Fatal Multiorgan Failure Associated with Disseminated Herpes Simplex Virus-1 Infection: A Case Report

Glas, Michael; Smola, Sigrun; Pfuhl, Thorsten; Pokorny, Juliane; Bohle, Rainer M.; Bücker, Arno; Kamradt, Jörn; Volk, Thomas

doi:10.1155/2012/359360

Cited by 12 publications

(10 citation statements)

References 19 publications

(22 reference statements)

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“…There have been many reports of HSV pneumonia [ 3 ], and some cases of fulminant hepatitis [ 4 ] and sepsis [ 5 ] implicate HSV in immunocompetent and immunosuppressed patients. The present case is a rare description of HSV-1-induced septic shock causing multiorgan failure.…”

Section: Discussionmentioning

confidence: 99%

Septic shock complicated by disseminated herpes simplex virus-1 infection: a case report

et al. 2021

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Background Herpes virus remains dormant in human cells and could reactivate under immunosuppressed conditions, such as prolonged critical illnesses. The phenomenon of viral replication during intensive care is well known, even in patients without a history of immunosuppression, but it usually does not have a clinical impact. Systemic reactivation leads to viral DNA in blood. It remains unclear whether this replication is a marker of morbimortality or a true pathogenic process. Therefore, it is unclear what medical treatment is most appropriate for simple replication. In organ damage suspected to be induced by herpes virus, there is no consensus on the most appropriate treatment duration. Here, we report a rarely described case of multiorgan failure implicating herpes simplex virus and discuss its treatment. Case report A 53-year-old Caucasian immunosuppressed woman was admitted to the intensive care unit for septic shock. She presented pneumonia due to Klebsiella pneumoniae. Two weeks after admission, she showed multiorgan failure with acute respiratory distress syndrome and circulation failure. She had digestive and cutaneous lesions typical of herpes simplex virus 1. Blood and respiratory polymerase chain reaction was strongly herpes simplex virus-1 positive. No other bacteria, fungi, or viruses were found. The evolution was rapidly favorable after the initiation of antiviral treatment. Treatment was stopped after 3 weeks of well-conducted antiviral therapy. Curative-dose treatment was interrupted despite continuous strongly positive blood polymerase chain reaction results. In this context, prophylactic treatment was continued. Conclusion We report an exceptional presentation of multiorgan failure in the intensive care unit due to herpes simplex virus-1. The diagnosis was made based on typical herpes simplex virus-1 visceral lesions and the absence of other responsible microorganisms. Intense viral replication is a key diagnostic element. There is no consensus regarding the most appropriate treatment duration, but such decisions should not be based on blood polymerase chain reaction.

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Section: Discussionmentioning

confidence: 99%

Septic shock complicated by disseminated herpes simplex virus-1 infection: a case report

et al. 2021

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“…HSV may be identified using PCR, direct fluorescent antibody (DFA) loading, or a cytological smear test (Fatahzadeh & Schwartz, 2007). When analyzing from PCR, more than 10 2 DNA copies/ml may be an indicator for sepsis (Glas et al, 2012). Another virus which causes sepsis is the influenza virus.…”

Section: Sepsis Biomarkers Used In Point‐of‐critical‐care Sensorsmentioning

confidence: 99%

“…However, it is important to note several limitations, notably many bacterial and fungal detection systems have limits of detection close if not similar to the densities for determining septic conditions (Table 5). This relatively low sensitivity for pathogens may produce false negative results, where they are undetected yet still possibly present at harmful loads (Glas et al, 2012). Additionally, the ever‐fluid definition for sepsis prevents clinicals, researchers, or the average person from grasping its causes or implications, as the definition was changed as recently as 2016.…”

Section: Conclusion: Challenges Commericialization Paths and Potential Outcomesmentioning

confidence: 99%

Point‐of‐critical‐care diagnostics for sepsis enabled by multiplexed micro and nanosensing technologies

Ashley

Hassan

2021

WIREs Nanomed Nanobiotechnol

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Sepsis is responsible for the highest economic and mortality burden in critical care settings around the world, prompting the World Health Organization in 2018 to designate it as a global health priority. Despite its high universal prevalence and mortality rate, a disproportionately low amount of sponsored research funding is directed toward diagnosis and treatment of sepsis, when early treatment has been shown to significantly improve survival. Additionally, current technologies and methods are inadequate to provide an accurate and timely diagnosis of septic patients in multiple clinical environments. For improved patient outcomes, a comprehensive immunological evaluation is critical which is comprised of both traditional testing and quantifying recently proposed biomarkers for sepsis. There is an urgent need to develop novel point‐of‐care, low‐cost systems which can accurately stratify patients. These point‐of‐critical‐care sensors should adopt a multiplexed approach utilizing multimodal sensing for heterogenous biomarker detection. For effective multiplexing, the sensors must satisfy criteria including rapid sample to result delivery, low sample volumes for clinical sample sparring, and reduced costs per test. A compendium of currently developed multiplexed micro and nano (M/N)‐based diagnostic technologies for potential applications toward sepsis are presented. We have also explored the various biomarkers targeted for sepsis including immune cell morphology changes, circulating proteins, small molecules, and presence of infectious pathogens. An overview of different M/N detection mechanisms are also provided, along with recent advances in related nanotechnologies which have shown improved patient outcomes and perspectives on what future successful technologies may encompass. This article is categorized under: Diagnostic Tools > Biosensing

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“…Host immune responses are critical for restraining and abrogating viral replication, controlling viral load, and limiting disease severity ( 5 – 10 ). For example, HSV and HCMV infections in immunocompetent individuals trigger a rapid expansion of natural killer (NK) cells and virus-specific cytotoxic T lymphocytes (CTL) that are important for eliminating infected cells ( 3 , 11 , 12 ).…”

Section: Introductionmentioning

confidence: 99%

CD1d Expression and Invariant NKT Cell Responses in Herpesvirus Infections

2015

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Invariant natural killer T (iNKT) cells are a highly conserved subset of unconventional T lymphocytes that express a canonical, semi-invariant T cell receptor and surface markers shared with the natural killer cell lineage. iNKT cells recognize exogenous and endogenous glycolipid antigens restricted by non-polymorphic CD1d molecules, and are highly responsive to the prototypical agonist, α-galactosylceramide. Upon activation, iNKT cells rapidly coordinate signaling between innate and adaptive immune cells through the secretion of proinflammatory cytokines, leading to the maturation of antigen-presenting cells, and expansion of antigen-specific CD4+ and CD8+ T cells. Because of their potent immunoregulatory properties, iNKT cells have been extensively studied and are known to play a pivotal role in mediating immune responses against microbial pathogens including viruses. Here, we review evidence that herpesviruses manipulate CD1d expression to escape iNKT cell surveillance and establish lifelong latency in humans. Collectively, published findings suggest that iNKT cells play critical roles in anti-herpesvirus immune responses and could be harnessed therapeutically to limit viral infection and viral-associated disease.

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Fatal Multiorgan Failure Associated with Disseminated Herpes Simplex Virus-1 Infection: A Case Report

Cited by 12 publications

References 19 publications

Septic shock complicated by disseminated herpes simplex virus-1 infection: a case report

Septic shock complicated by disseminated herpes simplex virus-1 infection: a case report

Point‐of‐critical‐care diagnostics for sepsis enabled by multiplexed micro and nanosensing technologies

CD1d Expression and Invariant NKT Cell Responses in Herpesvirus Infections

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