Advertisement

Atypical herpesvirus hominis type 2 infection in uremic patients receiving immunosuppressive therapy

      This paper is only available as a PDF. To read, Please Download here.

      Abstract

      In four uremic patients (three renal transplant recipients and one with idiopathic thrombocytopenia), painful, initially vesicular lesions developed in the anogenital region while they were receiving immunosuppressive drug therapy. These lesions enlarged, coalesced and ulcerated, presenting a puzzling diagnostic problem. Initial misdiagnoses often resulted in inappropriate antimicrobial therapy. Routine cultures, histologic sections and Tzanck preparations were seldom helpful. The correct diagnosis of herpesvirus hominis (HVH) infection was established within 18 to 48 hours by viral culture of swab or biopsy material. Subsequent identification of isolates as HVH type 2 was confirmed by neutralization kinetics, infectivity titers and ability to plaque in chick embryo cells. Various therapeutic regimens were ineffective. Clinical improvement best correlated with decrease in dosage of immunosuppressive agents.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The American Journal of Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Nahmias AJ
        • Roizman B
        Infection with herpes-simplex viruses 1 and 2.
        N Engl J Med. 1973; 289: 667
        • Nahmias AJ
        • Roizman B
        Infection with herpes-simplex viruses 1 and 2.
        N Engl J Med. 1973; 289: 719
        • Nahmias AJ
        • Roizman B
        Infection with herpes-simplex viruses 1 and 2.
        N Engl J Med. 1973; 289: 781
        • Nahmias AJ
        • Dowdle WR
        • Naib ZM
        • et al.
        Genital infection with type 2 herpes virus hominis' A commonly occurring venereal disease.
        Br J Vener Dis. 1969; 45: 294
        • Centifanto YM
        • Drylie DM
        • Deardourff SL
        • et al.
        Herpesvirus type 2 in the male genitourinary tract.
        Science. 1972; 178: 318
        • Jeansson S
        • Molin L
        Genital herpes infection in non-specific urethritis.
        Br Med J. 1971; 3: 247
        • Muller SA
        • Herrmann EC
        • Winkelmann RK
        Herpes simplex infections in hematologic malignancies.
        Am J Med. 1972; 52: 102
        • Montgomerie JZ
        • Becroft DMO
        • Croxson MC
        • et al.
        Herpessimplex-virus infection after renal transplantation.
        Lancet. 1969; 2: 867
        • Spencer ES
        • Andersen HK
        Clinically evident non-terminal infections with herpesviruses and the wart virus in immunosuppressed renal allograft recipients.
        Br Med J. 1970; 3: 251
        • Lopez C
        • Simmons RL
        • Mauer SM
        • et al.
        Association of renal allograft rejection with virus infections.
        Am J Med. 1974; 56: 280
        • Dowdle WR
        • Nahmias AJ
        • Harwell RW
        • et al.
        Association of antigenic type of Herpesvirus hominis with site of viral recovery.
        J Immunol. 1967; 99: 974
        • Plummer G
        • Waner JL
        • Phuangsab A
        • et al.
        Type 1 and type 2 herpes simplex viruses' serological and biological differences.
        J Virol. 1970; 5: 51
        • Figueroa ME
        • Rawls WE
        Biological markers for differentiation of herpes-virus strains of oral and genital origin.
        J Gen Virol. 1969; 4: 259
        • Rawls WE
        Herpes simplex virus.
        (chap 10)in: Kaplan AS The Herpesviruses. Academic Press, Inc, New York1973
        • Givler RL
        Necrotizing anorectal lesions associated with pseudomonas infection in leukemia.
        Dis Colon Rectum. 1969; 12: 438
        • Tokumaru T
        • McNair Scott TF
        The herpesvirus group: herpesvirus hominis, herpesvirus simiae, herpesvirus suis.
        (chap 11)in: Lennette EH Schmidt NJ Diagnostic Procedures for Viral and Rickettsial Diseases. American Public Health Association, Inc, New York1964
        • Weller TH
        Varicella-herpes zoster virus.
        (chap 26)in: Lennette EH Schmidt NJ Diagnostic Procedures for Viral and Rickettsial Diseases. American Public Health Association, Inc, New York1964
        • Baringer J.R.
        • Swoveland P
        Recovery of herpes-simplex virus from human trigeminal ganglions.
        N Engl J Med. 1973; 288: 648
        • Baringer J.R.
        Recovery of herpes simplex virus from human sacral ganglions.
        N Engl J Med. 1974; 291: 828
        • Hinthorn DR
        • Baker LH
        • Romig DA
        • et al.
        Recurrent conjugal neuralgia caused by Herpesvirus hominis type 2.
        JAMA. 1976; 236: 587
        • Rosenberg GL
        • Notkins AL
        Induction of cellular immunity to herpes simplex virus relationship to the humoral immune response.
        J Immunol. 1974; 112: 1019
        • Steele RW
        • Vincent MM
        • Hensen SA
        • et al.
        Cellular immune responses to herpes simplex virus type 1 in recurrent herpes labialis' in vitro blastogenesis and cytotoxicity to infected cell lines.
        J Infect Dis. 1975; 131: 528
        • Newberry WM
        • Sanford JP
        Defective cellular immunity in renal failure depression of reactivity of lymphocytes to phytohemagglutinin by renal failure serum.
        J Clin Invest. 1971; 50: 1262
        • Briggs WA
        • Merrill JP
        • O'Brien TF
        • et al.
        Severe pneumonia in renal transplant patients.
        Ann Intern Med. 1971; 75: 887
        • Sabin AB
        Misery of recurrent herpes: what to do?.
        N Engl J Med. 1975; 293: 986
        • Nahmias AJ
        Herpes simplex virus infection—present status of diagnosis and management.
        South Med J. 1975; 68: 1191
        • Kaufman RH
        • Gardner HL
        • Brown D
        • et al.
        Herpes genitalis treated by photodynamic inactivation of virus.
        Am J Obstet Gynecol. 1973; 117: 1144
        • Myers MG
        • Oxman MN
        • Clark JE
        • et al.
        Failure of neutral-red photodynamic inactivation in recurrent herpes simplex virus infections.
        N Engl J Med. 1975; 293: 945
        • Aronson MD
        • Phillips CF
        • Gump DW
        • et al.
        Vidarabine therapy for severe herpesvirus infections.
        JAMA. 1976; 235: 1339