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

Josh Levitsky, Anupama T. Duddempudi, Fred D. Lakeman, Richard J. Whitley, James P. Luby, William M. Lee, Robert J. Fontana, Andres T. Blei, Michael G. Ison, Julie Polson, Carla Pezzia, Anne Larson, Timothy Davern, Paul Martin, Timothy Cashland, Eileen Hay, Natalie Murray, Obaid S. Shaikh, Atif Zaman, Steven HanRobert Fontana, Brendan McGuire, Ray Chung, Alastair Smith, Michael Schilsky, Adrian Reuben, Santiago Munoz, Rajender Reddy, R. Todd Stravitz, Lorenzo Rossaro, Raj Satyanarayana, Tarek Hassanein

Research output: Contribution to journalArticle

58 Citations (Scopus)

Abstract

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 × 108 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.

Original languageEnglish (US)
Pages (from-to)1498-1504
Number of pages7
JournalLiver Transplantation
Volume14
Issue number10
DOIs
StatePublished - 2008
Externally publishedYes

Fingerprint

Acute Liver Failure
Virus Diseases
Simplexvirus
Liver Transplantation
DNA
Pregnancy
Polymerase Chain Reaction
Emergency Treatment
Acyclovir
Serology
Serum

ASJC Scopus subject areas

  • Surgery
  • Transplantation
  • Hepatology

Cite this

Levitsky, J., Duddempudi, A. T., Lakeman, F. D., Whitley, R. J., Luby, J. P., Lee, W. M., ... Hassanein, T. (2008). Detection and diagnosis of herpes simplex virus infection in adults with acute liver failure. Liver Transplantation, 14(10), 1498-1504. https://doi.org/10.1002/lt.21567

Detection and diagnosis of herpes simplex virus infection in adults with acute liver failure. / Levitsky, Josh; Duddempudi, Anupama T.; Lakeman, Fred D.; Whitley, Richard J.; Luby, James P.; Lee, William M.; Fontana, Robert J.; Blei, Andres T.; Ison, Michael G.; Polson, Julie; Pezzia, Carla; Larson, Anne; Davern, Timothy; Martin, Paul; Cashland, Timothy; Hay, Eileen; Murray, Natalie; Shaikh, Obaid S.; Zaman, Atif; Han, Steven; Fontana, Robert; McGuire, Brendan; Chung, Ray; Smith, Alastair; Schilsky, Michael; Reuben, Adrian; Munoz, Santiago; Reddy, Rajender; Stravitz, R. Todd; Rossaro, Lorenzo; Satyanarayana, Raj; Hassanein, Tarek.

In: Liver Transplantation, Vol. 14, No. 10, 2008, p. 1498-1504.

Research output: Contribution to journalArticle

Levitsky, J, Duddempudi, AT, Lakeman, FD, Whitley, RJ, Luby, JP, Lee, WM, Fontana, RJ, Blei, AT, Ison, MG, Polson, J, Pezzia, C, Larson, A, Davern, T, Martin, P, Cashland, T, Hay, E, Murray, N, Shaikh, OS, Zaman, A, Han, S, Fontana, R, McGuire, B, Chung, R, Smith, A, Schilsky, M, Reuben, A, Munoz, S, Reddy, R, Stravitz, RT, Rossaro, L, Satyanarayana, R & Hassanein, T 2008, 'Detection and diagnosis of herpes simplex virus infection in adults with acute liver failure', Liver Transplantation, vol. 14, no. 10, pp. 1498-1504. https://doi.org/10.1002/lt.21567
Levitsky J, Duddempudi AT, Lakeman FD, Whitley RJ, Luby JP, Lee WM et al. Detection and diagnosis of herpes simplex virus infection in adults with acute liver failure. Liver Transplantation. 2008;14(10):1498-1504. https://doi.org/10.1002/lt.21567
Levitsky, Josh ; Duddempudi, Anupama T. ; Lakeman, Fred D. ; Whitley, Richard J. ; Luby, James P. ; Lee, William M. ; Fontana, Robert J. ; Blei, Andres T. ; Ison, Michael G. ; Polson, Julie ; Pezzia, Carla ; Larson, Anne ; Davern, Timothy ; Martin, Paul ; Cashland, Timothy ; Hay, Eileen ; Murray, Natalie ; Shaikh, Obaid S. ; Zaman, Atif ; Han, Steven ; Fontana, Robert ; McGuire, Brendan ; Chung, Ray ; Smith, Alastair ; Schilsky, Michael ; Reuben, Adrian ; Munoz, Santiago ; Reddy, Rajender ; Stravitz, R. Todd ; Rossaro, Lorenzo ; Satyanarayana, Raj ; Hassanein, Tarek. / Detection and diagnosis of herpes simplex virus infection in adults with acute liver failure. In: Liver Transplantation. 2008 ; Vol. 14, No. 10. pp. 1498-1504.
@article{e7189189c9a54a13a66ffd99f0c5689f,
title = "Detection and diagnosis of herpes simplex virus infection in adults with acute liver failure",
abstract = "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 × 108 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.",
author = "Josh Levitsky and Duddempudi, {Anupama T.} and Lakeman, {Fred D.} and Whitley, {Richard J.} and Luby, {James P.} and Lee, {William M.} and Fontana, {Robert J.} and Blei, {Andres T.} and Ison, {Michael G.} and Julie Polson and Carla Pezzia and Anne Larson and Timothy Davern and Paul Martin and Timothy Cashland and Eileen Hay and Natalie Murray and Shaikh, {Obaid S.} and Atif Zaman and Steven Han and Robert Fontana and Brendan McGuire and Ray Chung and Alastair Smith and Michael Schilsky and Adrian Reuben and Santiago Munoz and Rajender Reddy and Stravitz, {R. Todd} and Lorenzo Rossaro and Raj Satyanarayana and Tarek Hassanein",
year = "2008",
doi = "10.1002/lt.21567",
language = "English (US)",
volume = "14",
pages = "1498--1504",
journal = "Liver Transplantation",
issn = "1527-6465",
publisher = "John Wiley and Sons Ltd",
number = "10",

}

TY - JOUR

T1 - Detection and diagnosis of herpes simplex virus infection in adults with acute liver failure

AU - Levitsky, Josh

AU - Duddempudi, Anupama T.

AU - Lakeman, Fred D.

AU - Whitley, Richard J.

AU - Luby, James P.

AU - Lee, William M.

AU - Fontana, Robert J.

AU - Blei, Andres T.

AU - Ison, Michael G.

AU - Polson, Julie

AU - Pezzia, Carla

AU - Larson, Anne

AU - Davern, Timothy

AU - Martin, Paul

AU - Cashland, Timothy

AU - Hay, Eileen

AU - Murray, Natalie

AU - Shaikh, Obaid S.

AU - Zaman, Atif

AU - Han, Steven

AU - Fontana, Robert

AU - McGuire, Brendan

AU - Chung, Ray

AU - Smith, Alastair

AU - Schilsky, Michael

AU - Reuben, Adrian

AU - Munoz, Santiago

AU - Reddy, Rajender

AU - Stravitz, R. Todd

AU - Rossaro, Lorenzo

AU - Satyanarayana, Raj

AU - Hassanein, Tarek

PY - 2008

Y1 - 2008

N2 - 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 × 108 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.

AB - 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 × 108 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.

UR - http://www.scopus.com/inward/record.url?scp=57849093133&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=57849093133&partnerID=8YFLogxK

U2 - 10.1002/lt.21567

DO - 10.1002/lt.21567

M3 - Article

C2 - 18825709

AN - SCOPUS:57849093133

VL - 14

SP - 1498

EP - 1504

JO - Liver Transplantation

JF - Liver Transplantation

SN - 1527-6465

IS - 10

ER -