Hepatitis caused by the herpes simplex virus type 1 and 2

Hepatitis caused by the herpes simplex virus type 1 and 2 (HSV 1 and HSV 2) is a disease caused by herpes simplex viruses, by which the fetus is infected from the mother with a disease caused by these viruses.

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Spread

Infection caused by the herpes simplex virus (HSV), is one of the most widespread and widespread diseases.

According to WHO, this infection is the second most viral infection after the flu. In recent years, the role of herpetic infection as a marker of HIV infection has grown.

HSV is a population consisting of herpes simplex virus type 1 and 2 (genital). For example, in the US, 30 million people. Suffer from recurrences of genital herpes.

Primary infection of a human HSV occurs in childhood and in the vast majority of cases it is practically asymptomatic. The virus after ingestion remains in it for life, taking a latent form of persistence. In stressful situations (trauma, mental disorders, diseases, etc.) clinical recurrence of infection in the form of stomatitis, herpes skin, genital herpes, ophthalmoherpes and damage to the nervous system.

To the childbearing age (19-30 years) 75-90% or even 100% of women are infected with HSV. In pregnant women, the infection caused by HSV 2 is detected at a frequency of 7 to 47%.

Causes and pathogenesis

Intrauterine infection of the embryo and fetus is mainly associated with HSV 2 - it accounts for up to 80% of ante- and neonatal infection caused by HSV. Active herpetic infection in the mother after the 32nd week of pregnancy leads to infection of the fetus and the newborn in 40-60% of cases. A high risk of infection with the HSV fetus occurs if the pregnant woman with HSV infection has various inflammatory processes in the genital area (chronic vulvovaginitis, slow endometritis), and in the anamnesis - spontaneous abortions.

It is believed that in most cases, intrauterine HSV infection is still due to the asymptomatic isolation of the herpes virus in a pregnant woman. In this case, the woman does not even have any mention in the history of herpetic infection.

The transplacental pathway is the main route for antenatal infection with viruses, including HSV. In this regard, the persistent form of infection in a woman determines the high probability of infection of the fetus throughout the pregnancy.

Recurrent genital herpes with viralemia during pregnancy can cause fetal death in the form of spontaneous abortions in the early stages of pregnancy - in 30% of cases and the cause of late miscarriages - in 50% of cases.

Infection of the fetus HSV in the III trimester leads to the development of an infectious process with a variety of clinical manifestations of hypotrophy, meningoencephalitis, pneumonia, pneumopathy, sepsis, hepatitis. A child is born with a clinical picture of the disease. However, it is known that with the infection of HSV in the antenatal period, children can be born relatively healthy. In this connection, the question arises: why, with such a wide spread of infection in pregnant women, the fetal lesion occurs rarely or even very rarely? Theoretically, it can be assumed that infection of the fetus is most likely to occur with a primary infection in the course of pregnancy or if the primary infection of the fetus occurs directly in the birth, 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, this assumption is in contradiction with the existing view of the widespread detection of markers of HSV infection, beginning with early childhood. These questions need additional study.

[7], [8], [9], [10], [11], [12], [13], [14], [15],

Morphology

In cases of antenatal HSV infection, I always find gay changes in the liver. With intrauterine herpetic infection with hepatitis syndrome, characteristic histological signs of congenital hepatitis are described. Macroscopic examination shows an increase in liver size. On the cut, the liver tissue is mottled: on a dark brown background, a variety of yellowish-white foci with a diameter of 2-3 mm are identified throughout the surface.

At a microscopic examination, foci of coagulation necrosis are determined in the liver. Lumpy disintegration is noted in the central part of necrosis foci, and lymphocytic infiltration is observed along the periphery. Dyscomplexation of hepatic beams and dystrophic changes in hepatocytes are revealed. A characteristic sign of herpetic infection is the presence of basophilic inclusions - the bodies of Cowdry, which are colored with a light aureole. In the stroma of the liver, lobular and interlobular connective tissue, focal lymphohystiocytic infiltrates are located.

Symptoms of hepatitis caused by herpes simplex virus type 1 and 2

Newborns with congenital HSV-hepatitis in most cases appear to be full-term, with a normal mass and enter the hospital in a state of moderate seriousness, less often in a serious condition. Manifestations of HSV infection are observed in the form of bubble rashes on the lips, wings of the nose, palatine arches, on the tongue and soft palate on a hyperemic background in 33-71% of cases. Symptoms of intoxication are moderately expressed. Children are flaccid, regurgitate, suck badly. A severe condition is noted, as a rule, in newborns with severe CNS involvement.

The icteric syndrome develops in the first three days - from mild to severe; in some children, with all other signs of hepatitis, jaundice may be absent.

All patients have hepatomegaly. In this case, the liver of moderate density, with a smooth surface, with a round or sharp edge, protrudes from the hypochondrium 3-5 cm. The spleen in most patients (60-70%) is also increased.

Biochemical parameters vary. The activity of hepatic cell enzymes is increased 2-5 times, while the parameters of ALT and ACT are 80-450 U / l. The level of total bilirubin increases 3-5 times, in children with cholestasis it is 7-10 times, while the conjugated and unconjugated fraction is almost equal. In the syndrome of cholestasis, the activity of alkaline phosphatase and GGTP increases by 2-3 times in comparison with the norm.

In children with a cholestatic form of hepatitis, jaundice is severe, with a greenish tinge; children are bothered by itching, they are sleeping badly. This manifests hemorrhagic syndrome in the form of ecchymosis on the skin, bleeding from injection sites, bloody vomiting. In a number of cases, herpetic hepatitis can take fulminant form, with severe clinical and laboratory manifestations of hemorrhagic syndrome and coma development.

With ultrasound in all children with congenital herpetic hepatitis there is an increased echolocation of the liver parenchyma.

Most clinicians note that children with congenital herpetic hepatitis have a long subfebrile condition, there are an increase in the size of several groups of lymph nodes and various disorders of the nervous system (muscle hypotension or hypertension, increased excitability, hypertensive syndrome, etc.).

Variants of flow

Congenital hepatitis due to HSV infection has an acute course. Jaundice, even intense, disappears by the 6th month of life. Hepatomegaly persists for several months. Indicators of functional liver samples are normal to the 2-6th month, disproteinemia is not observed. Chronic course of congenital hepatitis, caused by the virus of idleness of herpes, is not observed.

In a number of cases, hepatitis can terminate legally, as a rule, with the development of the fulminant form of the disease.

In connection with various disorders of the nervous system, which can manifest not only at birth, but also in the future, children are for a long time on the account of a neurologist.

Diagnosis of hepatitis caused by herpes simplex virus type 1 and 2

When a child with congenital hepatitis is born, it is not always clear what kind of etiology is the liver damage.

It is necessary to exclude various intrauterine infections, accompanied by hepatitis syndrome. These are viral hepatitis B, cytomegaly, chlamydia, toxoplasmosis, septic bacterial processes. The diagnosis of HSV infection targets the presence of grouping rashes on the skin and mucous membranes in a baby; 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 the positive results of HSV DNA detection in serum and other biological substrates by PCR and also on the detection of specific anti-HSV IgG class in increasing titres (more than 4-fold increase).

[16], [17], [18], [19], [20], [21]

Treatment of hepatitis caused by the herpes simplex virus type 1 and 2

Antiviral therapy uses viferon in a daily dose of 500 thousand IU for 2-4 weeks in combination with hepatoprotectors, for example, with phosphoglyme. With a cholestatic variant of hepatitis, ursofalk is prescribed in drops for 2-3 weeks, sorbents, phenobarbital, 25% magnesium sulfate solution.

Acyclovir is used in combination with hepatitis with severe CNS lesions at a rate of 15 mg per 1 kg of body weight per day for 7-10 days, depending on the condition of the child. If necessary, detoxification infusion therapy is performed. Locally treated herpetic eruptions.

Prevention

To prevent antenatal infection of the fetus when an active herpetic infection is detected in the mother, it is necessary to perform not only local treatment of the rashes, but also antiviral therapy, for example, for interferon alfa-viferon approved for pregnant women, in a daily dose of 1-2 million IU for 2-3 weeks at a time gestation for more than 16 weeks,

The question of the administration of parenteral forms of recombinant interferon alfa, as well as antiviral drugs from the acyclovir group, is decided strictly individually, taking into account the real risk of fetal damage.

An antiherpetic vaccine is under development.