Herpes simplex virus hepatitis after solid organ transplantation in adults

Article Abstract:

Hepatitis caused by herpes simplex virus (HSV) is rare. It occurs most frequently in patients who have a reduced ability to fight infection because the function of their immune system is impaired. In most cases, hepatitis caused by HSV results in death. This article describes the cases of 12 patients who developed HSV hepatitis following organ transplantation between 1980 and 1988. During this period, 3,536 liver, kidney and heart transplants were performed in Pittsburgh, Pennsylvania. Twelve of these patients (average age of 37 years) developed HSV hepatitis following organ transplantation. Eight of the patients had liver transplants, three had kidney transplants and one had a heart transplant. In these patients, HSV hepatitis occurred between 5 and 46 days after organ transplantation, and resulted in death in eight of the 12 patients. The clinical symptoms in the patients who died included low blood pressure, bacteria in the blood (bacteremia), bleeding in the stomach and intestines, and disseminated intravascular coagulation (DIC, widespread abnormal blood clotting). All five of the patients with DIC died, and the three patients with extensive liver damage died. Three of the patients who had liver damage that was confined to one small part of the liver were treated successfully with acyclovir. Beginning in February of 1989, all subsequent kidney and liver transplant recipients were treated with acyclovir to prevent the development of HSV hepatitis. Since then, 1,144 transplants have been performed in Pittsburgh without any cases of HSV hepatitis. These findings indicate that treatment with acyclovir is beneficial for preventing HSV hepatitis in transplant patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Drug therapy, Hepatitis, Viral, Viral hepatitis

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Acyclovir-resistant herpes simplex virus causing pneumonia after marrow transplantation

Article Abstract:

Acyclovir is an antiviral agent used in the treatment of herpes simplex virus (HSV) infections. HSV infections are both common and serious in patients with compromised immune systems. These patients have a greater risk for developing opportunistic infections. To prevent graft rejection, the immune systems of bone marrow transplant patients must be suppressed. These patients are given acyclovir as a prophylactic (preventative) treatment for HSV. In order for acyclovir to be effective as an antiviral agent, it must be activated. Acyclovir becomes activated by an enzyme called thymidine kinase (TK). However, certain mutant strains of HSV do not have TK and thus are not killed by acyclovir. Strains of TK-deficient (acyclovir-resistant) HSV have been identified in AIDS patients and in other immunocompromised individuals. Three patients with leukemia underwent bone marrow transplants, and were treated with acyclovir as a preventative measure. All three patients developed graft-versus-host disease, a reaction that occurs after a transplant because the recipient's immune system is suppressed. Initially, the patients had HSV infection that was sensitive to acyclovir. However, all three patients developed acyclovir-resistant HSV infections, resulting in pneumonia. The HSV strains that were resistant to acyclovir were found to be sensitive to foscarnet and vidarabine, but not to gancyclovir, another antiviral agent. It is concluded that acyclovir-resistant HSV infections are a threat to immunocompromised patients. Early detection of HSV infection should be performed in immunocompromised patients, and antiviral drug testing should be done to determine an appropriate treatment. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Causes of, Drug resistance in microorganisms, Microbial drug resistance, Viral pneumonia

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Clinical features and analysis of risk factors for invasive candidal infection after marrow transplantation

Article Abstract:

The fungi candida is similar to yeast and is very common in nature. The severity of infection with candida can range from mild symptoms to fungemia (the presence of fungi in the blood) and internal organ involvement. Some types of candidal infections can affect the spleen, liver and kidneys. These infections occur in surgical patients, burn and trauma patients, and patients who require catheters (tubes used for adding or removing fluids from the body). In addition, patients with tissue or organ transplants are particularly susceptible to this type of infection because they are treated with drugs that suppress the immune system (the body's natural defense system for fighting infection). To identify risk factors associated with candida infections, 1,506 bone marrow transplant patients were studied between 1980 and 1986. Blood cultures and biopsies showed that 171 patients developed candida infections. Test results showed that 102 of the patients had fungemia; 39 percent of these patients died. Mortality was 90 percent among the patients who had tissue involvement. Age, graft-versus-host disease (rejection of the transplanted tissue) and tissue mismatch were factors that increased the risk of candida infection. Irradiation, cyclophosphamide and transplantation for aplastic anemia decreased the risk of infection. (Consumer Summary produced by Reliance Medical Information, Inc.)

Risk factors, Candidiasis

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