Acute cerebellitis caused by herpes simplex virus

Case presentation of acute cerebellitis caused by herpes simplex virus.

Evasión de la respuesta inmune por virus herpes simplex / Immune evasion by herpes simplex viruses

Herpes simplex viruses and humans have co-existed for tens of thousands of years. This long relationship has translated into the evolution and selection of viral determinants to evade the host immune response and reciprocally the evolution and selection of host immune components for limiting virus infection and damage. Currently there are no vaccines available to avoid infection with these viruses or therapies to cure them. Herpes simplex viruses are neurotropic and reside latently in neurons at the trigeminal and dorsal root ganglia, occasionally reactivating. Most viral recurrences are subclinical and thus, unnoticed. Here, we discuss the initial steps of infection by herpes simplex viruses and the molecular mechanisms they have developed to evade innate and adaptive immunity. A better understanding of the molecular mechanisms evolved by these viruses to evade host immunity should help us envision novel vaccine strategies and therapies that limit infection and dissemination.

Los virus herpes simplex y humanos co-existen desde decenas de miles de años. Esta prolongada relación se ha traducido en la evolución y selección de determinantes virales para evadir la respuesta inmune y recíprocamente la evolución y selección de componentes inmunes del hospedero para limitar la infección viral y el daño que producen. Actualmente no existen vacunas para evitar la infección de estos virus o terapias que la curen. Los virus herpes simplex son neurotrópicos y permanecen latentes en neuronas de ganglios trigémino y dorsales, reactivándose esporádicamente. La mayoría de las recurrencias por virus herpes simplex son sub-clínicas y por tanto pasan inadvertidas. Aquí discutimos los pasos iniciales de la infección porvirus herpes simplex y los mecanismos moleculares que estos virus han desarrollado para evadir la respuesta inmune innata y adaptativa. Una mejor comprensión de los mecanismos moleculares evolucionados por estos virus para evadir la respuesta inmune del hospedero deberían ayudarnos visualizar nuevas estrategias para desarrollar vacunas y terapias que limiten su infección y diseminación.

Infección intrauterina por Herpes virus simplex y aplasia cutis / Intrauterine Herpes simplex virus infection and aplasia cutis

Presentamos un caso de infección por Herpes virus simplex adquirido por vía transplacentaria en un neonato nacido a las 34 semanas de gestación por parto vaginal. La madre presentó un único episodio de infección genital por herpes virus en la décima semana de gestación.En el momento del nacimiento el niño presentódos ampollas y lesiones de aplasia cutis que semejaba una epidermólisis bullosa. Además, se evidenciaron múltiples anomalías congénitas del sistema nervioso central, oftalmológicas y cardíacas que sustentan la infección herpética intrauterina. El test de Tzanck y la serología para Herpes virus simplex 2 (IgG) fueron positivas. La infección intrauterina por virus herpes está asociada a alta morbilidad y mortalidad pero responde a la terapia antiviral. Este diagnóstico debe ser considerado en todo neonato con una enfermedad ampollar o piel erosionada.

We present a case of Herpes simplex virus infection acquired by transplacental route in a neonate born at 34 weeks of gestation by vaginal delivery. The mother presented a single episode of genital herpes simplex virus infection in the tenth week of pregnancy. At birth, the neonate presented two blisters and lesions of aplasia cutis resembling epidermolysis bullosa. In addition, he presented multiple congenital anomalies of the brain, eyes and heart, supporting the intrauterine infection. Tzanck test and serology for Herpes simplex virus 2(IgG) were positive. Intrauterine infection by herpes virus is associated with high morbidity and mortality, however it responds to antiviral therapy. This diagnosis should be considered in any neonate with blisters or denuded skin.

rare cause of dysphagia in a pregnant woman: herpes simplex esophagitis

Herpes simplex esophagitis [HSE] has rarely been reported in immunocompetent individuals. In a search of Medline until October 2012, we found only one case of HSE in a pregnant female. We present the first case of HSE in a healthy 36-year-old female at 27 weeks gestation who recovered without antiviral therapy

Hepatitis viruses: Not always what it seems to be / Los virus de las hepatitis no siempre son habituales

The classic hepatotropic viruses, hepatitis A through E, are not the only viral agents able to infect the liver. Other systemic viruses may cause hepatic injury that can range from mild and transient elevation of aminotransferases to acute hepatitis and occasionally acute liver failure and fulminant hepatitis. The clinical presentation may be indistinguishable from that associated with classic hepatotropic viruses. These agents include cytomegalovirus; Epstein-Barr virus; herpes simplex virus; varicella-zoster virus; human herpesvirus 6, 7, and 8; human parvovirus B19; adenoviruses among others. Wide spectrums of clinical syndromes are associated with cytomegalovirus disease. Unique clinical syndromes may present in neonates, young adults and immunocompromised hosts infected with cytomegalovirus. Cases of fulminant hepatitis have been reported in both immunocompromised and immunocompetent hosts infected with Epstein Barr virus. Occasionally, these patients with acute hepatic failure may need liver transplantation. Herpes simplex viruses may involve the liver in neonatal infections, pregnancy, immunocompromised hosts and occasionally, immunocompetent adults. Varicella-Zoster virus has also been associated with severe acute hepatitis and fulminant hepatitis in adults. The drug of choice for these conditions is intravenous acyclovir. These may also need liver transplantation in the more severe forms of clinical presentation. Typical liver biopsy findings can be useful in determining the diagnosis of these viral infections. Human herpesviruses 6, 7, and 8, human parvovirus B19, and adenoviruses can also be present with features of acute liver injury and occasionally as fulminant hepatitis. The clinical syndromes are less well delineated than those associated with herpesviruses. It is important to consider these viruses as possible etiologic agents in patients who have acute liver injury and their serologic markers for the classic hepatotropic viruses are not indicative of an active infection.

Los agentes de la hepatitis viral A, B, C, D y E no son los únicos virus que pueden causar un síndrome de daño hepático agudo. Agentes virales como el citomegalovirus, Epstein-Barr, herpes simplex 1 y 2, Varicella-Zoster, virus herpes humano 6, 7, y 8, parvovirus B19 y adenovirus pueden causar daño hepático agudo e inclusive presentarse como hepatitis fulminante. Los cuadros clínicos de daño hepático agudo por citomegalovirus, Epstein Barr y herpes simplex 1 y 2 han sido caracterizado mejor. Se ha intentado el uso de drogas antivirales específicas como el uso intravenoso de aciclovir. Ocasionalmente, se ha requerido el trasplante hepático para rescatar pacientes con hepatitis fulminantes por estos agentes virales. La biopsia hepática puede ser de utilidad en estos casos puesto que los hallazgos son bastante característicos. La expresión clínica asociada a infecciones por virus herpes humano 6, 7 y 8, parvovirus B19 y adenovirus son menos características. Ha habido varios casos de hepatitis fulminante causada por estos agentes virales. Estos agentes virales deben ser considerados en el diagnóstico de casos de daño hepático agudo e inclusive hepatitis fulminante cuando los marcadores virales para los virus de hepatitis A-E son negativos.

Prevalência e fatores de risco para a infecção pelo herpes simples vírus tipo-2 em uma coorte de homens que fazem sexo com homens no Rio de Janeiro / Prevalence and risk factors for herpes simplex type-2 virus in a cohort of men who have sex with men in Rio de Janeiro

O HSV-2 é a principal causa de herpes genital, sendo a maior parte destas infecções assintomática. A infecção pelo HSV-2 pode ser um fator de risco para a aquisição e transmissão de outras DST, inclusive da infecção causada pelo HIV. Objetivo: Estimar a prevalência e identificar os fatores de risco associados à infecção pelo HSV-2 em uma coorte de homens que fazem sexo com homens da Fundação Oswaldo Cruz, Rio de Janeiro, Brasil. Métodos: Estudo transversal, com avaliação de dados sócio-demográficos, comportamentais e laboratoriais referentes à linha de base de 403 voluntários incluídos na referida coorte, no período de 1994-1998. As amostras foram testadas através do ELISA para detecção de anticorpos tipo-específicos contra a gG2 do HSV-2 (HerpeSelect - Focus Technologies)Resultados: A prevalência para anticorpos anti-HSV-2 encontrada nesta população foi de 65,2 por cento. Após análise multivariada, os fatores que se mostraram independentemente associados à infecção pelo HSV-2 foram idade mais elevada (maior ou igual a 26 anos), raça não branca, ter sorologia positiva para sífilis (TPHA), ter feito sexo desprotegido com parceria sexual masculina e ter feito sexo desprotegido com parceria sexual feminina nos seis meses que antecederam a visita. Conclusão: Este estudo mostra uma elevada prevalência da infecção pelo HSV-2 neste grupo e associação dessa infecção com outras DST, em concordância com outros estudos. Estes dados podem ter uma importante contribuição no sentido de avaliar estratégias que possam contribuir para a prevenção desta infecção na população de homens que fazem sexo com homens, que é tida como uma população vulnerável e central à dinâmica da disseminação do HSV-2 em todo o mundo...

HSV-2 is the primary cause of genital herpes and most of the infections are asymptomatic. The infection by HSV-2 may be a risk factor to acquisition and transmission of other sexually transmitted diseases (STD), including infection by HIV virus. Objective: Estimate the prevalence and identify the risk factors associated of infection by HSV-2 in a cohort of men who have sex with men (MSM) in Fundação Oswaldo Cruz [Oswaldo Cruz Foundation], Rio de Janeiro, Brazil.Methods: Cross-sectional study, evaluating sociodemographic, behavioral, and laboratorialdata from baseline of 403 volunteers included in this cohort, in the period of 1994-1998. The samples were tested by ELISA to detect type-specific antibodies against HSV-2 gG2 (HerpeSelect - Focus Technologies). Results: The prevalence to antibodies anti-HV2-2 observed in this population was 65.2 percent.After multivariate analysis, the factors independently associated to HSV-2 infection were older age (> 26 years), non-white race, positive serology for syphilis (TPHA), history of unprotected sex with male partners and history of unprotected sex with female partners inthe last six months before the visit.Conclusion: This study shows a high prevalence of HSV-2 infection in this group and association with other STD, consistent with other studies. This data may have a significant contribution to evaluate strategies that may contribute to prevent this infection amongMSM, as this is considered a vulnerable core-population to the dynamics of HSV-2 spreading all over the world...

Seroprevalence of herpes simplex and Varicella zoster virus among diabetic and non-diabetic patients with acute peripheral facial palsy

The aim was to study the prevalence of herpes simplex virus [HSV] and varicella zoster virus [VZV] seropositive patients among diabetic patients with acute peripheral facial paralysis [APFP] as compared to non-diabetics with APFP and a healthy control group. Participants consisted of 40 diabetic patients and 40 non-diabetic patients with APFP from Hai Al-Jamea Hospital, Jeddah, Kingdom of Saudi Arabia studied over a period from July 2000 to December 2001. In addition, 20 age and sex matched healthy volunteers were included as a control group. Paired sera were obtained from all participants within the first 4 days of the illness [acute phase] and 2-3 weeks later [convalescent phase]. Paired sera were also obtained from the control group within an equivalent period. Detection of immunoglobulin [Ig] M and IgG class antibodies to HSV and VZV in these sera was carried out using enzyme-linked immunosorbent assays kits. The demonstration of IgM antibodies, 2-fold elevations of IgG antibodies or both was considered positive evidence for virus infection. The present study has shown that there was no statistically significant difference in the prevalence of HSV-seropositive patients in the diabetic and non-diabetic patients with Bell's palsy; however, it was significantly higher in both groups than in the healthy control group. There were no statistically significant differences in the prevalence of VZV-seropositive patients among the 3 groups. The significantly high prevalence of HSV-seropositive patients among the diabetic as well as the non-diabetic patients with Bell's palsy suggests an equally important role of HSV infection in the pathogenesis of Bell's palsy in the diabetic as in the non-diabetic patients

Rol del virus herpes simplex en la queratitis inmune estromal / Role of herpes simplex virus in the immune stromal keratitis

Background: Herpes simplex virus (HSV) infection of the cornea is a leading cause of blindness in occidental countries and a common recurrent manifestation of it is the immune stromal keratitis (ISK). However, it is not known whether active viral replication occurs during the acute phase of the disease, because isolation of the virus by conventional culture techniques has not been accomplished. Aim: To establish the presence of HSV in patients with ISK. Material and methods : Fourteen corneal swabbing samples, from active diseased eyes of patients with clinical diagnosis of ISK, were submitted to Herpchek© and PCR for the identification of HSV antigens and genome. Results: All ISK samples were negative by both techniques. Conclusions : It was not possible to identify HSV antigens nor their genome by the methodology used. It is likely that, they can't be detected in corneal superficial layers or probably there is no viral replication at this stage of the disease, so antiviral therapy should be reconsidered

Infecciones recurrentes por virus herpes simplex / Herpes simplex virus recurrent infections

En el tratamiento de esta patología es muy importante efectuar un diagnóstico correcto. Revisamos fundamentalmente la terapia de la recurrencia herpética. En la terapia el fármaco clásico ha sido aciclovir, medicamento seguro y efectivo, pero con el inconveniente de tener una baja biodisponibilidad. Los nuevos antivirales, como valaciclovir, han mejorado la biodisponibilidad permitiendo una igual o mejor respuesta clínica con una dosificación mucho más cómoda. Estos fármacos pueden ocuparse también para terapia abortiva o supresiva. mejoraba la recurrencia del paciente con el tratamiento antiviral, será importante tratar de evitar, hasta donde se pueda, la aparición de nuevas recurrencias. Para esto, se debe tratar de identificar y controlar las causas gatillantes y mejorar la condición inmunológicas local y/o general. También es importante considerar esta enfermedad integralmente en el paciente, entregando educación y las medidas necesarias para prevención

Secuelas oculares debidas a infección herpética en un grupo de niños chilenos / Ocular sequels caused by herpetic infection in chilean children

Estudio prospectivo, multicéntrico, en el cual investigadores entrenados seleccionaron y siguieron clínica y virológicamente (aislamiento viral, anticuerpos monoclonales y PCR) pacientes de 0 a 18 años de edad con diagnóstico clínico de infección ocular por HSV. Se efectuó determinación de la agudeza visual (AV) por el Test de Mirada Preferencial, HOTV, E Snellen u optotipos de Snellen, con la mejor corrección óptica, examen refractivo bajo cicloplegia, estudio completo de estrabismo, topografía, paquimetría y fotografía. Se enrolaron entre 1993 a 1997 16 niños, dos de ellos con compromiso bilateral (18 ojos). En todos salvo un niño, se identificó HSV tipo I. Mediana de edad 5 años. El diagnóstico de ingreso fue el edema disciforme en 45 por ciento y en 33 por ciento de los casos una queratitis epitelial dendrítica. El 87,5 por ciento de los pacientes con edema disciforme presentó al menos una recurrencia por año. Los pacientes con compromiso epiteliar presentaron en todos los casos AV > 20/40, a diferencia de los pacientes con edema disciforme en que 71,4 por ciento presentaron AV final < de 20/50. El leucoma corneal fue severo en 62,5 por ciento de los ojos con edema disciforme y desarrollaron estrabismo 50 por ciento de los casos. En tres casos se requiere trasplante corneal. La enfermedad ocular herpética afecta principalmente a población joven y sana. El diagnóstico más frecuente fue el edema disciforme que presentó evolución crónica, requirió un gran número de consultas médicas y de tratamiento prolongado (entre 3 y 6 meses) y presentaron la mayor frecuencia de secualas. En general, el 78 por ciento de los pacientes estudiados desarrolló algún tipo de secuela visual

Gengivoestomatite herpética aguda primária / Acute primary herpetic gingivostomatitis

A gengivoestomatite herpética aguda primária é uma manifestaçäo clínica causada pelo vírus Herpesvirus hominis (HVH). Trata-se de manifestaçäo que compromete a cavidade bucal, muito comum em crianças de 4 a 6 anos, de real interesse estomatológico e de grande conotaçäo pediátrica. Neste trabalho, säo relatados 2 casos de gengivoestomatite herpética aguda primária, evidenciando seus aspectos clínicos e valorizando as medidas paliativas, indispensáveis para que näo ocorra disseminaçäo do processo

SIDA y saliva. Aspectos actuales / AIDS and saliva. Current aspects

El sindrome de inmunodeficiencia adquirida (SIDA) se caracteriza por una marcada disminución inmunológica, teniendo como consecuencia una mayor susceptibilidad a enfermedades oportunistas, pasando por varios estadios hasta llegar invariablemente a la muerte. Dentro de las enfermedades oportunistas características del sindrome, existen varias trasmitidas por saliva: hepatitis B, tuberculosis, herpes zoster, herpes simple, citomegalovirus y mononucleosis. Por otra parte, aunque la evidencia ocupacional, familiar y prácticas sexuales establecen que el SIDA no se trasmite por vía oral (saliva), muchos individuos continúan expresando miedo acerca del contagio de VIH por esta vía. Para tratar de esclarecer y conocer los aspectos actuales acerca de este rubro, el principal objetivo de este trabajo es conocer y discutir la relación que guarda la saliva con el virus de inmunodeficiencia humana (VIH)

Inhibition of three alphaherpesviruses (Herpes simplex 1 and 2 and pseudorabies virus) by heparin, heparan and other sulfated polyelectrolytes

The first step of the herpes virus infection is the attachment to heparan sulfate molecules on the cellular membrane. In order to improve the characterization of this phenomenon, we compared the inhibitory effect of six sulfated polyelectrolytes (PE): heparin, heparan, low molecular wight heparin, chondroitin, dextran and protamine on plaque formation by pseudorabies virus (PRV) were compared. The PE with the highest antiherpetic effect was heparin, followed by dextran sulfate. Heparan sulfate, which has been proposed as the initial receptor of herpes virus on the cell surface showed and effect 100-fold lower than heparin. Comparative inhibition curves of heparin and heparan sulfate against three herpes viruses: herpes simplex virus 1 (HSV-1), HSV 2 and PRV showed similar kinetics of inhibition of plaque formation, suggesting these viruses could share similar cell adsorption mechanisms