acyclovir and Acute-Disease

Acute cerebellitis is a well recognized complication of varicella zoster virus (VZV) infection in children. It has been described in adults in the setting of virus reactivation with a preceding herpes zoster rash, but it is exceedingly rare in adults who are not elderly or immunocompromised, particularly in the absence of a rash. To our knowledge, there has been only one reported case of acute cerebellitis in an immunocompetent adult less than age 65 with virological confirmation of acute VZV infection. We describe a 59-year-old immunocompetent man who presented with acute truncal ataxia without rash and was diagnosed with VZV cerebellitis, supported by anti-VZV IgM and anti-VZV IgG antibodies in the serum and a positive VZV polymerase chain reaction in cerebrospinal fluid. He had robust improvement with intravenous acyclovir treatment and was free of neurologic disability at two month follow-up. This case highlights the importance of virological evaluation in patients with acute ataxia, even in the absence of typical features of infection.

Topics: Acute Disease; Acyclovir; Antiviral Agents; Ataxia; Cerebellar Diseases; Humans; Male; Middle Aged; Varicella Zoster Virus Infection

Topics: Acute Disease; Acyclovir; Antiviral Agents; Brain; Encephalitis, Herpes Simplex; Encephalitis, Viral; Humans; Magnetic Resonance Imaging; Polymerase Chain Reaction

A 55-year-old man was admitted to our hospital for investigation of high fever, decreased consciousness and bilateral visual impairment. His cerebrospinal fluid analysis revealed pleocytosis of mononuclear cells and an increased protein concentration. FLAIR images revealed multiple high-intensity lesions in the frontal lobe, part of which was enhanced with gadolinium. Despite initiating treatment with acyclovir and corticosteroids, his consciousness and visual acuity deteriorated. Immunopathological examination of brain biopsies showed numerous herpes simplex virus type 2-positive neurons and macrophages, leading to a diagnosis of herpes simplex encephalitis (HSE). Fundoscopic examination revealed multiple foci of retinitis with vasculopathies, and inflammation in the anterior chamber and vitreous, indicating acute retinal necrosis (ARN). Foscarnet treatment was initiated in place of acyclovir and his consciousness improved, with a slight improvement in visual acuity. ARN is typically caused by a herpes virus infection limited to the eyeball, and rarely in combination with HSE. In such cases, there is a latency of approximately 2-4 weeks between ARN and the onset of encephalitis. Our case is unique in that HSE and ARN developed simultaneously, and it highlights that there may not always be a latency between the onsets of the two disorders. Finally, foscarnet should be considered in cases of HSE and ARN with acyclovir resistance.

Topics: Acute Disease; Acyclovir; Antiviral Agents; Disease Progression; Drug Resistance, Viral; Encephalitis, Herpes Simplex; Foscarnet; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Retinal Necrosis Syndrome, Acute; Treatment Failure; Treatment Outcome

Infectious mononucleosis (IM) is a clinical syndrome, usually caused by the Epstein Barr virus (EPV), characterised by lymphadenopathy, fever and sore throat. Most cases of symptomatic IM occur in older teenagers or young adults. Usually IM is a benign self-limiting illness and requires only symptomatic treatment. However, occasionally the disease course can be complicated or prolonged and lead to decreased productivity in terms of school or work. Antiviral medications have been used to treat IM, but the use of antivirals for IM is controversial. They may be effective by preventing viral replication which helps to keep the virus inactive. However, there are no guidelines for antivirals in IM.. To assess the effects of antiviral therapy for infectious mononucleosis (IM).. We searched the Cochrane Central Register of Controlled Trials (CENTRAL, Issue 3, March 2016), which contains the Cochrane Acute Respiratory Infections (ARI) Group's Specialised Register, MEDLINE (1946 to 15 April 2016), Embase (1974 to 15 April 2016), CINAHL (1981 to 15 April 2016), LILACS (1982 to 15 April 2016) and Web of Science (1955 to 15 April 2016). We searched the World Health Organization (WHO) International Clinical Trials Registry Platform and ClinicalTrials.gov for completed and ongoing trials.. We included randomised controlled trials (RCTs) comparing antivirals versus placebo or no treatment in IM. We included trials of immunocompetent participants of any age or sex with clinical and laboratory-confirmed diagnosis of IM, who had symptoms for up to 14 days. Our primary outcomes were time to clinical recovery and adverse events and side effects of medication. Secondary outcomes included duration of abnormal clinical examination, complications, viral shedding, health-related quality of life, days missing from school or work and economic outcomes.. Two review authors independently assessed studies for inclusion, assessed the included studies' risk of bias and extracted data using a customised data extraction sheet. We used the GRADE criteria to rate the quality of the evidence. We pooled heterogeneous data where possible, and presented the results narratively where we could not statistically combine data.. We included seven RCTs with a total of 333 participants in our review. Three trials studied hospitalised patients, two trials were conducted in an outpatient setting, while the trial setting was unclear in two studies. Participants' ages ranged from two years to young adults. The type of antiviral, administration route, and treatment duration varied between the trials. The antivirals in the included studies were acyclovir, valomaciclovir and valacyclovir. Follow-up varied from 20 days to six months. The diagnosis of IM was based on clinical symptoms and laboratory parameters.The risk of bias for all included studies was either unclear or high risk of bias. The quality of evidence was graded as very low for all outcomes and so the results should be interpreted with caution. There were statistically significant improvements in the treatment group for two of the 12 outcomes. These improvements may be of limited clinical significance.There was a mean reduction in 'time to clinical recovery as assessed by physician' of five days in the treatment group but with wide confidence intervals (CIs) (95% CI -8.04 to -1.08; two studies, 87 participants). Prospective studies indicate that clinical signs and symptoms may take one month or more to resolve and that fatigue may be persistent in approximately 10% of patients at six-month follow-up, so this may not be a clinically meaningful result.Trial results for the outcome 'adverse events and side effects of medication' were reported narratively in only five studies. In some reports authors were unsure whether an adverse event was related to medication or complication of disease. These results could not be pooled due to the potential for double counting results but overall, the majority of trials reporting this outcome did not find any significant difference between treatment and control groups.There was a mean reduction in 'duration of lymphadenopathy' of nine days (95% CI -11.75 to -6.14, two studies, 61 participants) in favour of the treatment group.In terms of viral shedding, the overall effect from six studies was that viral shedding was suppressed while on antiviral treatment, but this effect was not sustained when treatment stopped.For all other outcomes there was no statistically significant difference between antiviral treatment and control groups.. The effectiveness of antiviral agents (acyclovir, valomaciclovir and valacyclovir) in acute IM is uncertain. The quality of the evidence is very low. The majority of included studies were at unclear or high risk of bias and so questions remain about the effectiveness of this intervention. Although two of the 12 outcomes have results that favour treatment over control, the quality of the evidence of these results is very low and may not be clinically meaningful. Alongside the lack of evidence of effectiveness, decision makers need to consider the potential adverse events and possible associated costs, and antiviral resistance. Further research in this area is warranted.

Topics: Acute Disease; Acyclovir; Adolescent; Adult; Antiviral Agents; Child; Child, Preschool; Female; Guanine; Humans; Infectious Mononucleosis; Male; Randomized Controlled Trials as Topic; Valacyclovir; Valine; Young Adult

Acute hemicerebellitis, marked by headache with or without cerebellar signs, is a rare clinical entity involving a unilateral cerebellar hemisphere. The pathogenesis of acute hemicerebellitis remains unclear, and the disease rarely occurs in adults. Here, we report an 18-year-old woman who presented with a lack of coordination of the right hand and leg lasting longer than one week, following a pulsatile headache. A neurological examination disclosed ocular dysmetria, right-sided limb ataxia and slight truncal ataxia. Cerebrospinal fluid analysis showed mononuclear pleocytosis. The serology and autoimmune studies were unremarkable. Brain magnetic resonance imaging (MRI) revealed a focal signal change in the right cerebellar hemisphere and vermis. Acute hemicerebellitis was diagnosed, and the patient was treated with intravenous methylprednisolone sodium succinate and acyclovir. Subsequently, the headache resolved, and the cerebellar signs were markedly improved. Twenty days after admission, she became asymptomatic and brain MRI showed resolution of cerebellar hyperintensity on the right side. In conclusion, we identified only 6 additional patients with adult-onset acute hemicerebellitis from previous reports, highlighting the importance of recognizing this rare clinical entity. Its clinical outcome is usually favorable, but in the acute phase, attention should be directed toward clinical symptoms that are suggestive of increased intracranial pressure.

Topics: Acute Disease; Acyclovir; Adolescent; Adult; Age of Onset; Antiviral Agents; Cerebellar Diseases; Encephalitis, Viral; Female; Glucocorticoids; Headache; Humans; Intracranial Hypertension; Magnetic Resonance Imaging; Methylprednisolone Hemisuccinate; Treatment Outcome

Acute cerebellar ataxia of childhood is the most frequent neurological complication of chickenpox virus infection. Acute cerebellar ataxia is categorized within the group of acute postinfectious complications. The aims of this study were: (I) to evaluate the clinical presentation, management, and follow-up of children hospitalized due to acute cerebellar ataxia in a tertiary pediatric hospital, where immunization for chickenpox is not available, and (II) to describe the differential diagnosis of acute postinfectious cerebellitis. We evaluated 95 patients with acute cerebellar ataxia. The diagnostic criteria for acute ataxia were: Acute-onset loss of coordination or gait difficulties, with or without nystagmus, lasting less than 48 hours in a previously healthy child. All children met the inclusion criteria, except those with drug-induced ataxia in whom duration should be less than 24 hours for inclusion in the study. The data were recorded in a clinical pediatrics and neurological chart. Among immunosuppressed patients acute cerebellar ataxia was most frequently due to chickenpox. Most of the patients were male. Age at presentation ranged from preschool to 5 years of age. Time lapse between presentation of the rash and hospital admission ranged from 1 to 3 days. CSF study was performed in 59.5% of the cases. Brain magnetic resonance imaging and computed tomography scan showed edema in 33.3%. Intravenous acyclovir was used in 23 patients, however, no significant differences were found in clinical manifestations and follow-up between treated and untreated patients. Ataxia was the first clinical manifestation. Mean hospital stay ranged from 2 to 11 days with a mean of 4 days.

Topics: Acute Disease; Acyclovir; Antiviral Agents; Cerebellar Ataxia; Child; Diagnosis, Differential; Female; Humans; Male; Retrospective Studies; Time Factors

Herpes zoster is due to the reactivation of the virus causing varicella, called varicella-zoster virus. It affects peripheral nerves and causes painful skin and nerve lesions. This pain may last for months, or years after the initial lesions have resolved: post-herpetic neuralgia is the most frequent complication. Antiviral drugs, acting directly on the infectious agent are prescribed to reduce or block viral replication, relieve pain, and shorten symptom duration, especially for people of 50 years of age or more. However, there is currently no systematic collection of data concerning the effectiveness of antiviral drugs administered outside of clinical trials. This review evaluates the effectiveness of antiviral drugs on: (a) the intensity of pain and progression of the rash during the acute phase of herpes zoster, and (b) the frequency, intensity, and duration of post-herpetic neuralgia. During the acute phase, antiviral drugs (acyclovir, valacyclovir and famcyclovir) significantly reduce the intensity of acute pain, accelerate the healing of the vesicular rash, and reduce the duration of viral excretion. According to some authors, these drugs taken at an early stage of the disease would help to prevent the development of post herpetic neuralgia. But for others, there is no convincing evidence that antiviral drugs reduce the risk of painful complications.

Topics: 2-Aminopurine; Acute Disease; Acyclovir; Age Factors; Aged; Antiviral Agents; Drug Administration Schedule; Drug Evaluation; Early Diagnosis; Famciclovir; Global Health; Herpes Zoster; Humans; Meta-Analysis as Topic; Middle Aged; Neuralgia, Postherpetic; Randomized Controlled Trials as Topic; Valacyclovir; Valine

Lipschütz ulcers are characterised by a first flare of non-sexually related acute genital ulcers (AGU) occurring in adolescent girls. Epstein-Barr primary infection is the most frequently reported aetiology but other infectious agents are probably implicated. We report the first case of mumps associated with an AGU in a 21-year-old girl. She presented a bilateral parotitis with genital ulcers, and serology confirmed she had mumps. As in our case, most Lipschütz ulcers heal spontaneously within a couple of weeks and the diagnosis should be reconsidered in case of recurrence.

Topics: Acute Disease; Acyclovir; Antiviral Agents; Female; Humans; Immunoglobulin G; Immunoglobulin M; Mumps; Mumps virus; Skin Ulcer; Treatment Outcome; Valacyclovir; Valine; Vulvar Diseases; Young Adult

Ocular infection with herpes simplex virus (HSV) is usually acquired early in life, with 50% of people from higher and 80% from lower socioeconomic groups in the USA having antibodies by the age of 30 years. Attacks usually resolve spontaneously within 1-2 weeks, but 50% of people will experience a recurrence within 10 years.. We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of treatments in people with epithelial keratitis? What are the effects of treatments in people with stomal keratitis? What are the effects of interventions to prevent recurrence of ocular herpes simplex? What are the effects of interventions to prevent recurrence of ocular herpes simplex in people with corneal grafts? We searched: Medline, Embase, The Cochrane Library, and other important databases up to July 2007 (BMJ Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).. We found seven systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.. In this systematic review we present information relating to the effectiveness and safety of the following interventions: adding oral aciclovir to topical corticosteroids plus topical antiviral treatment; adding topical corticosteroids to topical antiviral treatment; antiviral agents (topical); debridement; interferons (topical); and oral aciclovir.

Topics: Acute Disease; Acyclovir; Administration, Oral; Antiviral Agents; Debridement; Humans; Interferons; Keratitis, Herpetic; Recurrence

We report what we believe to be the first two cases of acute interstitial nephritis associated with vancomycin and ceftriaxone therapy in adults. A 40-year-old man with a medical history of traumatic brain injury and tonic-clonic seizure disorder was admitted to the hospital with a seizure episode and temperature of 103 degrees F. He was administered ceftriaxone, vancomycin, and acyclovir for suspected bacterial and/or viral meningitis. On day 4, the patient was noted to have diffuse erythematous plaques on the neck, chest, arms, abdomen, and back, as well as an elevated serum creatinine level of 3.1 mg/dl (baseline 0.9 mg/dl) and an elevated eosinophil count (6%). Dermatology and renal consultations were obtained, and a diagnosis of suspected acute interstitial nephritis was made. After a 3-day course of antibiotic treatment (day 4 of hospitalization), all antibiotics were discontinued and topical triamcinolone 0.1% ointment and hydrocortisone 2.5% cream were begun for the rash. The patient was discharged 5 days later with improvement in the rash, serum creatinine level (1.0 mg/dl), and eosinophil count (0.9%). A 59-year-old woman with a medical history of diabetes mellitus was admitted to the hospital with a serum creatinine level of 3.7 mg/dl, eosinophil count of 8.4%, and fractional excretion of sodium of 2.94%. The patient had been receiving treatment with vancomycin and ceftriaxone for osteomyelitis for 28 days before this hospital admission. Her baseline serum creatinine level (before antibiotic therapy) was 1.0 mg/dl. Renal consultation was obtained, and a diagnosis of probable acute interstitial nephritis was made. Ceftriaxone and vancomycin were discontinued, and her serum creatinine level gradually decreased to 3.3 mg/dl and then further to 1.5 mg/dl over the next 3 months. Use of the Naranjo adverse drug reaction probability scale revealed that the adverse reaction was possible in the first case and probable in the second case. Health care professionals need to be cognizant that drug-induced acute interstitial nephritis can be associated with concomitant administration of ceftriaxone and vancomycin therapy. Early detection of this rare adverse reaction is paramount in order to prevent acute renal insufficiency.

Topics: Acute Disease; Acyclovir; Adult; Anti-Bacterial Agents; Antiviral Agents; Ceftriaxone; Drug Therapy, Combination; Female; Humans; Injections, Intravenous; Male; Meningitis, Bacterial; Meningitis, Viral; Middle Aged; Nephritis, Interstitial; Vancomycin

Topics: 2-Aminopurine; Acute Disease; Acyclovir; Administration, Oral; Adult; Age Factors; Analgesics, Non-Narcotic; Analgesics, Opioid; Anticonvulsants; Antidepressive Agents, Tricyclic; Antiviral Agents; Bromodeoxyuridine; Child; Drug Therapy, Combination; Famciclovir; Female; Herpes Zoster; Herpesvirus 3, Human; Herpesvirus Vaccines; Humans; Male; Middle Aged; Neuralgia, Postherpetic; Pain; Prodrugs; Risk Factors; Sex Factors; Time Factors; Vaccination; Valacyclovir; Valine

A previously healthy 30-year-old woman was admitted to our hospital because of impaired consciousness after convulsion. A temporary diagnosis of herpes simplex encephalitis was made, and intravenous acyclovir (ACV) therapy (250 mg four times daily in normal saline over 2 hours) was started. Three days later, she became confused, and was having hallucinations, dysarthria and generalized painful seizures occurred without focal neurologic deficit. Whether the neuropsychiatric symptoms were related to herpes simplex encephalitis or acyclovir neurotoxity was initially unclear. The brain MRI and lumbar puncture findings were initially normal, but abnormal FLAIR lesions appeared later. ACV-associated encephalopathy was considered. ACV was discontinued, and she recovered from the neurological disorder within 24 hours. Although blood levels of acyclovir were not determined, it is unlikely that they were in a toxic range, in view of her normal renal function.

Topics: Acute Disease; Acyclovir; Adult; Antiviral Agents; Brain Diseases; Dysarthria; Encephalitis, Viral; Epilepsy, Generalized; Female; Hallucinations; Humans; Kidney Diseases; Magnetic Resonance Imaging

Treatment of genital herpes requires accurate diagnosis, patient support, and effective treatment. Diagnosis is usually straightforward for classic presentations characterized by vesicular lesions but can be challenging for atypical presentations, which are more common. Diagnosis of asymptomatic infection requires access to molecular technology or type-specific serologic assays. Misconceptions about herpes simplex infection are common and patient education is essential. Patient concerns extend beyond disease frequency and severity-the psychological impact should not be underestimated. Antiviral therapy is relevant at all stages of infection. Acyclovir, valacyclovir, and famciclovir are effective and well tolerated for genital herpes treatment. Continuous suppressive therapy controls all symptoms of recurrent disease and helps to relieve disease complications. The prodrugs valacyclovir and famciclovir offer easier, less-frequent dosing than required for acyclovir. Valacyclovir achieves effective suppression when taken once a day. Interventions to prevent genital herpes transmission and to control the global problem are urgently required.

Topics: 2-Aminopurine; Acute Disease; Acyclovir; Adult; AIDS-Related Opportunistic Infections; Antibodies, Viral; Antiviral Agents; Chronic Disease; Clinical Trials as Topic; Dose-Response Relationship, Drug; Famciclovir; Herpes Genitalis; Herpesvirus 1, Human; Herpesvirus 2, Human; HIV Infections; Humans; Immunocompetence; Patient Education as Topic; Prodrugs; Secondary Prevention; Treatment Outcome; Valacyclovir; Valine

Our goal was to determine if any treatment of acute herpes zoster alters the incidence or duration of postherpetic neuralgia (PHN), a common sequela in elderly patients.. We systematically searched MEDLINE and The Cochrane Library. We also examined the reference lists of identified trials and reviews.. We included all randomized controlled trials of treatments of zoster published in English that included assessment of pain at any time after rash healing.. Forty-two trials met inclusion criteria, and 2 reviewers independently evaluated them for methodologic quality and the statistical and clinical significance of results.. Four placebo-controlled trials of oral acyclovir with 692 patients provided marginal evidence for reduction in pain incidence at 1 to 3 months following zoster onset. Famciclovir significantly reduced duration but not incidence of PHN in one placebo-controlled trial of 419 patients. Valacyclovir significantly reduced duration but not incidence of PHN in one acyclovir-controlled trial of 1141 patients. Steroids had no effect on PHN. Amitriptyline for 90 days reduced pain incidence at 6 months in one placebo-controlled trial of 80 patients. A single trial of percutaneous electrical nerve stimulation (PENS) in 50 patients suggested a decrease in pain incidence at 3 and 6 months compared with famciclovir.. There is limited evidence that current interventions prevent or shorten PHN. Famciclovir and valacyclovir have been shown to reduce the duration of PHN in single published trials. Well-designed and larger trials of amitriptyline and PENS should be conducted.

Topics: Acute Disease; Acyclovir; Aged; Amitriptyline; Analgesics, Non-Narcotic; Antiviral Agents; Drug Therapy, Combination; Evidence-Based Medicine; Herpes Zoster; Humans; Middle Aged; Neuralgia; Randomized Controlled Trials as Topic; Steroids

With the US population aging steadily, herpes zoster represents a growing contributor to diminished quality of life. Dermatologic manifestations appear as immunity declines with age but rarely pose a significant threat, except in instances when ocular structures are involved. Pain is of more concern, because it usually accompanies and may even precede and persist after acute eruptions. In most young patients, pain is transient and bearable. Unfortunately, in the elderly--who are at highest risk for herpes zoster--pain is often more prolonged and more intense. In spite of a wide spectrum of interventions, palliative efforts remain rather ineffectual. At present, intervening as early as possible, ideally within 48 to 72 hours of disease onset, offers the greatest chance of minimizing neurologic sequelae. Inoculation with varicella vaccine in patients between ages 55 and 65 may prove to boost cell-mediated immunity sufficiently so that recrudescence of the varicella virus can be relegated to the annals of history.

Topics: 2-Aminopurine; Acute Disease; Acyclovir; Aged; Antiviral Agents; Chronic Disease; Famciclovir; Herpes Zoster; Humans; Neuralgia; Risk Factors; Valacyclovir; Valine

Recently, acyclovir use has been proposed for the treatment of Bell's palsy in view of the hypothetical viral origin of the disorder. Recent studies suggest that the maximum effect is achieved by combining acyclovir with prednisone. Nevertheless, acyclovir alone appears to be useful in the treatment of some patients (hypertensive subjects). Protocols are defined for the medical treatment of Bell's palsy.

Topics: Acute Disease; Acyclovir; Antiviral Agents; Facial Paralysis; Herpes Simplex; Humans

Longitudinally designed case studies, reporting cognitive and psychosocial outcome of herpes simplex virus encephalitis (HSVE), were conducted prior to current antiviral medication usage and primarily in persons with either left hemispheric or bilateral temporal lobe involvement. The current study demonstrated relatively better outcome (cognitive recovery and functional independence for activities of daily life) in an individual treated with IV Acyclovir within hours of initial symptoms and whose CT scans showed right hemispheric involvement. In contrast with earlier case reports, no semantic specific categories of memory impairment were noted on serial assessment. The time from first symptoms to antiviral medical treatment appears to be the best predictor of outcome from HSVE. Historical case studies with relatively poorer outcome and differing deficits suggest survivors of HSVE are a heterogenous group. Variability in anatomic lesions and time to treatment contribute to outcome.

Topics: Activities of Daily Living; Acute Disease; Acyclovir; Aged; Antiviral Agents; Cognition; Emergency Treatment; Encephalitis, Herpes Simplex; Female; Humans; Time Factors; Treatment Outcome

Topics: Acute Disease; Acyclovir; Antiviral Agents; Chickenpox; Humans; Male; Middle Aged; Pneumonia, Viral; Respiratory Insufficiency

Hepatitis due to herpes simplex virus (HSV) is unusual in healthy individuals. To date, only 56 cases of HSV hepatitis in adult patients have been reported, including 21 pregnant patients. We describe a 25-year-old white woman in her 30th week of gestation who had progressive acute hepatitis. Histologic examination of the liver biopsy specimen showed diffuse microabscesses involving more than 50% of the hepatic parenchyma, with multiple hepatocytes containing Cowdry type A and ground-glass nuclear inclusions. The diagnosis of herpes hepatitis was confirmed by positive immunoreactivity to HSV antibodies in the tissue sections. Intravenous acyclovir therapy was immediately initiated, and the patient's condition improved dramatically. She then had a normal baby at term. Subsequently, the patient had a second pregnancy and an uncomplicated vaginal delivery without recurrence of the disease. Even though alterations of the humoral and cell-mediated immunity occur during pregnancy, herpes hepatitis is rare in pregnant women. Since the prompt administration of antiviral drugs is a lifesaving measure, we recommend including HSV hepatitis in the differential diagnosis of acute hepatitis in pregnancy.

Topics: Acute Disease; Acyclovir; Adult; Antibodies, Viral; Antibody Formation; Antiviral Agents; Biopsy; Diagnosis, Differential; Female; Hepatitis, Viral, Human; Herpes Simplex; Humans; Immunity, Cellular; Injections, Intravenous; Liver Abscess; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Outcome; Simplexvirus

Inhibition of varicella-zoster virus replication during acute herpes zoster would, theoretically, accelerate cutaneous healing and reduce the pain, both acute and chronic, associated with shingles. Early antiviral drugs were of limited efficacy, excessively toxic, or needed to be given parenterally, and were unsuitable for use in immunocompetent individuals. Acyclovir was a significant advance and remains the antiviral drug of choice for herpes zoster. There is ample evidence for its efficacy in acute illness, but its ability to influence post-herpetic neuralgia is controversial. This review also discusses the role of adjunctive therapy with steroids in acute shingles.

Topics: Acute Disease; Acyclovir; Adult; Antiviral Agents; Cytarabine; Herpes Zoster; Humans; Idoxuridine; Interferons; Middle Aged; Steroids; Vidarabine

Topics: Acute Disease; Acyclovir; Adult; Child; Diagnosis, Differential; Encephalitis, Arbovirus; Encephalitis, Tick-Borne; Encephalitis, Viral; Encephalomyelitis; Glucocorticoids; Herpes Simplex; Humans; Immunoglobulins; Infant; Subacute Sclerosing Panencephalitis

Genital herpes is a common, distressing infection whose incidence has been underestimated. Recent serological surveys, employing type-specific antibody assays, show a rising prevalence of previous herpes simplex virus (HSV) type 2 infections in post-adolescent populations in developed countries; many of these infections have been asymptomatic. In some geographical locations, HSV-1 infections are a common cause of first episodes. They may occur in stable, monogamous relationships and are less likely to recur than genital infections caused by HSV-2. The clinical features of first episode genital herpes show marked individual variation in severity; they tend to be more severe in women than in men. Local and distant complications are common in immunocompetent individuals and may be life-threatening in those who are immunocompromised. The psychological and social consequences which result from the life-long infection and its risks of transmission to new sexual partners often prove more disabling to affected individuals than do the milder physical symptoms associated with recurrent episodes. Counselling, support, and patient education are essential components of management. Acyclovir is clearly established as the first choice therapy in both first and recurrent episodes of genital herpes. This drug has potent antiviral effect and provides significant clinical benefit in first episodes. Systemic therapy for initial episodes does not prevent either the establishment of latency or the development of future recurrences even when used in high or prolonged dosage. Episodic treatment of recurrences, with either oral or topical acyclovir, requires early patient initiation of therapy to provide significant clinical benefit.

Topics: Acute Disease; Acyclovir; Female; Herpes Genitalis; Humans; Male

The authors report a 56-year-old woman with Ramsey Hunt syndrome with multiple cranial nerve paralysis and acute respiratory failure. Five days before admission, she experienced right otalgia and right facial pain and consulted an otolaryngologist of our hospital, who diagnosed the illness as acute parotitis and laryngopharyngitis. One day before admission, she experienced mild dyspnea and general fatigue and came to our hospital emergency room. A chest X-ray film revealed no abnormalities but some blisters were observed around her right ear. The next day, her dyspnea became more severe and she was admitted. A chest X-ray film on admission revealed right lower lobe consolidation, and neurological examination disclosed multiple cranial nerve paralysis, i.e., paralysis of the right fifth, seventh, eighth, ninth, tenth, eleventh, twelfth and left tenth cranial nerve. The serum titer of anti-herpes zoster antibody was elevated to 1,024, and the patient was diagnosed as having Ramsey Hunt syndrome with multiple cranial nerve paralysis. Arterial blood gas analysis revealed hypoxemia with hypercapnea, which was considered to be due to aspiration pneumonia and central airway obstruction caused by vocal cord paralysis. Mechanical ventilation was soon instituted and several antibiotics and acyclovir were administered intravenously, with marked effects. Three months after admission, the patient was discharged with no sequelae except mild hoarseness. Patients with herpes zoster oticus, facial nerve paralysis and auditory symptoms are diagnosed as having Ramsey Hunt syndrome. This case was complicated by lower cranial nerve paralysis and acute respiratory failure, which is very rare.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Acute Disease; Acyclovir; Anti-Bacterial Agents; Cranial Nerve Diseases; Drug Therapy, Combination; Female; Herpes Zoster Oticus; Humans; Middle Aged; Paralysis; Pneumonia, Aspiration; Respiratory Insufficiency

An overview of all the available placebo-controlled trial data for oral acyclovir in acute herpes zoster infection has confirmed that a dose of 800 mg five times daily for seven to ten days is effective in reducing the incidence of post-herpetic neuralgia and the duration of pain. Although one study failed to demonstrate such an effect, three other studies and a combined analysis, using the log rank test, did so. The duration of pain was shortened from an average of 86 to 49 days (p less than 0.001). Future studies will need to take account of these findings since oral acyclovir is most likely to be used as the standard reference therapy.

Topics: Acute Disease; Acyclovir; Herpes Zoster; Herpes Zoster Oticus; Humans; Pain; Randomized Controlled Trials as Topic

Patients with Herpes simplex encephalitis often are considered to be poor rehabilitation candidates because of their multiple deficits and grave prognosis. This report presents case reports on three patients with biopsy-proven Herpes simplex encephalitis, all of whom were treated with acyclovir in acute care and then admitted to an inpatient rehabilitation program. All had multiple brain lesions with minimal motor findings but cognitive and communication deficits. One patient, two weeks after admission, slipped into a coma and was transferred to an acute care hospital where he subsequently expired. The other two made useful functional gains and were discharged home in two weeks and 10 weeks, suggesting that a trial of rehabilitation may be warranted after Herpes simplex encephalitis.

Topics: Activities of Daily Living; Acute Disease; Acyclovir; Adaptation, Physiological; Adult; Encephalitis; Female; Herpes Simplex; Humans; Male; Middle Aged; Prognosis

Topics: Acquired Immunodeficiency Syndrome; Acute Disease; Acyclovir; Chorioretinitis; Cytomegalovirus Infections; Diagnosis, Differential; Ganciclovir; Herpes Zoster Ophthalmicus; Humans; Keratitis, Dendritic; Light Coagulation; Mycoses; Necrosis; Opportunistic Infections; Retina; Retinitis; Syphilis; Toxoplasmosis

Topics: Acute Disease; Acyclovir; Antiviral Agents; Burkitt Lymphoma; Chronic Disease; Herpesvirus 4, Human; Humans; Infectious Mononucleosis; Nasopharyngeal Neoplasms; Recurrence; Tumor Virus Infections

Topics: Acute Disease; Acyclovir; Animals; Ganglia; Genes, Viral; Herpes Simplex; Humans; Lymph Nodes; Mice; Mutation; Nerve Endings; Neurons; Simplexvirus; Thymidine Kinase; Virion; Virus Replication

Topics: Acute Disease; Acyclovir; Anti-Bacterial Agents; Bacterial Infections; Catheterization; Chickenpox; Gram-Negative Bacteria; Herpes Zoster; Humans; Immunization; Immunization, Passive; Infection Control; Leukemia, Lymphoid; Mycoses; Protozoan Infections; Sulfamethoxazole; Trimethoprim

Both valganciclovir and high-dose valacyclovir are recommended for cytomegalovirus prophylaxis after renal transplantation. A head-to-head comparison of both regimens is lacking. The objective of the study was to compare valacyclovir prophylaxis with valganciclovir, which constituted the control group.. In a randomized, open-label, single-center trial, recipients of renal transplants (recipient or donor cytomegalovirus-seropositive) were randomly allocated (1:1) to 3-month prophylaxis with valacyclovir (2 g four times daily) or valganciclovir (900 mg daily). Enrollment occurred from November of 2007 to April of 2012. The primary end points were cytomegalovirus DNAemia and biopsy-proven acute rejection at 12 months. Analysis was by intention to treat.. In total, 119 patients were assigned to valacyclovir (n=59) or valganciclovir prophylaxis (n=60). Cytomegalovirus DNAemia developed in 24 (43%) of 59 patients in the valacyclovir group and 18 (31%) of 60 patients in the valganciclovir group (adjusted hazard ratio, 1.35; 95% confidence interval, 0.71 to 2.54; P=0.36). The incidence of cytomegalovirus disease was 2% with valacyclovir and 5% with valganciclovir prophylaxis (adjusted hazard ratio, 0.21; 95% confidence interval, 0.01 to 5.90; P=0.36). Significantly more patients with valacyclovir prophylaxis developed biopsy-proven acute rejection (18 of 59 [31%] versus 10 of 60 [17%]; adjusted hazard ratio, 2.49; 95% confidence interval, 1.09 to 5.65; P=0.03). The incidence of polyomavirus viremia was higher in the valganciclovir group (18% versus 36%; adjusted hazard ratio, 0.43; 95% confidence interval, 0.19 to 0.96; P=0.04).. Valganciclovir shows no superior efficacy in cytomegalovirus DNAemia prevention compared with valacyclovir prophylaxis. However, the risk of biopsy-proven acute rejection is higher with valacyclovir.

Topics: Acute Disease; Acyclovir; Adult; Antiviral Agents; Biomarkers; Biopsy; Cytomegalovirus; Cytomegalovirus Infections; Czech Republic; DNA, Viral; Drug Administration Schedule; Female; Ganciclovir; Graft Rejection; Graft Survival; Humans; Immunosuppressive Agents; Intention to Treat Analysis; Kidney Transplantation; Male; Middle Aged; Time Factors; Treatment Outcome; Valacyclovir; Valganciclovir; Valine; Viral Load

Skin and mucosal herpes simplex virus type 2 (HSV-2) shedding predominantly occurs in short subclinical episodes. We assessed whether standard-dose or high-dose antiviral therapy reduces the frequency of such shedding.. HSV-2-seropositive, HIV-seronegative people were enrolled at the University of Washington Virology Research Clinic (WA, USA). We did three separate but complementary open-label cross-over studies comparing no medication with aciclovir 400 mg twice daily (standard-dose aciclovir), valaciclovir 500 mg daily (standard-dose valaciclovir) with aciclovir 800 mg three times daily (high-dose aciclovir), and standard-dose valaciclovir with valaciclovir 1 g three times daily (high-dose valaciclovir). The allocation sequence was generated by a random number generator. Study drugs were supplied in identical, numbered, sealed boxes. Study periods lasted 4-7 weeks, separated by 1 week wash-out. Participants collected genital swabs four times daily for quantitative HSV DNA PCR. Clinical data were masked from laboratory personnel. The primary endpoint was within-person comparison of shedding rate in each study group. Analysis was per protocol. The trials are registered at ClinicalTrials.gov (NCT00362297, NCT00723229, NCT01346475).. Of 113 participants randomised, 90 were eligible for analysis of the primary endpoint. Participants collected 23 605 swabs; 1272 (5·4%) were HSV-positive. The frequency of HSV shedding was significantly higher in the no medication group (n=384, 18·1% of swabs) than in the standard-dose aciclovir group (25, 1·2%; incidence rate ratio [IRR] 0·05, 95% CI 0·03-0·08). High-dose aciclovir was associated with less shedding than standard-dose valaciclovir (198 [4·2%] vs 209 [4·5%]; IRR 0·79, 95% CI 0·63-1·00). Shedding was less frequent in the high-dose valaciclovir group than in the standard-dose valaciclovir group (164 [3·3%] vs 292 [5·8%]; 0·54, 0·44-0·66). The number of episodes per person-year did not differ significantly for standard-dose valaciclovir (22·6) versus high-dose aciclovir (20·2; p=0·54), and standard-dose valaciclovir (14·9) versus high-dose valaciclovir (16·5; p=0·34), but did for no medication (28·7) and standard-dose aciclovir (10·0; p=0·001). Median episode duration was longer for no medication than for standard-dose aciclovir (13 h vs 7 h; p=0·01) and for standard-dose valaciclovir than for high-dose valaciclovir (10 h vs 7 h; p=0·03), but did not differ significantly between standard-dose valaciclovir and high-dose aciclovir (8 h vs 8 h; p=0·23). Likewise, maximum log(10) copies of HSV detected per mL was higher for no medication than for standard dose aciclovir (3·3 vs 2·9; p=0·02), and for standard-dose valaciclovir than for high-dose valaciclovir (2·5 vs 3·0; p=0·001), but no significant difference was recorded for standard-dose valaciclovir versus high-dose aciclovir (2·7 vs 2·8; p=0·66). 80% of episodes were subclinical in all study groups. Except for a higher frequency of headaches with high-dose valaciclovir (n=13, 30%) than with other regimens, all regimens were well tolerated.. Short bursts of subclinical genital HSV reactivation are frequent, even during high-dose antiherpes therapy, and probably account for continued transmission of HSV during suppressive antiviral therapy. More potent antiviral therapy is needed to eliminate HSV transmission.. NIH. Valaciclovir was provided for trial 3 for free by GlaxoSmithKline.

Topics: Acute Disease; Acyclovir; Adult; Antiviral Agents; Cross-Over Studies; DNA, Viral; Drug Administration Schedule; Female; Herpes Genitalis; Herpesvirus 2, Human; Humans; Male; Middle Aged; Polymerase Chain Reaction; Recurrence; Treatment Outcome; Valacyclovir; Valine

Herpes zoster is a common infectious disease that can result in significant acute and chronic morbidity. The safety and efficacy of once-daily oral valomaciclovir (EPB-348) was evaluated for non-inferiority to 3-times daily valacyclovir, an approved therapy. In this study, 373 immunocompetent adults with onset of a herpes zoster rash within the preceding 72 hr were randomly assigned to receive one of four treatments for 7 days: (1) EPB-348 1,000 mg once-daily; (2) EPB-348 2,000 mg once-daily; (3) EPB-348 3,000 mg once-daily; or (4) valacyclovir 1,000 mg 3-times daily. A 20% margin was the reference for non-inferiority assessment. For the primary efficacy measure of time to complete crusting of the zoster rash by Day 28, non-inferiority criteria were met for once-daily EPB-348 2,000 mg and once-daily EPB-348 3,000 mg compared to 3-times daily valacyclovir. Additionally, EPB-348 3,000 mg significantly shortened the time to complete rash crusting by Day 28 compared to valacyclovir. For secondary efficacy measures, non-inferiority was achieved for the EPB-348 1,000 and 2,000 mg groups compared to the valacyclovir group for time to rash resolution by Day 28. No EPB-348 group was non-inferior to valacyclovir for time to cessation of new lesion formation or time to cessation of pain by Day 120, though no significant differences occurred between treatment groups. Nausea, headache, and vomiting were the most common adverse events. Based on these results, additional studies are warranted to define further EPB-348's potential as an effective and safe therapy for acute herpes zoster.

Topics: Acute Disease; Acyclovir; Antiviral Agents; Double-Blind Method; Female; Guanine; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunocompetence; Male; Middle Aged; Treatment Outcome; Valacyclovir; Valine

The treatment of postherpetic neuralgia (PHN) continues to be a challenge in clinical pain management. In this randomized, controlled study, we assessed the effectiveness of repetitive paravertebral injections with local anesthetics and steroids for the prevention of PHN in patients with acute herpes zoster.. One hundred thirty-two patients with acute herpes zoster diagnosed 1-7 days after the onset of the rash were randomly assigned to receive either standard therapy (oral antivirals and analgesics) or standard therapy with additional repetitive paravertebral injections of a mixture of 10 mL 0.25% bupivacaine and 40 mg methylprednisolone acetate every 48 h for a week. Efficacy was evaluated at 1, 3, 6, and 12 mo after the end of the treatments. The primary end point was the proportion of patients with zoster-associated pain and/or allodynia 1 mo after inclusion. Statistical analysis was performed based on the intent-to-treat population.. One hundred thirteen patients completed the 1-yr follow-up. At 1 mo posttherapy, 13% of patients in the paravertebral group reported zoster-related pain, compared with 45% in the standard group (P < 0.001). At 3, 6, and 12 mo posttherapy, the incidence of PHN was still significantly lower in the paravertebral group than in the standard group. The quality of life improved in both groups at each follow-up time point with no significant difference between groups.. Repetitive paravertebral anesthetic block in combination with steroids plus standard treatment with acyclovir and analgesics significantly reduced the incidence of PHN than the standard treatment alone.

Topics: Acute Disease; Acyclovir; Administration, Oral; Aged; Analgesics; Anesthetics, Local; Antiviral Agents; Bupivacaine; Drug Administration Schedule; Drug Combinations; Drug Therapy, Combination; Female; Herpes Zoster; Humans; Injections; Male; Methylprednisolone; Methylprednisolone Acetate; Middle Aged; Nerve Block; Neuralgia, Postherpetic; Pain Measurement; Prospective Studies; Quality of Life; Steroids; Time Factors; Treatment Outcome

Cytomegalovirus (CMV) disease is a risk factor for allograft rejection in renal transplant (RTx) recipients. However, the role of asymptomatic CMV infection remains controversial.. To determine the impact of CMV disease and asymptomatic infection on biopsy-proven acute rejection (BPAR) during 12 months post-RTx.. A total of 106 consecutive RTx recipients at risk for CMV (donor and/or recipient CMV seropositive) were followed prospectively for 12 months post-RTx. CMV activity was monitored using nested PCR from whole blood. Three-month prophylaxis with valacyclovir or ganciclovir was given to 94 patients. BPAR episodes were classified according to the Banff 97 criteria. Multivariate Cox proportional hazards model was used to estimate the effect of CMV disease, asymptomatic infection, and other covariates on BPAR.. Asymptomatic CMV infection occurred in 23% of the patients and 10% developed CMV disease. The incidence of BPAR was 29%. CMV disease was an independent risk factor for BPAR (HR=3.0, P=0.014), while asymptomatic CMV infection was not (P=0.987). In addition to CMV disease, expanded criteria donor and donor age were independent predictors for BPAR. In univariate analysis, valacyclovir (HR=0.26, P=0.008) decreased the risk of BPAR. A similar trend was observed with ganciclovir (HR=0.42, P=0.058). Only valacyclovir remained significant in multivariate analysis (HR=0.18, P=0.044).. CMV disease, but not asymptomatic infection, is an independent risk factor for BPAR during the first 12 months post-RTx.

Topics: Acute Disease; Acyclovir; Antiviral Agents; Carrier State; Cytomegalovirus; Cytomegalovirus Infections; Female; Ganciclovir; Graft Rejection; Humans; Incidence; Kidney Transplantation; Male; Middle Aged; Multivariate Analysis; Postoperative Complications; Prospective Studies; Risk Factors; Treatment Outcome; Valacyclovir; Valine

We tested whether health related quality of life (HRQOL) predicts mortality, development of active cytomegalovirus (CMV) disease, and study retention. We studied 957 patients with CD4 counts <100 cells/mm(3) in AIDS Clinical Trials Group Protocol 204, a randomized, double-blind trial comparing three prophylactic regimens against CMV end-organ disease. The MOS-HIV, a brief HRQOL questionnaire, generated physical health summary (PHS) and mental health summary (MHS) scores. We used Cox proportional hazards to predict events by baseline HRQOL, adjusted for treatment, demographics, and CD4. Each point increase in baseline PHS decreased the risk of death by 4%, CMV by 2%, and dropout by 2%. Each point increase in baseline MHS decreased the risk of death by 4% and study dropout by 1%. In conclusion, self-rated physical and mental health demonstrated predictive validity for survival, CMV end-organ disease, and retention in advanced HIV patients. The results show the clinical importance of HRQOL and may facilitate interpretation by clinicians.

Topics: Acute Disease; Acyclovir; Adult; Age Factors; Anti-HIV Agents; Cytomegalovirus Infections; Double-Blind Method; Health Status; HIV Infections; Humans; Middle Aged; Patient Dropouts; Predictive Value of Tests; Proportional Hazards Models; Psychiatric Status Rating Scales; Quality of Life; Racial Groups; Sex Factors; Survival Rate; Valacyclovir; Valine

Topics: Acute Disease; Acyclovir; Antiviral Agents; Cadaver; Cyclosporine; Cytomegalovirus Infections; Drug Therapy, Combination; Emulsions; Graft Rejection; Histocompatibility Testing; Humans; Immunosuppressive Agents; Kidney Transplantation; Living Donors; Muromonab-CD3; Mycophenolic Acid; Prednisone; Reoperation; Time Factors; Treatment Outcome

A widely held view is that any increase in the potency of an immunosuppressive agent will lead to an increase in infection and malignancy, such as life-threatening Epstein-Barr virus (EBV) induced posttransplant lymphoproliferative disorders (PTLD). We tested this paradigm by studying the effect of adding mofetil to a steroid-free protocol under cover of high-dose aciclovir prophylaxis on the number of acute rejections, EBV infections and PTLDs after kidney transplantation.. EBV serology was performed in 267 consecutive renal transplantations (1990-1997). All were treated with cyclosporine with an initial 10-day antilymphocyte globulin course, supplemented from September 1995 with MMF. In 208 consecutive transplantations after June 1992 aciclovir 3200 mg/day was given for 3 months posttransplantation.. After an observation period of up to 7 years we found that: (1) primary or reactivated EBV infection (PREBV) was correlated to acute rejection (treated with OKT3; P<0.00005) and to the incidence of PTLD (P=0.03; P=0.01, if Hodgkin's disease is included); (2) aciclovir protected against PREBV (P<0.00005) and (3) adding mofetil to the immunosuppressive protocol reduced PREBV further (P=0.0001), (4) in 78 transplantations treated with cyclosporine/antilymphocyte globulin/mofetil we observed only 10 acute rejections (P=0.0001), 10 PREBVs (P<0.00005), and no PTLDs compared with the cyclosporine/antilymphocyte globulin group (P=0.04).. Supplemental immunosuppression with mofetil protects against acute rejection. In combination with aciclovir, there is also a reduction in the number of PREBVs, apparently as a result of both direct viral prophylaxis and better rejection control, and in the incidence of EBV-induced PTLD.

Topics: Acute Disease; Acyclovir; Adolescent; Adult; Antilymphocyte Serum; Antiviral Agents; Child; Female; Graft Rejection; Herpesviridae Infections; Herpesvirus 4, Human; Humans; Immunosuppressive Agents; Incidence; Kidney Transplantation; Lymphoproliferative Disorders; Male; Middle Aged; Muromonab-CD3; Mycophenolic Acid; Prospective Studies; Retrospective Studies

Topics: Acute Disease; Acyclovir; Adolescent; Adult; Aged; Aged, 80 and over; Antiviral Agents; Female; Herpes Zoster; Humans; Male; Middle Aged; Neuralgia; Single-Blind Method

To evaluate the relief of acute pain and possible preventive effects on postherpetic neuralgia through the use of an epidural blockade in the acute stage of herpes zoster.. Prospective, nonrandomized, comparative clinical trial.. A dermatologic clinic in a university hospital.. Sixty-five consecutive patients with pain due to acute herpes zoster were treated for a 7-day hospitalization period from July 1, 1996, through June 30, 1997.. The consecutive patients were divided into 2 groups. Group A consisted of 30 patients who were seen from July 1, 1996, through December 31, 1996, and who were treated with intravenous acyclovir (5 mg/kg) for 7 days. Group B consisted of 35 patients who were seen from January 1, 1997, through June 30, 1997, and who were treated with intravenous acyclovir (5 mg/kg) and an epidural blockade for 7 days. The changes in the intensity of pain and the total duration of pain in both groups were assessed for 12 to 18 months.. The number of days required for relief of pain and the total duration of pain.. The mean +/- SD number of days required for relief of pain, which was rated on a scale of 100 (worst pain) to 0 (no pain), was significantly fewer in group B than in group A: it took 2.6 +/- 1.1 days to go from 100 to 50 on the relief-of-pain scale in group B, but 3.8 +/- 1.1 days in group A (P = .03), and 12.5 +/- 6.4 days to go from 100 to 10 in group B, but 20.1 +/- 14.6 days in group A (P = .04). The duration of late residual pain was significantly shorter in group B (5.9 +/- 5.8 days) than in group A (11.9 +/- 7.5 days) (P = .03). The total duration of pain was also significantly shorter in group B (18.5 +/- 9.3 days) than in group A (31.6 +/- 17.6 days) (P = .04).. We believe that an epidural blockade combined with an antiviral agent is a very effective treatment modality for the pain of acute herpes zoster, and we recommend its use for the prevention of postherpetic neuralgia, with a view to shortening the total duration of pain, especially late residual pain.

Topics: Acute Disease; Acyclovir; Adult; Aged; Aged, 80 and over; Analgesia, Epidural; Analysis of Variance; Anesthetics, Local; Antiviral Agents; Bupivacaine; Female; Follow-Up Studies; Glucocorticoids; Herpes Zoster; Humans; Injections, Intravenous; Male; Methylprednisolone; Middle Aged; Nerve Block; Neuralgia; Pain Measurement; Prospective Studies; Time Factors

Posttransplantation cytomegalovirus (CMV) infection remains a significant cause of morbidity in kidney transplant recipients. We performed a randomized prospective controlled trial of oral acyclovir versus oral ganciclovir for CMV prophylaxis in a group of renal allograft recipients considered at high risk for CMV disease due to the use of OKT3 induction therapy.. A total of 101 recipients of cadaveric (83) and zero haplotype-matched live donor (18) kidney transplants were entered into the trial. A total of 22 D-R- patients received no prophylaxis. Twenty-seven D+R-, 29 D+R+, and 23 D-R+ patients were randomized to receive 3 months of either oral acyclovir (800 mg q.i.d.) or oral ganciclovir (1000 mg t.i.d.). Doses were adjusted according to the level of renal function. The D+R- patients were also given CMV immune globulin biweekly for 16 weeks. Surveillance blood cultures were obtained at transplantation, at months 1, 2, 3, and 6, and when clinically indicated. The primary study end points were time to CMV infection and disease the first 6 months after transplantation.. The mean follow up was 14.4 months. Both agents were well tolerated, and no drug interruptions for toxicity occurred. CMV was isolated in 14 of 39 (35.9%) acyclovir-treated and 1 of 40 (2.5%) ganciclovir-treated recipients by 6 months (P=0.0001). Symptomatic CMV disease occurred in 9 of 14 (64%) of the acyclovir patients, two with tissue-invasive disease. Infection rates for acyclovir vs. ganciclovir, respectively, stratified by CMV serology were: D+R-, 54 vs. 0%, P=0.0008; D+R+, 43 vs. 6.6%, P=0.01; D-R+, 8.3 vs. 0%, P=NS. No patient developed CMV infection while taking oral ganciclovir, however three delayed infections occurred 2-7 months after finishing therapy. Each patient had been previously treated for acute rejection.. Oral acyclovir provides effective CMV prophylaxis only for recipients of seronegative donor kidneys. Oral ganciclovir is a superior agent providing effective CMV prophylaxis for recipients of seropositive donor kidneys. Recipients who are treated for acute rejection are at risk for delayed CMV infection during the first posttransplantation year.

Topics: Acute Disease; Acyclovir; Administration, Oral; Adult; Antiviral Agents; Cytomegalovirus Infections; Female; Ganciclovir; Graft Rejection; Humans; Immunization, Passive; Immunoglobulins; Immunoglobulins, Intravenous; Kidney Transplantation; Male; Middle Aged; Prospective Studies

The clinical efficacy and safety of sorivudine as treatment for acute cutaneous zoster in human immunodeficiency virus-infected adults was compared with that of acyclovir in a double-blinded randomized study. A total of 125 patients with laboratory-confirmed zoster rash present for < or =72 h were assigned treatment with either 40 mg of sorivudine once daily or 800 mg of acyclovir five times daily, both taken orally for 7 days. Patients were assessed daily until all lesions crusted and then monthly for 6 months for postherpetic neuralgia (PHN) and for 12 months for recurrent or new episodes of zoster. Sorivudine significantly shortened the median period of new vesicle formation from 3.0 to 4.0 days (log rank P = .0001). Sorivudine was effective regardless of duration of rash before treatment. Zoster recurrences and new episodes were experienced by fewer patients assigned sorivudine (11%) than acyclovir (26%, P = .037). No differences were seen in incidence, severity, or duration of either acute neuritis or PHN. Both treatments were well tolerated.

Topics: Acute Disease; Acyclovir; Adolescent; Adult; Antiviral Agents; Arabinofuranosyluracil; Double-Blind Method; Herpes Zoster; HIV Infections; Humans; Middle Aged; Patient Compliance

To evaluate (a) the prophylactic effect of the antiherpetic drug acyclovir on oral ulcers in patients with acute myeloid leukaemia receiving remission induction chemotherapy and thus (b), indirectly, the role of herpes simplex virus in the aetiology of these ulcers.. Randomised, double blind, placebo controlled trial.. 74 herpes simplex virus seropositive patients aged 18-84. Thirty seven patients received acyclovir (800 mg by mouth daily) and 37 placebo. The patients were examined daily for 28 days.. Occurrence of herpes labialis, intraoral ulcers, and acute necrotising ulcerative gingivitis.. The two populations were comparable in age, sex, type of antineoplastic treatment, and history of herpes labialis. Acute oral infections occurred in 25 of the acyclovir treated patients and 36 of the placebo treated patients (relative risk 0.69 (95% confidence interval 0.55 to 0.87)). This difference was due to a reduction in the incidence of herpes labialis (one case versus eight cases; relative risk 0.13 (0.02 to 0.95)), intraoral ulcers excluding the soft palate (one case versus 13 cases; relative risk 0.08 (0.01 to 0.56)), and acute necrotising ulcerative gingivitis (one case versus eight cases; relative risk 0.13 (0.02 to 0.95)). However, ulcers on the soft palate were diagnosed with similar frequency in the two groups. Isolation of herpes simplex virus type 1 in saliva was reduced from 15 cases in the placebo group to one case in the acyclovir group (relative risk 0.07 (0.01 to 0.48)).. Intraoral ulcers excluding the soft palate are most often due to infection with herpes simplex virus, whereas ulcers on the soft palate have a non-herpetic aetiology. The findings suggest that acute necrotising ulcerative gingivitis may also be due to herpes simplex virus. Prophylaxis with acyclovir should be considered for patients with acute myeloid leukaemia during remission induction therapy.

Topics: Acute Disease; Acyclovir; Adolescent; Adult; Aged; Aged, 80 and over; Double-Blind Method; Female; Gingivitis, Necrotizing Ulcerative; Herpes Labialis; Herpes Simplex; Humans; Leukemia, Myeloid; Male; Middle Aged; Mouth Diseases; Opportunistic Infections; Stomatitis, Herpetic; Ulcer

Acyclovir given for 7 to 10 days is of proved benefit in acute herpes zoster, but studies of its effectiveness in preventing postherpetic neuralgia have had conflicting results. The role of corticosteroids in the treatment of herpes zoster is also controversial.. We conducted a double-blind, controlled trial in patients with acute herpes zoster to determine whether either 21 days of acyclovir therapy or the addition of prednisolone offered any improvement over 7 days of acyclovir therapy. Patients with a rash of less than 72 hours' duration were assigned to receive acyclovir (800 mg orally, five times daily) for 7 days with either prednisolone or placebo, or acyclovir for 21 days with either prednisolone or placebo. Prednisolone therapy was initiated at a dose of 40 mg per day and tapered over a three-week period. Patients were assessed frequently through day 28 and then monthly through month 6 to assess postherpetic neuralgia.. Of 400 patients recruited, 349 completed the study. No significant differences were detected between the four groups in the progression of the rash (P > 0.1). With steroid therapy, a significantly higher proportion of the rash area had healed on days 7 and 14 (P = 0.02). Pain reduction was greater during the acute phase of disease in patients treated with steroids or 21 days of acyclovir (P < 0.01 and P = 0.02, respectively, on day 7; P < 0.01 for steroid therapy on day 14). However, on follow-up there were no significant differences between any of the groups in the time to a first or a complete cessation of pain. The steroid recipients reported more adverse events.. In acute herpes zoster, treatment with acyclovir for 21 days or the addition of prednisolone to acyclovir therapy confers only slight benefits over standard 7-day treatment with acyclovir. Neither additional treatment reduces the frequency of postherpetic neuralgia.

Topics: Acute Disease; Acyclovir; Adolescent; Adult; Double-Blind Method; Drug Administration Schedule; Drug Therapy, Combination; Female; Herpes Zoster; Humans; Male; Middle Aged; Neuralgia; Pain Measurement; Prednisolone; Statistics as Topic

46 patients with acute herpes zoster ophthalmicus of less than 72 hours duration were recruited into a placebo controlled trial to assess the efficacy of oral acyclovir, 800 mg 5 times daily, in preventing or modifying ocular complications and pain. Fewer acyclovir recipients developed intraocular complications and these were less severe but neither difference was statistically significant. However, active ocular disease was significantly less common in the acyclovir group (p = 0.01) at 6 months. Pain was significantly less severe in the acyclovir group between 2 and 6 months. The proportion of patients with pain scores greater than 0 was significantly lower in the acyclovir group between 2 and 3 months. Oral acyclovir appears to modify the disease process in herpes zoster ophthalmicus, to reduce the severity and incidence of postherpetic pain and especially to protect against long-term ocular complications.

Topics: Acute Disease; Acyclovir; Administration, Oral; Adult; Aged; Aged, 80 and over; Double-Blind Method; Drug Administration Schedule; Eye Diseases; Female; Follow-Up Studies; Herpes Zoster Ophthalmicus; Humans; Male; Middle Aged; Pain; Pain Measurement; Placebos; Steroids

The effects of prednisone, oral acyclovir, and radiotherapy were compared with placebo in the prevention of post-herpetic neuralgia. No treatment used was able to prevent, with statistical significance, post-herpetic neuralgia, although prednisone and acyclovir showed some pain reduction in the acute phase. Radiotherapy was of no value in either the acute or post-herpetic phase.

Topics: Acute Disease; Acyclovir; Administration, Oral; Aged; Combined Modality Therapy; Female; Herpes Zoster; Humans; Male; Middle Aged; Neuralgia; Prednisone

A double-blind, randomised trial evaluated the efficacy of oral acyclovir, 800 mg 5 times daily for 7 days, in acute herpes zoster and postherpetic neuralgia. Forty patients aged 16 years or over, presenting to their general practitioners within 3 days of rash onset, received acyclovir, while 43 patients received placebo. Acyclovir reduced the extent and duration of the rash, the spread of the rash to adjacent dermatomes and the incidence of disseminated lesions. It shortened the period of new lesion formation and reduced the incidence of ulceration. The weekly prevalence of pain was reduced on acyclovir by the fourth week, with a reduction in the monthly prevalence of chronic pain in the second and third months and a reduction in associated local neurological symptoms between months 3-6. Total analgesic use in the first 4 weeks was reduced by acyclovir, but during follow up there was no difference in the prevalence of analgesic use between groups. There were slightly fewer medical events on acyclovir in the second week, but the frequency was the same in each group for the rest of the 6 months. Biochemical and haematological tests showed no adverse effects of treatment.

Topics: Acute Disease; Acyclovir; Administration, Oral; Adolescent; Adult; Aged; Aged, 80 and over; Analgesics; Clinical Trials as Topic; Double-Blind Method; Drug Administration Schedule; Family Practice; Female; Follow-Up Studies; Herpes Zoster; Humans; Male; Middle Aged; Neuralgia; Random Allocation; Tablets

Oral acyclovir, 800 mg five times per day for seven days, was compared with placebo in a randomized, double-blind trial conducted at three centers in the United Kingdom. The study group consisted of 364 elderly immunocompetent patients with herpes zoster who were entered within 72 hours of the onset of rash. Acyclovir significantly reduced the times to last new lesion formation (p less than 0.01), loss of vesicles (p less than 0.01), and full crusting (p = 0.03). No significant hastening of rash healing was seen in those who started therapy later than 48 hours after the onset of rash. There was also a significant reduction pain during treatment with acyclovir (p = 0.02). Acyclovir produced no effects on the frequency or severity of post-herpetic neuralgia. No clinically important adverse effects of acyclovir were reported.

Topics: Acute Disease; Acyclovir; Clinical Trials as Topic; Double-Blind Method; Drug Administration Schedule; Female; Herpes Zoster; Humans; Male; Middle Aged; Placebos; Random Allocation; Time Factors

Previous studies have shown that intravenous acyclovir does modify rash development, reduce viral shedding and alleviate acute pain in herpes zoster. To assess the clinical efficacy of an oral dosage regimen with 800 mg acyclovir five times daily, double-blind, placebo-controlled studies were carried out at three centres within the U.K., using a common protocol. According to inclusion criteria (immune competent patients over 60 years of age with a clinical diagnosis of herpes zoster with rash of no more than 72 h duration, no previous systemic antiviral treatment, no history of renal insufficiency) 205 patients were recruited after they had given their informed consent. Patients were randomly assigned to receive either two 400 mg tablets acyclovir (41 men, 59 women) or matching placebo (46 men, 59 women) five times daily for seven days. Treatment was predominantly domiciliary based. According to clinical assessment and pain score acyclovir recipients showed a significant benefit in terms of reduction in rash progression if treatment was started within 48 h of the onset of rash, and alleviation of pain during the acute phase of herpes zoster. Overall, the number of patients developing extradermal lesions was significantly lower in the acyclovir group than in the placebo group (p = 0.02). However, there were no significant differences in rash progression and pain response in patients with herpes zoster affecting the ophthalmic division of the trigeminal nerve in patients who received acyclovir (n = 21) compared to those who received placebo (n = 32). 12 acyclovir and 13 placebo recipients reported symptoms, predominantly gastrointestinal in nature, possibly or probably related to therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Acute Disease; Acyclovir; Administration, Oral; Aged; Aged, 80 and over; Clinical Trials as Topic; Double-Blind Method; Female; Herpes Zoster; Humans; Immunocompetence; Male; Middle Aged; Random Allocation

Bone marrow transplantations were performed on 15 patients (aged 5-39 years) with severe aplastic anaemia. Twelve patients are alive 76-1930 days (median 668 d) after transplantation, with complete haematopoetic recovery. Total-body radiation with 3.6 Gy in four patients, cyclosporin A administration to ten patients and buffy-coat transfusion to nine patients entirely prevented early rejection. Two patients died of pneumonia (aspergillus; varicella-zoster virus), one patient died of bleeding from a splenic-artery aneurysm. In patients under the age of 40 years with severe aplastic anaemia bone marrow transplantation as early as possible after diagnosis is the treatment of choice if HLA-identical siblings are available as donors. In patients over 40 years treatment should at first be tried with antithymocyte globulin.

Topics: Acute Disease; Acyclovir; Adolescent; Adult; Anemia, Aplastic; Blood Transfusion; Bone Marrow Transplantation; Child; Child, Preschool; Cyclophosphamide; Cyclosporins; Cytomegalovirus; Cytomegalovirus Infections; Female; Graft Rejection; Humans; Immune Sera; Immunization, Passive; Immunoglobulins; Immunoglobulins, Intravenous; Leukocyte Transfusion; Male; Methotrexate; Whole-Body Irradiation

Shedding of Epstein-Barr virus (EBV) into saliva was studied in 31 patients with verified acute infectious mononucleosis. The patients had been randomized for intravenous treatment with acyclovir (ACV) at 10 mg/kg body weight at 8 h intervals for 7 days, or placebo, in a double-blind trial. EBV in centrifuged throat washings was detected by transformation of umbilical cord lymphocytes and by immunofluorescence staining for EBV-associated nuclear antigen in fixed cell smears. Saliva samples were obtained before and during treatment, and after 4 weeks and 6 months, respectively. ACV effectively but transiently interrupted EBV production (P less than 0.001), but virus shedding resumed at the initial level within 3 weeks of cessation of the treatment. Initially, 93.5% of the patients had detectable EBV in the saliva compared with 83% in the 4th week and 58% after 6 months.

Topics: Acute Disease; Acyclovir; Adolescent; Adult; Clinical Trials as Topic; Double-Blind Method; Herpesvirus 4, Human; Humans; Infectious Mononucleosis; Oropharynx; Random Allocation; Saliva

Oral acyclovir at a dose of 800 mg five times daily for seven days was compared with placebo in a randomised double blind trial conducted at three centres in the United Kingdom. The study group comprised 205 elderly immune competent patients suffering from herpes zoster who were entered within 72 hours of the onset of rash. Acyclovir significantly reduced the times to arrest of new lesion formation (p = 0.005), loss of vesicles (p less than 0.001), and full crusting (p = 0.02) in those patients entered within 48 hours of the onset of rash. In addition, there was a significant reduction in pain during treatment with acyclovir as compared with placebo (p = 0.008). Of the patients with severe pain on entry, 40% (10/25) of those treated with acyclovir had no or only mild pain at the end of treatment, whereas in the placebo group all had residual moderate or severe pain (p less than 0.001). No clinically important adverse effects of acyclovir were reported. Oral acyclovir may modify acute herpes zoster and reduce pain.

Topics: Acute Disease; Acyclovir; Administration, Oral; Aged; Clinical Trials as Topic; Double-Blind Method; Female; Herpes Zoster; Humans; Male; Pain; Random Allocation

Seventy-one nonimmunocompromised patients with herpes zoster ophthalmicus, presenting within seven days of onset of characteristic skin eruption, were enrolled in a prospective, longitudinal, randomized, double-masked, placebo-controlled trial with oral acyclovir. In a previous interim report we noted more prompt resolution of dermatomal signs and symptoms with acyclovir treatment. There was also a reduction of viral shedding in acyclovir-treated patients coupled with a trend to greater rate of microdissemination of the virus in placebo-treated patients (Cobo LM, et al. Ophthalmology 1985; 92:1574-83). While further substantiating these findings, we report that a ten-day course of treatment with oral acyclovir (600 mg, five times a day) is well-tolerated and significantly reduces the incidence and severity of the most common complications of herpes zoster ophthalmicus: dendritiform keratopathy, stromal keratitis, and uveitis. While this acyclovir treatment regimen reduces the zoster-related pain during the acute phase of the disease, especially in patients treated within 72 hours of onset of skin lesions, it has no evident effect on either incidence, severity, or duration of post-herpetic neuralgia in the patients studied.

Topics: Acute Disease; Acyclovir; Administration, Oral; Female; Herpes Zoster Ophthalmicus; Humans; Male; Middle Aged; Neuralgia; Pain; Skin

Orofacial mucocutaneous infections resulting from herpes simplex virus (HSV) were detected in 40% of patients with acute leukemia. Of the 34 separate episodes, oral mucosal sites were involved in 22 cases. Evidence to support dissemination of HSV was found in 3 patients on 4 separate occasions. The relationship of neutrophil levels to the onset and resolution of lesions is examined. The value of acyclovir for treatment of these HSV-induced lesions is reported, and the question of administering this agent for routine prophylaxis against HSV in these patients is addressed.

Topics: Acute Disease; Acyclovir; Adult; Clinical Trials as Topic; Herpes Labialis; Humans; Leukemia, Lymphoid; Leukemia, Myeloid, Acute; Prospective Studies; Stomatitis, Herpetic; Time Factors

Topics: Acute Disease; Acyclovir; Administration, Oral; Adult; Aged; Clinical Trials as Topic; Double-Blind Method; Female; Herpes Zoster Ophthalmicus; Humans; Male; Middle Aged; Random Allocation

Topics: Acute Disease; Acyclovir; Adult; Clinical Trials as Topic; Creatinine; Female; Herpes Zoster; Humans; Infusions, Parenteral; Male; Nausea; Vomiting

In a double-blind, randomised trial, immune-competent adults with acute herpes zoster received either 5 mg/kg acyclovir (17) or placebo (20) intravenously three times daily. Acyclovir significantly improved rash development, as evidenced by reducing the time of new lesion formation and the times to vesicle collapse and full crusting. Pain at the end of treatment and at three months was less in the treated group but the difference was not statistically significant. Ocular involvement was not affected.

Topics: Acute Disease; Acyclovir; Adult; Clinical Trials as Topic; Double-Blind Method; Female; Herpes Zoster; Humans; Male; Random Allocation

Twenty-nine adult patients with acute leukemia receiving timed sequential chemotherapy participated in a randomized, double-blind, placebo-controlled trial of acyclovir prophylaxis against reactivated herpes simplex virus infection. Patients with pretreatment antibody titers of 1:16 or greater received acyclovir or placebo starting 4 days after their initial chemotherapy. Treatment was given either for 32 days or until the patients were discharged from the hospital or until a culture-positive herpes simplex virus infection was found. Culture-positive herpes simplex virus infection developed in 11 of 15 patients who received placebo. No infection appeared in 14 patients who received acyclovir (p less than 0.00005). No obvious acute drug toxicity was seen. Recurrent infection was seen in 6 of 14 patients after cessation of acyclovir when retreated with chemotherapy, suggesting no effect on viral latency in these 6 patients. Acyclovir provided highly effective prophylaxis against reactivated herpes simplex virus infections in adult patients with acute leukemia receiving timed sequential chemotherapy.

Topics: Acute Disease; Acyclovir; Adolescent; Adult; Aged; Clinical Trials as Topic; Double-Blind Method; Female; Herpes Simplex; Humans; Leukemia; Male; Middle Aged; Random Allocation; Virus Activation

31 adults took part in a randomised, placebo-controlled, double-blind trial of intravenous acyclovir therapy (500 mg/m2 intravenously 3 times daily for 5 days) for acute herpes zoster. Acyclovir reduced pain, decreased erythema, prevented the formation of new lesions, and healed skin faster than did placebo. The duration of viral shedding was also significantly shorter in acyclovir recipients (2 days versus 5 days). However, 6(35%) of 17 acyclovir recipients had recurrence of pain after the drug was discontinued, and acyclovir did not appear to affect post-herpetic neuralgia. Acyclovir therapy was associated with a transient rise in serum creatinine levels, and may have been related to nausea and vomiting. Intravenous acyclovir was effective therapy for acute herpes zoster but the ideal treatment regimen might be a lower daily dose given for a longer period.

Topics: Acute Disease; Acyclovir; Adult; Aged; Antiviral Agents; Clinical Trials as Topic; Double-Blind Method; Female; Guanine; Herpes Zoster; Humans; Injections, Intravenous; Male; Middle Aged; Pain; Random Allocation

Topics: Acute Disease; Acyclovir; Adult; Age Factors; Aged; Antiviral Agents; Double-Blind Method; Drug Evaluation; Female; Guanine; Herpes Zoster; Humans; Male; Middle Aged; Pain

Topics: Acute Disease; Acyclovir; Aged; Clinical Trials as Topic; Double-Blind Method; Female; Guanine; Herpes Zoster; Humans; Injections, Intravenous; Male; Pain; Random Allocation

Topics: Acute Disease; Acyclovir; Adrenal Cortex Hormones; Antiviral Agents; Cerebellar Ataxia; Cerebellar Diseases; Child; Consciousness Disorders; COVID-19; COVID-19 Drug Treatment; COVID-19 Nucleic Acid Testing; Drainage; Encephalitis, Viral; Headache; Humans; Hydrocephalus; Male; Nasopharynx; Neuroimaging; SARS-CoV-2

BACKGROUND Acute cerebellitis in adults is a rare disease. The etiology is unknown but postulated to be due to primary infection or para-infection. Different presentations have been reported, which complicates the diagnosis process. CASE REPORT We report the case of a young man who presented with headache, vomiting, and vertigo. He was found to have ataxia and cerebellar signs, bradycardia magnetic resonance imaging (MRI) of the brain showed acute cerebellitis, and cerebrospinal fluid (CSF) studies showed lymphocytosis. Further investigations showed the presence of Epstein-Barr virus (EBV) immunoglobulin M (IgM) and IgG. His symptoms resolved completely with corticosteroid and antiviral treatments. CONCLUSIONS Acute cerebellitis can present in various ways. Bradycardia, along with neurological deficits, should raise the suspicion of acute cerebellitis.

Topics: Acute Disease; Acyclovir; Anti-Bacterial Agents; Anti-Inflammatory Agents; Antiviral Agents; Ataxia; Bradycardia; Ceftriaxone; Cerebellar Diseases; Dexamethasone; Epstein-Barr Virus Infections; Glucocorticoids; Humans; Immunoglobulin G; Immunoglobulin M; Lymphocytosis; Male; Young Adult

A 79-year-old man presented with chest and back pain on the right side but with no cutaneous lesions. He had received oral corticosteroids and immunosuppressants for systemic lupus erythematosus. He had spastic paraplegia, sensory disturbance in the lower limbs, and dysfunction of the bladder and bowel. He showed mononuclear-dominant pleocytosis and elevated proteins in the cerebrospinal fluid (CSF), and a decreased CSF/blood glucose ratio. Although polymerase chain reaction techniques found no varicella-zoster virus (VZV) DNA, VZV IgG antibodies were elevated in both the serum and CSF, and the VZV IgG index was dramatically elevated. MRI revealed no lesions in the brain or spine. However, somatosensory evoked potentials in the tibial nerve showed abnormal prolongation of the central sensory conduction time. We diagnosed the patient with acute myelitis associated with zoster sine herpete (ZSH). He received acyclovir and intravenous methylprednisolone pulse therapy in the early stage, and his symptoms and CSF findings completely recovered. We conclude that acute myelitis associated with ZSH should be treated as soon as possible because VZV infection may induce necrotizing myelitis if the treatment is delayed.

Topics: Acute Disease; Acyclovir; Aged; Antiviral Agents; Biomarkers; Diffusion Magnetic Resonance Imaging; Early Diagnosis; Herpesvirus 3, Human; Humans; Immunocompromised Host; Immunoglobulin G; Lupus Erythematosus, Systemic; Male; Methylprednisolone; Myelitis; Pulse Therapy, Drug; Time Factors; Treatment Outcome; Zoster Sine Herpete

Topics: Acute Disease; Acyclovir; Adult; Anti-Bacterial Agents; Antiviral Agents; Bacterial Infections; Cephalosporins; Ciprofloxacin; Female; Humans; Male; Pancreatitis; Retrospective Studies; Tertiary Care Centers; Treatment Outcome; Virus Diseases

An 89-year-old man was admitted because of persistent fever and impaired consciousness. On admission, his consciousness level was E3V3M4 according to the Glasgow Coma Scale. MRI of the brain showed high intensity lesions in the bilateral cingulate gyri. In the cerebrospinal fluid, both cell counts and glucose level were in the normal ranges. He had received antibiotics and intravenous isotonic saline. On the fifth day of hospitalization, blood examination revealed elevation of anti-herpes simplex virus (HSV) immunoglobulin M antibody, and herpes simplex encephalitis (HSE) was diagnosed. Despite treatment with acyclovir, his respiratory function and consciousness level deteriorated rapidly. On the eighth day, he died of respiratory failure. At autopsy, the brain showed multiple softenings of the gray and white matter in the hippocampus, amygdala, and temporal, insular, and cingulate cortices. Some of these lesions were hemorrhagic. Microscopic examination revealed that the lesions were necrotic and associated with perivascular inflammatory cell infiltration in the limbic system, hypothalamus, brainstem tegmentum area, and medulla. Eosinophilic intranuclear inclusions were rarely found in the astrocytes in the medulla. Immunohistochemistry revealed anti-HSV-1 antibody positive neurons in the brainstem tegmentum including reticular formation and the raphe nuclei. HSV-DNA was also detected in the postmortem cerebrospinal fluid. This was a rare case of HSE in which inflammation in the brainstem proved to be the cause of lethal respiratory failure.

Topics: Acute Disease; Acyclovir; Age of Onset; Aged, 80 and over; Antibodies, Viral; Autopsy; Biomarkers; Brain Stem; Diffusion Magnetic Resonance Imaging; Encephalitis, Herpes Simplex; Fatal Outcome; Humans; Immunoglobulin M; Male; Respiratory Insufficiency; Simplexvirus

Non-alphabetical hepatitis (Epstein Barr virus -EBV-, cytomegalovirus -CMV-, Herpes simplex virus -HSV-, varicella zoster virus -VZV-etc.) may be a mode of revelation of several underlying chronic liver diseases including autoimmune hepatitis (HAI). We report a peculiar case of acute EBV hepatitis, revealing type I autoimmune hepatitis confirmed by liver biopsy through puncture in a female patient on breast cancer treatment. The study involved a 29-year-old female patient on breast cancer treatment scheduled to receive radiotherapy and chemotherapy, hospitalized for acute severe hepatitis (fever with jaundice, hypertransaminasemia (normal AST level 47 and normal ALT level 23 and prothrombin activity 25%). The test for viral hepatitis A, B, C, and E was negative and subhepatic veins were free on doppler. Non-alphabetical hepatitis was suspected based on fever with jaundice. Patient's assessment showed recent EBV infection diagnosed on the basis of the presence of anti-VAC IgM/G and anti-EBNA Ab IgG. The patient received acyclovir for 10 days. Progression was marked by ascites. The diagnosis of autoimmune hepatitis was retained based on laboratory tests (gamma peak on serum protein electrophoresis and positive anti-nuclear antibodies) and histological examination. Clinical-biological remission was obtained with corticosteroid therapy. EBV infections should be investigated in immunocompromised patients with fever in the clinical course of acute hepatitis. Practitioners should also suspect it in patients with persistent cytolysis following an infectious episode in order to prevent the occurrence of autoimmune hepatitis, in particular in female patients, in a context of self-immunity and negative serological tests for alphabetical viral hepatitis.

Topics: Acute Disease; Acyclovir; Adult; Antiviral Agents; Ascites; Breast Neoplasms; Disease Progression; Epstein-Barr Virus Infections; Female; Glucocorticoids; Hepatitis, Autoimmune; Hepatitis, Viral, Human; Humans; Severity of Illness Index

Topics: Acute Disease; Acyclovir; Administration, Intravenous; Female; Fever; Herpes Simplex; Herpesvirus 2, Human; Humans; Pharyngitis; Young Adult

A 60-year-old man with a history of severe herpes simplex virus type 1 (HSV-1) encephalitis 2 years prior presented with acute onset of visual loss in the left eye. Dilated funduscopic examination showed retinitis and occlusive vasculitis with retinal necrosis. PCR of the vitreous fluid was positive for HSV-1, and he was diagnosed with acute retinal necrosis (ARN) due to HSV-1. The patient was treated with intravenous acyclovir and intravitreous foscarnet for 2 weeks, followed by high dose oral valacyclovir for 2 weeks. He was subsequently placed on planned life-long suppressive valacyclovir. His case demonstrates that acute visual loss concomitant with or subsequent to HSV-1 encephalitis warrants suspicion of ARN. Prompt therapy with effective antiviral medication is necessary to reduce the risk of sight-threatening complications. Chronic suppression with oral antiviral therapy after ARN is recommended to prevent involvement of the contralateral eye, though there is no consensus on the duration and dosage of antivirals.

Topics: Acute Disease; Acyclovir; Antiviral Agents; Diagnosis, Differential; Encephalitis, Herpes Simplex; Eye Infections, Viral; Foscarnet; Herpesvirus 1, Human; Humans; Intravitreal Injections; Male; Middle Aged; Ophthalmoscopes; Rare Diseases; Retinal Necrosis Syndrome, Acute; Treatment Outcome; Valacyclovir

Herpes zoster ophthalmicus (HZO) has variable initial manifestations, and acute orbital inflammation may be the first sign without apparent zoster rash. This case series is significant for presenting diverse clinical features and treatment options of HZO with acute orbital inflammation.. To report a case series of patients diagnosed as HZO with acute orbital inflammation including two cases with unique presentations.. Medical records of four patients of HZO with acute orbital inflammation were reviewed. Two men and two women with a median age of 57 years (range, 32 to 69 years) were diagnosed as having HZO with acute orbital inflammation. Initial presentations included two cases of zoster rash and two cases of orbital pain preceding vesicles. Clinical orbital findings included proptosis, ptosis, ophthalmoplegia, and decreased visual acuity. Orbital magnetic resonance image showed enlarged extraocular muscle with enhancement and optic nerve sheath enhancement in all four patients, and unilateral dacryoadenitis in one patient. All four patients were administered with systemic steroid, three patients received intravenous acyclovir, and one patient received oral acyclovir. Orbital signs improved in all patients over several months.. Herpes zoster ophthalmicus may initially present with orbital inflammatory signs, such as acute orbital myositis, perioptic neuritis, or dacryoadenitis, without zoster rash. Physicians should be aware of acute orbital inflammation as a presenting sign of HZO.

Topics: Acute Disease; Acyclovir; Adult; Aged; Antiviral Agents; Drug Combinations; Eye Infections, Viral; Female; Glucocorticoids; Herpes Zoster Ophthalmicus; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Orbital Myositis

Topics: Acute Disease; Acyclovir; Adult; Antibodies, Viral; Antiviral Agents; Cerebellar Ataxia; Female; Humans; Immunocompetence; West Nile Fever; West Nile virus

Ramsay-Hunt syndrome (RHS) is a rare complication of herpes zoster in which reactivation of latent varicella zoster virus (VZV) infection occurs in the geniculate ganglion. Major clinical findings are peripheral facial nerve palsy accompanied by ipsilateral ear pain and erythematous vesicular rash on the external ear (herpes zoster oticus) and in the mouth. Thus, diagnosis of RHS is usually clinical. However, auricular herpetic eruption is not always present, making diagnosis more difficult. This report describes a case of RHS with left facial palsy without skin lesions in 60-year-old woman. Multiple ulcers were found on her left soft palate. Polymerase chain reaction analysis on oral mucosa biopsy samples and serologic assays allowed the identification of VZV as the causal agent. Knowledge of the anatomy of the facial nerve is important for oral and maxillofacial surgeons when dealing with patients with RHS, especially in unusual and clinically misleading forms of this syndrome.

Topics: Acute Disease; Acyclovir; Antiviral Agents; Female; Glucocorticoids; Herpesvirus 3, Human; Humans; Middle Aged; Oral Ulcer; Palate, Soft; Parkinsonian Disorders; Prednisolone; Valacyclovir; Valine

Topics: Acute Disease; Acyclovir; Antiviral Agents; Child; Encephalitis, Viral; Epstein-Barr Virus Infections; Female; Herpesvirus 4, Human; Humans; Outcome Assessment, Health Care

Pyogenic tonsillitis may often be observed in the general Western population. In severe cases, it may require antibiotic treatment or even hospitalization and often a prompt clinical response will be noted. Here we present an unusual case of progressive multiple organ failure including fulminant liver failure following acute tonsillitis initially mistaken for "classic" pyogenic (that is bacterial) tonsillitis.. A 68-year-old previously healthy white man was referred with suspicion of pyogenic angina. After tonsillectomy, he developed acute liver failure and consecutive multiple organ failure including acute hemodynamic, pulmonary and dialysis-dependent renal failure. Immunohistopathological analysis of his tonsils and liver as well as serum polymerase chain reaction analyses revealed herpes simplex virus-2 to be the causative pathogen. Treatment included high-dose acyclovir and multiorgan supportive intensive care therapy. His final outcome was favorable.. Fulminant herpes simplex virus-2-induced multiple organ failure is rarely observed in the Western hemisphere and should be considered a potential diagnosis in patients with tonsillitis and multiple organ failure including acute liver failure. From a clinical perspective, it seems important to note that fulminant herpes simplex virus-2 infection may masquerade as "routine" bacterial severe sepsis/septic shock. This persevering condition should be diagnosed early and treated goal-oriented in order to gain control of this life-threatening condition.

Topics: Acute Disease; Acyclovir; Aged; Antiviral Agents; Critical Care; Herpes Simplex; Herpesvirus 2, Human; Humans; Liver; Liver Failure, Acute; Male; Multiple Organ Failure; Tonsillitis; Treatment Outcome

We describe a case of isolated acute appendicitis due to Aspergillus carneus in a neutropenic child with acute myeloid leukemia (AML) treated according to the AIEOP AML 2002/01 protocol. Despite prophylaxis with acyclovir, ciprofloxacin and fluconazole administered during the neutropenic phase, 16 days after the end of chemotherapy the child developed fever without identified infective foci, which prompted a therapy shift to meropenem and liposomial amphotericin B. After five days of persisting fever he developed ingravescent abdominal lower right quadrant pain. Abdominal ultrasound was consistent with acute appendicitis and he underwent appendectomy with prompt defervescence. PAS+ fungal elements were found at histopathology examination of the resected vermiform appendix, and galactomannan was low positive. A. carneus, a rare species of Aspergillus formerly placed in section Flavipedes and recently considered a member of section Terrei, was identified in the specimen. Treatment with voriconazole was promptly started with success. No other site of Aspergillus localization was detected. Appendicitis is rarely caused by fungal organisms and isolated intestinal aspergillosis without pulmonary infection is unusual. To our knowledge, this is the first report of infection due to A. carneus in a child and in a primary gastrointestinal infection.

Topics: Acute Disease; Acyclovir; Amphotericin B; Antifungal Agents; Appendicitis; Aspergillosis; Aspergillus; Child; Ciprofloxacin; Fluconazole; Humans; Leukemia, Myeloid, Acute; Male; Neutropenia; Pyrimidines; Voriconazole

An 81-year-old woman suffering from sarcoidosis, chronic renal failure caused by hypertention was treated by valacyclovir 500 mg/day, for the diagnosis of herpes zoster of her right back. Her consciousness gradually became worse, and 3 days after taking the drug, she was sent to the emergency department of the hospital. Her conscious level was E2V2M5 (Glasgow Coma Scale) and myoclonus especially in her lower extremities occurred. Head CT and MRI show no obvious, acute abnormal findings other than chronic ischemic lesions, while an electroencephalogram (EEG) shows periodic synchronous discharges (PSDs) and disorganized background activity. Based on these findings, she was diagnosed as valacyclovir-associated acute encephalopathy. After conservative therapy of maintenance hemodialysis, her consciousness gradually improved, and PSDs disappeared accordingly and background activity of EEG became improved. In this case report, we presented valacyclovir-associated neurotoxicity with PSDs in EEG as potentially a surrogate marker. We should be cautious to use valaciclovir which may cause drug-induced encephalopathy especially in elderly or patients with renal failure even though the dose was adjusted in advance.

Topics: Acute Disease; Acyclovir; Aged, 80 and over; Antiviral Agents; Brain Diseases; Electroencephalography; Female; Herpes Zoster; Humans; Kidney Failure, Chronic; Periodicity; Valacyclovir; Valine

Infection with the Epstein-Barr virus (EBV) is a common disease and is mainly asymptomatic during childhood, whereas infectious mononucleosis with clinical signs such as fever, pharyngitis, lymphadenopathy and hepatosplenomegaly often occurs in adolescents and adults with primary infection. Acalculous cholecystitis has been reported as a rare complication. We report herein a case of acalculous cholecystitis accompanied by infectious mononucleosis by EBV, which was treated successfully by medical treatment. A 33-year-old woman who had been admitted by fever, pharyngitis and lymphadenopathy developed a right upper quadrant pain, that was diagnosed as acalculous cholecystitis based on an imaging study. Antibiotic treatment did not resolve the symptoms, and surgical intervention was considered. We diagnosed her as having infectious mononucleosis based on a typical physical presentation and seropositivity for the EBV viral capsid antigen, suggesting that the acalculous cholecystatis might have been a complication of the EBV infection. After the administration of glucocorticoid and acyclovir, the patient became afebrile and the abdominal pain disappeared. Though acalculous cholecystitis rarely accompanies infectious mononucleosis caused by EBV, clinicians should be aware of this complication to avoid unnecessary cholecystectomy.

Topics: Acalculous Cholecystitis; Acute Disease; Acyclovir; Adult; Epstein-Barr Virus Infections; Female; Glucocorticoids; Humans; Infectious Mononucleosis

Several treatments have been described for the management of patients with herpes zoster ophthalmicus (HZO). However, the progress of these patients is usually slow, and many of them develop postherpetic neuritis (PHN). In the present paper, three clinical cases are presented, in which a significant symptomatic improvement was obtained by using a preauricular injection of a mixture of betamethasone depot combined with acyclovir. PHN did not develop in any of them.. The preauricular injection of betamethasone depot and acyclovir could be a good alternative for the management of HZO.

Topics: Acute Disease; Acyclovir; Aged; Antiviral Agents; Betamethasone; Delayed-Action Preparations; Drug Therapy, Combination; Ear; Female; Glucocorticoids; Herpes Zoster Ophthalmicus; Humans; Injections; Male; Middle Aged

Viral encephalitis are rare and potentially serious conditions with different etiologist, and not always identifiable. Our aim is to describe the etiological, clinical presentation and neurological outcome of viral encephalitis admitted in Paediatrics Intensive Care Units (PICUs) in Spain.. Observational prospective multicenter study. Children with viral encephalitis admitted to 14 PICUs, for a period of 3 years (2010-2013) were included. Polymerase chain reaction for the etiological diagnosis and neurotropic virus serology in blood and cerebrospinal fluid were used. Personal history, clinical presentation, evolution and neurological status at discharge were recorded.. 80 patients were included with a mean age of 5 years, 70% male. The most relevant clinical symptoms were decreased consciousness (86%), fever (82.4%), seizures (67%), vomiting (42%), headache (27%), agitation (25%) and dis-orientation (23%). The etiologic diagnosis was established in 35%, being more frequent herpes simplex virus and enterovirus. The outcome was discharge without sequelae in 55 patients (69%), mild to moderate sequelae in 19 (23.5%) and severe in 6 (7.5%). Two patients died.. In the Spanish PICU etiological diagnosis was established only in a third of cases of children with suspected acute viral encephalitis. Despite the clinical severity we observed a low mortality and morbidity rate. At discharge from the PICU, most children had no neurological sequelae or were mild.. Etiologia, presentacion clinica y evolucion neurologica de las encefalitis viricas graves en la edad pediatrica (estudio ECOVE).. Introduccion. Las encefalitis viricas son procesos raros y potencialmente graves, con etiologia diversa y no siempre identificable. El objetivo es describir las caracteristicas etiologicas, la presentacion clinica y la evolucion neurologica de las encefalitis viricas que ingresaron en las unidades de cuidados intensivos pediatricos (UCIP) en España. Pacientes y metodos. Estudio prospectivo multicentrico observacional. Se incluyeron los niños ingresados en 14 UCIP con diagnostico de encefalitis virica durante un periodo de tres años (2010-2013). Para el diagnostico etiologico se utilizo reaccion en cadena de la polimerasa y serologia a virus neurotropos en la sangre y el liquido cefalorraquideo. Se registraron los antecedentes personales, la presentacion clinica, la evolucion y la situacion neurologica en el momento del alta. Resultados. Se incluyeron 80 pacientes con edad media de 5 años; el 70%, varones. Los sintomas clinicos mas relevantes fueron disminucion de conciencia (86%), fiebre (82,4%), convulsiones (67%), vomitos (42%), cefalea (27%), agitacion (25%) y desorientacion (23%). Se llego al diagnostico etiologico en un 35%, y los mas frecuentes fueron virus herpes simple y enterovirus. La evolucion fue curacion sin secuelas en 55 pacientes (69%, sobre todo enterovirus, rotavirus y virus respiratorios), secuelas leves-moderadas en 19 (23,5%) y graves en seis (7,5%). Dos pacientes fallecieron. Conclusiones. En las UCIP españolas solo se realizo el diagnostico etiologico en un tercio de los niños con sospecha de encefalitis virica grave. A pesar de la gravedad clinica, hemos observado una tasa de mortalidad y morbilidad baja. La amplia mayoria son dados de alta de la UCIP con ninguna o escasa secuela neurologica.

Topics: Acute Disease; Acyclovir; Adolescent; Antiviral Agents; Brain Damage, Chronic; Child; Child, Preschool; Clarithromycin; Consciousness Disorders; Encephalitis, Viral; Female; Fever; Headache; Humans; Infant; Male; Prospective Studies; Seasons; Seizures; Serologic Tests; Spain; Treatment Outcome; Vomiting

Topics: Acute Disease; Acyclovir; Antiviral Agents; Biopsy; Cesarean Section; Female; Hepatitis, Viral, Human; Herpes Simplex; Humans; Liver; Pregnancy; Pregnancy Complications; Simplexvirus; Treatment Outcome; Young Adult

A 7 years old boy presenting with acute flaccid paralysis after Varicella zoster infection was diagnosed as having acute transverse myelitis on MRI. He recovered fully after treatment with intravenous corticosteroids and acyclovir. The occurrence of this condition during or following Varicella infection is uncommon. There are previously very few reported cases of post-Varicella acute transverse myelitis in which recovery started after 3 months of treatment. In this case complete recovery occurred in 2 weeks of treatment. This report emphasizes the need for Varicella zoster vaccine to prevent not only acute Varicella, but also its rare postinfectious neurologic sequelae.

Topics: Acute Disease; Acyclovir; Administration, Intravenous; Antiviral Agents; Chickenpox; Child; Glucocorticoids; Herpesvirus 3, Human; Humans; Male; Methylprednisolone; Myelitis, Transverse; Treatment Outcome

A young woman presented with a febrile illness in the third trimester of pregnancy. Laboratory investigation revealed severe acute hepatitis with thrombocytopenia and coagulopathy. Liver injury progressed despite emergent caesarian section and delivery of a healthy infant. Therefore, therapeutic plasma exchange (TPE) was performed on three consecutive days post-partum for a presumed diagnosis of acute liver failure (ALF) associated with pregnancy due to hemolysis, elevated liver enzymes, and low platelets (HELLP) or acute fatty liver of pregnancy (AFLP). Treatment with TPE was followed by biochemical and clinical improvement but during her recovery herpes simplex virus type 2 (HSV-2) infection was diagnosed serologically and confirmed histologically. Changes in the immune system during pregnancy make pregnant patients more susceptible to acute HSV hepatitis, HSV-related ALF, and death. The disease is characterized by massive hepatic inflammation with hepatocyte necrosis, mediated by both direct viral cytotoxicity and the innate humoral immune response. TPE may have a therapeutic role in acute inflammatory disorders such as HSV hepatitis by reducing viral load and attenuating systemic inflammation and liver cell injury. Further investigation is needed to clarify this potential effect. The roles of vigilance, clinical suspicion, and currently accepted therapies are emphasized.

Topics: Acute Disease; Acyclovir; Anti-Bacterial Agents; Antiviral Agents; Cesarean Section; Combined Modality Therapy; Dexamethasone; Emergencies; Female; Fetal Organ Maturity; Hepatitis, Viral, Human; Herpes Simplex; Humans; Hydrocortisone; Infant, Newborn; Liver Failure; Male; Plasma Exchange; Pregnancy; Pregnancy Complications; Pregnancy Complications, Infectious; Puerperal Disorders; Systemic Inflammatory Response Syndrome; Young Adult

Topics: Acute Disease; Acyclovir; Antiviral Agents; Encephalitis, Herpes Simplex; Glucocorticoids; Humans; Magnetic Resonance Imaging; Male; Methylprednisolone; Middle Aged; Pulse Therapy, Drug; Tomography, X-Ray Computed; Treatment Outcome

Topics: Acute Disease; Acyclovir; Antiviral Agents; Child; Female; Fluorescein Angiography; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Immunocompromised Host; Recurrence; Retinal Vasculitis; Uveitis, Anterior; Virus Activation; Visual Acuity

Topics: Acute Disease; Acyclovir; Antiviral Agents; Confusion; Electroencephalography; Herpes Zoster; Humans; Kidney Failure, Chronic; Male; Middle Aged; Renal Dialysis

We present a patient with polymorphic ventricular tachycardia and subsequent ventricular fibrillation with acquired long QT syndrome secondary to herpes encephalitis.

Topics: Acute Disease; Acyclovir; Antiviral Agents; Defibrillators, Implantable; Electrocardiography; Encephalitis, Herpes Simplex; Female; Foscarnet; Ganciclovir; Headache; Heart Arrest; Herpesvirus 2, Human; Humans; Long QT Syndrome; Magnetic Resonance Imaging; Meningitis, Viral; Middle Aged; Seizures; Tachycardia, Ventricular; Torsades de Pointes

Topics: Acute Disease; Acyclovir; Antiviral Agents; Chickenpox; Child; Constipation; Herpesvirus 3, Human; Humans; Laxatives; Male; Urinary Catheterization; Urinary Retention

Topics: Acute Disease; Acyclovir; Antiviral Agents; Colon; Constipation; Diagnosis, Differential; Follow-Up Studies; Herpes Zoster; Herpesvirus 3, Human; Humans; Injections, Intravenous; Intestinal Pseudo-Obstruction; Magnetic Resonance Imaging; Male; Middle Aged; Peristalsis; Radiography, Abdominal; Severity of Illness Index; Thoracic Wall

To evaluate the efficacy of treatment with gabapentin plus valacyclovir hydrochloride for the prevention of postherpetic neuralgia in patients with acute herpes zoster.. Uncontrolled, open-label study.. A private dermatology clinic.. Consecutive immunocompetent adults (age, ≥ 50 years) who presented with herpes zoster within 72 hours of vesicle formation with moderate to severe pain (≥ 4 on the 10-point Likert scale) were recruited for study participation. Intervention The patients received 1000 mg of valacylovir hydrochloride 3 times a day for 7 days plus gabapentin at an initial dose of 300 mg/d, titrated up to a maximum of 3600 mg/d, side effects permitting.. Proportion of patients with zoster pain (pain > 0) at 3, 4, and 6 months as well as average pain severity, the proportion of patients with sleep disturbance, and quality-of-life measures (determined by the Medical Outcome Study Short Form 36-Item Health Survey).. A total of 133 patients (mean age, 64.6 years) were enrolled in the study. The overall incidence of zoster pain at 6 months was 9.8%.. The combination of gabapentin and valacyclovir administered acutely in patients with herpes zoster reduces the incidence of postherpetic neuralgia. Trial Registration clinicaltrials.gov Identifier: NCT01250561.

Topics: Acute Disease; Acyclovir; Aged; Amines; Analgesics; Antiviral Agents; Cyclohexanecarboxylic Acids; Drug Therapy, Combination; Female; Gabapentin; gamma-Aminobutyric Acid; Herpes Zoster; Humans; Incidence; Male; Middle Aged; Neuralgia, Postherpetic; Valacyclovir; Valine

Topics: Acute Disease; Acyclovir; Antiviral Agents; Endoscopy, Digestive System; Esophagitis; Female; Humans; Immunochemistry; Stomatitis, Herpetic; Young Adult

Primary Epstein-Barr virus (EBV) infection often results in infectious mononucleosis and is associated with serious sequelae. No treatment is approved for EBV infection, and an antiviral intervention would be significant. The objectives of this study are to characterize the pharmacokinetics and explore the pharmacodynamics of acyclovir in plasma and oral washings of 8 subjects receiving 7 days of valacyclovir 1500 mg twice daily for EBV infectious mononucleosis. Virologic and clinical responses are assessed over 12 days. Acyclovir is measured by liquid chromatography/ultraviolet detection. EBV DNA is quantitated by TaqMan polymerase chain reaction. NONMEM VI and linear regression are used for data analysis. Acyclovir profiles in plasma and oral washings are consistent with a 1-compartment model. Final model estimates of clearance, volume of distribution, and fraction of acyclovir in oral wash supernatant are 49.9 L/h, 74.1 L, and 1.14%, respectively. The quantity of EBV DNA in oral washings and blood, and the severity of illness, measured by a graded scale, decrease during treatment. After treatment, viral rebound occurs in oral washings but not in blood, and the severity of illness continues to decline. Acyclovir pharmacokinetic parameters do not correlate with response metrics. These results support further studies of valacyclovir for EBV infectious mononucleosis.

Topics: Acute Disease; Acyclovir; Adolescent; Antiviral Agents; DNA, Viral; Dose-Response Relationship, Drug; Female; Half-Life; Herpesvirus 4, Human; Humans; Infectious Mononucleosis; Linear Models; Male; Models, Statistical; Mouth; Prospective Studies; Valacyclovir; Valine; Young Adult

Herpes simplex virus bronchopneumonitis is a clinical entity described in critically ill patients and classically associated to immunosuppression. Recent reports have shown a higher frequency of virus detection from samples obtained by bronchoalveolar lavage of immunocompetent critically ill patients undergoing mechanical ventilation. This fact suggests its role as an independent pathogenic substrate. We report the case of a female patient who was admitted after an elective surgery of rectal tumor with suspected bronchoaspiration during anesthetic induction. The patient presented persistent fever despite broad spectrum antibiotic treatment. All cultures were negative for bacterial growth. The chest X-ray did not show opacifities. Prolonged mechanical ventilation with repeated failures to wean made it mandatory to perform percutaneous tracheostomy. A fibrobronchoscopy with bronchoalveolar lavage, performed previously, showed positive result for herpes simplex virus (PCR and specific nuclear inclusions in cells). Thus, treatment was initiated with acyclovir, with clinical improvement and weaning from mechanical ventilation.

Topics: Acute Disease; Acyclovir; Adenocarcinoma; Aged; Antimetabolites, Antineoplastic; Antiviral Agents; Bronchoalveolar Lavage Fluid; Bronchopneumonia; Combined Modality Therapy; Diagnosis, Differential; Female; Fluorouracil; Herpes Simplex; Humans; Immunocompromised Host; Pneumonia, Aspiration; Pneumonia, Viral; Postoperative Complications; Radiotherapy, Adjuvant; Rectal Neoplasms; Respiration, Artificial; Respiratory Insufficiency

To describe 3 cases of an acute zonal occult outer retinopathy-like illness responsive to valacyclovir hydrochloride.. Retrospective, interventional case series.. Three patients were treated with valacyclovir and monitored by clinical examination, Goldmann visual field testing, and electroretinography.. Patients with an acute zonal occult outer retinopathy-like illness presented following progressive vision loss. This course was immediately reversed by treatment with oral valacyclovir, and visual acuity and visual field improved significantly at 1 week and 1 month. Patients remained stable without treatment during a follow-up period ranging from 1 to 3 years.. Some conditions with features of acute zonal occult outer retinopathy may be attributable to a subacute herpetic viral infection that is responsive to oral antiviral medication.

Topics: Acute Disease; Acyclovir; Adolescent; Adult; Antiviral Agents; Electroretinography; Eye Infections, Viral; Female; Herpesviridae Infections; Humans; Male; Retinal Diseases; Retrospective Studies; Scotoma; Tomography, Optical Coherence; Valacyclovir; Valine; Visual Field Tests; Visual Fields

Acute retinal necrosis, caused by the herpes family of viruses, is a rapidly progressing ocular inflammatory disorder commonly reported in adults but rarely in children. The accepted diagnostic criteria include presence of 1 or more foci of retinal necrosis, rapid progression, circumferential spread, occlusive vasculopathy, and inflammation in the vitreous and anterior chamber. We report bilateral acute retinal necrosis with encephalitis due to herpes simplex virus (HSV-2) in newborn twins.

Topics: Acute Disease; Acyclovir; Adult; Antiviral Agents; Encephalitis, Herpes Simplex; Herpes Genitalis; Herpesvirus 2, Human; Humans; Infant, Newborn; Infant, Premature; Infectious Disease Transmission, Vertical; Male; Necrosis; Retinitis; Twins

Epstein-Barr virus (EBV) infection occurring in the postoperative period represents a significant risk for pediatric transplant recipients. It presents in various manners, including a mononucleosis-like syndrome, hepatitis, encephalopathy, or posttransplant lymphoproliferative disease (PTLD). Valacyclovir has in vitro activity against EBV. We sought to review our experience with valacyclovir on peripheral blood EBV viral loads among a group of EBV-infected patients after liver transplantation (OLT).. Twelve children of ages 6-36 months (median, 12 months), underwent OLT. Eight (66%) were EBV immunoglobulin (Ig)G seronegative at the time of the operation. Eight patients developed primary infection and 4 patients developed reactivation of a post primary infection. Valacyclovir was prescribed immediately to 3 patients when we detected an acute-primary EBV infection. Valacyclovir was prescribed for 2 patients who had primary EBV infections followed by PTLD. Three patients who had primary EBV infection were administered valacyclovir after they became chronically EBV PCR positive for more than 1 year. Four out of 12 cases (33%) were EBV seropositive at the time of OLT, and underwent postprimary EBV reactivation displaying chronic EBV carrier state for 8-10 months before valacyclovir treatment. Peripheral blood EBV viral loads were tested every 2 months. The primary outcome was the proportion of subjects with EBV viremia who had a >or=2 log 10 decrease in EBV copies/mL after valacyclovir treatment. The duration of valacyclovir treatment was a median of 10 months (range, 8-11 months). At the beginning of the treatment period the median level of EBV viral load was 1.1 x 10(4) (range, 1 x 10(4) to 1 x 10(7)). EBV virus was cleared in only 1 patient with primary acute EBV infection. EBV viral loads did not change in 7 of 12 patients and decreased only 1 log 10 (n = 2) or 2 log 10 (n = 2).. In this small, non-placebo-controlled study, valacyclovir treatment was not effective to decrease peripheral blood EBV viral loads.

Topics: Acute Disease; Acyclovir; Antiviral Agents; Body Weight; Child, Preschool; Chronic Disease; Epstein-Barr Virus Infections; Humans; Infant; Liver Function Tests; Liver Transplantation; Postoperative Complications; Recurrence; Retrospective Studies; Valacyclovir; Valine; Viral Load; Virus Activation

Acute isolated sphenoid sinusitis is a relatively uncommon entity. Because its symptoms and clinical findings are nonspecific, it can be easily misdiagnosed. Left unrecognized and untreated, it can lead to several well-known and severe complications, including meningitis, cerebral abscess, cavernous sinus thrombosis, and epidural or subdural empyema. We report the case of a 28-year-old woman with acute sphenoid sinusitis complicated by ischemic stroke in the left caudate nucleus, lentiform nucleus, and posterior part of the internal capsule. The stroke was diagnosed on magnetic resonance imaging. Also, magnetic resonance angiography showed a narrowing of the internal carotid artery and a narrowing of the first part of the left anterior and middle cerebral arteries (A1 and M1 segments). The patient was treated with medical therapy, including antibiotics, and surgical drainage of the sphenoid sinus via an endoscopic approach. Her outcome was good, and she experienced minimal neurologic sequelae. We discuss the possible explanations for this rare complication.

Topics: Acute Disease; Acyclovir; Adult; Anti-Bacterial Agents; Anticoagulants; Antiviral Agents; Carotid Artery Diseases; Cefotaxime; Dalteparin; Dexamethasone; Female; Glucocorticoids; Humans; Magnetic Resonance Angiography; Sphenoid Sinusitis; Stroke; Tomography, X-Ray Computed; Vancomycin

A detailed examination of 40 children with recurrent exudative otitis media (EOM) using enzyme immunoassay and polymerase chain reaction suggested that ENT pathology in the above children (EOM, adenoiditis, tonsillopharyngitis, sinusitis) may be a complication of acute or chronic Epstein-Barr virus infection (EBVI) because primary EBVI infection or its long-term persistence followed secondary immunodeficiency resulting in lymphoid system impairment and damage of upper airway epithelium. This causes a recurrent and persistent course of EOM. Etiotropic and pathogenetically sound treatment of children with recurrent EOM includes antiviral therapy, immunocorrection, rehabilitation with participation of pediatrician, immunologist, infection therapist.

Topics: Acoustic Impedance Tests; Acute Disease; Acyclovir; Antigens, CD; Antiviral Agents; Child; Child, Preschool; Chronic Disease; Epstein-Barr Virus Infections; Female; Humans; Immunoglobulins; Infant; Male; Otitis Media with Effusion

Topics: Abnormalities, Multiple; Acute Disease; Acyclovir; Antiviral Agents; Drug Therapy, Combination; False Negative Reactions; Female; Hepatitis, Viral, Human; Humans; Immunohistochemistry; Injections, Intravenous; Kidney Transplantation; Liver; Polymerase Chain Reaction; Simplexvirus; Syndrome; Urogenital Abnormalities; Valacyclovir; Valine; Young Adult

We report a case of subacute-onset isolated parkinsonian syndrome in a 16 years old patient. Epstein-Barr infection was diagnosed according to serologic evidences. Parkinson-like syndrome completely recovered after 60 days. Autoantibodies reacting against a 130 Kda antigens expressed in human neuroblastoma cell line were detected. Pathogenesis and differential diagnosis are briefly discussed. EBV testing could be worthwhile in juvenile, acute-onset, parkinsonism.

Topics: Acute Disease; Acyclovir; Adolescent; Antiviral Agents; Autoantibodies; Blotting, Western; Cell Line, Tumor; Encephalitis, Viral; Epstein-Barr Virus Infections; Humans; Male; Neuroblastoma; Neurons; Parkinsonian Disorders

Eczema herpeticum is an acute, disseminated herpes simplex virus infection which remains a feared complication of eczematous skin diseases, especially atopic dermatitis. The vesicular and erosive clinical picture is often accompanied by systemic signs and symptoms. Why some atopic patients experience multiple attacks of eczema herpeticum and others never have the disorder remains a mystery. Patients with severe or untreated atopic dermatitis are more likely to be affected. The pathogenesis appears to involve a complex interplay of factors, including demasking of binding sites for the virus through the dermatitis, failure to up-regulate antiviral proteins and a lack of plasmacytoid dendritic cells. Treatment of choice is systemic acyclovir therapy.

Topics: Acute Disease; Acyclovir; Administration, Oral; Adult; Antiviral Agents; Child; Dermatitis, Atopic; Diagnosis, Differential; Female; Glucocorticoids; Herpes Simplex Virus Vaccines; Humans; Kaposi Varicelliform Eruption; Male; Risk Factors; Time Factors

Topics: Acute Disease; Acyclovir; Adult; Antiviral Agents; Cerebellar Ataxia; Diagnosis, Differential; Female; Herpesvirus 3, Human; Humans; Risk Factors

Exacerbation of genital herpes simplex is followed by suppression of immunocompetence of patients. This proves necessity of adjuvant immunocorrective therapy. In our previous investigations it was shown that plaferon LB possessed immunotropic effect, and phenowine (as an antioxidant remedy) was intensifying the action of plaferon. These data allow us to examine protective action of plaferon and phenowine in complex treatment of genital herpes. High-performance scheme of herpetic relapse was suggested, which was established on aetiotropic effect of acyclovir and immunomodulating action of plaferon and phenowine: satisfactory outcome in 92,1 percent (monotherapy with acyclovir--70,7%). Results of complex therapy appeared in reduction of period of acute infection (on average 2,3 days) and in prolongation of remission (on average 157,3 days, vs 88,5 days in control group). Therapeutic action was achieved by antiviral properties of acyclovir and plaferon, immunostimulating action of plaferon and antioxidant effect of phenowine.

Topics: Acute Disease; Acyclovir; Adjuvants, Immunologic; Antioxidants; Antiviral Agents; Drug Therapy, Combination; Female; Herpes Genitalis; Humans; Neuropeptides; Phytotherapy; Plant Extracts; Time Factors; Treatment Outcome; Vitis; Vulvovaginitis

We compared bedside tests of vestibulo-ocular function (head thrust and head heave signs) with caloric testing results in 68 patients with acute vestibular neuritis seen at onset and in follow-up for one year. The head thrust and head heave signs each were strong predictors of a decreased probability of recovery, and if both were present, there was a trend for a slower recovery and a further decrease in the probability of recovery. If the head thrust sign was absent, recovery was assured. Our results suggest that careful bedside testing of semicircular canal (head thrust maneuver) and otolith (head heave maneuver) function provides useful information for predicting prognosis in patients with acute vestibular neuritis.

Topics: Acute Disease; Acyclovir; Adolescent; Adrenal Cortex Hormones; Adult; Aged; Aged, 80 and over; Calorimetry; Female; Follow-Up Studies; Head Movements; Humans; Male; Middle Aged; Motor Activity; Multivariate Analysis; Point-of-Care Systems; Prognosis; Time Factors; Vertigo

To describe a case of limbic encephalitis which initially presented as viral limbic encephalitis and during the clinical evaluation a renal carcinoma was diagnosed.. Patient with history of peripheral paresis of right facial nerve, 1 month after symptoms appearance and treatment, developed fever, vomiting, grand mal seizure, decreased level of consciousness, confusion, hallucinations and agitation. The patient initially presented a clinical picture of viral LE. which confirmed by CSF. MRI brain showed areas with pathological intensity signal in the region of limbic system unilateral. During the clinical evaluation a renal carcinoma was discovered and a nephrectomy has been performed.. Although PLE typically presents as a chronic or subacute disease, it may be fulminant and clinically indistinguishable from an acute HSVE. This association pose the problem of a possible relation between this two syndromes and the correct diagnosis is very important, because there are effective treatments.

Topics: Acute Disease; Acyclovir; Anti-Bacterial Agents; Anticonvulsants; Carcinoma, Renal Cell; Cerebrospinal Fluid; Diagnosis, Differential; Drug Therapy, Combination; Electroencephalography; Encephalitis, Viral; Enoxaparin; Ethambutol; Follow-Up Studies; Herpesvirus 1, Human; Humans; Isoniazid; Limbic Encephalitis; Limbic System; Magnetic Resonance Imaging; Male; Meningoencephalitis; Methylprednisolone; Middle Aged; Nephrectomy; Neuropsychological Tests; Paraneoplastic Syndromes, Nervous System; Phenytoin; Rifampin; Time Factors; Tomography, X-Ray Computed; Treatment Outcome; Vancomycin

Topics: Acute Disease; Acyclovir; Adult; Antiviral Agents; Chickenpox; Herpesvirus 3, Human; Humans; Male; Nepal; Panuveitis; Seasons

Adverse neurological and renal effects can occur in patients taking acyclovir. Neurotoxicity of acyclovir results from an accumulation of the antiviral and its metabolites in the bloodstream. This can be observed in the elderly or in patients with chronic renal failure, generally in dialysis patients. Acute renal failure results from intratubular crystallization of acyclovir.. A 78-year-old right-handed woman was admitted in an emergency setting for aphasia. Analysis of the cerebrospinal fluid was normal, but herpetic meningo-encephalitis was suspected and intravenous treatment was initiated with acyclovir. After the second infusion, the patient began to suffer from visual hallucinations, confusion and acute renal failure. Herpes PCR was negative in the cerebrospinal fluid, and the adverse drug reactions regressed completely after 72 hours.. Renal function has to be checked often in patients given acyclovir for appropriate dose titration. Patients recover prompt from the adverse effects at drug withdrawal.

Topics: Acute Disease; Acyclovir; Aged; Antiviral Agents; Encephalitis, Herpes Simplex; Female; Humans; Neurotoxicity Syndromes; Renal Insufficiency

We present the case of a 38-yr-old woman who required an epidural blood patch in the context of acute varicella (chickenpox). The unique risks in this case include the possible triggering of central nervous system complications after the introduction of viremic blood into the epidural or intrathecal space. However, the risk was believed to be acceptable because the patient was receiving antiviral coverage. She enjoyed complete relief of her headache but experienced transient back and leg pain. Leptomeningeal irritation caused by acute varicella infection may put patients at increased risk for pain after epidural blood patch.

Topics: Acute Disease; Acyclovir; Adult; Antiviral Agents; Blood Patch, Epidural; Chickenpox; Female; Headache; Humans; Magnetic Resonance Imaging; Pain; Spinal Cord; Valacyclovir; Valine

To determine the prognostic value of nasociliary skin lesions (Hutchinson's sign) for ocular inflammation and corneal sensory denervation in acute herpes zoster ophthalmicus.. A longitudinal observational study with a 2-month follow-up was performed involving 83 non-immunocompromised adults with acute herpes zoster ophthalmicus, with a skin rash duration of less than 7 days, referred by their general practitioner. All skin lesions at the tip, the side and the root of the nose, representing the dermatomes of the external nasal and infratrochlear branches of the nasociliary nerve, were documented by taking photographs and marking anatomical drawings. Ocular inflammatory signs were observed by slit-lamp biomicroscopy, and corneal sensitivity was measured with the Cochet-Bonnet esthesiometer at 2-month follow-up.. Hutchinson's sign was a powerful predictor of ocular inflammation and corneal denervation in herpes zoster ophthalmicus [relative risks: 3.35 (CI 95%: 1.82-6.15) and 4.02 (CI 95%:1.55-10.42), respectively]. The manifestation of herpes zoster skin lesions at the dermatomes of both nasociliary branches was invariably associated with the development of ocular inflammation.. Clinicians should be alert for early skin lesions within the complete nasociliary dermatome, because they are a reliable prognostic sign of sight-threatening ocular complications in acute herpes zoster ophthalmicus.

Topics: Acute Disease; Acyclovir; Aged; Antiviral Agents; Cornea; Cranial Nerve Diseases; Female; Herpes Zoster Ophthalmicus; Humans; Hypesthesia; Male; Neuralgia; Neurons, Afferent; Ophthalmic Nerve; Prognosis; Skin; Skin Diseases, Viral

Topics: Acute Disease; Acyclovir; Aged; Anticonvulsants; Antiviral Agents; Carbamazepine; Diagnosis, Differential; Female; Headache; Herpes Zoster; Humans; Oxcarbazepine; Time Factors; Trigeminal Neuralgia; Valacyclovir; Valine

Topics: Acute Disease; Acyclovir; Adrenal Cortex Hormones; Cerebellar Diseases; Child; Encephalitis; Gait Ataxia; Humans; Hydrocephalus; Magnetic Resonance Imaging; Male

Varicella-zoster virus (VZV) infection was studied in 40 adult patients who underwent cord blood transplantation (CBT) from unrelated donors. Twenty-five patients developed VZV reactivation at a median of 5 months after CBT (range 1.7-26 months). The cumulative incidence of VZV reactivation after CBT was 80% at 30 months. Twenty-two patients developed localized herpes zoster. The remaining three patients developed atypical non-localized herpes zoster, which was associated with visceral dissemination in one patient. All the patients responded well to antiviral therapy. Unexpectedly, the absence of grade II-IV acute graft-versus-host disease (GVHD) was associated with a higher rate of VZV reactivation after CBT (100% versus 55%, P=0.01). These results suggest that recovery of VZV-specific immune responses after CBT is delayed even in patients without severe acute GVHD.

Topics: Acute Disease; Acyclovir; Adult; Antiviral Agents; Cord Blood Stem Cell Transplantation; Female; Follow-Up Studies; Graft vs Host Disease; Hematologic Diseases; Herpes Zoster; Herpesvirus 3, Human; Humans; Incidence; Male; Middle Aged; Proportional Hazards Models; Risk Factors; Time Factors; Transplantation Conditioning; Virus Activation

Corticosteroids are often used in the treatment of acute viral encephalitis, although the efficacy of corticosteroid therapy has not been proven. We examined the effects of high-dose corticosteroid therapy on acute viral encephalitis in 5 patients with progressive disturbances of consciousness. In 3 patients who were treated within 5 days after the onset of illness, pulse therapy dramatically reduced the degree of consciousness disturbance. They became alert within 24 h, and then neurological symptoms gradually improved. Corticosteroid therapy in the other 2 patients, in whom treatment was started more than 3 weeks after the onset of illness, was not as effective, but repeated therapy at 2-week intervals resulted in complete recovery. These findings suggest that high-dose corticosteroid therapy is effective, particularly for disturbances of consciousness, an important prognostic factor in acute viral encephalitis.

Topics: Acute Disease; Acyclovir; Adrenal Cortex Hormones; Adult; Antiviral Agents; Cell Count; Consciousness; Disease Progression; Drug Therapy, Combination; Encephalitis, Viral; Female; Glasgow Coma Scale; Globins; Glucocorticoids; Humans; Male; Methylprednisolone; Middle Aged; Pulse Therapy, Drug

To present to general dentists the typical signs and symptoms associated with adult acute (primary) herpetic gingivostomatitis. The pertinent laboratory tests, management options and current pharmacotherapy are also reviewed. REVIEW DESIGN: The clinical files of 13 adult patients were reviewed. All had no history of herpes simplex virus infection and presented with oral lesions suggestive of primary herpetic infection. The subjects were all patients of one of the investigators, and their workup included Tzanck testing and viral culture.. The patients ranged in age from 18 to 79 (mean 37.2, standard deviation 19.6) years. Nine (69%) were men. Viral culture was confirmed as the gold standard for diagnosis. The sensitivity of Tzanck testing was 77% (10/13), slightly higher than that reported previously (40% to 50%). In this patient group the febrile lymphadenopathic profile was typical of younger patients (18 to 42 years of age), whereas older patients presented with predominantly oral symptoms.. Primary herpetic gingivostomatitis is not limited to children but can affect people of any age. Proper diagnosis and treatment are essential, particularly in elderly and immunocompromised patients. Tzanck testing may serve as a useful adjunct in diagnosis. Antiviral agents such as valacyclovir and famciclovir should be considered part of early management. Dentists are often the first health care professionals to be consulted by patients with this condition, and recognition of the infection is paramount.

Topics: 2-Aminopurine; Acute Disease; Acyclovir; Adolescent; Adult; Age Factors; Aged; Antiviral Agents; Cytodiagnosis; Famciclovir; Female; Fluorescent Antibody Technique, Direct; Humans; Male; Middle Aged; Simplexvirus; Stomatitis, Herpetic; Valacyclovir; Valine; Virus Cultivation

Postherpetic neuralgia is pain that persists long after the disappearance of the cutaneous lesions of herpes zoster. However, the mechanisms of this delayed pain are unclear. Herpes simplex virus infection induces cutaneous lesions and pain-related responses in mice. The authors examined whether such responses would persist after the disappearance of the cutaneous lesions and whether some analgesics would be effective against them.. Female BALB/c mice were inoculated with herpes simplex virus type 1 on the unilateral hind paw. Pain-related responses of hind paw were determined using von Frey filaments. Beginning 5 days after inoculation, mice were given perorally the antiherpes agent acyclovir five times a day for 7 days. Effects of morphine (3-5 mg/kg subcutaneously), gabapentin (30-100 mg/kg perorally), mexiletine (10-30 mg/kg intraperitoneally), and diclofenac (30 mg/kg intraperitoneally) on pain-related responses were examined on days 25-35 after inoculation.. Viral inoculation induced cutaneous lesions and pain-related responses beginning on day 5 after inoculation. Acyclovir treatment healed all skin lesions by day 15 after inoculation. Approximately half of the mice given acyclovir showed pain-related responses at least until day 40 after inoculation. Morphine, gabapentin, and mexiletine dose-dependently inhibited pain-related responses, but diclofenac had no effects.. The authors show a mouse model of delayed postherpetic pain. This may be useful for manifesting the mechanisms of postherpetic neuralgia and the factors contributing to the transition from acute herpetic pain to delayed postherpetic pain. This may also be useful for the development of new analgesics against postherpetic neuralgia.

Topics: Acetates; Acute Disease; Acyclovir; Amines; Analgesics; Analgesics, Opioid; Animals; Antiviral Agents; Behavior, Animal; Cyclohexanecarboxylic Acids; DNA, Viral; Female; Gabapentin; gamma-Aminobutyric Acid; Herpesviridae Infections; Herpesvirus 1, Human; Mexiletine; Mice; Mice, Inbred BALB C; Morphine; Pain; Pain Measurement; Physical Stimulation

We report the case of a 43-year-old man who developed an acute encephalopathy after IVIg therapy for AIDP. Imaging studies showed predominantly posterior leukoencephalopathy. The signs and symptoms of the encephalopathy completely resolved by steroids. Two patients with acute encephalopathy, following IVIg therapy, were reported previously in the literature. However, our observation differed from them by the presence of a marked pleiocytosis of cephalospinal fluid before beginning of IgIV. Two hypothesis may be made: a post-infectious meningo-encephalo-AIDP or a complication of IgIV. This side effect, even rare, has not to be underestimated.

Topics: Acute Disease; Acyclovir; Adult; Anti-Inflammatory Agents; Antiviral Agents; Brain; Ceftriaxone; Cephalosporins; Dementia, Vascular; Drug Therapy, Combination; Humans; Immunoglobulins, Intravenous; Magnetic Resonance Imaging; Male; Polyradiculoneuropathy; Steroids

Topics: Acute Disease; Acyclovir; Adrenal Cortex Hormones; Antiviral Agents; Clinical Trials as Topic; Decompression, Surgical; Facial Paralysis; Humans; Practice Guidelines as Topic

A twenty-eight year old woman with necrotitizing retinitis and herpes simplex virus type 1 isolated in aqueous humor with polymerase chain reaction (PCR). An Acyclovir and corticosteroid therapy was started with unsuccessful response, Foscarnet was added getting quiescence of lesions.. Acute Retinal Necrosis Syndrome (ARNS), induced by a virus of the herpes family, could develop in immunocompetent people. A characteristic clinical case with uveitis and vitritis, white retinitis areas and occlusive vasculitis is reported. Antiviral therapy with acyclovir and antiinflammatory treatment must be established quickly. Foscarnet can effectively treat ARNS in inmunocompetent patients. In spite of therapy, this is a potentially blinding retinal disease.

Topics: Acute Disease; Acyclovir; Adult; Antiviral Agents; Diagnosis, Differential; Drug Therapy, Combination; Female; Foscarnet; Herpesvirus 1, Human; Humans; Keratitis, Herpetic; Necrosis; Polymerase Chain Reaction; Retina; Retinal Diseases; Time Factors

Topics: Acute Disease; Acyclovir; Antiviral Agents; Drug Therapy, Combination; Female; Fluorescein Angiography; Glucocorticoids; Humans; Indocyanine Green; Middle Aged; Prednisolone; Pupil Disorders; Retinal Diseases; Visual Acuity

This study was conducted to compare the survival rates of bone marrow transplantation (BMT) patients who were affected with the survival rates of those who were not affected by oral recrudescent human herpes virus-1 infection (HHV-1) after transplantation.. Fifty-two consecutive patients who underwent BMT were included in the study. The time of death after BMT was displayed, by means of the Kaplan-Meier method, for the following parameters: age and gender of the patient, donor gender, primary disease, stem cells, conditioning regimen, platelet number after day 100, acute and chronic graft-versus-host disease, oral recurrent HHV-1 infection post-BMT, oral lichenoid lesions of graft-versus-host disease, graft-versus-host disease at the salivary glands, parenteral nutrition, and oral mucositis. The data were initially analyzed by means of the log-rank test and then included in the Cox proportional hazards model.. The multivariate analysis demonstrated a significance of 5% for only the platelet numbers and oral recurrent HHV-1 infection.. The present study provides evidence that platelet numbers below 100,000 cells/mm(3) after day 100 and oral recurrent HHV-1 infection are independent negative prognostic variables in BMT patients' 24-month survival rates.

Topics: Acute Disease; Acyclovir; Adolescent; Adult; Age Factors; Anemia, Aplastic; Antiviral Agents; Bone Marrow Transplantation; Chronic Disease; Female; Graft vs Host Disease; Humans; Leukemia; Linear Models; Lymphoma; Male; Middle Aged; Multivariate Analysis; Platelet Count; Prognosis; Proportional Hazards Models; Recurrence; Salivary Gland Diseases; Sex Factors; Stomatitis; Stomatitis, Herpetic; Survival Rate; Tissue Donors; Transplantation Conditioning

Although the efficacy of modern antiviral agents for the treatment of herpes zoster is unquestioned, their ability to affect the associated pain remains controversial.. We have therefore evaluated the inpatient hospital records of 550 patients with herpes zoster with regard to pain-related clinical aspects and therapeutic responsiveness.. Intensity of pain was quantified by calculating a daily pain equivalence index (PEI) on the basis of different classes of pain medication and the number of tablets used in each category.. The mean age of patients was 66.7 years, cranial segments were predominantly involved (55%), 64% of patients suffered from associated diseases and 77% experienced herpes-related pain. The PEI was 0.90 in the entire patient population, with significantly higher values in women and in patients with 3 or more associated diseases. It was lower in sacral and cranial nerve involvement, and it decreased rapidly in patients prior to discharge from hospital. Although there were significant differences in hospital stay between patients who received aciclovir and those who did not (mean 20.3 vs. 23.8 days), and for high- versus low-dose oral or intravenous administration, no significant differences were noted between the two groups for initial PEI values and during the course of observation, irrespective of the route of administration or the dose of aciclovir and the individual patient's PEI value. The groups were otherwise closely similar with regard to basic demographic and clinical data. 23.3% predominantly aged female patients with more associated diseases than the total patient population had a persistently elevated PEI and stayed in hospital beyond 21 days (mean 35.1 days), representing patients who went on to postherpetic neuralgia.. These data further delineate clinical aspects of acute herpes zoster neuralgia, underline the unsolved therapeutic problems associated with this condition despite otherwise effective antiviral treatment, and characterise a subgroup of patients at risk to develop postherpetic neuralgia.

Topics: Acute Disease; Acyclovir; Administration, Oral; Adolescent; Adult; Aged; Aged, 80 and over; Antiviral Agents; Female; Germany; Herpes Zoster; Humans; Infusions, Intravenous; Length of Stay; Male; Medical Records; Middle Aged; Neuralgia; Pain Measurement; Retrospective Studies; Treatment Outcome

There remains a lack of agreement on the effect of antiviral therapy on herpes simplex virus (HSV) latency and subsequent reactivation. To gain insight into this important issue, a single-cell polymerase chain reaction assay was used to quantify the effects of high-dose acyclovir on latent infection in a mouse model. Treatment with 50 mg/kg of acyclovir every 8 h reduced the number of latently infected neurons by >90% when treatment was begun before 24 h after infection and by 80% and 70% when begun at 48 or 72 h after infection, respectively. The biologic significance of these reductions was evaluated by using a well-established in vivo reactivation model. The number of animals in which virus reactivated was reduced significantly, even when acyclovir therapy was delayed until 72 h after infection, a time when animals had developed lesions. These findings indicate that potent antiviral therapy during early primary HSV infection can reduce the magnitude of the latent infection, such that a significant decrease in reactivation is observed.

Topics: Acute Disease; Acyclovir; Animals; Antiviral Agents; Area Under Curve; Eye; Herpes Simplex; Herpesvirus 1, Human; Mice; Neurons; Simplexvirus; Trigeminal Ganglion; Virus Activation; Virus Replication

Over an eight-month period from October 1997 to May 1998, four patients who had received bone marrow transplant (BMT) from unrelated donor presented with severe mucosal cutaneous infections involving acyclovir resistant herpes simplex virus 1 (HSV-1). The four isolates were acyclovir (ACV) resistant, three of which were also foscarnet resistant as determined by the dye uptake method. The sequencing of the thymidine kinase (TK) gene did not permit to establish a relation between mutations and resistance to ACV. Three patients were considered as clinically cured of their HSV infection by replacement of ACV or foscarnet with either valacyclovir (one case) or cidofovir (two cases) but eventually two of them died of graft vs host disease. One patient died of extensive HSV infection despite administration of cidofovir. This study emphasizes the importance of monitoring the herpes virus resistance to antiviral drugs in bone marrow transplant recipients and the usefulness of the evaluation of novel antiviral drug for treatment of infections due to strains of HSV resistant to ACV and foscarnet that occur in about 5% of immunocompromised patients.

Topics: Acute Disease; Acyclovir; Adolescent; Amino Acid Substitution; Antiviral Agents; Bone Marrow Transplantation; Child; Cidofovir; Codon; Cytosine; DNA Mutational Analysis; Drug Resistance, Viral; Female; Foscarnet; Graft vs Host Disease; Herpes Simplex; Humans; Immunocompromised Host; Leukemia, Myelogenous, Chronic, BCR-ABL Positive; Leukemia, Myeloid; Lymphoma, Non-Hodgkin; Male; Mutation, Missense; Organophosphonates; Organophosphorus Compounds; Point Mutation; Salvage Therapy; Simplexvirus; Thymidine Kinase; Transplantation, Homologous; Valacyclovir; Valine; Viral Proteins; Virus Activation

Recent studies provide compelling data for the hypothesis that herpes simplex virus type I (HSV-1) is implicated in the pathogenesis of idiopathic peripheral facial palsy (Bell's palsy). The present study analyzed the severity of facial palsy in patients with HSV-1 reactivation and sought to determine the efficacy of acyclovir-prednisone therapy for these patients.. In total, 176 patients, clinically diagnosed with Bell's palsy. were divided into three groups by polymerase chain reaction (PCR) and serological tests--31 patients with HSV-1 reactivation, 45 patients with VZV reactivation (zoster sine herpete) and 100 patients without HSV-1 or VZV reactivation (Bell's palsy).. The difference in the worst grade of facial palsy between patients with zoster sine herpete and Bell's palsy was significant (P = 0.01 10, Mann-Whitney U-test). In contrast, no difference in the severity of palsy was observed between patients with HSV-1 reactivation and Bell's palsy. Twelve patients received acyclovir-prednisone treatment within 7 days of onset based on positive PCR results and ten of the 12 (83%) recovered completely. In contrast, 14 patients with HSV-1 reactivation received prednisone treatment because their PCR tests were performed at a later date; ten of these 14 (71%) recovered completely. The difference in the cure rate between the two treatment groups was not significant (P > 0.05, Fisher exact test).. The results indicate that the severity of palsy in patients with HSV-1 reactivation is similar to that in patients with Bell's palsy and suggest that early diagnosis of HSV-1 reactivation by PCR and subsequent acyclovir-prednisone therapy do not improve recovery from facial palsy.

Topics: Acute Disease; Acyclovir; Anti-Inflammatory Agents; Antiviral Agents; Bell Palsy; Drug Therapy, Combination; Herpes Simplex; Herpesvirus 1, Human; Humans; Middle Aged; Prednisone; Severity of Illness Index; Virus Activation

The current communication describes clinical findings in two recipients of allogeneic bone marrow transplantation (BMT) with varicella zoster virus infection who complained of acute severe abdominal pain preceding cutaneous manifestations. Physical examination, laboratory data and gastroscopic findings were nonspecific. In these cases, acyclovir was very effective for the symptoms. Varicella zoster virus infection should be suspected in BMT recipients who have rebellant acute abdominal pain but no characteristic skin eruptions.

Topics: Abdominal Pain; Acute Disease; Acyclovir; Adolescent; Adult; Antiviral Agents; Bone Marrow Transplantation; Herpes Zoster; Herpesvirus 3, Human; Humans; Male; Skin Diseases, Infectious; Transplantation, Homologous

Topics: Acute Disease; Acyclovir; Adrenal Cortex Hormones; Antiviral Agents; Drug Therapy, Combination; Herpes Zoster; Humans; Pain

Topics: Acute Disease; Acyclovir; Antiviral Agents; Evidence-Based Medicine; Herpes Zoster; Humans; Male; Middle Aged; Time Factors

To report uveitis secondary to ocular penetration of caterpillar hairs (setae).. Case report. A documented attack of acute anterior uveitis was caused by initially overlooked penetration of caterpillar setae.. A 66-year-old man presenting with unilateral hypertensive keratouveitis was treated with antiherpes simplex medication (along with local anti-inflammatory and cycloplegic agents) after anterior chamber paracentesis and serologic testing. Laboratory testing was negative. Resolution occurred after 5 days, and corneal clearing showed a predescemetic caterpillar seta.. Patient history taken in an anterior uveitis setting should include gardening habits and searching for possible exposure to insects or arachnids.

Topics: Acute Disease; Acyclovir; Aged; Animals; Cornea; Corneal Injuries; Dexamethasone; Drug Therapy, Combination; Eye Foreign Bodies; Eye Injuries, Penetrating; Gentamicins; Hair; Humans; Lepidoptera; Uveitis, Anterior

Facial diplegia is a rare event, most commonly of unknown origin. We report the case of a woman who presented bilateral Bell's palsy a few days after a normal delivery.. Five days after the delivery of gemellary pregnancy, a 34-year old woman developed complete bilateral facial palsy. No treatment was initially prescribed. She was first seen in our department two weeks after the onset of her illness. The diagnostic work-up was negative and we considered that our patient had bilateral Bell's palsy. Treatment with methylprednisolone and intravenous acyclovir, initiated since admission, have had very limited effect.. As has already been shown for facial palsy, idiopathic facial diplegia, although exceptional, seems to be more frequent during the last trimester of pregnancy and in the early puerperium. Seven cases have been reported in the literature over the last 30 years. We discuss here the pathophysiology.

Topics: Acute Disease; Acyclovir; Adult; Anti-Inflammatory Agents; Antiviral Agents; Bell Palsy; Chronic Disease; Diagnosis, Differential; Drug Therapy, Combination; Female; Humans; Magnetic Resonance Imaging; Methylprednisolone; Pregnancy; Puerperal Disorders; Risk Factors; Spinal Puncture; Twins

A child with acute disseminated encephalomyelitis (ADEM) developed after acute herpetic gingivostomatisis was described. Inspite of the improvement of his gingivostomatitis, his consciousness gradually deteriorated and he was admitted to Nakadori General Hospital. His consciousness level was drowsiness and increased bilateral patellar reflexes were shown. Because magnetic resonance imaging (MRI) T2-weighted scan showed areas of high signal intensity disseminated in superior portion of medulla oblongata, dorsal portion of pons, basal nuclei and thalamus, he was suspected as having ADEM. Anti-herpes simplex virus (HSV) 1 IgG and IgM antibodies elevated in both blood and cerebrospinal fluid. From these results, HSV1 infection was thought to be the preceding infection of ADEM. Methylprednisolone therapy (20 mg/kg daily) for 3 days, followed by prednisolone (2 mg/kg) was started, with an excellent response. In addition, administration of acyclovir was also continued, considering the complication of HSV encephalitis. MRI T2-weighted scan performed at 2 months later after the onset of ADEM revealed disappearance of the lesions. He was discharged without remaining disorders. It is difficult to distinguish between ADEM and HSV encephalitis because both of these diseases show various neurological symptoms. In our case, MRI was the most useful method for correct diagnosis of ADEM. We concluded that ADEM is important as a disease of central nervus system due to HSV1 infection, in addition to encephalitis.

Topics: Acute Disease; Acyclovir; Antiviral Agents; Child, Preschool; DNA, Viral; Electroencephalography; Encephalomyelitis, Acute Disseminated; Humans; Immunoglobulin G; Immunoglobulin M; Magnetic Resonance Imaging; Male; Polymerase Chain Reaction; Stomatitis, Herpetic

Topics: Acute Disease; Acyclovir; Antineoplastic Combined Chemotherapy Protocols; Antiviral Agents; Cytarabine; Etoposide; Female; Humans; Idarubicin; Imipenem; Kidney Transplantation; Leukemia, Myeloid; Middle Aged; Myelodysplastic Syndromes; Postoperative Complications; Thienamycins

Mycophenolate mofetil (MMF) is a new immunosuppressive drug used in combination with cyclosporin A (CsA) or tacrolimus and prednisone to prevent rejection of renal allografts in both adult and pediatric recipients. It has been shown in several large studies that MMF significantly decreases the incidence of acute rejection in adults and has acceptable adverse effects. In this retrospective study, we compare the incidence of adverse events between pediatric and adult renal allograft recipients. Twenty-two children and 37 adult renal allograft recipients were included in the study. The initial dose of MMF was 1.5 g b.i.d. for the adult patients and ranged from 15 to 30 mg/kg/d for the pediatric patients. All patients received p.o. acyclovir as prophylaxis for cytomegalovirus (CMV). The two groups were similar regarding gender distribution and graft source. Acute rejections occurred in 10 of the 22 pediatric patients (45%) and in nine of the 37 adults (24%), p = NS. The incidence of infections was similar in both groups except for the occurrence of CMV (n = 5), which was seen only in adults. The incidence of GI symptoms was significantly higher in the pediatric population (54.5% vs. 21.6%; p = 0.02). Significant weight loss was seen more often in the smaller pediatric patients (weight < or = 15 kg) compared to the larger pediatric patients, 60% vs. 11.7%, p = 0.05. Among the patients who had significant GI symptoms 50% of the adults and 75% of the pediatric recipients required either dose reduction or, most commonly, discontinuation of the MMF. The need to discontinue MMF was significantly higher in the pediatric patients, especially in those that weighed less than 15 kg. We suggest the possibility that the optimum dose, dosing interval or preparation of MMF has not yet been established for pediatric patients. One should therefore monitor pediatric patients closely, especially the small ones, to avoid significant nutritional problems and other adverse GI events.

Topics: Acute Disease; Acyclovir; Adolescent; Adult; Age Factors; Antiviral Agents; Body Weight; Child; Child, Preschool; Cytomegalovirus Infections; Data Interpretation, Statistical; Female; Graft Rejection; Humans; Immunosuppressive Agents; Infant; Kidney Transplantation; Male; Mycophenolic Acid

We compared immunoglobulin (IgG) and acyclovir (ACV) therapies on the establishment, maintenance, and reactivation from latency of HSV-1(McKrae) in a mouse ocular infection model. Mice were given one intraperitoneal (IP) dose of human IgG 24 h after infection (Day 1 p. i.) or ACV in the drinking water from Days 1 to 7 p.i. Both treatments allowed similar percentages of mice to survive the infection and decreased ocular virus shedding as compared with untreated controls. At most time points, there were no differences between IgG- and ACV-treated animals with respect to tissue virus titers or in the rates of virus reactivation during explant cocultivation. However, after ultraviolet exposure, HSV reactivated in 30% of ACV-treated mice compared with 90% of IgG-treated mice (P = 0.02). Also by quantitative PCR, we found more latent HSV-1 DNA copies in IgG-treated mice compared with those given ACV (P = 0.02). IgG treatment protects mice from HSV-1 infection essentially as well as ACV does. Nonetheless, it permits higher levels of latent infection and subsequent in vivo reactivation. These studies have implications for the mechanism by which IgG functions to attenuate HSV infections and for its potential value as a therapeutic agent in humans.

Topics: Acute Disease; Acyclovir; Animals; Antiviral Agents; Cell Line; Chlorocebus aethiops; Female; Herpes Simplex; Herpesvirus 1, Human; Humans; Immunization, Passive; Immunoglobulin G; Mice; Mice, Inbred BALB C; Viral Load; Virus Activation; Virus Latency; Virus Shedding

We reported a case of non-herpetic acute encephalitis with unilateral temporal cortex lesion revealed by MR imaging and SPECT study. The patient was an eighteen years old woman who developed tonic-clonic seizure after common cold symptom. She was healthy before this episode. Neurological abnormality was only a single convulsion at onset and there was no other abnormal physical and neurological signs except for low grade fever. Electroencephalogram showed spike and slow wave complex of 2 Hz focused on a right posteriotemporal point (T 6) and an MR FLAIR (fluid-attenuated inversion recovery) image revealed a high signal intensity area at right temporal cortex. There was a decrease of cerebral blood flow in the same portion on SPECT study. This lesion was obscure on T1 and T2 MR images. Cerebrospinal fluid showed pleocytosis with normal glucose level and protein concentration. Bacterial and fungal cultures of CSF were negative and a detection of tubercule bacillus by PCR hybridization method was also negative. Although CSF findings suggested viral infection of CNS, virological study could not demonstrate infections of herpes simplex virus type 1, type 2, varicella-zoster virus, cytomegalovirus, measles virus, mumps virus, Japanese encephalitis virus, and influenza virus type A and B. After infusion of acyclovir and antibiotics, the patient was discharged from our hospital without sequelae of encephalitis. EEG was normal at this point and a high intensity area of MR FLAIR image disappeared two months later. SPECT findings were normalized six months later. The encephalitis presenting unilateral temporal cortex lesion without the infection of herpes simplex virus is thought to be very rare. Our case was distinguished from non-herpetic acute limbic encephalitis by an extent of the lesion and clinical manifestations. MR FLAIR image was useful for the detection of the lesion in this case.

Topics: Acute Disease; Acyclovir; Adolescent; Antiviral Agents; Diagnosis, Differential; Encephalitis; Female; Humans; Image Enhancement; Magnetic Resonance Imaging; Temporal Lobe; Treatment Outcome

A 26-year old man was admitted because of acute abdominal pain. He had received an allogeneic bone marrow transplant (BMT) for aplastic anemia 6 months before. All physical, laboratory, roentgenographic, and ultrasonographic studies were performed but nondiagnostic. On the fourth hospital day the patient developed visual disturbance and on the following day skin eruption appeared. Laboratory findings revealed severe liver dysfunction. We diagnosed this case as varicella-zoster virus (VZV) infection with visceral dissemination. Antiviral therapy with acyclovir was initiated and abdominal pain markedly reduced and visual acuity was recovered after 4 days. In case of VZV infection, acute abdominal pain prior to skin eruptions is rare. However in such cases the patients are highly fatal due to visceral dissemination. Antiviral therapy begun before visceral dissemination of VZV is highly effective in preventing serious disease, whereas it is less effective after dissemination. We consider that early diagnosis and treatment of VZV infection is necessary for BMT recipients who are undergoing immunosuppressive therapy.

Topics: Abdominal Pain; Acute Disease; Acyclovir; Adult; Anemia, Aplastic; Antiviral Agents; Bone Marrow Transplantation; Herpes Zoster; Humans; Immunocompromised Host; Male; Opportunistic Infections; Transplantation, Homologous

Varicella pneumonia is the most common complication of adult varicella. Symptoms may be severe and the mortality rate high in patients who are immunodeficient or pregnant. Symptoms may be mild and progression more favorable in adults previously in good health. We report two cases of varicella infection complicated by severe pulmonary involvement in adult patients who were previously healthy. Case 1 was a 36-year-old male who 6 days after developing varicella was clinically observed to have dyspnea and hemopytsis. He died of acute respiratory failure on the following day. Case 2 was a 28-year-old male whose respiratory symptoms started the third day after developing varicella. These symptoms were relieved by treatment with acyclovir and gammaglobulin. Careful observation is and an early treatment of varicella should be undertaken not only for patients with suppressed cellular immunity, but also for healthy adults, to prevent severe complications.

Topics: Acute Disease; Acyclovir; Adult; Antiviral Agents; Chickenpox; gamma-Globulins; Hemoptysis; Humans; Male; Pneumonia, Viral; Respiratory Insufficiency

We reported a 5-year-old boy with acute encephalitis due to suspected herpes simplex infection, who developed confusion, agitation and insomnia during intravenous administration of acyclovir. He recovered from these neuro-psychiatric symptoms two days after the cessation of acyclovir. The same symptoms recurred two days after its re-administration and resolved on the next day of the second cessation of the drug. Electroencephalogram (EEG) showed periodic lateralized epileptiform discharges (PLEDs) on hospital day 16, which disappeared on hospital day 27, suggesting that neurotoxicity of acyclovir may induce PLEDs. Although acyclovir is useful for the treatment of herpes simplex and varicella-zoster virus infections, we have to pay attention to its neurotoxicity.

Topics: Acute Disease; Acyclovir; Antiviral Agents; Child, Preschool; Encephalitis, Viral; Herpes Simplex; Humans; Male; Psychoses, Substance-Induced

Topics: Acute Disease; Acyclovir; Adult; Anti-Inflammatory Agents; Antiviral Agents; Dexamethasone; Diagnosis, Differential; Female; HLA-B27 Antigen; Humans; Intraocular Pressure; Iridocyclitis; Keratitis, Herpetic; Methylprednisolone; Mydriatics; Rheumatic Diseases; Toxoplasmosis, Ocular; Uveitis, Anterior

The efficacy of early versus late treatment with acyclovir and valaciclovir on zoster-associated pain was assessed from two databases (1076 patients) that were compiled from randomized trials. Early treatment was started < 48 h and late treatment was started 48-72 h after the onset of cutaneous herpes zoster. Median times to complete resolution of zoster-associated pain were 28 and 62 days, respectively, for patients (> or = 18 years of age) treated with acyclovir and placebo within 48 h (hazard ratio [HR], 1.68; 95% confidence limit [95% CL], 1.19, 2.38) and 28 and 58 days, respectively, for those treated later (HR, 2.20; 95% CL, 1.03, 4.71). In the valaciclovir versus acyclovir study (in patients > or = 50 years of age), the corresponding figures were 44 and 51 days for patients treated early (HR, 1.28; 95% CL, 1.03, 1.60) and 36 and 48 days for those treated later (HR, 1.40; 95% CL, 1.04, 1.87). Acyclovir significantly shortened the time to complete resolution of zoster-associated pain compared with placebo (and valaciclovir was superior to acyclovir in this regard) even when therapy was delayed up to 72 h after rash onset.

Topics: Acute Disease; Acyclovir; Adolescent; Adult; Antiviral Agents; Databases, Factual; Drug Administration Schedule; Female; Herpes Zoster; Humans; Male; Middle Aged; Pain; Randomized Controlled Trials as Topic; Valacyclovir; Valine

Famciclovir and valaciclovir were approved for use in the treatment of herpes zoster despite controversy over antiviral therapy in zoster due to high costs and uncertain benefits. To explore these issues, a Markov decision model was developed, and the incremental cost effectiveness of antiviral treatment for herpes zoster was estimated using these agents compared with no antiviral therapy. A third-party payer perspective was taken. Sensitivity analyses were performed, modeling differences in antiviral efficacy, postherpetic neuralgia (PHN) risk, and other illness parameters. Treatment of severely symptomatic acute zoster was found reasonable from a cost-effectiveness standpoint in base-case and worst-case scenarios. Treatment of mildly symptomatic acute zoster was more expensive but would likely be considered cost effective in scenarios where PHN risk was higher, PHN duration longer, or antiviral shortening of PHN greater. Further research comparing antiviral efficacy in herpes zoster is needed.

Topics: 2-Aminopurine; Acute Disease; Acyclovir; Aged; Aged, 80 and over; Antiviral Agents; Computer Simulation; Cost-Benefit Analysis; Famciclovir; Herpes Zoster; Humans; Markov Chains; Middle Aged; Models, Economic; Neuralgia; Risk Factors; Valacyclovir; Valine

EEG has been used widely in diagnosing encephalitis, as it demonstrates rather typical abnormalities, especially in herpes simplex virus encephalitis (HSVE). We analysed 204 EEG recordings from 98 consecutive acyclovir-treated patients with acute encephalitis between 1984 and 1994. Periodic complexes (PC) in the acute phase predicted poor outcome (Kendall tau 0.40, P < 0.001). However, unlike in many other diseases, e.g. stroke and intracerebral haemorrhage, the diffuse slowing of the background activity at acute phase did not predict outcome (Kendall tau -0.6, P = 0.35). At follow-up, the emergence of diffuse slow background activity was significantly associated with a less favourable outcome (Kendall tau 0.33, P = 0.0016). Among clinical variables, only epileptic seizures early during the course of the disease correlated significantly with outcome. EEG does have value as a prognostic indicator in acute encephalitides, but it seems that diffuse slowing of background activity or irritative features acutely are not as important as previously thought, based on the experiences of the pre-acyclovir era.

Topics: Acute Disease; Acyclovir; Adult; Antiviral Agents; Electroencephalography; Encephalitis; Female; Herpes Simplex; Humans; Male; Middle Aged; Regression Analysis; Treatment Outcome; Virus Diseases

To report a case of acute viral disease accompanied by bilateral optic neuritis with substantial paraclinical evidence that human immunodeficiency virus was the causative agent.. Clinical and paraclinical examination. Magnetic resonance imaging.. Virus and antibody titers as well as reverse lymphocytosis were consistent with acute infection by the human immunodeficiency virus-1.. Human immunodeficiency virus infection should be considered in the differential diagnosis of acute optic neuritis.

Topics: Acute Disease; Acyclovir; Adult; Diagnosis, Differential; Enzyme-Linked Immunosorbent Assay; Eye Infections, Viral; Female; HIV Antibodies; HIV Infections; HIV-1; Humans; Magnetic Resonance Imaging; Optic Nerve; Optic Neuritis; Polymerase Chain Reaction; Prednisolone; RNA, Viral

Topics: Acute Disease; Acyclovir; Adult; Antiviral Agents; Colonic Diseases; Herpes Zoster; Humans; Intestinal Pseudo-Obstruction; Male

Despite advances in immunosuppression, allograft rejection occurs frequently after liver transplantation. The use of induction therapy with cytolytic antibodies may decrease the frequency of rejection in liver transplant recipients, but may also increase the rate of cytomegalovirus (CMV) infection. It has been our center's strategy to use induction therapy in our liver transplant recipients. To determine the outcome of our strategy, we retrospectively reviewed all liver transplants performed in the first 5 yr of our liver transplant program. The frequency of acute rejection in the first year after liver transplantation was only 34% in patients who received induction therapy. The type of induction therapy antibody did not affect the rejection rate. Clinically significant CMV infection (requiring treatment) occurred in 22% of patients. These results suggest that use of induction therapy with cytolytic antibodies does not lead to a high incidence of CMV infection and decreases the incidence of rejection after liver transplantation.

Topics: Acute Disease; Acyclovir; Adolescent; Adult; Aged; Antilymphocyte Serum; Antiviral Agents; Azathioprine; Biopsy; Cyclosporine; Cytomegalovirus Infections; Female; Follow-Up Studies; Glucocorticoids; Graft Rejection; Graft Survival; Humans; Immunosuppressive Agents; Incidence; Liver Transplantation; Male; Methylprednisolone; Middle Aged; Muromonab-CD3; Retrospective Studies; T-Lymphocytes; Transplantation, Homologous; Treatment Outcome

Follow up of cognitive sequelae of acute encephalitis and estimation of the frequency of persisting dementia.. Out of a series of 45 consecutive patients with acute encephalitis prospectively studied in 1990-95, 40 were screened for difficulty in everyday life using the Blessed dementia scale (BDS) 3.7 (1.4), mean (SD), years after onset. Eight patients had had herpes simplex encephalitis (HSVE), 16 some other identified aetiology, and in 21 the aetiology was unknown. All, except two patients with a nonherpetic encephalitis, were treated with acyclovir. All patients with disability in BDS (12/40), were invited to a neuropsychological reassessment, and the results of this assessment were compared with those of a similar assessment done after the acute stage. At follow up one patient could not complete the tests due to intractable epilepsy.. In six of 11 cases the symptoms causing disability were mainly psychiatric. Five patients (two with HSVE) had a pronounced memory impairment together with other cognitive deficits, indicating dementia (frequency of 12.8%). In eight of the 11 testable cases cognitive performance had improved over the years, in two cases a decline was found and one patient with severe deficits showed no change. Intractable epilepsy was found in four of 12 cases.. Cognitive decline had taken place already at the acute stage, and further deterioration was uncommon. Considerable improvement occurred in most patients during follow up. Also in patients with HSVE treated with acyclovir the cognitive recovery was substantial and of a magnitude not expected based on previous literature. Intractable epilepsy contributed to the cognitive deterioration in some cases. Affective disorders also had a surprisingly important role for the long term outcome.

Topics: Acute Disease; Acyclovir; Adult; Aged; Antiviral Agents; Cognition Disorders; Depressive Disorder; Encephalitis, Viral; Female; Follow-Up Studies; Humans; Male; Middle Aged; Neuropsychological Tests; Prospective Studies; Severity of Illness Index

The ability of famciclovir and valaciclovir to affect the establishment and maintenance of latency in mice with a cutaneous herpes simplex type 1 (HSV-1) infection was examined. Mice were treated via drinking water starting at various times between days 1 and 5 and terminating on day 10 after inoculation. Clinical signs and viral replication in the target tissues were monitored. Three to four months later, trigeminal and dorsal root ganglia were explanted from groups of 16 mice and examined for latent virus by cocultivation. The two compounds differed in their effects on the acute neural infection, and ganglia explanted from famciclovir-treated mice were markedly reduced in their ability to reactivate virus, although neither drug affected latency if treatment was delayed for several months. The difference between the compounds is likely to reflect differences in the metabolism of their respective products, penciclovir and acyclovir, in infected neurons.

Topics: 2-Aminopurine; Acute Disease; Acyclovir; Animals; Antiviral Agents; Brain Stem; Disease Models, Animal; Ear, External; Famciclovir; Female; Ganglia, Spinal; Herpes Simplex; Herpesvirus 1, Human; Mice; Mice, Inbred BALB C; Prodrugs; Trigeminal Ganglion; Valacyclovir; Valine; Virus Activation; Virus Latency; Virus Replication

Topics: Acute Disease; Acyclovir; Adult; Antiviral Agents; Astigmatism; Cornea; Eye Foreign Bodies; Eyelids; Follow-Up Studies; Humans; Image Processing, Computer-Assisted; Keratitis, Herpetic; Male; Visual Acuity

Topics: Acute Disease; Acyclovir; Adolescent; Arthritis, Infectious; Female; Herpes Simplex; Humans

Positive diagnosis of Herpes simplex virus (HSV) encephalitis was rarely obtained in the past, when brain biopsy had been performed. Other tests (HSV antigen and HSV antibodies detection and interferon alpha measurement, in cerebrospinal fluid) failed to prove HSV infection. Polymerase chain reaction has been proposed for accurate and rapid diagnosis of HSV encephalitis. With 35 cycles of a DNA polymerase sequence duplication, sensitivity reaches 95% and specificity 100%. HSV PCR is a useful tool for the diagnosis of acute encephalitis. This should be available in many neurologic clinics. Therapeutic consequences include rapid disruption of aciclovir when clinical features, MRI study and negative PCR suggest non herpetic encephalitis.

Topics: Acute Disease; Acyclovir; Adolescent; Adult; Aged; Antiviral Agents; Child; Child, Preschool; Encephalitis, Viral; Herpes Simplex; Humans; Infant; Middle Aged; Polymerase Chain Reaction; Prognosis; Recurrence; Sensitivity and Specificity; Simplexvirus

We report 4 patients with acute contact dermatitis of the lips following application of Zovirax cream. Patch tests with pure acyclovir, and combinations of the ingredients of the cream base, with and without acyclovir, provided no evidence of sensitization to any constituents of the cream.

Topics: Acute Disease; Acyclovir; Adolescent; Adult; Antiviral Agents; Cheilitis; Dermatitis, Allergic Contact; Female; Humans; Male; Patch Tests

We report a case of acute herpetic esophagitis in a 33 year old man who was presumed to be immuno-compromised following prolonged steroid and cyclosporin treatment for acute rejection of a transplanted kidney. In Korea, all reported cases of herpetic esophagitis have been diagnosed in immuno-compromised and debilitated patients with a typical endoscopic appearance of ulcerating lesions. However, our patient showed multiple vesicular lesions without ulcer along the entire esophagus. The diagnosis was confirmed by colorimetric detection of herpes virus DNA using in situ hybridization. The endoscopic findings reported herein probably represent the typical early stage of acute herpetic esophagitis.

Topics: Acute Disease; Acyclovir; Adult; DNA, Viral; Esophagitis; Esophagoscopy; Herpes Simplex; Herpesvirus 1, Human; Humans; Immunocompromised Host; In Situ Hybridization; Kidney Transplantation; Male

Topics: Acute Disease; Acyclovir; Herpes Simplex; Herpesvirus 1, Human; Hospitals, General; Humans; New Jersey; Postoperative Complications; Respiratory Tract Infections; Surgical Procedures, Operative

Primary varicella-zoster virus infection in children with haematological malignancy is a life threatening disease. In one year, there were 10 cases of varicella and 2 cases of zoster among these children as well as 5 mothers who were accompanying their children who developed varicella in the oncology ward. Two children died of fulminating disease despite aggressive antiviral and supportive treatment. Acyclovir can be used in treatment and prophylaxis in exposed susceptible children. Varicella -zoster immune globulin is not available in this country. Vaccination with live virus has been shown to be protective in immunocompromised children and needs consideration.

Topics: Acute Disease; Acyclovir; Chickenpox; Chickenpox Vaccine; Child; Child, Preschool; Cross Infection; Disease Outbreaks; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunocompromised Host; Infection Control; Leukemia, Myelogenous, Chronic, BCR-ABL Positive; Leukemia, Myeloid; Male; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Severity of Illness Index; Survival Rate; Treatment Outcome; Vaccines, Attenuated; Viral Vaccines

Previous studies demonstrated that the adjuvant-free form of a fusion protein consisting of a truncated herpes simplex virus type 1 (HSV-1) glycoprotein D and human interleukin-2 (tgD-IL-2) elicited superior protective immunity in mice. In this study, the immunotherapeutic efficacy of tgD-IL-2 against vaginal HSV-2 infection was investigated using a guinea pig model. Footpad injections of tgD-IL-2 (12.5 micrograms/dose) after the onset of primary lesions strongly suppressed recurrence in the chronic phase of infection; consequently, the number of days with lesions was reduced 65%. Continuous medication with 100 mg/kg/day acyclovir for 5 days failed to suppress recurrent infection. In a UV radiation-induced recurrence model, prophylactic tgD-IL-2 significantly suppressed both duration and severity of disease. A single injection of tgD-IL-2 plus acyclovir produced an additive effect on the suppression of the disease in the acute phase. These results suggest that tgD-IL-2 is a promising immunotherapeutic agent against HSV-2 genital infections.

Topics: Acute Disease; Acyclovir; Animals; Chemotherapy, Adjuvant; Disease Models, Animal; Female; Guinea Pigs; Herpes Genitalis; Herpesvirus 2, Human; Immunotherapy; Interleukin-2; Recombinant Fusion Proteins; Recurrence; Ultraviolet Rays; Vagina; Viral Envelope Proteins; Virus Replication; Virus Shedding

To describe the clinical and pathologic features of acute herpetic tonsillitis and to compare the histologic findings with those of herpetic lymphadenitis.. We present a case report of a 22-year-old woman with bilateral cervical adenopathy, acute tonsillitis, and suspected peritonsillar abscess.. Histologic examination of the excised tonsils demonstrated discrete necrotic areas that contained cells with intranuclear viral inclusions.. The diagnosis of herpetic tonsillitis was confirmed by demonstrating herpes simplex virus (HSV)-infected cells on paraffin section immunostains and by positive HSV cultures of the tonsillar tissue.. HSV infection is an uncommon cause of acute tonsillitis; the histologic findings are similar to those seen in herpes simplex lymphadenitis.

Topics: Acute Disease; Acyclovir; Adult; Diagnosis, Differential; Female; Herpes Simplex; Humans; Immunohistochemistry; Inclusion Bodies, Viral; Lymphadenitis; Necrosis; Simplexvirus; Tonsillectomy; Tonsillitis

A 56-year old man was hospitalized for spasmodic paraparesis with sphincter disorders. After exclusion of spinal cord compression and all other inflammatory, infectious or neoplastic causes, the possibility of a connexion with an hepatitis B vaccination performed with a recumbent vaccine three weeks before the neurological disorders appeared was considered. The pathogenesis of such a myelitis remains uncertain. It is based on the possible reactivation of a dormant virus or a crossed antigenic reaction between a protein of the vaccine and the nervous system. The course of the disease is usually favourable. The frequency of this complication would be more accurately determined if all neurological manifestations occurring after hepatitis B vaccination were reported.

Topics: Acute Disease; Acyclovir; Drug Therapy, Combination; Hepatitis B; Hepatitis B Vaccines; Humans; Male; Male Urogenital Diseases; Methylprednisolone; Middle Aged; Myelitis

Topics: Acute Disease; Acyclovir; Aged; Colitis; Colon; Herpes Zoster; Humans; Male

Topics: Acute Disease; Acyclovir; Aged; Herpes Zoster; Humans; Male; Myositis

We evaluated the effects of the immunomodulator, imiquimod (R-837) applied topically, alone and in combination with i.p. acyclovir (ACV) on acute, recurrent and neural HSV-2 genital infection in guinea-pigs when 10 days of therapy was begun after HSV lesions developed. The combined therapy was most effective, significantly reducing the severity of the acute disease, as early as 2 days (P < 0.05), and vaginal viral shedding (P < 0.05) as early as 1 day after therapy was begun. The total lesion score for the acute disease was also significantly less in the group receiving imiquimod and ACV (5.4 +/- 0.5) compared to controls (13.1 +/- 1.2, P < 0.001) or imiquimod alone (9.8 +/- 1.2, P < 0.05). Therapy, however, had no significant effect on the number of days with recurrent lesions. Imiquimod increased the lymphoproliferative response to HSV (P < 0.01), while combined therapy reduced HSV antibody titers (P < 0.01) on day 28 compared to placebo and also reduced the effect of imiquimod alone on the lymphoproliferative response. The combination of this effective immunomodulator, imiquimod, and acyclovir appears to provide effective therapy for acute genital HSV-2 infection even when begun after lesion development.

Topics: Acute Disease; Acyclovir; Aminoquinolines; Animals; Drug Synergism; Drug Therapy, Combination; Female; Ganglia, Spinal; Guinea Pigs; Herpes Genitalis; Imiquimod; Interferon Inducers; Recurrence; Spinal Cord; Vagina; Virus Shedding

Topics: Acute Disease; Acyclovir; Child, Preschool; Deafness; Herpes Simplex; Humans; Male; Time Factors

B-cell lymphomas (BCL) occur with increased frequency in immunosuppressed patients. BCL develop in severe combined immunodeficient (SCID) mice after engraftment with human peripheral blood leukocytes (PBL; hu-PBL-SCID mice) and infection with Epstein-Barr virus (EBV). The contributions of latent and active EBV infection to BCL development, the potential enhancing effects of immunosuppressive therapy, and inhibitory effects of antiviral therapy on the development of BCL in this model were studied.. SCID mice were engrafted with PBL from EBV-seropositive donors (latent infection), PBL from EBV-seronegative donors followed by infection with EBV (active infection), PBL from EBV-seropositive donors followed by infection with EBV (latent plus active infection), or EBV-transformed B-lymphoblastoid cells and monitored for the development of BCL. Hu-PBL-SCID mice were treated with the immunosuppressive agents cyclosporine or methylprednisolone or the antiviral agents acyclovir or ganciclovir.. Tumors developing in hu-PBL-SCID mice were high-grade lymphomas of human B-cell origin and contained EBV-DNA. BCL developed in 70% of mice 11 to 14 weeks after latent infection. BCL developed after 4 to 7 weeks in all hu-PBL-SCID mice after active infection. Treatment with cyclosporine or methylprednisolone had no effect on BCL development after active infection, but inhibited rather than enhanced the development of BCL in latently infected mice. Ganciclovir, but not acyclovir, inhibited BCL development after active infection.. The hu-PBL-SCID mouse provides an in vivo model of BCL associated with immunosuppression. Active EBV infection results in the rapid development of BCL in this model even when latently infected B cells are present. Inhibition of BCL development in latently infected hu-PBL-SCID mice by immunosuppressive therapy may reflect inhibition of a T-cell/B-cell interaction necessary for B-cell activation. Inhibition of BCL development by granciclovir suggests a possible role for this agent in the management of BCL associated with immunosuppression.

Topics: Acute Disease; Acyclovir; Animals; Antiviral Agents; Ganciclovir; Herpesvirus 4, Human; Humans; Immune Tolerance; Immunosuppressive Agents; Lymphoma, B-Cell; Mice; Mice, SCID; Tumor Virus Infections

This retrospective study was designed to assess the effects of acyclovir treatment of acute herpes zoster on subsequent postherpetic neuralgia, and to examine the effects of amitriptyline in the treatment of postherpetic neuralgia. Eighty seven patients with postherpetic neuralgia of three or more months' duration were studied: 24 of them had had their herpes zoster treated with oral acyclovir. At first presentation, only 25% of the 24 patients who had had their herpes zoster treated with acyclovir selected the word group containing burning on the McGill pain questionnaire compared with 76% of the 63 patients who had not received acyclovir. A higher proportion of patients who had had acyclovir than had not selected the word group which contains the word aching (63% versus 49%). Acyclovir thus appears to change the nature of postherpetic neuralgia. Postherpetic neuralgia was treated with amitriptyline, alone or in combination with distigmine and/or sodium valproate. There was a strong correlation between pain relief and the interval between the occurrence of herpes zoster and the initiation of treatment with amitriptyline--early treatment is almost twice as likely to be successful as late. Since conventional analgesics and sympatholytic drugs are of no benefit in the treatment of established postherpetic neuralgia, the sequelae of herpes zoster must, therefore, be recognized and treated with amitriptyline as soon as possible.

Topics: Acute Disease; Acyclovir; Aged; Amitriptyline; Herpes Zoster; Humans; Middle Aged; Neuralgia; Retrospective Studies

Topics: Acute Disease; Acyclovir; Amitriptyline; Herpes Zoster; Humans; Neuralgia

Topics: Acute Disease; Acyclovir; Adult; Herpes Zoster; Humans; Male; Meningitis, Viral

Pathways of viral gene expression were investigated during the acute phase of sensory ganglionic infection with HSV-1. To facilitate these studies we constructed KOS/62-3, an HSV-1 vector in which the Escherichia coli lac-Z gene was inserted behind both copies of the promoter for the viral latency-associated transcripts. Following footpad inoculation of mice with the virus, acutely infected dorsal root ganglion (DRG) neurons were assayed by dual immunofluorescence for the presence of beta-galactosidase and HSV viral antigens. Most infected neurons stained for either beta-galactosidase or viral antigens. Less than 0.2% of neurons staining for viral antigens also expressed beta-galactosidase, and less than 10% of neurons expressing beta-galactosidase also stained for viral antigen. As a consequence of these findings, we propose that there are essentially two populations of HSV-infected neurons during the acute phase of ganglionic infection. In one population of neurons there is abundant viral protein synthesis but minimal transcription of latency-associated transcripts, whereas in a second population of neurons viral gene expression is severely restricted except for the synthesis of latency-associated transcripts. Since DRG neurons are a heterogeneous population of cells, we further sought to determine whether either pathway of gene expression was more likely to occur in a particular neuronal phenotype. To accomplish this, antibodies were used to characterize the DRG neuronal phenotypes acutely infected with the virus. The results indicated that the pathway of neuronal infection characterized by transcription of abundant latency-associated transcripts and minimal viral protein synthesis was much more likely to occur in DRG neurons expressing the cellular antigen SSEA-3. These data indicate that the neuron plays a major role in regulating the outcome of infection with HSV. Finally, we sought to determine whether DNA replication occurs in the course of establishment of a latent infection. We found that the DNA content of neurons latently infected with KOS(M) strain HSV was not affected by treatment with nucleotide analogues during the acute phase of ganglionic infection, suggesting that viral DNA replication does not occur during the establishment of latent infection.

Topics: Acute Disease; Acyclovir; Animals; Antigens, Viral; beta-Galactosidase; Cytarabine; DNA, Viral; Female; Ganglia, Spinal; Herpes Simplex; Mice; Neurons; Phenotype; Recombinant Proteins; Tissue Distribution; Virus Replication

The authors provide the clinical and laboratory data on the etiological structure of acute viral encephalitides in children. Special attention is devoted to the description of the clinical picture of the gravest form of encephalitis caused by type I herpes simplex virus. Present the laboratory data on the long-term preservation of type I herpes simplex virus in the CNS, which correlates to the clinical and morphological findings of the subacute or recurrent course of the disease. Discuss the results of the treatment with the antiviral drug acyclovir (zovirax).

Topics: Acute Disease; Acyclovir; Antibodies, Viral; Cerebrospinal Fluid; Child; Child, Preschool; Encephalitis; Herpes Simplex; Humans; Infant; Recurrence; Simplexvirus

Topics: Acute Disease; Acyclovir; Administration, Oral; Antibodies, Viral; Aspirin; Atrial Fibrillation; Cerebrovascular Disorders; Embolism; Humans; Immunoassay; Infectious Mononucleosis; National Institutes of Health (U.S.); Simplexvirus; United States; Warfarin

Systemic acyclovir (ACV), a new potent anti-herpes drug, was shown to reduce effectively the morbidity in the acute phase of herpes zoster ophthalmicus (AHZO). Using high dose oral ACV (5 X 800 mg/day) our aim in this study was: (1) to compare disease profiles in the ACV-treated group and in a group of zoster patients having had no ACV, analysed retrospectively; (2) to establish if high-dose ACV was able to prevent severe long term complications of AHZO; and (3) to determine the present role of corticosteroids in AHZO. From 1984 to 1988, 48 patients with AHZO of less than 3 days' duration were included. All patients received at least 7 days of oral ACV (5 X 800 mg/d) associated with topical ACV. Steroids were not given unless severe uveitis occurred. Follow-up was 2 years in 43 patients and 1 year in all 48 patients. Main conclusions from our study are: 1. Ocular involvement occurred in 67% of ACV-treated cases, a rate comparable to our retrospective group (59%) and to the literature (71%). However the rate of severe long term complications was minimal (4%) when compared to our non-treated retrospective group (21%). 2. Steroid treatment was not necessary in any of the ACV-treated patients. 3. ACV was well tolerated and did not have to be discontinued in any of the patients. High dose ACV and avoidance of steroids seems to eliminate the severe complications of AHZO.

Topics: Acute Disease; Acyclovir; Administration, Oral; Adolescent; Adrenal Cortex Hormones; Adult; Aged; Aged, 80 and over; Child; Dose-Response Relationship, Drug; Drug Tolerance; Female; Follow-Up Studies; Herpes Zoster Ophthalmicus; Humans; Male; Middle Aged; Prospective Studies; Retrospective Studies; Uveitis

Topics: Acute Disease; Acyclovir; Adult; Dermatitis, Contact; Drug Eruptions; Female; Herpes Simplex; Humans; Middle Aged; Ointments

We report three cases of neonatal herpes simplex virus (HSV) infection presenting as fulminant hepatitis. None of the patients had clear risk factors for HSV infection and they all died. Antiviral treatment for HSV is currently available but must be administered early in the course of the disease before irreversible liver tissue damage is present. Since the diagnosis may be difficult to establish, we wish to draw the attention of clinicians to the presentation of neonatal HSV infection and suggest that in such cases viral cultures, including culture of liver tissue, should be obtained early and antiviral treatment administered while awaiting the culture results.

Topics: Acute Disease; Acyclovir; Diagnosis, Differential; Female; Hepatitis, Viral, Human; Herpes Simplex; Humans; Infant, Newborn; Male; Necrosis; Simplexvirus; Time Factors

One patient with bilateral acute retinal necrosis underwent encircling scleral buckle, vitrectomy, and intravitreal acyclovir on both eyes. This procedure was performed on the right eye while the retina was attached. The retina of the right eye was reattached by performing fluid-gas exchange and modified panretinal photocoagulation when the retina subsequently detached. Soon after the development of retinal detachment in the left eye, the above surgical procedures were performed on the left eye, and the retina was successfully reattached. Bilateral acute retinal necrosis with significant vitreous opacification, which is a devastating ocular disease causing possible blindness in both eyes, requires more aggressive, early surgical management.

Topics: Acute Disease; Acyclovir; Adult; Fundus Oculi; Humans; Light Coagulation; Male; Necrosis; Retinal Detachment; Retinal Diseases; Scleral Buckling; Syndrome; Vitrectomy

A 43-year-old homosexual man was hospitalized in April 1988 because of acute epigastric pain. It was known that he had had a HIV infection for a year, and in April 1988 it was defined as stage Walter Reed I. Acute, exudative, nonspecific pancreatitis was diagnosed. Three weeks later cerebral symptoms (disturbances of consciousness), hypoacusis, and impaired vision developed. The ocular fundus displayed areas of edema and whitish clouding in the retina, first in the left eye and later also in the right. These were initially assumed to be anemic infarctions until the differential diagnosis of acute retinal necrosis with possible herpesvirus infection was made. On the basis of ophthalmoscopic findings cytomegalovirus retinitis appeared improbable. Serologic examinations showed increased levels of IgG antibody titers of cytomegalovirus and herpes simplex virus (both 1:20,000). Therapy with intravenous infusions of Acyclovir was instituted (1500 mg/d). After a few days the patient regained consciousness as well as his hearing and vision. There was complete resolution of the retinal exudates. This excellent therapeutic result of Acyclovir therapy confirmed the diagnosis of acute retinal necrosis syndrome, identified the cerebral symptoms as herpes encephalitis, and explained the entire disease process as the first opportunistic infection in HIV infection, i.e., by that time the patient had developed stage Walter Reed 6 (AIDS). Problems of differential diagnosis and the therapeutic schedule with Acyclovir are discussed.

Topics: Acquired Immunodeficiency Syndrome; Acute Disease; Acyclovir; Adult; Encephalitis; Herpes Simplex; Humans; Male; Ophthalmoscopy; Pancreatitis; Referral and Consultation; Retinal Necrosis Syndrome, Acute

Oral ulcerations are frequently observed in cancer patients receiving chemotherapy or radiation therapy. Herpes simplex virus is the most common viral pathogen association with lesions. Reactivation of latent virus is responsible for the vast majority of culture-positive infections. The natural history of this virus has been well studied in selected patient populations. These infections may cause local complications and, if untreated, may not heal for weeks. Reactivation of the virus may occur predictably in patients after bone marrow transplantation or acute leukemia. Recognition that herpes simplex virus is present in oral lesions is of importance because of the availability of safe, effective antiviral therapy. Prospective, randomized, double-blind clinical trials have demonstrated that acyclovir is the most effective agent to treat or prevent herpes simplex virus infections in immunocompromised patients.

Topics: Acute Disease; Acyclovir; Herpes Simplex; Humans; Neoplasms

Topics: Acute Disease; Acyclovir; Humans; Joint Diseases; Pain; Recurrence; Stevens-Johnson Syndrome

Topics: Abortion, Threatened; Acute Disease; Acyclovir; Animals; Animals, Newborn; Disease Models, Animal; Female; Fetal Death; Herpes Simplex; Litter Size; Mice; Pregnancy; Pregnancy Complications, Infectious

Topics: Acute Disease; Acyclovir; Adult; Aged; Antiviral Agents; Clinical Trials as Topic; Female; Herpes Genitalis; Herpes Labialis; Herpes Zoster; Herpesvirus 1, Human; Herpesvirus 3, Human; Humans; Male; Middle Aged; Recurrence; Reproducibility of Results; Treatment Outcome

Two hundred patients were treated by various nerve blocks with (A; 100 cases) or without (B; 100 cases) acyclovir (ACV) for acute herpes zoster, and studied retrospectively to determine the factors influencing the duration of pain. All patients started to receive the treatment within 2 weeks after manifestation of herpetic rash, and were divided equally into two groups by the severity of pain. The severe (I) and moderate (II) pain groups had similar locations of skin lesions. Group I had significantly larger population of the aged, and higher proportion of patients who had preherpetic pain than group II. The period of pain was significantly longer in group I B than group I A, in group II B than group II A, in group I A than group II A and in group I B than group II B. However, distribution of the rash, age and occurrence of preherpetic pain were not related to the duration of pain in the groups with the same degree of pain and treatment. These results showed that ACV was effective in inflammatory pain and accelerated healing in the acute phase of herpes zoster. The severity of pain had the greatest influence on the duration of pain. The age and preherpetic pain closely correlated with the severity of pain.

Topics: Acute Disease; Acyclovir; Adolescent; Adult; Aged; Combined Modality Therapy; Herpes Zoster; Humans; Middle Aged; Nerve Block; Neuralgia; Pain Management; Retrospective Studies

Topics: Acute Disease; Acyclovir; Facial Paralysis; Herpes Zoster; Humans

Acute retinal necrosis syndrome in a healthy 32-year-old man was treated successfully with systemic acyclovir and corticosteroids in combination with vitrectomy, 360 degrees encircling band and transscleral cryocoagulation. Herpes simplex virus antibodies were detected in the vitrectomy aspirate supporting the current view that acute retinal necrosis is caused by viruses of the herpes group.

Topics: Acute Disease; Acyclovir; Adult; Humans; Male; Necrosis; Retinitis; Syndrome; Vasculitis; Vitrectomy

We report a case of recurrent varicella-zoster virus infection in a patient with severe acquired immune deficiency syndrome in whom the infection has become clinically unresponsive to treatment with acyclovir.

Topics: Acquired Immunodeficiency Syndrome; Acute Disease; Acyclovir; Adult; Drug Combinations; Drug Therapy, Combination; Herpes Zoster; Herpesvirus 3, Human; Homosexuality; Humans; Immune Tolerance; Male; Recurrence; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Retinal detachment (RD) occurs in more than 50% of eyes with acute retinal necrosis (ARN) and is the leading cause of visual loss in this syndrome. In order to decrease the incidence of RD in ARN, the authors treated 12 eyes of 10 patients with prophylactic laser photocoagulation. Retinal detachment occurred in two eyes (17%). Over the same time period, seven eyes with ARN did not receive prophylactic laser treatment, most often because of dense vitreous debris, with a 67% rate of RD. Prophylactic photocoagulation treatment should be considered in the management of patients with ARN.

Topics: Acute Disease; Acyclovir; Administration, Oral; Adult; Aged; Female; Humans; Injections, Intravenous; Light Coagulation; Male; Middle Aged; Necrosis; Prednisone; Retina; Retinal Detachment; Retinitis; Syndrome; Visual Acuity

Topics: Acute Disease; Acyclovir; Administration, Topical; Anti-Inflammatory Agents; Glucocorticoids; Herpes Zoster Ophthalmicus; Humans

Topics: Acute Disease; Acyclovir; Adult; Chlamydia Infections; Diagnosis, Differential; Female; Gonorrhea; Herpes Genitalis; Humans; Male; Meningitis; Sexually Transmitted Diseases; Simplexvirus; Syphilis

Both viral meningitis and encephalitis in infants and children give clinical features of various severity. The mechanism of viral encephalitis varies from CNS cellular destruction, immune or oedematous process. The clinical and EEG features of herpes encephalitis in the child are usually well recognizable. CSF characteristics are important for differential diagnosis. Management therapy includes anti-oedema treatment, prevention or cure of seizures. Passive immunisation against rubella, rubeola and measles is the best prevention therapy for post-infectious encephalitis. Herpes encephalitis prognosis has improved with acyclovir therapy. In France, mortality due to post-infectious encephalitis is estimated below 5% and sequellae below 20%.

Topics: Acute Disease; Acyclovir; Adolescent; Child, Preschool; Diagnosis, Differential; Encephalitis; Herpesviridae Infections; Humans; Infant; Meningitis, Viral; Meningoencephalitis; Prognosis

Topics: Acute Disease; Acyclovir; Chediak-Higashi Syndrome; Child, Preschool; Drug Evaluation; Herpesviridae Infections; Herpesvirus 4, Human; Humans; Male

Four nucleoside analogues--acyclovir [9-(2-hydroxyethoxymethyl)guanine], bromovinyldeoxyuridine [(E)-5-(2-bromovinyl)-2-deoxyuridine], vinylarauracil 5-vinyl-1-beta-D-arabinofuranosyluracil and bromovinylarauracil [(E)-5-(2-bromovinyl)-1-beta-D-arabinofuranosyluracil]--were compared in the therapy of acute keratitis induced in the rabbit cornea by inoculation of the KUPKA strain of herpes simplex virus type 1 (HSV-1). In comparison to placebo-treated animals, the drugs reduced the mean plaque counts in conjunctival swabs as follows: acyclovir to 0.16-1.73%, bromovinyldeoxyuridine to 0.02-0.25%, vinylarauracil to 0.55-5.96% and bromovinylarauracil to 0.12-3.39% of control values. Latency was established to a most limited extent in 1 or 2 out of 5 rabbits treated with vinylarauracil or bromovinylarauracil, respectively. One or 6 out of 84 or 98 explanted ganglion fragments (1.3 or 6%) were positive for HSV-1 as compared to 72 fragments out of 173 (43%) from placebo-treated rabbits. Acyclovir and bromovinyldeoxyuridine completely prevented latency.

Topics: Acute Disease; Acyclovir; Animals; Antiviral Agents; Arabinofuranosyluracil; Bromodeoxyuridine; Chemical Phenomena; Chemistry; Keratitis, Dendritic; Rabbits; Simplexvirus; Uridine

Topics: Acute Disease; Acyclovir; Antibodies, Viral; Herpes Zoster; Herpesvirus 3, Human; Humans; Injections, Intravenous

Topics: Acute Disease; Acyclovir; Administration, Oral; Herpes Zoster; Humans

Topics: Acute Disease; Acyclovir; Chickenpox; Humans; Kidney Transplantation; Male; Middle Aged

Topics: Acute Disease; Acyclovir; Adult; Esophagitis; Esophagoscopy; Female; Humans; Immune Tolerance; Male; Virus Diseases

Three adults previously in good health developed pulmonary oedema during chickenpox. Severe hypoxemia required mechanical ventilation. All patients recovered without extensive pulmonary sequela on the first month pulmonary functional test. The severity of adult chickenpox requires hospitalization for treatment with Acyclovir.

Topics: Acute Disease; Acyclovir; Adult; Chickenpox; Humans; Male; Respiratory Distress Syndrome

Topics: Acute Disease; Acyclovir; Adult; Antiviral Agents; Cytomegalovirus Infections; Female; Forced Expiratory Flow Rates; Ganciclovir; Humans; Kidney Transplantation; Postoperative Complications

46 patients suffering from various malignancies (17 non Hodgkin lymphomas, 12 Hodgkin's diseases, 11 acute leukaemias, 4 myelomas, 2 carcinomas), 6 patients with haematological disorders such as ITP, SAA, myeloproliferative disease, LAS and 3 patients without preexisting disease were treated with acyclovir for herpes virus infection diagnosed by clinical means. All but 7 patients had been given intensive treatment with various cytostatic agents and/or irradiation. Most patients were treated with 1500 mg acyclovir daily for 5 to 13 days. Dosage was adjusted according to renal function and clinical response in the remaining 10 cases. 11 patients received intravenous immunoglobulins in addition. Side effects were negligible (local irritation, minimal rise in serum creatinine levels in 5 patients). All patients responded to treatment; 6 patients complained of severe neuralgia lasting for more than one month; 5 patients relapsed.

Topics: Acute Disease; Acyclovir; Adolescent; Adult; Aged; Chickenpox; Combined Modality Therapy; Female; Herpes Genitalis; Herpes Simplex; Herpes Zoster; Herpesviridae Infections; Hodgkin Disease; Humans; Keratitis, Dendritic; Leukemia; Lymphoma; Male; Middle Aged; Tumor Virus Infections

9-(1,3-Dihydroxy-2-propoxymethyl)guanine (DHPG), a nucleoside analogue, inhibits the replication of human and murine cytomegalovirus (MCMV) in cell culture. We studied the effects of treatment with DHPG on acute MCMV infection in mice and assessed the impact of drug therapy on the eventual development of latent viral infection. In virus-susceptible Balb/c mice, DHPG treatment limited dissemination of virus infection and prevented death. In sublethal infection of both Balb/c and virus-resistant C3H/St mice, DHPG prevented recovery of infectious virus from visceral organs, including the spleen. Despite these effects of drug treatment on virus replication during acute infection, latent MCMV could be reactivated in vivo by immunosuppression and in vitro by spleen explantation in virtually all mice. These results indicate that successful treatment of MCMV infection and marked suppression of viral replication do not prevent establishment of viral latency.

Topics: Acute Disease; Acyclovir; Animals; Antiviral Agents; Cytomegalovirus; Cytomegalovirus Infections; Female; Ganciclovir; Mice; Mice, Inbred BALB C; Salivary Glands; Spleen; Time Factors; Virus Replication

We treated 13 eyes of 12 patients with the acute retinal necrosis syndrome (ARN) with intravenous acyclovir (1500 mg/M2/day) for an average of 10.9 days. All patients were also treated with oral aspirin or Coumadin. in an attempt to prevent thrombotic complications and nine of twelve patients were treated with oral prednisone after intravenous acyclovir had been initiated. Regression of retinal lesions was first seen on average 3.9 days after initiation of therapy and required 32.5 days on average for completion. No eye developed new retinal lesions or progressive optic nerve involvement 48 hours or more after initiation of therapy, although progression within the first 48 hours was occasionally seen. Treatment did not ameliorate vitritis or prevent retinal detachment, which occurred in 11 of 13 eyes, an average of 59 days after the initiation of therapy. There were no evident ocular or systemic complications of therapy. Our data suggest the need for a prospective randomized clinical trial to evaluate the efficacy of intravenous or oral acyclovir in the treatment of the acute retinal necrosis syndrome.

Topics: Acute Disease; Acyclovir; Adolescent; Adult; Child; Drug Evaluation; Female; Humans; Inflammation; Injections, Intravenous; Male; Middle Aged; Retinal Artery; Retinal Detachment; Retinal Diseases; Retinitis; Syndrome; Vision, Ocular; Vitreous Body

Ten children between the ages of five and fifteen years old with leukemia (two with acute nonlymphocytic leukemia in first remission, four with acute lymphocytic leukemia in first or second remission, one with acute lymphocytic leukemia in relapse, and one with chronic myelocytic leukemia in chronic phase), malignant lymphoma (one) or severe aplastic anemia (one) were given transplants from HLA-matched or mismatched family members between March, 1982 and April, 1984. Two patients died of leukemia relapses on days 107 and 257 following transplantation. One patient died of cardiac failure on day 157. One patient who received HLA-mismatched marrow from his father died of pulmonary edema and acute graft versus host disease on day 32. Six are alive 268-843 days post transplantation. None of the ten patients developed interstitial pneumonia due to cytomegalovirus which is one of the major causes of death reported in other published studies.

Topics: Acute Disease; Acyclovir; Adolescent; Anemia, Aplastic; Bone Marrow Transplantation; Child; Child, Preschool; Cyclophosphamide; Female; Graft vs Host Disease; Herpesviridae Infections; Humans; Immunologic Deficiency Syndromes; Leukemia; Leukemia, Lymphoid; Leukemia, Myeloid; Lymphoma; Male; Methotrexate; Transplantation, Homologous

Two patients with acute retinal necrosis were treated with vitrectomy, intravitreal infusion of acyclovir, and prophylactic scleral buckling procedures. Both patients have had a uneventful postoperative course and a recovery of visual acuity; follow-up has been at five and 14 months. There has been no sign of toxicity from the intravitreally administered acyclovir by electroretinographic or clinical criteria.

Topics: Acute Disease; Acyclovir; Adolescent; Female; Humans; Male; Middle Aged; Necrosis; Retina; Retinal Diseases; Scleral Buckling; Syndrome; Vitrectomy; Vitreous Body

Topics: Acute Disease; Acyclovir; Anemia, Macrocytic; Anemia, Megaloblastic; Bone Marrow; Encephalitis; Erythropoiesis; Herpes Simplex; Humans

Murine cytomegalovirus (MCMV) is inhibited in vitro by 1 to 2 microM acyclovir. Therapy of a systemic MCMV infection in weanling mice with acyclovir was only minimally effective when drug was administered intraperitoneally, while oral administration by addition of acyclovir to the drinking water was highly efficacious in mice with disseminated MCMV. Effective therapy was characterized by reduction of virus titers in lung, liver, spleen, and kidney. In mice chronically infected with MCMV, treatment for 30 days with oral acyclovir eliminated or reduced virus titers in all target organs except the salivary gland. Therapeutic efficacy in this model infection using oral administration of acyclovir could be correlated with the achievement of acyclovir levels in the plasma of experimental animals two to 10 times greater than the mean inhibitory concentration for MCMV in vitro throughout treatment. The lack of efficacy observed when drug was administered intraperitoneally was associated with acyclovir levels exceeding 1 microM for one to three hours after each dose.

Topics: Acute Disease; Acyclovir; Administration, Oral; Animals; Antiviral Agents; Chronic Disease; Cytomegalovirus; Cytomegalovirus Infections; Female; Guanine; Mice

Topics: Acute Disease; Acyclovir; Guanine; Herpes Simplex; Humans; Keratoconjunctivitis; Kidney Transplantation; Male; Middle Aged