acyclovir and Anus-Diseases

Topics: Acyclovir; Aged; Anus Diseases; Diagnosis, Differential; Diagnostic Errors; Female; Herpes Simplex; Histocytochemistry; Humans; Immunohistochemistry; Microscopy; Pyoderma Gangrenosum; Simplexvirus; Treatment Outcome

Hypertrophic pseudo tumoral herpetic lesion is an uncommon presentation in immunocompromized hosts that can be refractory to established therapies. We describe bipolar anal and tonsilar herpetic tumoral lesions related to acyclovir-resistant HSV-2 in a human immunodeficiency virus-infected patient. Treatment with valacyclovir, cidofovir, and thalidomide failed and surgical excision was required.

Topics: Acyclovir; Animals; Antiretroviral Therapy, Highly Active; Antiviral Agents; Anus Diseases; Chlorocebus aethiops; Drug Resistance, Viral; Herpes Simplex; Herpesvirus 2, Human; HIV Infections; Humans; Hypertrophy; Male; Middle Aged; Palatine Tonsil; Pharyngeal Diseases; Vero Cells

Topics: Acyclovir; Adult; Antiviral Agents; Anus Diseases; Female; Herpes Simplex; Humans; Skin Ulcer

Nodules are exceptional manifestations of herpes simplex virus (HSV) infection in immunocompromised patients. Only two cases of nodular HSV-2 infection of the perianal region have been reported previously.. The case of a 46-year-old homosexual man with AIDS presenting with painful perianal nodules resembling squamous cell carcinoma is described.. This case report presents details of the histologic findings and treatment regimen.. Histologic examination showed the presence of rare multinucleated giant epithelial cells and a dense inflammatory infiltrate composed mostly of plasma cells. Polymerase chain reaction analysis was positive for HSV-2 and negative for HSV-1, cytomegalovirus, Epstein-Barr virus, and human herpesvirus types 6 and 7. After being treated ineffectively with oral acyclovir (4 g/d) for 15 days, the patient was treated with oral valacyclovir (6 g/d), resulting in marked improvement in 10 days and complete resolution after 2 months.. In immunocompromised patients, HSV-2 infection may present with atypical clinical and histopathological features.

Topics: Acyclovir; AIDS-Related Opportunistic Infections; Antiviral Agents; Anus Diseases; Herpes Simplex; HIV Infections; Humans; Inflammation; Male; Middle Aged; Plasma Cells; Simplexvirus

Topics: Acyclovir; Adult; AIDS-Related Opportunistic Infections; Antiviral Agents; Anus Diseases; Herpes Simplex; Humans; Injections, Intramuscular; Interferon alpha-2; Interferon-alpha; Male; Recombinant Proteins; Ulcer

Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients.. One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol.. Mean age was 33 (range, 19-59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent), Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas. Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months +/- 2.9 SEM (range, 1-94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures.. Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.

Topics: Acyclovir; Adult; Anus Diseases; Chlamydia; Combined Modality Therapy; Cytomegalovirus; HIV Seropositivity; Humans; Male; Middle Aged; Mycobacterium; Neisseria gonorrhoeae; Opportunistic Infections; Prospective Studies; Rectal Diseases; Risk-Taking; Simplexvirus; Treatment Outcome

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; Anus Diseases; Drug Resistance, Microbial; Herpes Genitalis; Humans; Male; Trifluridine

The aim of this study was to determine the prevalence and type of symptomatic anal and perianal diseases in patients belonging to group IV of the Centers for Disease Control classification of infections with human immuno-deficiency virus. Among the 190 prospectively included patients, 31 (16.3 percent) (30 men, 29 homosexuals or bisexuals; 1 woman) had anal symptoms and were referred for proctological examination. Thirty-five "specific" diagnoses were reached in 25 (13.2 percent) patients: 21 ulcerations, 7 condyloma acuminata, 6 perianal sepsis and 1 non-Hodgkin malignant lymphoma. The causes of ulcerations were 16 herpes, one syphilitic chancre and one fissure-in-ano. Three ulcerations remained unexplained despite bacteriological, viral, and histological investigations. Eight patients underwent 10 surgical procedures without significantly delayed wound healing.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; Anus Diseases; Anus Neoplasms; Condylomata Acuminata; Female; Herpes Simplex; Humans; Lymphoma, Non-Hodgkin; Male; Middle Aged; Opportunistic Infections; Prevalence; Prospective Studies; Ulcer

The case of a 25-year-old homosexual man with large inguinal and perianal ulcers is reported. He had been pretreated extensively with acyclovir. Herpes simplex virus (HSV) was identified in the ulcer tissue by in-situ hybridization. No clinical improvement with acyclovir but a prompt response to foscarnet was noted. In a relapse after 11 weeks an acyclovir-resistant HSV type 2 was isolated. Again, a prompt response to foscarnet was noted. The case is presented in detail, and the clinical impact of resistance of HSV to acyclovir is discussed.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; Antiviral Agents; Anus Diseases; Drug Resistance, Microbial; Foscarnet; Herpes Simplex; Humans; Male; Phosphonoacetic Acid

Four immunosuppressed patients are described with chronic ulcerative herpes simplex virus infection in the sacral and perianal area. Three of these patients were evaluated for decubitus ulcers. Prompt diagnosis was possible when the characteristic morphologic features were recognized and when viral culture and Tzanck smear specimens were obtained. Previously reported cases are reviewed as well. Chronic mucocutaneous herpes simplex infections are complications of immunocompromised hosts and should be recognized early if appropriate therapy is to be initiated.

Topics: Acyclovir; Adult; Anus Diseases; Female; Glomerulosclerosis, Focal Segmental; Herpes Simplex; Humans; Immunosuppression Therapy; Leukemia, Lymphoid; Lupus Erythematosus, Systemic; Male; Middle Aged; Sacrococcygeal Region

A case of primary anal herpes is documented. Therapy with intravenous acyclovir is demonstrated.

Topics: Acyclovir; Adult; Anus Diseases; Female; Herpes Genitalis; Humans; Male