Detection and diagnosis of herpes simplex virus infection in adults with acute liver failure

Josh Levitsky, Anupama T. Duddempudi, Fred D. Lakeman, Richard J. Whitley, James P. Luby, William M. Lee, Robert J. Fontana, Andres T. Blei, Michael G. Ison, Julie Polson, Carla Pezzia, Anne Larson, Timothy Davern, Paul Martin, Timothy Cashland, Eileen Hay, Natalie Murray, Obaid S. Shaikh, Atif Zaman, Steven HanRobert Fontana, Brendan McGuire, Ray Chung, Alastair Smith, Michael Schilsky, Adrian Reuben, Santiago Munoz, Rajender Reddy, R. Todd Stravitz, Lorenzo Rossaro, Raj Satyanarayana, Tarek Hassanein

Research output: Contribution to journalArticlepeer-review

77 Scopus citations


Disseminated herpes simplex virus (HSV) infection may lead to acute liver failure (ALF) and the need for emergency liver transplantation (LT). The primary aim of this study was to determine the utility of HSV serological testing and HSV DNA testing by polymerase chain reaction (PCR) in the diagnosis and management of indeterminate, pregnancy-related, and known HSV-related ALF. Stored sera obtained on study day 1 or 2 from patients enrolled in the United States ALF Study Group with indeterminate (n = 51), pregnancy-related (n = 12), and HSV-related (n = 4) ALF were screened for HSV DNA by PCR and serology. While 7 of the indeterminate and pregnant patients had positive anti-HSV immunoglobulin M, none had detectable HSV DNA. The 4 known HSV cases all had high-titer HSV DNA on presentation (range: 3.5 to 36 × 108 copies/mL). Two HSV patients underwent LT but developed posttransplant extrahepatic HSV infection despite suppression of HSV DNA with acyclovir treatment, and one of them eventually died. The 2 other fulminant HSV patients died within 48 hours of presentation. In conclusion, serum HSV DNA indicative of occult HSV infection was not detected in 51 indeterminate and 12 pregnancy-related ALF patients. The 4 patients with known HSV-related ALF all had high HSV DNA levels at presentation, and despite the rapid use of antiviral therapy and emergency LT, substantial morbidity and mortality were encountered, highlighting the poor prognosis with severe disseminated HSV infection.

Original languageEnglish (US)
Pages (from-to)1498-1504
Number of pages7
JournalLiver Transplantation
Issue number10
StatePublished - 2008

ASJC Scopus subject areas

  • Surgery
  • Hepatology
  • Transplantation


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