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Hepatitis caused by herpes simplex virus types 1 and 2
Last reviewed: 05.07.2025
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Spreading
Herpes simplex virus (HSV) infection is a common and widespread disease.
According to WHO, this infection is the second most common viral infection after influenza. In recent years, the role of herpes infection as a marker of HIV infection has increased.
HSV is a population consisting of herpes simplex viruses types 1 and 2 (genital). For example, in the US, 30 million people suffer from recurrent genital herpes.
Primary infection of humans with HSV occurs in childhood and in the vast majority of cases is practically asymptomatic. Once the virus enters the human body, it remains in it for life, taking a latent form of persistence. In stressful situations (injuries, mental disorders, illnesses, etc.), clinical relapses of the infection are possible in the form of stomatitis, skin herpes, genital herpes, ophthalmic herpes, and damage to the nervous system.
By the time of childbearing age (19-30 years), 75-90% or even 100% of women are infected with HSV. In pregnant women, infection caused by HSV 2 is detected with a frequency of 7 to 47%.
Causes and pathogenesis
Intrauterine infection of the embryo and fetus is associated primarily with HSV 2 - it accounts for up to 80% of ante- and neonatal infections caused by HSV. Active herpes infection in the mother after the 32nd week of pregnancy leads to infection of the fetus and newborn in 40-60% of cases. A high risk of HSV infection of the fetus occurs if a pregnant woman with HSV infection has various inflammatory processes in the genital area (chronic vulvovaginitis, sluggish endometritis), as well as a history of spontaneous abortions.
It is believed that in most cases, intrauterine HSV infection is still caused by asymptomatic release of the herpes virus in a pregnant woman. In this case, the woman does not even have a history of herpes infection.
The transplacental route is the main route for antenatal infection with viruses, including HSV. In this regard, a persistent form of infection in a woman determines a high probability of infection of the fetus throughout the pregnancy.
Recurrent genital herpes with viremia during pregnancy can cause fetal death in the form of spontaneous abortions in early pregnancy - in 30% of cases and late miscarriages - in 50% of cases.
Infection of the fetus with HSV in the third trimester leads to the development of an infectious process with various clinical manifestations of malnutrition, meningoencephalitis, pneumonia, pneumopathy, sepsis, and hepatitis. The child is born with a clinical picture of the disease. However, it is known that with HSV infection in the antenatal period, children can be born relatively healthy. In this regard, the question arises: why, with such a widespread infection in pregnant women, does fetal damage occur rarely or even very rarely? Theoretically, it can be assumed that fetal infection most likely occurs with primary infection during pregnancy or if the primary infection of the fetus occurs directly during labor or immediately after the birth of the child. In other words, the clinical picture of congenital herpetic hepatitis presumably occurs in children born to seronegative mothers infected with herpes simplex viruses during the current pregnancy. However, such an assumption contradicts the existing idea of the widespread detection of HSV infection markers, starting from early childhood. These issues require further study.
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Morphology
In cases of antenatal HSV infection, hepatic changes are always detected. In intrauterine herpes infection with hepatitis syndrome, characteristic histological signs of congenital hepatitis are described. Macroscopic examination reveals an increase in liver size. On section, liver tissue is mottled: on a dark brown background, many yellowish-white foci with a diameter of 2-3 mm are detected over the entire surface.
Microscopic examination of the liver reveals foci of coagulation necrosis. In the central part of the necrosis foci, lumpy decay is observed, and on the periphery - lymphocytic infiltration. Discomplexation of the liver beams and dystrophic changes in the hepatocytes are revealed. A characteristic sign of herpes infection is the presence of basophilic inclusions - Cowdry bodies, which are stained with a light rim. Focal lymphohistiocytic infiltrates are located in the stroma of the liver, lobular and interlobular connective tissue.
Symptoms of hepatitis caused by herpes simplex virus types 1 and 2
Newborns with congenital HSV hepatitis are mostly born full-term, with normal weight, and are admitted to hospital in a moderate condition, less often in a severe condition. Manifestations of HSV infection are observed in the form of vesicular rashes on the lips, wings of the nose, palatine arches, on the uvula and soft palate against a hyperemic background in 33-71% of cases. Symptoms of intoxication are moderate. Children are lethargic, regurgitate, and suck poorly. A severe condition is usually observed in newborns with severe CNS damage.
Jaundice syndrome develops in the first three days - from a mild to intense degree; in some children, with all other signs of hepatitis, jaundice may be absent.
All patients have hepatomegaly. The liver is of moderate density, with a smooth surface, with a rounded or sharp edge, protruding from the hypochondrium by 3-5 cm. The spleen in most patients (60-70%) is also enlarged.
Biochemical parameters vary. The activity of liver cell enzymes increases by 2-5 times, with ALT and AST parameters being 80-450 U/l. The level of total bilirubin increases by 3-5 times, in children with cholestasis syndrome - by 7-10 times, with the conjugated and unconjugated fractions being almost equal. With cholestasis syndrome, the activity parameters of alkaline phosphatase and GGT increase by 2-3 times compared to the norm.
In children with cholestatic hepatitis, jaundice is pronounced, with a greenish tint; children are bothered by itching, they sleep poorly. At the same time, hemorrhagic syndrome manifests itself in the form of ecchymosis on the skin, bleeding from injection sites, bloody vomiting. In some cases, herpetic hepatitis can take a fulminant form, with severe clinical and laboratory manifestations of hemorrhagic syndrome and the development of coma.
In ultrasound examination, all children with congenital herpetic hepatitis show increased echo density of the liver parenchyma.
Most clinicians note that children with congenital herpetic hepatitis experience prolonged subfebrile temperature, an increase in the size of several groups of lymph nodes and various disorders of the nervous system (muscle hypotonia or hypertension, increased excitability, hypertensive syndrome, etc.).
Flow options
Congenital hepatitis caused by HSV infection has an acute course. Jaundice, even if severe, disappears by the 6th month of life. Hepatomegaly persists for several months. Functional liver function tests are normalized by the 2nd to 6th month; dysproteinemia is not observed. Chronic congenital hepatitis caused by the herpes simplex virus is not observed.
In some cases, hepatitis can end legally, usually with the development of a fulminant form of the disease.
Due to various disorders of the nervous system, which can manifest themselves not only at birth but also later, children are registered with a neurologist for a long time.
Diagnosis of hepatitis caused by herpes simplex virus types 1 and 2
When a child is born with congenital hepatitis, it is not always clear what the etiology of the liver damage is.
It is necessary to exclude various intrauterine infections accompanied by hepatitis syndrome. These are viral hepatitis B, cytomegalovirus, chlamydia, toxoplasmosis, septic bacterial processes. The diagnosis of HSV infection is guided by the presence of grouped rashes on the skin and mucous membranes of the infant; sometimes there are indications of activation of genital and labial herpes in the mother during pregnancy.
Modern specific diagnostics of HSV infection is based on positive results of HSV DNA detection in blood serum and other biological substrates using PCR, as well as on the detection of specific anti-HSV class IgG in increasing titers (more than 4-fold increase).
Treatment of hepatitis caused by herpes simplex virus types 1 and 2
In antiviral therapy, Viferon is used in a daily dose of 500 thousand IU for 2-4 weeks in combination with hepatoprotectors, for example, with Phosphogliv. In the case of cholestatic hepatitis, Ursofalk drops are prescribed for 2-3 weeks, sorbents, phenobarbital, 25% magnesium sulfate solution.
Acyclovir is used in combination with hepatitis and severe CNS lesions at a rate of 15 mg per 1 kg of body weight per day for 7-10 days, depending on the child's condition. If necessary, detoxifying infusion therapy is performed. Herpetic eruptions are treated locally.
Prevention
To prevent antenatal infection of the fetus when an active herpes infection is detected in the mother, it is necessary to carry out not only local treatment of the rash, but also antiviral therapy, for example, the drug interferon alpha - Viferon, which is approved for pregnant women, at a daily dose of 1-2 million IU for 2-3 weeks at gestation periods of more than 16 weeks,
The question of prescribing parenteral forms of recombinant interferon alpha, as well as antiviral drugs from the acyclovir group, is decided strictly individually, taking into account the real risk of damage to the fetus.
An anti-herpes vaccine is under development.