Roubalová K, Suchánková A, Vítek A, Sajdová J
National Reference Laboratory for Herpesviruses, Institute of Public Health, Srobárova 48, 101 42, Prague, Czech Republic.
J Clin Virol. 2000 Jun;17(1):37-42. doi: 10.1016/s1386-6532(00)00071-8.
Despite of prophylactic antiviral therapy, latent HSV may be reactivated in bone marrow transplant (BMT) recipients and cause serious disease. Rapid diagnosis of HSV infection is needed to prompt institution of appropriate therapy.
We report a case of the allogenic BMT recipient, who developed ulcerative esophagitis which progressed to generalized HSV infection and graft versus host reaction (GVHR).We consider several diagnostic approaches to detection of active HSV infection in this patient.
Polymerase chain reaction (PCR) was used to detect HSV DNA in esophageal biopsy specimens and peripheral leukocytes (PBL). Isolation of HSV in tissue culture was performed to prove infectious virus in swabs from mucocutaneous lesions or in PBL.
Using PCR, HSV DNA was detected in peripheral leukocytes of the patient who had developed generalized HSV infection accompanied with hepatosplenomegaly and hepatitis. At that time, a fully infectious ACV-resistant HSV was isolated from his PBL. On the other hand, HSV DNA was not detected in PBL of other BMT-recipients with skin- or organ-localized infection.
Presence of HSV-DNA in PBL of BMT recipients can signalize generalized HSV infection. Isolation of HSV from PBL by cocultivation with human fibroblasts can be used as an alternative diagnostic approach in these patients.
尽管进行了预防性抗病毒治疗，但潜伏的单纯疱疹病毒（HSV）仍可能在骨髓移植（BMT）受者中重新激活并引发严重疾病。需要快速诊断HSV感染以便及时开始适当的治疗。
我们报告了1例异基因BMT受者，该患者发生了溃疡性食管炎，并进展为全身性HSV感染和移植物抗宿主反应（GVHR）。我们考虑了几种诊断方法来检测该患者的活动性HSV感染。
采用聚合酶链反应（PCR）检测食管活检标本和外周血白细胞（PBL）中的HSV DNA。通过组织培养分离HSV，以证明来自皮肤黏膜病变拭子或PBL中的感染性病毒。
使用PCR，在发生全身性HSV感染并伴有肝脾肿大和肝炎的患者的外周血白细胞中检测到了HSV DNA。此时，从他的PBL中分离出了一种完全具有感染性的阿昔洛韦耐药HSV。另一方面，在其他有皮肤或器官局部感染的BMT受者的PBL中未检测到HSV DNA。
BMT受者的PBL中存在HSV-DNA可能提示全身性HSV感染。通过与人成纤维细胞共培养从PBL中分离HSV可作为这些患者的一种替代诊断方法。
