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Herpes simplex virus hepatitis in infants: clinical outcomes and correlates of disease severity

Katherine E McGoogan1, Allah B Haafiz, Regino P González Peralta

  • 1Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of Florida College of Medicine and Shands Children's Hospital, Gainesville, FL 32610, USA. kmcgoogan@peds.ufl.edu

The Journal of Pediatrics
|May 3, 2011
PubMed

Insights

Herpes simplex virus (HSV) hepatitis in infants can range from mild to fatal. Key indicators of poor outcomes include positive HSV DNA, lack of skin lesions, and signs of liver dysfunction.

Area of Science:

  • Pediatric Infectious Diseases
  • Hepatology
  • Neonatal Care

Background:

  • Herpes simplex virus (HSV) infection in infants poses a significant health risk.
  • Understanding the clinical spectrum and predictors of severity in neonatal HSV hepatitis is crucial for timely intervention.
  • Existing literature may not fully detail the specific clinical outcomes and prognostic factors.

Purpose of the Study:

  • To characterize the clinical outcomes of infants diagnosed with HSV infection.
  • To identify reliable indicators of disease severity in infants with HSV hepatitis.
  • To determine predictors for critical outcomes such as death, liver transplantation, and intensive care unit (ICU) admission.

Main Methods:

  • Retrospective review of infants aged 6 months or younger with confirmed HSV infection between 1999 and 2009.
  • Analysis of laboratory and clinical data in patients with concurrent hepatitis.
  • Identification of variables predicting specific outcomes: mortality, need for liver transplantation, and ICU admission.

Main Results:

  • Out of 15 infants, 27% experienced fatal outcomes, and 13% required liver transplantation.
  • Lack of skin lesions, positive HSV polymerase chain reaction (PCR) results, severe thrombocytopenia, and multi-organ dysfunction predicted ICU admission.
  • Elevated International Normalized Ratio (INR), peak total bilirubin, and peak direct bilirubin levels were associated with increased risk of death or liver transplantation.

Conclusions:

  • Herpes simplex virus hepatitis presents a wide spectrum of illness, from mild liver enzyme elevation to fulminant hepatic failure and death.
  • Detection of HSV DNA via PCR, absence of skin lesions, and severity of coagulopathy, thrombocytopenia, and cholestasis are indicators of poor prognosis.
  • These findings aid in risk stratification and management of infants with HSV hepatitis.
Abstract

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