Detection and diagnosis of herpes simplex virus infection in adults with acute liver failure
Detection and diagnosis of herpes simplex virus infection in adults with acute liver failure
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DOI：
10.1002/lt.21567
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发表时间：
2008-10-01
影响因子：
4.6
通讯作者：
Ison, Michael G.
中科院分区：
文献类型：
--
作者：
Levitsky, Josh;Duddempudi, Anupama T.;Ison, Michael G.
播散型单纯疱疹病毒(HSV)感染可导致急性肝功能衰竭(ALF)和急诊肝移植(LT)。本研究的主要目的是确定单纯疱疹病毒血清学检测和聚合酶链式反应(PCR)检测单纯疱疹病毒DNA在不明原因、妊娠相关和已知的单纯疱疹病毒相关性ALF诊断和治疗中的应用。对美国ALF研究组登记的51例不明原因ALF患者、12例妊娠相关ALF患者和4例HSV相关ALF患者在研究第1天或第2天获得的储存血清，用聚合酶链式反应和血清学方法筛选HSV DNA。7例不明原因和妊娠患者抗HSV免疫球蛋白M阳性，无一例检测到HSV DNA。已知的4例单纯疱疹病毒感染者均有高滴度的HSV DNA(范围3.5~36×10(8)拷贝/毫升)。两名单纯疱疹病毒患者接受了肝移植，但尽管阿昔洛韦抑制了单纯疱疹病毒DNA，但移植后发生了肝外单纯疱疹病毒感染，其中一人最终死亡。另2例暴发型单纯疱疹病毒感染者在发病后48小时内死亡。总之，在51例不明原因ALF患者和12例妊娠相关ALF患者中，未检测到隐匿性HSV感染的血清HSV DNA。已知的4例HSV相关性ALF患者发病时均有较高的HSV DNA水平，尽管迅速应用了抗病毒治疗和急诊肝移植，但仍有相当高的发病率和死亡率，突出了预后不良的严重播散性HSV感染。
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.