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HSV hepatitis is an uncommon infection that occurs in the third trimester of pregnancy or in immunosuppressed patients.
Adjacent to the characteristic irregular zones of necrosis in HSV hepatitis, the infected hepatocytes demonstrate intranuclear inclusions (eosinophilic Cowdry type A or basophilic Cowdry type B) surrounded by clear halos with peripheral chromatin margination (ground-glass nuclei). The infection with this virus is very common but, in healthy people does not produce disease.
Is a member of the herpesviridae family together with herpes simplex, Epstein-Barr, varicella-zoster viruses.
Presence of "cytomegalic" cells with reddish-blue intranuclear inclusions surrounded by a clear halo to impart a peculiar owl's eye appearance, hepatocytes, bile duct epithelium, endothelial and connective tissue cells. In cases of congenital hepatitis the picture is that of a severe "neonatal hepatitis" with necrosis and formation of multinucleated giant cell without significant inflammatory cell reaction. In cases of cytomegalovirus mononucleosis, which are rare, the liver shows a prominent diffuse lobular inflammation with lymphocytes, plasma cells and macrophages without significant necrosis.
The "gold standard" for diagnosis of CMV is the conventional cell culture based on the appearance of the typical cytopathic effect (CPE) in the infected cells. Notice an area of necrosis with nuclear inclusions in hepatocytes and not much inflammatory reaction. This virus produces infectious mononucleosis in young adults throughout the world and seems to contribute to Burkitt's lymphoma and nasopharyngeal carcinoma. Mononucleosis hepatitis is characterized by peculiar necroinflammatory changes which, at the difference of classical viral hepatitides consist of more inflammation and less necrosis.
Another peculiar feature is the presence of a marked regenerative activity of hepatocytes with presence of increased number of binucleate cells, polyploid nuclei and mitotic figures. High power of previous illustration showing the signs of high regenerative activity: binucleate cells and a mitotic figure.
La infeccion por virus herpes simplex tipo 1 (HSV-1) se manifiesta habitualmente como lesiones de tipo vesicular, dolorosas en los labios (conocido en algunos lugares tambien como “fuego”). El virus se adquiere frecuentemente en la infancia a traves de contacto con secrecion de estas vesiculas o saliva de una persona infectada.
La infeccion por HSV-1 en pacientes con algun grado de inmunodepresion puede asociarse a cuadros de mayor gravedad, especificamente la hepatitis.
Infeccion por virus de inmunodeficiencia adquirida (HIV, SIDA): Particularmente con recuentos de CD4 menores de 200 por mm3. Receptores de trasplante de organos: En el 60 a 80% de los pacientes receptores de organos previamente infectados es posible detectar el virus en secrecion faringea durante las primeras semanas post-trasplante. Las otras caracteristicas clinicas son las habituales de encontrar en la insuficiencia hepatica aguda. Cuando hay lesiones orales o cutaneas presentes, puede buscarse directamente el virus mediante cultivo viral, reaccion de polimerasa en cadena (PCR) o tincion de Tzanck de la secrecion. Herpes simplex virus 1 and 2 (HSV-1 and HSV-2) are two strains of the Herpes virus family, Herpesviridae, which cause infections in humans. After an initial, or primary, infection, HSV establishes latency, during which the virus is present in the cell bodies of nerves which innervate the area of original outbreak.
Herpes infections are marked by painful, watery blisters in the skin or mucous membranes (such as the mouth or lips) or on the genitals. HSV is generally transmitted by direct contact of lips or genitals when the sores are present, or just before they appear (known as shedding). Entry and replication of the HSV involves interactions of several viral glycoproteins with cell surface receptors or particles. Once bound to the HVEM, glycoprotein D changes its conformation and interacts with glycoproteins H and L, which form a complex. The packaging of the viral particles, which include the genome, core and the capsid, occur in the nucleus. About Me“The master in the art of living makes little distinction between his work and his play, his labor and his leisure, his mind and his body, his information and his recreation, his love and his religion. Histologic features include zones of coagulative necrosis with viral cytopathic effects in adjacent viable hepatocytes, such as intranuclear inclusions (eosinophilic Cowdry type A or basophilic Cowdry type B) surrounded by clear halos with peripheral chromatin margination (ground-glass nuclei). Viral particles can be identified within hepatocytes and specific immunostains are available for confirmation and to exclude other viruses (e.g. The viral particles consist of a DNA core, a icosahedral capsid, adn a surrounding envelop. The infection acquired in the may present a serious illness which begins shortly after birth with jaundice, purpura, hemolytic anemia, thrmobocytopenia, brain damage, microcephaly and paravetricular calcifications. The infection may produce a chronic disease with abnormal liver function tests and recurrent fever and jaundice.
However, an average of 7-10 days is required for the CPA to develop, which in a critically ill patient is too long.
This consists in the incubation of the tissue on a glass slide with antibodies to the virus.


Unfortunately, the ubiquitous presence of the virus and the common asymptomatic type infection makes the evaluation of a single measurement of antibody level difficult to interpret.
Their accuracy, when compared with culture or histologic methods, is still being evaluated. Type 1 produces herpes simplex infection especially recurrent blisters around the lips and generalized infections in older children and adults. The infection in childhood is common and asymptomatic but it may rarely cause mononucleosis syndrome.
There is marked mononuclear cell infiltration of sinusoids and portal fields contrasting with mild hepatocellular necrosis.
La primoinfeccion produce un cuadro de fiebre y malestar general acompanado de dolor y aparicion de vesiculas, eritema e inflamacion en la zona de inoculacion.
Cuando hay sospecha de esta infeccion en ausencia de las lesiones cutaneas el diagnostico se hace por medio de inmunofluorescencia en tejido hepatico, muestra habitualmente obtenida mediante biopsia transyugular.
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During reactivation, virus is produced in the cell and transported outwardly via the nerve cell’s axon to the skin. The blisters resemble those seen in Chickenpox — an infection caused by a third member of the alpha-Herpesviridae subfamily, Varicella Zoster Virus (VZV), also known as Human Herpes Virus 3 (HHV-3). In addition, herpes may be transmitted during childbirth, which can be fatal to the infant. The virus particle contains an envelope which, when bound to specific receptors on the cell surface, will fuse with the cell membrane. Glycoprotein B interaction with the glycoprotein H and L complex allows the virus to enter into the cell.
In the nucleus, cleavage of genome concatemers occurs and these are placed into pre-formed capsids.
Viral particles can be identified within hepatocytes and specific immunostains are available to exclude other viruses (e.g.
Under electron microscopy there are herpes-like virions, defective viral particles and spherical particles called dense bodies. The liver presents cholestasis, fatty changes, focal necrosis with cytomegalic cells in hepatocytes and bile ducts. Some adults and older children may develop "glandular fever", the so-called Cytomegalic Mononucleosis consisting of a febrile illness of 3-6 weeks duration with lymphocytosis, abnormal lymphocytes but negative Paul-Bunnell test and absence of sore throat and lymphadenitis.
Positive cases show a strong, dark-brown or red staining (depending on the counterstain) in the nucleus of the cell. Type 2 affects the genital tract and produces disseminated infection of the neonate with severe hepatic involvement. In debilitation, pregnancy, immunosuppression it may produce a disseminated disease which is usually fatal.
The sinusoids are filled and distended with mononuclear cells which are large and sometimes clustered to resemble granulomas sometimes similar to sarcoidosis. Portal tracts are healvily infiltrated by mononuclear inflammatory cells but there is mild erosion of the limiting plates. Si bien es infrecuente, su conocimiento permite un diagnostico precoz y tratamiento especifico, clave para evitar la alta mortalidad (sobre 80%) asociada a la hepatitis herpetica. Este cuadro es autolimitado, sin embargo el virus es capaz de infectar las neuronas sensitivas y autonomicas, permaneciendo en estado latente en los ganglios (frecuentemente el ganglio del trigemino), desde donde puede reactivarse e infectar celulas epidermicas nuevamente. El HSV-1 es un virus citopatico directo, destruyendo a la celula infectada, ya sea el queratinocito o especificamente el hepatocito. The ability of Herpes virus to establish latency leads to the chronic nature of Herpes infection; after the initial infection subsides, Herpes symptoms may periodically recur in the form of outbreaks of herpetic sores near the site of original infection. The immature immune system of the child is unable to defend against the virus and even if treated, infection can result in brain damage.
The viral particle migrates to the nucleus, where the genome is replicated using enzymes from the host cell. The viral envelope is acquired from the nuclear envelope, more specifically the inner lamellae of the membrane. He simply pursues his vision of excellence at whatever he does, leaving others to decide whether he is working or playing. Perinatal infection can be contracted in utero, from infected maternal genitalia and from breast milk.
Infected cell may become cytomegalic but since the infection may not produce morphological changes, the absence of large cells and of intranuclear inclusions do not exclude the infection.
Fatality is high but some patients may recover completely or may come out with permanent brain damage. The picture is similar to that of infectious mononucleosis and can be confused with acute viral hepatitis.


This assay requires the incubation of the sample submitted with a monoclonal antibody, labeled with a fluorescent tag. Disseminated herpes infection is commonly seen in immunocompromised patients (vesicular eruptions, encephalitis, esophagitis, keratitis).
The liver lesions are similar to those of herpes simplex, necrotizing with viral inclusions in hepatocytes. The difference is attributed to the exposure to a large quantity of viruses by deep kissing. The sinusoids are swollen adn the liver cell plates, in some areas, may be compressed and atrophic.
La hepatitis por herpes puede ser una causa de hepatitis fulminante precoz post-trasplante, mas precoz que la infeccion por citomegalovirus (CMV). Transmission occurs while passing through the birth canal and the risk of infection is minimal if there are no symptoms or exposed blisters during delivery. Initially, glycoprotein C, on the surface of the viral envelope, targets and binds to a cell surface particle, heparan sulfate.
Upon entering the cell, an ?-TIF protein also joins the viral particle and aids in immediate early Transcription. After a period of incubation of 24 or 48 hours, positive cells display nuclear apple-green fluorescence under the microscope. The virus is a typical member of the Herpesviridae family: DNA core, a icosahedral capsid with 162 capsomers, a surrounding envelope, 120 nm in diameter. Las elevaciones de prostaglandinas tambien se han asociado a reactivaciones, lo que puede explicar las reactivaciones asociadas a cuadros febriles. This is particularly likely during an outbreak, although individuals may shed virus between outbreaks. The first outbreak after exposure to HSV is commonly more severe than future outbreaks, as the body has not had a chance to produce antibodies; this first outbreak also carries the risk of developing meningitis. Practically all pirmary infections are asymptomatic but the infected individuals excrete the virus in the urine and saliva for months and years and are infectious. Similar symptoms may appear in the so-called Postperfusion Syndrome which develops after massive transfusions from multiple donors in both positive and negative individuals for anti-CMV antibodies.
Groups of hepatocytes surrounding these areas contain intranuclear eosinophilic viral bodies (Cowdry type A inclusions). It is found in lymphoid tissues and in the epithelium of the nasopharynx and probably of the cervix. Obviously, the sinusoidal infiltration reflects the mononucleosis picture of the peripheral blood.
Although no cure is yet available, treatments exist which reduce the likelihood of viral shedding. Two major glycoproteins, glycoprotein B and glycoprotein D, also associate with the cell membrane. This enzyme shuts off protein synthesis in the host, degrades host mRNA, helps in viral replication, and regulates gene expression of viral proteins. The virus may be reactivated from the latent state by decreased imune response usually induced by disease or drugs especially by immunosuppressant therapy where reactivation of a primary infection and not re-infection appears to be the norm.
Glycoprotein D binds specifically to the herpesvirus entry mediator receptor (HVEM), thus providing a strong, fixed attachment to the host cell. While the viral genome immediately travels to the nucleus, the VHF protein remains in the cytoplasm. The white cells of 5% of blood donors contain CMV virus therefore infection by blood transfusion occurs in a large number (60%?) of patients. After infection, the lymphocyte under the influence of the viral genome produce new antigens which are deposited on their surface. Because of the wide distribution and the asymptomatic occurrence of CMV infection it is crucial to test donors for organ transplantation. T lymphocytes react to these antigens, become blastoid and form the atypical lymphocytes of the peripheral blood seen in these patients who at this piont develop the full symptoms of infectious mononucleosis which, evidently, is immunopathologically mediated. An infected organ under immunosuppressive therapy will reactivate the virus with disastrous consequences.
Some individuals cannot mount this t-lymphocytic reaction will succumb to the primary EVB infection. This is the case of those suffering of X-linked lymphoprolipherative disorder, Duncan's syndrome.



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