidence).Women chronically infected with HBV and high viral load (>10 6 log copies/ml (200,000 IU/ml) and higher) should be offered antiviral medication with tenofovir or telbivudine in the third trimester to reduce perinatal transmission of HBV (strong recommendation, low level of evidence).C-section should not be performed electively in HBV-pos...

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Section: Recommendationsmentioning

confidence: 99%

“…Th is diagnostic diffi culty is compounded by limited specifi city and sensitivity of routine HSV-IgM testing. HSV PCR should be performed when HSV hepatitis is suspected ( 89,90 ).…”

Section: Recommendationsmentioning

confidence: 99%

ACG Clinical Guideline: Liver Disease and Pregnancy

Tran

Ahn

Reau

2016

American Journal of Gastroenterology

235

257

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“…As illustrated by our case, visceral or disseminated HSV infections (particularly those with hepatic involvement) are frequently accompanied by some degree of HSV viremia, [52,57] which can be detected using PCR assays of whole blood using HSV specific primers. Notably, in the United States none of these assays is currently approved by the Food and Drug Administration (FDA) for this application.…”

Section: Discussionmentioning

confidence: 99%

“…[54,58] Concomitant viremia was described in only one of the previously reported cases of HSV hepatitis in patients with IBD, [53] and none of the cases of HSV colitis; however, HSV viremia has been used to predict hepatic involvement in other patient populations. [52,57–60] Importantly, even the presence of HSV viremia is generally not sufficient to make a definitive diagnosis of visceral HSV disease because it too can be frequently detected in patients with non-HSV-related critical illness. [56,61] Although quantification of viremia may be useful for differentiating between inconsequential reactivation and end-organ disease in this setting, [57] this has not been studied in a prospective fashion.…”

Section: Discussionmentioning

confidence: 99%

Concomitant herpes simplex virus colitis and hepatitis in a man with ulcerative colitis

et al. 2016

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Background:Herpesvirus infections often complicate the clinical course of patients with inflammatory bowel disease; however, invasive disease due to herpes simplex virus is distinctly uncommon.Methods:We present a case of herpes simplex virus colitis and hepatitis, review all the previously published cases of herpes simplex virus colitis, and discuss common clinical features and outcomes. We also discuss the epidemiology, clinical manifestations, diagnosis, and management of herpes simplex virus infections, focusing specifically on patients with inflammatory bowel disease.Results:A 43-year-old man with ulcerative colitis, previously controlled with an oral 5-aminosalicylic agent, developed symptoms of a colitis flare that did not respond to treatment with systemic corticosteroid therapy. One week later he developed orolabial ulcers and progressive hepatic dysfunction, with markedly elevated transaminases and coagulopathy. He underwent emergent total colectomy when imaging suggested bowel micro-perforation. Pathology from both the colon and liver was consistent with herpes simplex virus infection, and a viral culture of his orolabial lesions and a serum polymerase chain reaction assay also identified herpes simplex virus. He was treated with systemic antiviral therapy and made a complete recovery.Conclusions:Disseminated herpes simplex virus infection with concomitant involvement of the colon and liver has been reported only 3 times in the published literature, and to our knowledge this is the first such case in a patient with inflammatory bowel disease. The risk of invasive herpes simplex virus infections increases with some, but not all immunomodulatory therapies. Optimal management of herpes simplex virus in patients with inflammatory bowel disease includes targeted prophylactic therapy for patients with evidence of latent infection, and timely initiation of antiviral therapy for those patients suspected to have invasive disease.

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“…These lesions alter the epithelial barrier and may pave the way for bacterial infection. Secondly, the higher the viral load in the distal airways, the poorer the outcome [12,13], which is in favour of virus pathogenicity [20]. Thirdly, some specific mechanisms of adaptative immunity (overexpression of Herpes Virus Entry Mediator) in ICU septic patients favour the entry of HSV in lung cells [2].…”

mentioning

confidence: 99%