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Vélindabólga af völdum herpes simplex veiru í annars heilbrigðum einstaklingum

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Authors
Gunnar Gunnarsson
Guðrún Baldvinsdóttir
Auður Antonsdóttir
Sverrir Harðarson
Hallgrímur Guðjónsson
Issue Date
1999-03-01

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Other Titles
Herpes simplex esophagitis in immunocompetent individuals
Citation
Læknablaðið 1999, 85(3):211-7
Abstract
Objective: Infections by herpes simplex viruses (HSV) are common but esophageal involvement is relatively rare. It is most frequently diagnosed in immunocompromized patients. We describe four healthy, young men with HSV esophagitis and review the literature on the subject. Material and methods: The diagnosis of HSV esophagitis was considered likely if three out of four of our criteria were met but definite if all four were fulfilled. IgM and IgG against HSV was measured with two different ELISAs. Viral culture was done in Vero and A-549 cells. Virus typing was done with ELISA. Histopathological exam was performed. A MEDLINE search of HSV esophagitis among otherwise healthy individuals was performed and the literature reviewed. Results: Four young, healthy men were diagnosed with HSV esophagitis in 1997. Diagnosis was likely in two cases and definite in two. One patient was initially suspected of heart disease and another of gallbladder disease. All four patients were proven to have primary infection, were hospitalized, given intravenous hydration and treated with acyclovir. A MEDLINE search revealed 12 other cases of HSV esopha¬gitis in otherwise healthy individuals. Including all 16 cases, the age ranged from 18 to 50 years (mean age 26 years). There were two women and 14 men. The most frequent symptom was odynophagia (69%). Eight patients (50%) had fever but only six (37.5%)had lesions in skin and/or mucosa on examination. Esophageal ulcers or inflammation were detected in all patients. The changes were in the distal esophagus (13/16), in the middle (2/16) or the entire organ (1/16). HSV-1 was cultured from 10 patients. Viral inclusions were seen in esophageal samples from eight patients. HSV antibodies were measured in 10 patients, six of which were proven to have primary infection. Conclusions: HSV esophagitis is rare in otherwise healthy individuals but probably underdiagnosed. Most cases are young men. Clues to the diagnosis such as visible lesions in skin or mucosae are frequently not present. Vigilance and endoscopy with biopsies and culture is needed for an accurate diagnosis.
Inngangur: Sýkingar af völdum herpes simplex veiru eru algengar en herpes simplex vélindabólga er hins vegar tiltölulega sjaldgæf. Langoftast er hún greind hjá ónæmisbældum sjúklingum. Við lýsum fjórurn ungum, annars heilbrigðum karlmönnum sem greindir voru með herpes simplex vélindabólgu og gerum grein fyrir rituðu máli um þennan sjúkdóm. Efniviður og aðferðir: Herpes simplex vélindabólga var talin líkleg ef þremur af fjórum skilmerkjum okkar var fullnægt en ákveðin/örugg ef öllum fjórum var fullnægt. Mótefni, IgM og IgG, gegn herpes simplex veiru voru mæld með tveimur mismunandi ELISA aðferðum. Veiruræktun var gerð í Vero og A-549 frumum. Herpes simplex tegund var greind með ELISA aðferð. Sýni tekin frá vélinda voru skoðuð af meinafræðingi. Leit var gerð á MEDLINE að tilfellum herpes simplex vélindabólgu sem lýst var í annars heilbrigðum einstaklingum. Niðurstöður: Fjórir ungir karlmenn greindust með herpes simplex vélindabólgu árið 1997 á Landspítalanum. Greining var líkleg hjá tveimur og ákveðin hjá tveimur. Einn þeirra var upphaflega grunaður um að hafa hjartasjúkdóm og annar að hafa gallblöðrubólgu. Allir reyndust hafa herpes simplex veiru frumsýkingu, voru lagðir inn á sjúkradeild og meðhöndlaðir með vökva í æð og acíklóvír. Við leit í MED¬LINE fundust 12 tilfelli herpes simplex vél-indabólgu í einstaklingum sem ekki voru ónæm-isbældir og fullnægðu skilmerkjum. Að okkar sjúklingum meðtöldum var aldursbil hópsins 18 til 50 ár (meðalaldur 26 ár). Konur voru tvær en karlar 14. Algengasta einkenni var verkur við kyngingu (69%). Hjá átta sjúklingum (50%) var lýst hita en aðeins sex (37,5%) sjúklingar höfðu greinanleg sár í húð og/eða slímhúð við skoðun. Algengast var að greina sár við speglun, venjulega í neðsta hluta vélinda (13/16), en tveir höfðu sár í miðhluta (2/16) og einn eftir endilöngu líffærinu (1/16). Herpes simplex veira-1 ræktaðist frá 10 sjúklingum. Hjá átta sjúkling-um greindust innlyksur í þekjufrumum í vélindasýnum. Mótefnamælingar voru gerðar hjá 10 sjúklingum og samræmdust þær frumsýkingu hjá sex þeirra. Ályktanir: Herpes simplex vélindabólga virðist sjaldgæf í annars heilbrigðum einstaklingum en sjúkdómurinn er sennilega vangreindur. Flestir sem hafa greinst eru ungir karlmenn. Vísbendingar eins og sýnileg mein í húð og/ eða slímhúð eru oft ekki til staðar. Þörf er árvekni og speglunar með sýnatöku til greiningar.
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