RESUMO
In immunocompetent patients, primary infection by herpes simplex virus (HSV), varicella-zoster virus (VZV), cytomegalovirus (CMV), human herpesvirus 6, and Epstein-Barr virus (EBV) generally produces mild, self-limited hepatitis. Primary infection by HSV in neonates and pregnant women, and infection by VZV in hematological and bone marrow recipients can cause fulminant hepatitis without characteristic skin lesions. In liver transplant recipients, hepatitis is the most common expression of CMV infection and the related symptoms are indistinguishable from those of acute rejection. Persistent hepatitis is a manifestation of the syndrome of active chronic infection by the EBV. Fulminating hepatitis due to herpes virus can be treated effectively if therapy is started early; hence, a high degree of clinical suspicion and inclusion of herpes virus in the differential diagnosis of this syndrome is necessary.
Assuntos
Hepatite Viral Humana/virologia , Herpesviridae/patogenicidade , Adulto , Antivirais/uso terapêutico , Varicela/complicações , Citomegalovirus/isolamento & purificação , Citomegalovirus/patogenicidade , Infecções por Citomegalovirus/complicações , Infecções por Vírus Epstein-Barr/complicações , Feminino , Hepatite Viral Humana/diagnóstico , Hepatite Viral Humana/tratamento farmacológico , Hepatite Viral Humana/etiologia , Herpes Simples/complicações , Herpesviridae/isolamento & purificação , Herpesvirus Humano 3/isolamento & purificação , Herpesvirus Humano 3/patogenicidade , Herpesvirus Humano 4/isolamento & purificação , Herpesvirus Humano 4/patogenicidade , Herpesvirus Humano 6/isolamento & purificação , Herpesvirus Humano 6/patogenicidade , Humanos , Hospedeiro Imunocomprometido , Recém-Nascido , Masculino , Gravidez , Complicações Infecciosas na Gravidez/virologia , Simplexvirus/isolamento & purificação , Simplexvirus/patogenicidadeRESUMO
La primoinfección por los virus herpes simple (VHS), varicela-zóster (VVZ), citomegalovirus (CMV), herpesvirus humano 6 y virus de Epstein-Barr (VEB) ocasiona hepatitis generalmente leve y autolimitada en pacientes inmunocompetentes. La primoinfección por el VHS en neonatos y en embarazadas, y también por el VVZ en pacientes hematológicos y receptores de trasplante de progenitores hematopoyéticos puede causar una hepatitis fulminante sin las lesiones cutáneas características. En los receptores de trasplante hepático, la hepatitis es la expresión más común de la infección por CMV y sus manifestaciones son indistinguibles del rechazo agudo. La hepatitis persistente es una manifestación del síndrome de infección crónica activa por el VEB. La hepatitis fulminante por virus herpes tiene tratamiento eficaz si se inicia precozmente, para ello es necesario tener un alto grado de sospecha clínica e incluir los virus herpes en el diagnóstico diferencial de este síndrome (AU)
In immunocompetent patients, primary infection by herpes simplex virus (HSV), varicella-zoster virus (VZV), cytomegalovirus (CMV), human herpesvirus 6, and Epstein-Barr virus (EBV) generally produces mild, self-limited hepatitis. Primary infection by HSV in neonates and pregnant women, and infection by VZV in hematological and bone marrow recipients can cause fulminant hepatitis without characteristic skin lesions. In liver transplant recipients, hepatitis is the most common expression of CMV infection and the related symptoms are indistinguishable from those of acute rejection. Persistent hepatitis is a manifestation of the syndrome of active chronic infection by the EBV. Fulminating hepatitis due to herpes virus can be treated effectively if therapy is started early; hence, a high degree of clinical suspicion and inclusion of herpes virus in the differential diagnosis of this syndrome is necessary (AU)
Assuntos
Humanos , Hepatite Viral Humana/virologia , Hepatite Viral Humana/diagnóstico , Hospedeiro Imunocomprometido , Herpesviridae , Citomegalovirus , Herpesvirus Humano 3 , Herpesvirus Humano 4 , Diagnóstico DiferencialRESUMO
A multicenter, comparative study was performed to determine the epidemiological, clinical, and prognostic differences between the diseases caused by Mycobacterium tuberculosis and Mycobacterium kansasii in human immunodeficiency virus (HIV)-infected patients. From 1 January 1995 through 31 December 1999, 25 HIV-infected patients received diagnoses of M. kansasii infection, and another 75 were selected as control subjects from among patients who had M. tuberculosis infection. Variables associated with M. tuberculosis disease in the multivariate analysis were previous intravenous drug use (odds ratio [OR], 8; 95% confidence interval [CI], 1.5-41.4) and interstitial radiologic pattern (OR, 12.7; 95% CI, 1.7-94.3). Variables associated with M. kansasii were previous diagnosis of acquired immunodeficiency syndrome (OR, 15.8; 95% CI, 4.2-59.6) and concomitant opportunistic infections (OR, 14.2; 95% CI, 2-105.7). Clinical and radiologic features were similar for both groups, but epidemiological characteristics and prognosis were different. M. kansasii disease was associated more closely with level of immunosuppression and progression of HIV infection than was disease caused by M. tuberculosis.
