Guías Latinoamericanas de Infecciones Congénitas y Perinatales de la Sociedad Latinoamericana de Infectología Pediátrica (SLIPE). Parte II / Latin American Guidelines on Congenital and Perinatal Infections from the Latin-American Society of Pediatric Infectious Diseases (SLIPE). Part II

Las infecciones perinatales son una causa de morbilidad, tanto fetal como neonatal, y que compromete la salud de la mujer embarazada, por lo que su diagnóstico, tratamiento, e intento de eliminación son una prioridad en América Latina y el Caribe. Este documento representa la segunda entrega realizada por expertos en la región dentro de la Sociedad Latinoamericana de Infectología Pediátrica (SLIPE), brindando una mirada actualizada en el manejo de las infecciones congénitas y entrega herramientas para detectar posibles momentos estratégicos de intervención y cambio en el manejo de las infecciones congénitas.

Perinatal infections are a major cause of morbidity and mortality in the fetus, neonate, and the health of the pregnant woman. Diagnosis, treatment, and the search for elimination of these diseases are a priority in Latin America and the Caribbean. This document represents the second delivery by a group of experts in the region inside the Latin-American Society of Pediatric Infectious Diseases (SLIPE), presenting a up-to-date look into the management of congenital infectious diseases and give a tool to detect possible strategic sceneries and a change in the management of congenital infections in our region.

Consequências da herpes tipo 1 no desenvolvimento neuropsicomotor / Consequences of herpes type 1 on neuropsymotor development / Consecuencias del herpes tipo 1 en el desarrollo neuropsicomotor

Objetivo: Descrever as consequências do herpes tipo 1 no desenvolvimento neuropsicomotor. Metodologia: Trata-se de uma revisão narrativa das consequências da Herpes do tipo 1 no Desenvolvimento Neuropsicomotor. Questão norteadora: "Quais os efeitos da infecção congênita da Herpes tipo 1 no Desenvolvimento Neuropsicomotor observadas entre os anos de 2010 a 2020?". O levantamento dos dados ocorreu: dezembro/2021 a janeiro/2022 nas bases de dados: Scientific Eletronic Library Online, Literatura Latino Americana e do Caribe em Ciências da Saúde e National Library of Medicine. Descritores: "Herpes"; "Desenvolvimento Neuropsicomotor"; "Herpes Congênita" e "Neuropsychomotor Development" com operadores booleanos AND e OR. Critérios de inclusão: artigos originais, texto completo. Exclusão: cartas ao editor, teses, dissertações e revisões de literatura. Resultados: Foram encontrados 21 artigos nas bases de dados pesquisadas, contudo, após a aplicação dos critérios de inclusão, 3 artigos foram considerados elegíveis. Após a análise, pode-se afirmar os impactos do Vírus Herpes pode gerar ao desenvolvimento neuropsicomotor, podendo ocasionar disfagia, disartria, alterações motoras, cognitivas e sociais, bem como outros sinais e sintomas que levarão ao atraso no desenvolvimento. Conclusão: O Herpes Vírus Simples pode ocasionar transtornos cerebrais em crianças, o que acarreta distúrbios para o amadurecimento normal, com consequente atrasos no desenvolvimento neuropsicomotor.

Objective: To describe the consequences of herpes type 1 on neuropsychomotor development. Methodology: This is a narrative review of the consequences of Herpes type 1 on Neuropsychomotor Development. Guiding question: "What are the effects of congenital Herpes type 1 infection on Neuropsychomotor Development observed between the years 2010 to 2020?". Data collection took place: December/2021 to January/2022 in the following databases: Scientific Electronic Library Online, Latin American and Caribbean Literature in Health Sciences and National Library of Medicine. Keywords: "Herpes"; "Neuropsychomotor Development"; "Herpes Congenita" and "Neuropsychomotor Development" with Boolean operators AND and OR. Inclusion criteria: original articles, full text. Exclusion: letters to the editor, theses, dissertations and literature reviews. Results: 21 articles were found in the searched databases, however, after applying the inclusion criteria, 3 articles were considered eligible. After the analysis, it can be said the impacts of the Herpes Virus can generate neuropsychomotor development, which can cause dysphagia, dysarthria, motor, cognitive and social changes, as well as other signs and symptoms that will lead to developmental delay. Conclusion: Herpes Simplex Virus can cause brain disorders in children, which causes disturbances to normal maturation, with consequent delays in neuropsychomotor development.

Objetivo: Describir las consecuencias del herpes tipo 1 en el desarrollo neuropsicomotor. Metodología: Se trata de una revisión narrativa de las consecuencias del Herpes Tipo 1 en el Desarrollo Neuropsicomotor. Pregunta norteadora: "¿Cuáles son los efectos de la infección congénita por Herpes tipo 1 en el desarrollo neuropsicomotor observados entre los años 2010 y 2020?". Los datos se recopilaron entre diciembre de 2021 y enero de 2022 en las siguientes bases de datos: Scientific Eletronic Library Online, Latin American and Caribbean Literature on Health Sciences y National Library of Medicine. Descriptores: "Herpes"; "Desarrollo neuropsicomotor"; "Herpes congénito" y "Desarrollo neuropsicomotor" con operadores booleanos AND y OR. Criterios de inclusión: artículos originales, texto completo. Criterios de exclusión: cartas al director, tesis, disertaciones y revisiones bibliográficas. Resultados: Se encontraron 21 artículos en las bases de datos consultadas, sin embargo, tras aplicar los criterios de inclusión, se consideraron elegibles 3 artículos. Después del análisis, se puede afirmar los impactos que el Herpes Virus puede tener en el desarrollo neuropsicomotor, que puede causar disfagia, disartria, alteraciones motoras, cognitivas y sociales, así como otros signos y síntomas que conducirán a un retraso en el desarrollo. Conclusión: El virus del herpes simple puede causar alteraciones cerebrales en los niños, lo que conduce a trastornos de la maduración normal, con los consiguientes retrasos en el desarrollo neuropsicomotor.

Hiperplasia sebácea ectópica en mucosa oral de neonatos: reporte de tres casos / Ectopic sebaceous gland hyperplasia in neonates oral mucosa: 3 case studies / Hiperplasia sebácea ectópica na mucosa oral de recém-nascidos: relato de 3 casos

La hiperplasia de glándulas sebáceas es un hallazgo benigno y transitorio, común en el período neonatal. Secundariamente al estímulo hormonal androgénico se produce un hipercrecimiento de las glándulas, con mayor frecuencia en nariz y mejillas, donde existen en mayor densidad. La hiperplasia de glándulas en una localización ectópica, llamada gránulos de Fordyce (GF), es excepcional en el período neonatal. Se han reportado en aproximadamente 1% de los recién nacidos, y con frecuencia se localizan en la mucosa oral. Los GF se describen como lesiones papulares de aspecto vesiculoso blanco amarillentas de 1-3 mm2, que podrían confundir al neonatólogo o al pediatra con entidades infecciosas, dando lugar a pruebas invasivas y tratamientos innecesarios. Se describen tres casos clínicos de neonatos con diagnóstico de hiperplasia sebácea ectópica localizada en mucosa oral, con el objetivo de revisar la etiología, las características clínicas, los diagnósticos diferenciales y la evolución de esta entidad benigna. Conclusiones: la hiperplasia sebácea ectópica en mucosa oral de neonatos es un hallazgo benigno autolimitado que se presenta con baja frecuencia. El reconocimiento clínico de esta entidad es importante para evitar diagnósticos incorrectos y tratamientos innecesarios.

Sebaceous gland hyperplasia is a common transient and benign finding in neonates. After androgenic hormonal stimulation, there is a gland overgrowth mainly in the nose and cheeks where there is a greater density of glands. Ectopic sebaceous gland hyperplasia, called Fordyce's Granules (FG), is exceptional in neonates and it is reported in approximately 1% of newborns and frequently located in the oral mucosa. FGs are described as 1-3mm2 yellowish-white papular and vesicular lesions. Neonatologists or pediatricians may confuse these clinical features with infectious diseases, leading to invasive tests and unnecessary treatment. We describe three clinical cases of neonates with diagnosis of ectopic sebaceous gland hyperplasia located in the oral mucosa, with the aim of reviewing the etiology, clinical characteristics, differential diagnoses and evolution of this benign entity. Conclusions: ectopic sebaceous gland hyperplasia of the lips is a self-limited benign finding occurring infrequently in newborns. The clinical recognition of this entity is important to avoid inaccurate diagnoses or unnecessary treatment.

A hiperplasia das glândulas sebáceas é um achado benigno e transitório comum nos neonatos. Secundário ao estímulo hormonal androgênico, há um hipercrescimento das glândulas com mais frequência no nariz e nas bochechas onde há uma maior densidade das glândulas. A hiperplasia das glândulas num local ectópico, chamado Fordyce Granules (FG), é excepcional no período neonatal, e ela é relatada em aproximadamente 1% dos recém-nascidos e muitas vezes está localizada na mucosa oral. Os FGs são descritos como lesões vesiculares brancas amareladas de 1-3mm2, o que poderia confundir o neonatologista ou pediatra com entidades infecciosas, levando a testes invasivos e tratamentos desnecessários. Descrevemos três relatos clínicos de recém-nascidos com diagnóstico de hiperplasia sebácea ectópica localizada na mucosa oral, com o objetivo de rever a etiologia, características clínicas, diagnósticos diferenciais e evolução desta entidade benigna. Conclusões: hiperplasia sebácea ectópica na mucosa oral de recém-nascidos é um achado benigno autolimitante que ocorre com baixa frequência. O reconhecimento clínico desta entidade é importante para evitar diagnósticos incorretos e tratamentos desnecessários.

Tumor-like herpes simplex infection in an HIV patient

Abstract A 56-year-old male, HIV-positive, presented with a 3-day history of multiple indurated erythematous nodules with superficial and well-defined erosions on his right gluteus. Skin biopsy showed ballooning-necrotic keratinocytes and cultures were positive for herpes simplex 2. Genital herpes simplex infection recurrences may not be restricted to the anterior part of the genitalia and clinical presentation in the lumbar area or gluteus must be differentiated from varicella-zoster virus infection. Tumor-like presentation is a very rare manifestation of HSV cutaneous infection. It is important to take this morphological variant into consideration not to delay the diagnosis of a viral infection, especially in an immunosuppressed patient.

Cerebrospinal fluid challenges for the diagnosis of herpes simplex infection in the central nervous system / Desafios do exame do líquido cefalorraquidiano para o diagnóstico de infecção por herpes simplex no sistema nervoso central

Abstract Herpes simplex virus (HSV) is a cause of a severe disease of the central nervous system (CNS) in humans. The demonstration of specific antibodies in the cerebrospinal fluid (CSF) may contribute to the retrospective neurological diagnosis. However, the commercial immunological tests for HSV infection are for use in serum samples. Objective: The aim of the present study was to adapt a commercial kit anti-HSV IgG used for serum samples to be performed with a CSF sample. Methods: Forty CSF specimens from 38 patients with suspected CNS HSV infection were serially diluted for detecting anti-HSV IgG by enzyme immunoassay (EIA). The same samples were also analyzed with the polymerase chain reaction (PCR). Results: The sensitivity of EIA test for HSV was 5% (dilution 1:40) and 65% (dilution 1:2) in CSF, and HSV DNA PCR was 15%. The combined analysis of EIA (dilution 1:2) and PCR increased the sensitivity up to 72.5%. The inflammatory CSF was associated with positive HSV PCR. Conclusions: We demonstrated the importance to adapt serological anti-HSV IgG EIA test for CSF assays to increase the accuracy of the analysis, considering the low concentration of specific antibodies in CSF.

Resumo O vírus herpes simples (HSV) é um dos agentes causadores de uma doença grave no sistema nervoso central (SNC) em humanos. A detecção de anticorpos específicos no líquido cefalorraquidiano (LCR) pode contribuir para o diagnóstico neurológico retrospectivo. Entretanto, os testes imunológicos comerciais são para uso em amostras de soro. Objetivo: Adaptar um kit comercial sorológico anti-HSV IgG para ser utilizado no de LCR. Metodos: Quarenta amostras de LCR de 38 pacientes com suspeita de infecção por HSV no SNC foram diluídas pesquisa de anticorpos anti-HSV IgG pelo método imunoenzimático (EIA). Além disso, as mesmas amostras também foram analisadas por reação em cadeia da polimerase (PCR). Resultados: A sensibilidade do teste EIA para o HSV consistiu em 5% (diluição 1:40) e 65% (diluição 1:2) no LCR, e o PCR do DNA do HSV, 15%. A análise combinada de EIA (diluição 1:2) e PCR aumentou a sensibilidade para 72,5%. Houve associação entre presença do LCR inflamatório e PCR positiva para HSV. Conclusões: Demonstramos a importância na adaptação previa do teste sorológico anti-HSV IgG EIA para ensaios do no LCR, a fim de aumentar a acuracia da análise, considerando a baixa concentração de anticorpos específicos no LCR.

Meningite recorrente de Mollaret: uma revisão / Mollaret's recurrent meningitis: an overview

A meningite recorrente linfocítica benigna ou meningite de Mollaret, inicialmente descrita pelo neurologista francês Pierre Mollaret em 1944, é uma condição relativamente rara, benigna mas incapacitante durante os seus períodos de agudização. Trata-se de quadro inflamatório meníngeo recorrente devido a reativação de infecção pelo herpes simples vírus, particularmente o herpesvirus do tipo 2 (HSV-2). Pode ser reconhecida a partir do seu quadro clínico de meningismo agudo, perfil liquórico linfocítico e identificação do genoma viral por PCR no líquor. Aciclovir e seus derivados podem ser utilizado no seu tratamento ou na sua profilaxia. Sua identificação é importante no sentido de se excluir outras causas de quadros meníngeos recorrentes.

Benign recurrent lymphocytic meningitis or Mollaret's meningitis (MM) was frst described by the French neurologist Pierre Mollaret in 1944. MM is a relatively rare, benign but disabling condition. MM is a recurrent meningeal inflammatory illness due to reactivation of herpes simplex virus infection, particularly herpesvirus type 2 (HSV-2). It can be recognized from its clinical picture of acute meningism, lymphocytic CSF profle and by the identifcation of the viral genome in the CSF by PCR. Acyclovir and its derivatives may be used for its treatment or prophylaxis. The identifcation of MM is important in order to exclude other causes of recurrent meningeal conditions.

Granuloma anular generalizado y fenómeno isotópico de Wolf / Generalized annular granuloma and Wolf''s isotopic response

El granuloma anular (GA) es una dermatosis inflamatoria granulomatosa, generalmente asintomática, con distintas formas de presentación clínica, que puede distribuirse de forma localizada o generalizada. su etiología es incierta pero se la ha vinculado a factores desencadenantes como traumatismos, fármacos, diabetes mellitus, tiroideopatías, neoplasias, infecciones virales (herpes simple y varicela zóster) y excepcionalmente puede aparecer en la misma localización donde previamente aconteció otra enfermedad con la cual no guarda relación alguna (fenómeno isotópico de Wolf). En su patogenia intervendrían mecanismos de hipersensibilidad retardada y de estrés oxidativo celular. Existen múltiples terapias con respuesta variable y se ha observado autorresolución en casi el 75% de los casos. Presentamos el caso de una mujer de 64 años de edad, hipotiroidea de larga data, con un granuloma anular generalizado que apareció sobre cicatrices residuales de un herpes zóster (fenómeno isotópico de Wolf) y su respuesta al tratamiento con Vitamina E por vía oral

Granuloma annulare (GA) is a granulomatous inflammatory dermatosis, usually asymptomatic, with different forms of clinical presentation, which can be localized or generalized. Its etiology is uncertain but has been linked to triggers such as trauma, drugs, diabetes mellitus, thyroid disease, neoplasms and viral infections (herpes simplex, varicella-zoster). Exceptionally, it may appear in the same location where another disease has previously occurred but with no relationship to it (Wolf isotopic response). In their pathogenesis, delayed hypersensitivity mechanisms and cellular oxidative stress would intervene. There are multiple therapies with variable response, and autorresolution has been observed in almost 75% of the cases. We present the case of a 64-year-old woman with a long history of hypothyroidism, with diagnosis of generalized granuloma annulare on residual scars of Herpes Zoster (Wolf 's isotopic response) and its response to oral Vitamin E.

Parálisis facial neonatal: identificación del virus del herpes simple 1 en el líquido cefalorraquídeo. Caso clínico / Neonatal facial palsy: Identification of herpes simplex virus 1 in cerebrospinal fluid. Case report

En los neonatos, la parálisis facial es muy infrecuente y, por lo general, diagnosticada al nacer. Se presenta el primer caso de parálisis facial neonatal con identificación del virus del herpes simple 1 en el líquido cefalorraquídeo. Un varón de 35 días de vida acudió a Urgencias por la desviación de la comisura bucal hacia la izquierda y la ausencia de cierre del ojo derecho, sin sintomatología infecciosa ni antecedentes relevantes. La exploración física fue compatible con parálisis facial periférica. Las exploraciones complementarias de urgencia (hemograma, bioquímica, coagulación y citoquímica de líquido cefalorraquídeo) fueron normales. Fue ingresado con prednisolona oral y aciclovir intravenoso. La resonancia magnética craneal fue normal. A las 48 horas, se recibió el resultado positivo de la reacción en cadena de la polimerasa para el virus del herpes simple 1 en el líquido cefalorraquídeo. Con evolución favorable, completó 7 días de prednisolona oral y fue dado de alta tras 21 días de aciclovir intravenoso, con exploración neurológica previa normal.

Neonatal facial palsy is very uncommon and is generally diagnosed at birth. We present the first published case of neonatal facial palsy with identification of herpes simplex virus 1 in cerebrospinal fluid. A 35-day-old male was presented at the Emergency Department with mouth deviation to the left and impossibility of full closure of the right eye. There were no symptoms of infection or relevant medical history. Physical examination was compatible with peripheral facial palsy. Studies performed at admission were normal (blood count, biochemical analysis and coagulation blood tests and cerebrospinal fluid analysis). The patient was admitted on oral prednisolone and intravenous aciclovir. Cranial magnetic resonance was normal. Polymerase chain reaction test for herpes simplex virus 1 in cerebrospinal fluid was reported positive after 48 hours of admission. Patient followed good evolution and received prednisolone for 7 days and acyclovir for 21 days. At discharge, neurological examination was normal.

Diagnosis of human herpes virus 1 and 2 (HHV-1 and HHV-2): use of a synthetic standard curve for absolute quantification by real time polymerase chain reaction

The use of quantitative real time polymerase chain reaction (qPCR) for herpesvirus detection has improved the sensitivity and specificity of diagnosis, as it is able to detect shedding episodes in the absence of clinical lesions and diagnose clinical specimens that have low viral loads. With an aim to improve the detection and quantification of herpesvirus by qPCR, synthetic standard curves for human herpesvirus 1 and 2 (HHV-1 and HHV-2) targeting regions gD and gG, respectively, were designed and evaluated. The results show that synthetic curves can replace DNA standard curves in diagnostic herpes qPCR.

Fungal and Viral Oral Infections in individuals with Onco-Hematologic Neoplasms in a University Hospital

Introduction: Individuals undergoing onco-hematologic treatment present higher risk for developing oral and/or systemic infections, due to the intense immunosuppression and compromise of the mucosal barriers during treatment. The aim of this study was to identify the fungal and viral oral infections that most frequently affected patients undergoing onco-hematologic treatment in a University Hospital, and relate them to the biopsychosocial data, underlying disease and treatment. Methods: This was a crosssectional study in which descriptive analysis of the data was performed, and the Exact Fisher test was applied to verify the association between the infections and the variables: sex, age group, educational level, underlying disease and treatment, considering a 5% probability of error. Results and Discussion: The clinical exam revealed that oral candidiasis was present in 8.92% of the individuals, and herpes simplex, in 4.5%. No significant associations were found between the variables and infections. The fungal and viral oral infections were little prevalente in individuals with hematologic neoplasms in the present study, suggesting that the action of dental surgeons in caring for the onco-hematologic patients at the Institution evaluated and the protocols use were efficient (AU)

Síndrome de TORCH: enfoque racional del diagnóstico y tratamiento pre y post natal. Recomendaciones del Comité Consultivo de Infecciones Neonatales Sociedad Chilena de Infectología, 2016 / TORCH syndrome: Rational approach of pre and post natal diagnosis and treatment. Recommendations of the Advisory Committee on Neonatal Infections Sociedad Chilena de Infectología, 2016

There is a lot of bacterial, viral or parasite infections who are able to be transmitted vertically from the mother to the fetus or newborn which implicates an enormous risk for it. The TORCH acronym is used universally to refer to a fetus or newborn which presents clinical features compatible with a vertically acquired infection and allows a rational diagnostic and therapeutic approach. The traditional "TORCH test" is nowadays considered not appropriate and it has been replaced for specific test for specific pathogens under well defined circumstances. The present document reviews the general characteristics, epidemiology, pathogenesis, diagnostic and therapeutic options for the most frequently involved pathogens in the fetus or newborn with TORCH suspicion.

Existen numerosas infecciones bacterianas, virales y parasitarias que pueden transmitirse desde la madre al feto o recién nacido (RN) y que significan un riesgo para él. El acrónimo TORCH se utiliza en forma universal para caracterizar a aquel feto o RN que presenta un cuadro clínico compatible con una infección congénita y que permite un enfrentamiento racional, tanto diagnóstico como terapéutico. El concepto tradicional de realizar un "test de TORCH" sin consideraciones específicas a cada paciente, hoy en día se considera no adecuado y ha sido reemplazado por exámenes específicos para patógenos específicos bajo circunstancias bien definidas. El presente documento revisa las características generales, epidemiológicas, patogénicas, diagnósticas y terapéuticas de los patógenos más frecuentemente involucrados en el estudio de pacientes con sospecha de TORCH.

Serological mareers of viral, syphilitic and tooplasmic infection in children and teenagers with nephrotic syndrome: case series from mato grosso state, Brazil / Marcadores sorológicos de infecções virais, sífilis e toxoplasmose em crianças e adolescentes com síndrome nefrótica: série de casos de Mato Grosso, Brasil

Some infections can be the cause of secondary nephrotic syndrome. The aim of this study was to describe the experience of a Renal Disease Reference Clinic from Central Brazil, in which serological markers of some infectious agents are systematically screened in children with nephrotic syndrome. Data were obtained from the assessment of medical files of all children under fifteen years of age, who matched nephrotic syndrome criteria. Subjects were tested for IgG and IgM antibodies against T. gondii and cytomegalovirus; antibodies against Herpes simplex, hepatitis C virus and HIV; and surface antigen (HBsAg) of hepatitis B virus. The VDRL test was also performed. 169 cases were studied. The median age on the first visit was 44 months and 103 (60.9%) patients were male. Anti-CMV IgG and IgM were found in 70.4% and 4.1%, respectively. IgG and IgM against Toxoplasma gondii were present in 32.5% and 5.3%, respectively. Two patients were positive for HBsAg, but none showed markers for HIV, hepatitis C, or Treponema pallidum. IgG and IgM against herpes simplex virus were performed on 54 patients, of which 48.1% and 22.2% were positive. IgM antibodies in some children with clinical signs of recent infection suggest that these diseases may play a role in the genesis of nephrotic syndrome.

Algumas infecções podem ser causa de síndrome nefrótica. O objetivo desse estudo foi descrever a experiência de clínica pediátrica de doenças renais do Brasil Central, onde marcadores sorológicos de algumas doenças infecciosas são sistematicamente avaliados em crianças com síndrome nefrótica. Dados foram obtidos de registros médicos de todas as crianças com menos de 15 anos que preenchiam critérios de síndrome nefrótica. Os participantes foram testados para presença de IgG e IgM contra Toxoplasma gondii e citomegalovirus; anticorpos contra herpes simples, vírus da hepatite C e HIV, além do antígeno de superfície da hepatite B (HBsAg). VDRL também foi testado. 169 casos foram estudados. A idade média na primeira visita foi 44 meses e 103 eram do sexo masculino (60.9%). Anti-CMV IgG e IgM foram identificados em 70,4% e 4,1%, respectivamente. IgG e IgM contra T. gondii eram positivos em 32,5% e 5,3%. Dois pacientes eram HBsAg positivos, mas nenhum mostrou positividade para HIV, hepatite C ou sífilis. IgG e IgM contra herpes simples foram realizados em 54 pacientes, dos quais 48,1% e 22,2% eram positivos. Anticorpos IgM positivos em algumas crianças com sinais clínicos de infecção recente sugerem que essas doenças podem exercer um papel na gênese da síndrome nefrótica.

Minimum detection limit of an in-house nested-PCR assay for herpes simplex virus and varicella zoster virus

Introduction Herpes simplex virus (HSV) and varicella zoster virus (VZV) are responsible for a variety of human diseases, including central nervous system diseases. The use of polymerase chain reaction (PCR) techniques on cerebrospinal fluid samples has allowed the detection of viral DNA with high sensitivity and specificity. Methods Serial dilutions of quantified commercial controls of each virus were subjected to an in-house nested-PCR technique. Results The minimum detection limits for HSV and VZV were 5 and 10 copies/µL, respectively. Conclusions The detection limit of nested-PCR for HSV and VZV in this study was similar to the limits found in previous studies. .

Herpes Simplex Virus Duodenitis Accompanying Crohn's Disease / 대한소화기학회지

Herpes simplex virus (HSV) is a recognized cause of gastrointestinal infection in immunodeficient patients. Although a few cases of HSV gastritis and colitis in immunocompromised patients have been reported, there are no reports of HSV duodenitis in patients with Crohn's disease (CD). A 74-year-old female was admitted with general weakness and refractory epigastric pain. She had been diagnosed with CD three years ago. Esophagogastroduodenoscopy (EGD) revealed diffuse edematous and whitish mucosa with multiple erosions in the duodenum. Considering the possibility of viral co-infection, cytomegalovirus (CMV) immunohistochemical staining, PCR, and cultures of duodenal biopsies were performed, all of which were negative with the exception of the isolation of HSV in culture. After administration of intravenous acyclovir for 1 week, follow-up EGD showed almost complete resolution of the lesions and the patient's symptoms improved. In CD patients with refractory gastrointestinal symptoms, HSV, as well as CMV, should be considered as a possible cause of infection, so that the diagnosis of viral infection is not delayed and the appropriate antiviral treatment can be initiated.