Sequential changes in pathophysiology of systemic inflammatory response in a disseminated neonatal herpes simplex virus (HSV) infection

Nagamori, Tsunehisa; Koyano, Shin; Asai, Yoko; Nohara, Fumikatsu; Okamoto, Toshio; Nagaya, Ken; Hayashi, Tokitsugi; Miura, Yurika; Tsuda, Naoya; Iseki, Kenichi; Azuma, Hiroshi

doi:10.1016/j.jcv.2011.12.017

Cited by 10 publications

(9 citation statements)

References 14 publications

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“…Dysregulated secretion of pro-inflammatory cytokines in response to HSV infection also induces the production of high mobility group box 1 protein (HMGB1) from injured cells ( 158 ). HMGB1 is a nuclear protein and regulates DNA transcription.…”

Section: The Immunology Of Viral Sepsismentioning

confidence: 99%

Epidemiology and Immune Pathogenesis of Viral Sepsis

et al. 2018

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Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. Sepsis can be caused by a broad range of pathogens; however, bacterial infections represent the majority of sepsis cases. Up to 42% of sepsis presentations are culture negative, suggesting a non-bacterial cause. Despite this, diagnosis of viral sepsis remains very rare. Almost any virus can cause sepsis in vulnerable patients (e.g., neonates, infants, and other immunosuppressed groups). The prevalence of viral sepsis is not known, nor is there enough information to make an accurate estimate. The initial standard of care for all cases of sepsis, even those that are subsequently proven to be culture negative, is the immediate use of broad-spectrum antibiotics. In the absence of definite diagnostic criteria for viral sepsis, or at least to exclude bacterial sepsis, this inevitably leads to unnecessary antimicrobial use, with associated consequences for antimicrobial resistance, effects on the host microbiome and excess healthcare costs. It is important to understand non-bacterial causes of sepsis so that inappropriate treatment can be minimised, and appropriate treatments can be developed to improve outcomes. In this review, we summarise what is known about viral sepsis, its most common causes, and how the immune responses to severe viral infections can contribute to sepsis. We also discuss strategies to improve our understanding of viral sepsis, and ways we can integrate this new information into effective treatment.

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Section: The Immunology Of Viral Sepsismentioning

confidence: 99%

Epidemiology and Immune Pathogenesis of Viral Sepsis

et al. 2018

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“…They used methylprednisolone within 72 hours after the disease onset and suggested that methylprednisolone therapy might be effective for the control of neonatal disseminated HSV infection with HLH. Nagamori et al (2012) reported a successfully treated case of neonatal disseminated HSV infection with early anti-inflammatory therapy using prednisolone and concluded that anti-inflammatory intervention might only be effective if it is undertaken during the early phase. In our case, 6 days were passed from disease onset before using methylprednisolone.…”

Section: Discussionmentioning

confidence: 99%

Critically Severe Case of Neonatal Herpes with High Viral Load and Hemophagocytic Syndrome

Takehara

Hirohata

Mutoh

et al. 2019

Tohoku J. Exp. Med.

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Neonatal disseminated herpes simplex virus (HSV) infection is a severe disease with high mortality and morbidity; yet, the pathophysiology remains unclear. Here, we report a male infant with disseminated HSV type 1 (HSV-1) infection, complicated by hemophagocytic lymphohistiocytosis (HLH) and multiple organ failure. The infant, born at 39 weeks of gestation by normal delivery, developed fever (38.5˚C) with the high serum C-reactive protein levels on the 1st day of life, and exhibited tachypnea on the 3rd day. On the 5th day of life, the patient received mechanical ventilation and was transferred to our neonatal ICU. Real-time PCR for HSV-1 DNA revealed an extremely high serum concentration (1.0 × 10 9 copies/µL), and he was diagnosed with HSV-1 infection. Acyclovir (ACV) and corticosteroid pulse therapies with methylprednisolone were started. Continuous hemodiafiltration (CHDF) using cytokine-absorbing hemofilters was also initiated because of renal failure. These therapies, however, failed to control the disease, and the patient died on the 41st day of life. The dose of ACV on CHDF might not be adequate, although we could not measure the serum ACV concentrations. After the patient's death, we measured his serum cytokine concentrations taken four times during the clinical course. Serum concentrations of interleukin (IL)-6, IL-10, IL-1β, and interferon (IFN)-γ were elevated at the time of admission and were remarkably decreased by 10 days after treatment. In particular, the concentrations of IL-1β and IFN-γ were lower than the measurable ranges. It is therefore important to measure serum cytokine concentrations in real time to prevent excessive immune suppression.

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“…Neonatal disseminated infections with HSV-1 or HSV-2 led to SIRS represented by high IL-6 and TNF-α levels, and occasionally to the rapid demise of multiple organ dysfunction syndrome or HLH. 9 10 11 12 Methylprednisolone therapy might be effective for the control of neonatal disseminated HSV infection with HLH. 10 11 In this reported case, 10 sequential changes in the declining pattern of IL-6, IL-10, and IFN-γ levels were consistent with the results of our observation, although HSV DNA copy number was not monitored.…”

Section: Discussionmentioning

confidence: 99%

“… 9 10 11 12 Methylprednisolone therapy might be effective for the control of neonatal disseminated HSV infection with HLH. 10 11 In this reported case, 10 sequential changes in the declining pattern of IL-6, IL-10, and IFN-γ levels were consistent with the results of our observation, although HSV DNA copy number was not monitored. On the contrary, appreciable levels of IL-10 and IFN-γ in the neonates with virus-associated HLH might be associated with a good prognosis.…”

Section: Discussionmentioning

confidence: 99%

“…On the contrary, appreciable levels of IL-10 and IFN-γ in the neonates with virus-associated HLH might be associated with a good prognosis. 9 10 Nagamori et al 11 have recently reported a successfully treated case of neonatal disseminate HSV infection with early anti-inflammatory therapy using prednisolone. On the basis of the kinetics of high-mobility group box protein1 (HMGB-1) and cytochrome c , they concluded that anti-inflammatory intervention may only be effective if it is undertaken during the early phase of disseminated neonatal HSV infections.…”

Section: Discussionmentioning

confidence: 99%

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Successful Treatment of Corticosteroid with Antiviral Therapy for a Neonatal Liver Failure with Disseminated Herpes Simplex Virus Infection

Maeba

Hasegawa

Shimomura

et al. 2015

AJP Rep

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Background Herpes simplex virus (HSV) infection carries one of the poorest outcomes of neonatal liver failure (NLF). Neonates with disseminated HSV infection can develop hemophagocytic lymphohistiocytosis (HLH), and occasionally need orthotopic liver transplantation. Early interventions may be critical for the cure of NLF. Case Report We describe herewith a 6-day-old neonate with fulminant hepatic failure due to disseminated HSV-1 infection, who successfully responded to high-dose corticosteroid therapy 72 hours after the onset of disease. Preceding acyclovir, gamma globulin, and exchange blood transfusion therapies failed to control the disease. Methylprednisolone pulse therapy led to a drastic improvement of liver function and cytokine storms, and prevented the disease progression to HLH. Sustained levels of plasma and cerebrospinal fluid HSV DNA declined after prolonged acyclovir therapy. Bilateral lesions of the periventricular white matter areas, assessed by magnetic resonance imaging, disappeared at 3 months of age. The infant showed normal growth and development at 4 years of age. Conclusion Early anti-hypercytokinemia therapy using corticosteroid, and prolonged antiviral therapy might only provide the transplantation-free cure of NLF with HSV dissemination.

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Sequential changes in pathophysiology of systemic inflammatory response in a disseminated neonatal herpes simplex virus (HSV) infection

Abstract: 1 Background. Disseminated neonatal herpes simplex virus (HSV) infection causes a typical2

Cited by 10 publications

References 14 publications

Epidemiology and Immune Pathogenesis of Viral Sepsis

Epidemiology and Immune Pathogenesis of Viral Sepsis

Critically Severe Case of Neonatal Herpes with High Viral Load and Hemophagocytic Syndrome

Successful Treatment of Corticosteroid with Antiviral Therapy for a Neonatal Liver Failure with Disseminated Herpes Simplex Virus Infection

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