Table 1. Demographic and Clinical Characteristics of Hospitalized Adults with Disseminated HSV Infection.
This table summarizes epidemiologic, demographic and clinical characteristics obtained by medical chart review from 13 individuals with HSV DNA detected in peripheral blood over the span of 4 years and 8 months at three medical institutions in Seattle. Summary of the virologic diagnostic data including quantification of polymerase chain reaction (PCR) copies per milliliter in peripheral blood. HSV type was determined either by type specific PCR assay or by serologic analysis. Alanine aminotransferase (ALT) levels are expressed in units per liter (U/L); blood urea nitrogen (BUN) and creatinine (Cr) are expressed in milligrams per deciliter (mg/dL).
| Pt | Age | Gender | Underlying Condition |
Immuno- suppresive medications |
Presenting signs and symptoms |
HSV type |
Copies per ml of peripheral blood |
Abnormal Labs |
Concurrent illnesses explaining symptoms |
Treatment | Outcome | Cause of Death |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | 59 | F | Liver Transplant. Autoimmune hepatitis |
FK506 Immuran Prednisone |
Anorexia, diarrhea |
Unk | 81 | BUN 50 ALT 106 WBC <4 |
Yes, (CMV viremia) |
IV GCV | Survived | |
| 2 | 42 | M | Liver Transplant HCV cirrhosis |
FK506 Immuran Prednisone |
Generalized fatigue, Abdominal Pain |
HSV- 2 |
1.5×106 | ALT 298 WBC <4 HSV by culture and PCR in ascitic fluid |
No | IV ACV | Survived | |
| 3 | 44 | M | CVID Agranulocytosis Sarcoidosis |
None | Neutropenic fever, sepsis |
Unk | 300 | BUN 107 WBC <4 |
No | IV ACV | Died | MSOF, Sepsis |
| 4 | 37 | F | HIV (CD4 count 14) |
None | Pneumonia, sepsis |
HSV- 1 and HSV- 2 |
4000 | ALT 143 Alk P 780 HSV by culture from mouth and anus |
Yes (PCP pneumonia) |
IV GCV | Died | ARDS, PCP pneumonia, and Sepsis |
| 5 | 54 | F | Perinuclear anti- neutrophil cytoplasmic antibody (+) |
Prednisone | SOB, syncope, weakness, abdominal pain, AMS |
Unk | 2.6×109 | ALT 7848 Cr 5.5 WBC <4 |
No | IV ACV | Died | Liver failure, Sepsis. |
| 6 | 25 | F | Ideopathic thrombocytopenic purpura |
None within 2 years, previously Prednisone |
Fever, Chills, myalgias, Abdominal pain, Skin lesion |
HSV- 2 |
3.5×106 | ALT 1910 Cr 3.3 HSV Cultured from Post mortem lung tissue |
No | IV ACV, oral vACV, then IV ACV |
Died | Sepsis, liver failure |
| 7 | 58 | F | None | Dexamethasone | Fever, AMS, Pneumococal meningitis, Skin lesion (Labial) |
HSV- 2 |
420 | CSF 1290 Nucleated cells 89% PMNs HSV Cultured from Labia |
Yes (S. Pneumo meningitis, bacteremia) |
IV ACV × 1d then oral vACV |
Died | Pneumococcal meningitis |
| 8 | 66 | F | Breast cancer, Hodgkins Lymphoma |
Prednisone | Dyspnea, Fever, hypoxia fatigue, Sepsis, ARDS, AMS |
HSV- 1 |
270 | ALT 149 WBC <4 HSV Cultured from BAL |
No | IV ACV | Died | ARDS, Sepsis, CVA and Intracranial hemorrage. |
| 9 | 61 | F | None | None | Abdominal Pain, Skin (labial) Lesions |
HSV- 2 |
2.2×106 | ALT 600 Cr 3.8 WBC <4 HSV Cultured from labia |
No | IV ACV then oral vACV |
Survived | |
| 10 | 57 | M | Renal Transplant Large B cell Lymphoma |
Prograf, Cellcept, Prednisone |
Memory problems, AMS, Headache, L hemiparesis, Skin Lesions Gait abnorm- alities |
HSV- 2 |
610 | WBC<4 HSV Cultured from skin on back |
Yes (PTLD, S. Aureus bacteremia) |
vACV PFA | Died | CNS lymphoma |
| 11 | 37 | F | Cranio- pharyngioma HSV encephalitis DM |
Dexamethasone | HSV encephalitis s/p Tumor resection, AMS |
HSV- 2 |
110 | ALT 200 Alkph 929 HSV by PCR from the CNS |
No | IV ACV | Survived, died 4m after dx |
|
| 12 | 40 | F | CML Bone marrow Transplant |
FK506 MMF Prednisone |
Worsening HSV skin lesions on acyclovir |
HSV- 1 |
110 | ALT 164 HSV initially Cultured from mouth, in 2nd admission from duodenum, rectum and BAL |
Yes (GVHD) | PFA | Survived, died 4m after dx |
|
| 13 | 49 | M | Intrathecal Fentanyl pump for pain |
None | Headaches Seizures AMS |
HSV- 1 |
5800 | CSF 520 cells (90% lymphs) HSV by PCR from CNS |
No | IV ACV | Survived | |
Abbreviations. ARDS- Acute respiratory distress syndrome, ACV- acyclovir, ALT- Alanine aminotransferase, ALKPH – Alkaline phosphatase, AMS- Altered Mental Status, BUN- Blood urea nitrogen, CSF- Cerebral Spinal Fluid, CML- Chronic myelogenous leukemia, CVID- Chronic variable immunodifficiency, Cr- Creatinine, CVA- Cerebral vascular accident, F – female, PFA- Foscarnet, GCV- gancyclovir, GVHD- Graft versus host disease, HCV- Hepatitis C Virus, HIV- Human immunodeficiency virus, IVIntravenous, lymphs- Lymphocytes, M- Male, MSOF- Multiple system organ failure, pANCA- Perinuclear anti-neutrophil cytoplasmic antibody, PCR- Polymerase Chain Reaction, PMN- Polymorphonuclear leucocyte, PTLD- Post-transplant lymphoproliferative disorder, vACV- Valacyclovir, UNK- Unknown.