Fatal disseminated herpes simplex virus infection and hemorrhage in the neonate

Miller, Denis R.; Hanshaw, James B.; O’Leary, Dennis S.; Hnilicka, Jana V.

doi:10.1016/s0022-3476(70)80481-4

Cited by 60 publications

(20 citation statements)

References 33 publications

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“…Lethal HSV hepatitis, coagulopathy, and DIC have been reported in both neonates and adults [20,21]. In our series, five patients (42%) developed DIC, and all died.…”

Section: Discussionmentioning

confidence: 49%

“…It is unclear whether diffuse hepatitis always starts with focal infiltration that, if recognized in time, can be cured with antiviral therapy or whether there was some basic pathogenetic difference between the two groups of patients. However, the primary cause of death, at least in the first group of patients, clearly was massive involvement of the liver leading to severe coagulopathy and liver failure.Lethal HSV hepatitis, coagulopathy, and DIC have been reported in both neonates and adults [20,21]. In our series, five patients (42%) developed DIC, and all died.…”

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confidence: 49%

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Herpes Simplex Virus Hepatitis after Solid Organ Transplantation in Adults

Kusne

Schwartz

Breinig

et al. 1991

Journal of Infectious Diseases

151

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Twelve patients developed herpes simplex (HSV) hepatitis a median of 18 days after solid organ transplantation. This is earlier than cytomegalovirus hepatitis, which usually occurs 30-40 days after transplantation. Eight recipients (67%) died, and in seven, the diagnosis was made at autopsy or <48 h before death. Clinical manifestations associated with mortality were hypotension, disseminated intravascular coagulation (DIC), metabolic acidosis, gastrointestinal bleeding, and bacteremia. Laboratory abnormalities at diagnosis associated with mortality were high creatinine, low platelet counts, prolonged partial thromboplastin time, and a high percentage of band forms on the blood smear. Disseminated HSV disease was noted in four of six patients who had an autopsy and included involvement of lungs in three and the gastrointestinal tract in three. Five recipients developed DIC and all died. Pathologically, HSV hepatitis has two forms, focal and diffuse. All three patients with diffuse liver pathology died. However, three of seven with focal liver pathology survived with antiviral therapy, which suggests that early diagnosis and treatment may be lifesaving. None of these patients had received prophylactic acyclovir. It is possible that acyclovir prophylaxis may be able to prevent this disease.Herpes simplex virus (HSV) hepatitis is considered rare [1]. It has been observed most frequently as part of disseminated HSV in immunologically compromised patients or during pregnancy. Sporadic cases have been reported from this institution in renal transplant recipients and have ended fatally [2,3], as have most cases reported in the literature. Here we report 12 cases that occurred after solid organ transplantation over a 9-year period (1980)(1981)(1982)(1983)(1984)(1985)(1986)(1987)(1988). This series is large enough to allow us to determine the approximate frequency of HSV hepatitis in our transplantation population; to present the effect of viral dissemination, the nature of the liver pathology, and the range of clinical and laboratory characteristics of the disease; and to investigate prognostic factors. Materials and Methods DefinitionsCases of HSV hepatitis were diagnosed by laboratory, histologic, and clinical findings of one or more of the following in liver tissue from a biopsy or autopsy: isolation of HSV, positive immunoperoxidase staining for HSV antigen, or histology showing intranuclear inclusion bodies and pathology consistent with HSV lesions. In one case there was no liver tissue to examine, and the diagnosis was made by isolation of HSV from multiple sites outside the liver, including buffy coat, and clinical evidence of fulminant hepatitis. The histologic pattern of Laboratory methodsTissue specimens obtained by biopsy or at autopsy were examined after routine staining and processing for detection of HSV antigen by immunoperoxidase staining and, on occasion, processed for isolation of HSV. Other specimens obtained from transplant recipients for viral isolation included throat wash, urine, buffy co...

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“…Lethal HSV hepatitis, coagulopathy, and DIC have been reported in both neonates and adults [20,21]. In our series, five patients (42%) developed DIC, and all died.…”

Section: Discussionmentioning

confidence: 49%

mentioning

confidence: 49%

Herpes Simplex Virus Hepatitis after Solid Organ Transplantation in Adults

Kusne

Schwartz

Breinig

et al. 1991

Journal of Infectious Diseases

151

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“…Fatal disseminated herpes simplex virus in the neonate was associated with spontaneous hemorrhage in 40% of 55 infants [10]. Although neurological symptoms were documented in approximately 25% of these neonates, intracranial hemorrhage was not described.…”

Section: Discussionmentioning

confidence: 99%

Parietal Pseudofracture and Spontaneous Intracranial Hemorrhage Suggesting Nonaccidental Trauma: Report of 2 Cases

Fenton¹,

Sirotnak²,

Handler³

2000

Pediatr Neurosurg

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Massive intracranial hemorrhage, no history of trauma and radiographic findings that were initially interpreted as linear parietal fractures raised the possibility of nonaccidental trauma in 2 infants. Both had severe coagulopathy, 1 due to hemorrhagic disease of the newborn (vitamin K deficiency) and the other due to disseminated herpes simplex virus infection. Both infants died. At autopsy, the parietal bone abnormalities were not fractures, but proved to be an anomalous suture in 1 and a connective tissue fissure in the other.

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“…Human neonatal herpes is usually characterized by hepato-adrenal necrosis (White, 1963;Zavoral et al, 1970;Catalano et al, 1971;Witzleben & Driscoll, 1965;Sieber et al, 1966;Zuelzer & Stulberg, 1952;France & Wilmers, 1953;Arje, Austin & Sanchez, 1955;Bell & Williams, 1961;Miihlethaler, 1961;Tucker & Scofield, 1961;Miller, Hanshaw, O'Leary & Hnilicka, 1970;Kluge, Skyberg & Bj¢ro, 1967;Haynes, Azimi & Cramblett, 1968;Patrizi, Middelkamp & Reed, 1968;Clark, 1965). Injection of the SA 8 suspension into the femoral vein produced adrenal necrosis.…”

Section: Discussionmentioning

confidence: 99%

Experimental Herpes neonatalis in SA 8-infected baboons (Papio cynocephalus)

et al. 1985

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Summary 13 newborn baboons were experimentally infected with a baboon-derived herpesvirus SA 8-strain. Intratracheal infection produced herpetic tracheobronchopneumonia, intravenous inoculation resulted in adrenal necrosis similar to that in human neonatal herpes infection.Naturally occurring neonatal herpesvirus infections are of importance in the perinatal pathology of several mammalian species. Herpesvirus equi causes intrauterine infections and abortions in equine species, H. homim's is the causative agent of human neonatal herpes, the pathogenesis of which is still debated. Perinatal infection during delivery is considered to be responsible in many cases (White, 1963; Wheeler & Huffines, 1965;Hutfield, 1966; Nahmias, Josey & Naib, 1967; Naib, Nahmias, Josey & Wheeler, 1970; Zavoral, Ray, Kinnard & Nahmias, 1970;Amstey, 1970; Catalano, Safeley, Museles & Jarzynski, 1971;Hare, 1974); in others focal placental necrosis, porencephaly, microencephaly, intracranial calcifications, microphthalmus, retinal dysplasia and prenatal cutaneous herpetic lesions suggest a diaplacenlal route of infection

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Fatal disseminated herpes simplex virus infection and hemorrhage in the neonate

Cited by 60 publications

References 33 publications

Herpes Simplex Virus Hepatitis after Solid Organ Transplantation in Adults

Herpes Simplex Virus Hepatitis after Solid Organ Transplantation in Adults

Parietal Pseudofracture and Spontaneous Intracranial Hemorrhage Suggesting Nonaccidental Trauma: Report of 2 Cases

Experimental Herpes neonatalis in SA 8-infected baboons (Papio cynocephalus)

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