acyclovir and Liver-Cirrhosis

The unexpected transmission of donor-derived infection through organ transplantation is a rare event with current donor screening practices. In this case report we describe a probable donor-derived transmission of Herpes Simplex Virus (HSV)-2 via deceased donor kidney transplantation resulting in HSV hepatitis in the recipient. This manifested as acute liver failure which resolved with appropriate anti-viral therapy. Following recovery from the acute liver insult, the patient developed fibrotic liver morphology and portal hypertension, an unusual departure from the typical course.

Topics: Acyclovir; Adult; Allografts; Antiviral Agents; Biopsy; Female; Hepatitis, Viral, Human; Herpes Simplex; Herpesvirus 2, Human; Humans; Hypertension, Portal; Kidney; Kidney Transplantation; Liver; Liver Cirrhosis; Liver Failure, Acute; Treatment Outcome

Topics: Acyclovir; Ampicillin; Anti-Bacterial Agents; Antiviral Agents; Cefpodoxime; Ceftizoxime; Doxycycline; Herpes Simplex; Humans; Immunocompetence; Liver Cirrhosis; Male; Middle Aged; Tonsillitis; Valacyclovir; Valine; Vibrio Infections; Vibrio vulnificus

A middle-aged man with decompensated cirrhosis and a dimorphic multisite skin rash is diagnosed with rare atypical herpes simplex infection, manifesting Sweet's syndrome (SS) in the absence of other described associations. SS, an acute febrile neutrophilic dermatosis, has three common forms-classical or idiopathic, malignancy associated and drug induced. Systemic autoimmune, connective tissue diseases and infections are also strong associations. The latter is commonly described in Gram-positive bacteria, salmonellosis and

Topics: Acyclovir; Antiviral Agents; Fatal Outcome; Herpes Simplex; Humans; Liver Cirrhosis; Male; Middle Aged; Multiple Organ Failure; Sepsis; Skin Diseases, Vesiculobullous; Sweet Syndrome

Cytomegalovirus (CMV) infection represents one of the most frequent opportunistic infections following solid-organ transplantation. The incidence and severity of CMV infection depend on the immunosuppressive regimen, the CMV serostatus of donor and recipient, and the type of transplant.. We evaluated CMV infection rates during the last 2 years in our center: March 2007 to March 2009. We enrolled 55 patients-13 females and 42 males-who underwent liver transplantation (OLT) due to hepatitis C virus (HCV) cirrhosis (n = 9), hepatitis B virus (HBV) cirrhosis (n = 5) HCC both on HCV and HBV cirrhosis (n = 37), or autoimmune disease (n = 4). Fifty percent of the patients received tacrolimus (TRL) and the others cyclosporine (CsA), both dosed according to weight. All patients received oral acyclovir (400 mg/td or less, adapted to renal function) as herpes simplex prophylaxis for 6 months. CMV prophylaxis prescribed CMV- hyperimmunoglobulin on postoperative days 1 and 7. CMV infection was monitored using polymerase chain reaction (PCR <1000 IU/mL) according to the following schedule: every week for the first month, every 2 weeks from month 2 to 3 and monthly from month 4 to 6. Patients were treated when three positive PCR results not affected by immunosuppressive dose reduction or when the PCR showed DNA greater than three times the limit of detection. CMV treatment stipulated valgancyclovir (900 mg twice daily) until three consecutive PCRs were negative or for 3 months dosed according to renal function. PCR was measured every 2 weeks during treatment.. Among the patients who were all D(+)/R(+) (CMV-Immunoglobulin G [IgG](+)/IgG(+)). 10 required treatment (18%) within 3 months from OLT. There subjects were prescribed TRL (n = 4) or CsA (n = 6). No renal impairment was observed among treated patients. Of those having the infection, one died due to other causes-sepsis from candida at 5 months after OLT.. CMV-hyperimmunoglobulin on postoperative days 1 and 7 did not confer protection for CMV among OLT patients. Preemptive treatment with intravenous gancyclovir plus valgancyclovir per os seemed to be useful and safe in infected patients requiring treatment.

Topics: Acyclovir; Antiviral Agents; Corticosterone; Cyclosporine; Cytomegalovirus Infections; Female; Graft Rejection; Hepatitis B; Hepatitis C; Humans; Immunosuppressive Agents; Liver Cirrhosis; Liver Transplantation; Male; Methylprednisolone; Middle Aged; Retrospective Studies; Tacrolimus

Topics: Acyclovir; Agglutinins; Anemia, Hemolytic, Autoimmune; Cryoglobulins; Cryopreservation; Herpes Zoster; Humans; Intraoperative Complications; Liver Cirrhosis; Liver Transplantation; Male; Middle Aged; Prednisone; Preoperative Care

Herpes simplex virus (HSV) infections causing severe disease are reported frequently in patients suffering from human immunodeficiency virus (HIV) infection. This disease pattern may also be seen in an immunocompromised disease state with other causes, however, as in the case presented in this paper. An 84-year-old woman had hepatic cirrhosis resulting from chronic hepatitis C virus infection. The woman developed ulcerative lesions in and around her mouth and in the genito-anal region, and these persisted for some months. Diagnosis of HSV infection was not obtained until after extensive laboratory investigations. Aciclovir infusion therapy started immediately afterwards led to dramatic improvement of the skin and mucous membrane changes. Complete clearing of lesions was not obtained, however, because the patient died as a result of the immunosuppression.

Topics: Acyclovir; Aged; Aged, 80 and over; Female; Fluorescent Antibody Technique; Hepatitis C; Herpes Genitalis; Herpes Simplex; Humans; Immune Tolerance; Inclusion Bodies, Viral; Liver Cirrhosis; Opportunistic Infections; Skin; Stomatitis, Herpetic