Hepatitis caused by herpes simplex viruses

Herpes simplex virus was isolated by W. Gruter in 1912. In 1921, V. Lipschutz found acidophilic inclusions in the nuclei of cells of affected tissues, considered pathognomonic signs of this infection.

Herpes simplex virus contains DNA, the virion has a diameter of 120 to 150 nm, multiplies well in the tissues of the chick embryo. In infected cells, the virus forms intranuclear inclusions and giant cells, has a well-marked cytopathic effect. The virus lasts for a long time at low temperatures (-70 ^o C), is inactivated at 50-52 ^o C after 30 minutes, is sensitive to the action of ultraviolet and X-rays, but can persist for 10 years or more in the dried state. When a virus is introduced into the cornea of the eye of a rabbit, guinea pig, monkey, keratoconjunctivitis occurs, and with intracerebral administration, encephalitis occurs.

Herpes simplex viruses on antigenic properties and differences in nucleotide sequences of DNA are divided into two groups: HSV 1 (human herpesvirus type 1, HHV 1) and HSV 2 (human herpesvirus type 2, HHV2). The first group is associated with the most common forms of the disease - damage to the skin of the face and mucous membranes of the mouth. Viruses of the second group often cause damage to the genital organs, as well as meningoencephalitis. Liver disorders can be caused by both HSV 1 and HSV 2. Infection with one type of HSV does not prevent the occurrence of infection caused by HSV of another type.

[1], [2], [3], [4], [5], [6], [7], [8]

Epidemiology of hepatitis caused by the herpes simplex virus

The infection is widespread. Infection occurs in the first 3 years of a child's life. Children of the first half of life are not infected with herpes simplex infection due to the presence of specific antibodies of IgG class, obtained by transplacent from the mother. However, in the absence of immunity in the mother, in the case of infection, the children of the first months of life are particularly ill - they have generalized forms. 70-90% of children of 3 years of age have a sufficiently high titer of virus neutralizing antibodies against HSV 2. From 5-7 years of age, the number of children with high levels of antibodies and to HSV 2 increases.

The source of infection is sick and virus carriers. Transmission is carried out by contact, sexual and, apparently, airborne droplets. Infection occurs when kissing through saliva, as well as through toys, household items, infected with saliva of the patient or virus carrier.

Possible transplatsetarny way of transmission of infection, but especially often the infection of the child occurs during the passage of the birth canal.

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The pathogenesis of hepatitis caused by the herpes simplex virus

The pathogenesis of HSV-hepatitis has not been studied to date in immunocompromised or immunocompetent patients. There is reason to believe that in a number of cases reactivation of latent HSV infection occurs against the background of cytostatic therapy. The possibility of direct cytopathic effects of HSV 1 and HSV 2 on hepatotoxicity is not ruled out.

Pathomorphology

Morphological changes in HSV-hepatitis have not been studied enough. There are two forms: focal and diffuse, in which diffuse microabscesses, occupying more than 50% of the parenchyma, and multiple hepatocytes with characteristic intranuclear vitreous inclusions and Cowdry bodies of type A.

The etiology of liver damage is confirmed by the presence of characteristic inclusions in hepatocytes - Caudry type A bodies, detection of HSV1 / 2 virus particles by electron microscopy, detection of HSV antigens in hepatocytes by immunohistochemical methods, and antibodies to HSV in liver tissue.

Hepatitis of newborns caused by the herpes simplex virus is often accompanied by massive liver necrosis.

Symptoms of hepatitis caused by the herpes simplex virus

The spectrum of HSV-expression of the liver varies from mild and subclinical to severe and malignant forms of hepatitis. The HSV gene, however, always has an acute course. Chronic course of the disease is not observed.

HSV-hepatitis can develop in both immunocompetent and immunocompromised patients. Predisposing factors other than immunity disorders, including those caused by organ transplantation, steroid hormones that are not associated with organ transplantation are pregnancy, the use of inhalation anesthetics, and others.

The incubation period for HSV-hepatitis is not exactly established. However, it is known that in adult patients who received organ transplantation, liver damage develops on average 18 days after transplantation. This is earlier than with cytomegalovirus hepatitis, developing in 30-40 days after a similar intervention,

The pre-zheltus period is not expressed in all patients; in a number of cases, the disease manifests itself with the appearance of jaundice.

Jaundice period

In most patients, liver damage is combined with fever, nausea, vomiting, abdominal pain, leukopenia, thrombocytopenia, coagulopathy. In a number of cases, HSV-hepatitis occurs in fulminant form.

Often the fulminant form of hepatitis caused by HSV 1 or HSV 2 is observed in pregnant women. In addition to isolated HSV-hepatitis, a fatal generalized HSV 2 infection may develop in pregnant women, including, in addition to fulminant hepatitis, fever, progressive pneumonia with respiratory failure, leukopenia, DIC syndrome, acute renal failure, infectious-toxic shock. The etiological diagnosis is confirmed by the isolation of HSV 2 from the contents of vesicles, hepatocytes and other autopsy material.

Among non-immunodeficient conditions, the disease is more common in newborns, but may be in older children and adults. Possible as isolated hepatitis, and liver damage as a result of the generalization of herpes simplex with the defeat of many organs and systems. In this case, patients have a high fever, severe symptoms of intoxication, drowsiness, breathing disorder, dyspnea. Cyanosis, vomiting, enlarged liver, spleen, jaundice, hemorrhage. In the serum, the activity of hepatic cell enzymes is increased, the level of conjugated bilirubin is increased, the prothrombin index is lowered. Characteristic herpetic eruptions in most patients with isolated HSV 1/2-hepatitis are absent.

In this case, hepatitis in newborns caused by HSV, can be accompanied by massive necrosis of the liver and lead to death. In some cases with HSV hepatitis in newborns, the activity of hepatic cell enzymes reaches high values (ALT to 1035 U / L, AST to 3700 U / L). The condition of such patients is always difficult.

Treatment of hepatitis caused by the herpes simplex virus

Since the overwhelming majority of patients with herpetic liver disease are not accompanied by vesicular rashes on the skin and mucous membranes, the virus is not considered by doctors as a possible etiologic cause of hepatitis, antiviral therapy is not prescribed, and many patients die from acute hepatic insufficiency. In the case of empiric administration of acyclovir, immunocompetent and immunocompromised patients do not.

In a number of cases of acute HSV 1/2-hepatitis, a positive effect is achieved by treatment with antiviral drugs, and especially with acyclovir, a timely intravenous administration of which can lead to a rapid improvement in the patients' condition.

Summarizing the above on the problem of HSV-hepatitis, we can say that this pathology, although it is infrequent, has great clinical significance. In this detailed and in-depth study of the prognostic factors of predisposition of certain categories of patients to the development of this disease has not yet been.