Karaciğer nakli alıcılarında herpes simpleks virüs viremisinin tanısı, klinik görünümleri ve tedavi yönetimi
Abstract
Aim: We aimed to evaluate the clinical variations, possible risk factors and results of diagnostic procedures in liver transplant (LT) recipients who suffered from Herpes Simplex Virus (HSV) viremia in the post-transplant period, despite Cytomegalovirus (CMV) prophylaxis.
Material and methods: The data of 1100 LT recipients were evaluated retrospectively. HSV DNA RT-PCR detected in blood and vesicular fluid samples of the patients with active painful mucocutaneous vesicular lesions and patients with organ involvement who had biopsy and confirmed HSV viremia were included in the study. The 110 recipients diagnosed with HSV viremia were included.
Results: In 110 recipients, total 130 HSV viremia episodes were observed over sixty months. HSV viremia rate was 11.8%. Of the 130 HSV episodes, 120 (92.3%) were mucocutaneous form of the disease. In 10 cases, there was a specific organ involvement. HSV-1 was detected in all of viremia episodes. Sixty-four (49.2%) episodes developed six months after the LT, 41 (31.5%) episodes developed between the 1st and 6th months after LT, and 25 (20.3%) episodes were observed within the first postoperative month. All episodes were treated successfully with different antiviral therapy modalities.
Conclusion: Despite CMV prophylaxis performed, HSV viremia may be occurred as a wide range of clinical presentation in LT recipients. It can be seen at any time point after the LT. HSV DNA RT-PCR from serum samples may not be sufficient for diagnosis of viremia, therefore the analysis of the vesicular fluid or the biopsy from the organs may be necessary for supporting the diagnosis.
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References
- 1. Zuckerman R, Wald A, AST Infectious Diseases Community of Practice. Herpes simplex virus infections in solid organ transplant recipients. Am J Transplant. 2009; 9: 104-7.
- 2. Whitley RJ, Roizman B. Herpes simplex virus infections. Lancet. 2001; 357: 1513-8.
- 3. Greenberg MS, Friedman H, Cohen SG, et al. A comparative study of herpes simplex infections in renal transplant and leukemic patients. J Infect Dis 1987; 156: 280–7.
- 4. Zuckerman RA, Limaye AP. Varicella-zoster virus (VZV) and herpes simplex virus (HSV) in solid organ transplant patients. Am J Transplant 2013; 13: 55–66.
- 5. Jenkins FJ, Rowe DT, Rinaldo CR Jr. Herpesvirus Infections in Organ Transplant Recipients. Clin Diagn Lab Immunol. 2003; 10: 1–7.
- 6. Mossad SB. Management of Infections in Solid Organ Transplant Recipients. Infect Dis Clin North Am. 2018; 32: 13-4.
- 7. Fishman JA. Overview: cytomegalovirus and the herpesviruses in transplantation. Am J Transplant. 2013; 13: 1-8.
- 8. Singh A, Preiksaitis J, Ferenczy A, Romanowski B. The laboratory diagnosis of herpes simplex virus infections. Can J Infect Dis Med Microbiol. 2005; 16: 92–8.
- 9. Wilck MB, Zuckerman RA, AST Infectious Diseases Community of Practice. Herpes simplex virus in solid organ transplantation. Am J Transplant. 2013; 13: 121-7.
- 10. Lee DH, Zuckerman RA AST Infectious Diseases Community of Practice. Herpes simplex virus infections in solid organ transplantation: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant. 2019; 33: 13526.
- 11. van Hoek B, de Rooij BJ, Verspaget HW. Risk factors for infection after liver transplantation. Best Pract Res Clin Gastroenterol. 2012; 26 :61-72.
- 12. Singh A, Preiksaitis J, Ferenczy A, Romanowski B. The laboratory diagnosis of herpes simplex virus infections. Can J Infect Dis Med Microbiol. 2005; 16: 92–8.
- 13. Wald A, Huang ML, Carrell D, Selke S, Corey L. Polymerase chain reaction for detection of herpes simplex virus (HSV) DNA on mucosal surfaces: comparison with HSV isolation in cell culture. J Infect Dis. 2003; 188 :1345‐51.
- 14. Busch CJ, Siegler BH, Werle H, et al. Risk factors for early viral infections after liver transplantation. Langenbecks Arch Surg. 2018; 403 :509-19.
- 15. Martin‐Gandul C, Stampf S, Hequet D, et al. Preventive strategies against cytomegalovirus and incidence of alpha‐herpesvirus infections in solid organ transplant recipients: a nationwide cohort study. Am J Transplant. 2017; 17 :1813‐22.
- 16. Netchiporouk E, Tchervenkov J, Paraskevas Set al. Evaluation of herpes simplex virus infection morbidity and mortality in the pancreas and kidney-pancreas transplant recipients. Transplant Proc. 2013; 45 :3343-7.
- 17. Lakeman FD, Whitley RJ. Diagnosis of herpes simplex encephalitis: application of polymerase chain reaction to cerebrospinal fluid from brain-biopsied patients and correlation with disease. National Institute of Allergy and Infectious Diseases Collaborative Antiviral Study Group. J Infect Dis. 1995; 171 :857-63.
- 18. Jazeron JF, Barbe C, Frobert E et al. Virological diagnosis of herpes simplex virus 1 esophagitis by quantitative real-time PCR assay. J Clin Microbiol. 2012; 50 :948-52.
- 19. Fishman JA, Issa NC. Infection in organ transplantation: risk factors and evolving patterns of infection. Infect Dis Clin North Am. 2010; 24: 273-83.
- 20. Linde A. The importance of specific virus diagnosis and monitoring for antiviral treatment. Antiviral Res. 2001; 51 :81-94.
- 21. Hirschi S, Biondini D, Ohana M, et al. Herpes simplex virus 2 hepatitis in a lung transplant recipient: a diagnostic challenge. Transpl Infect Dis. 2015; 17 :904‐8.
- 22. Razonable RR. Management of viral infections in solid organ transplant recipients. Expert Rev Anti Infect Ther. 2011; 9 :685-700.
- 23. Abad CL, Razonable RR. Treatment of alpha and beta herpesvirus infections in solid organ transplant recipients. Expert Rev Anti Infect Ther. 2017; 15 :93-110.
Karaciğer nakli alıcılarında herpes simpleks virüs viremisinin tanısı, klinik görünümleri ve tedavi yönetimiClinical presentation, diagnosis and management of herpes simplex virus viremia in liver transplant recipients
Abstract
Amaç: Karaciğer nakli (LT) alıcılarında, Sitomegalovirüs (CMV) profilaksisine rağmen nakil sonrası dönemde gelişen Herpes simpleks virüsü (HSV) viremisinin klinik varyasyonlarını, olası risk faktörlerini, tanı prosedürlerini ve sonuçlarını değerlendirmeyi amaçladık.
Gereç ve Yöntemler:1100 karaciğer nakli alıcısının verileri geriye dönük olarak değerlendirildi. Çalışmaya aktif ağrılı mukokutanöz veziküler lezyonları olan hastaların kan ve veziküler sıvı örneklerinde saptanan HSV DNA RT-PCR ve doku biyopsisi yapılan ile HSV viremisi doğrulanan ve organ tutulumu bulguları olan hastalar dahil edildi. HSV viremisi tanısı alan 110 karaciğer nakli alıcısı tespit edildi.
Bulgular:110 alıcıda altmış ay boyunca toplam 130 HSV viremi atağı gözlendi. HSV viremisi oranı %11,8 idi. 130 HSV atağının 120'si (%92,3) hastalığın mukokutanöz formu idi. 10 olguda spesifik bir organ tutulumu vardı. Tüm viremi ataklarında HSV-1 saptandı. Karaciğer naklinden altı ay sonra 64 (%49,2) atak gelişti, Karaciğer nakli sonrası birinci ve altıncı aylar arasında 41 (%31,5) atak gelişti ve postoperatif ilk ayda 25 (%20,3) atak gözlendi. Tüm ataklar farklı antiviral tedavi yöntemleri ile başarılı bir şekilde tedavi edildi.
Sonuç: Yapılan CMV profilaksisine rağmen, HSV viremisi, karaciğer nakli alıcılarında geniş bir klinik yelpazede ortaya çıkabilir. Serum örneklerinden alınan HSV DNA RT-PCR'ın viremi tanısı için her zaman yeterli olmayabilir, bu nedenle tanıyı desteklemek için veziküler sıvının analizi veya organlardan biyopsi yapılması gerekebilir.
Project Number
None
References
- 1. Zuckerman R, Wald A, AST Infectious Diseases Community of Practice. Herpes simplex virus infections in solid organ transplant recipients. Am J Transplant. 2009; 9: 104-7.
- 2. Whitley RJ, Roizman B. Herpes simplex virus infections. Lancet. 2001; 357: 1513-8.
- 3. Greenberg MS, Friedman H, Cohen SG, et al. A comparative study of herpes simplex infections in renal transplant and leukemic patients. J Infect Dis 1987; 156: 280–7.
- 4. Zuckerman RA, Limaye AP. Varicella-zoster virus (VZV) and herpes simplex virus (HSV) in solid organ transplant patients. Am J Transplant 2013; 13: 55–66.
- 5. Jenkins FJ, Rowe DT, Rinaldo CR Jr. Herpesvirus Infections in Organ Transplant Recipients. Clin Diagn Lab Immunol. 2003; 10: 1–7.
- 6. Mossad SB. Management of Infections in Solid Organ Transplant Recipients. Infect Dis Clin North Am. 2018; 32: 13-4.
- 7. Fishman JA. Overview: cytomegalovirus and the herpesviruses in transplantation. Am J Transplant. 2013; 13: 1-8.
- 8. Singh A, Preiksaitis J, Ferenczy A, Romanowski B. The laboratory diagnosis of herpes simplex virus infections. Can J Infect Dis Med Microbiol. 2005; 16: 92–8.
- 9. Wilck MB, Zuckerman RA, AST Infectious Diseases Community of Practice. Herpes simplex virus in solid organ transplantation. Am J Transplant. 2013; 13: 121-7.
- 10. Lee DH, Zuckerman RA AST Infectious Diseases Community of Practice. Herpes simplex virus infections in solid organ transplantation: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant. 2019; 33: 13526.
- 11. van Hoek B, de Rooij BJ, Verspaget HW. Risk factors for infection after liver transplantation. Best Pract Res Clin Gastroenterol. 2012; 26 :61-72.
- 12. Singh A, Preiksaitis J, Ferenczy A, Romanowski B. The laboratory diagnosis of herpes simplex virus infections. Can J Infect Dis Med Microbiol. 2005; 16: 92–8.
- 13. Wald A, Huang ML, Carrell D, Selke S, Corey L. Polymerase chain reaction for detection of herpes simplex virus (HSV) DNA on mucosal surfaces: comparison with HSV isolation in cell culture. J Infect Dis. 2003; 188 :1345‐51.
- 14. Busch CJ, Siegler BH, Werle H, et al. Risk factors for early viral infections after liver transplantation. Langenbecks Arch Surg. 2018; 403 :509-19.
- 15. Martin‐Gandul C, Stampf S, Hequet D, et al. Preventive strategies against cytomegalovirus and incidence of alpha‐herpesvirus infections in solid organ transplant recipients: a nationwide cohort study. Am J Transplant. 2017; 17 :1813‐22.
- 16. Netchiporouk E, Tchervenkov J, Paraskevas Set al. Evaluation of herpes simplex virus infection morbidity and mortality in the pancreas and kidney-pancreas transplant recipients. Transplant Proc. 2013; 45 :3343-7.
- 17. Lakeman FD, Whitley RJ. Diagnosis of herpes simplex encephalitis: application of polymerase chain reaction to cerebrospinal fluid from brain-biopsied patients and correlation with disease. National Institute of Allergy and Infectious Diseases Collaborative Antiviral Study Group. J Infect Dis. 1995; 171 :857-63.
- 18. Jazeron JF, Barbe C, Frobert E et al. Virological diagnosis of herpes simplex virus 1 esophagitis by quantitative real-time PCR assay. J Clin Microbiol. 2012; 50 :948-52.
- 19. Fishman JA, Issa NC. Infection in organ transplantation: risk factors and evolving patterns of infection. Infect Dis Clin North Am. 2010; 24: 273-83.
- 20. Linde A. The importance of specific virus diagnosis and monitoring for antiviral treatment. Antiviral Res. 2001; 51 :81-94.
- 21. Hirschi S, Biondini D, Ohana M, et al. Herpes simplex virus 2 hepatitis in a lung transplant recipient: a diagnostic challenge. Transpl Infect Dis. 2015; 17 :904‐8.
- 22. Razonable RR. Management of viral infections in solid organ transplant recipients. Expert Rev Anti Infect Ther. 2011; 9 :685-700.
- 23. Abad CL, Razonable RR. Treatment of alpha and beta herpesvirus infections in solid organ transplant recipients. Expert Rev Anti Infect Ther. 2017; 15 :93-110.
Details
| Primary Language | English |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Orıgınal Artıcle |
| Authors | |
| Project Number | None |
| Publication Date | September 29, 2021 |
| Published in Issue | Year 2021 Volume: 12 Issue: 3 |
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e-ISSN: 2149-8296
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