acyclovir and Blindness

Herpes simplex virus (HSV) keratitis is a common cause of ocular morbidity. Resistance to aciclovir is probably under recognized. We describe three cases of aciclovir-resistant herpes simplex virus keratitis treated with systemic foscarnet and present a review of the pharmacological options available to manage this condition.

Topics: Acyclovir; Administration, Oral; Administration, Topical; Aged, 80 and over; Antiviral Agents; Blindness; Drug Resistance, Viral; Humans; Keratitis, Herpetic; Male; Middle Aged; Treatment Outcome

Infection with Herpes simplex virus type 1 (HSV-1) typically causes lesions of the mouth, face, skin, esophagus, or brain. Herpes simplex virus type 2 (HSV-2) usually causes infections of the genitals, rectum, skin, hands, or meninges. The herpes viruses are a major cause of blindness from keratitis. The usual drugs used for herpes are Vidarabine, Acyclovir, Penciclovir and Ganciclovir; they are associated with several complications. The aim of this study was to investigate if a formulation containing 2.5 mg melatonin and 100 mg SB-73 would help patients with herpes, and to compare the preparation with 200 mg Acyclovir. SB-73 is a mixture of magnesium, phosphate, fatty acids extracted from Aspergillus sp. which has anti-herpes virus properties. A single blind randomized study was performed in which 70 patients underwent treatment using the supplement cited above (group A) and 75 received treatment of 200 mg Acyclovir (group B). Sixty-seven patients of the group A (95.7%) reported a complete regression of symptoms after 7 days of treatment. By comparison, 64 subjects (85.3%) of the Acyclovir reported regression of symptoms in the same period. There was statiscally significant difference between the groups (P < 0.05).

Topics: Acyclovir; Adult; Antiviral Agents; Blindness; Central Nervous System Depressants; Female; Herpes Genitalis; Herpesvirus 1, Human; Herpesvirus 2, Human; Humans; Keratitis; Linoleic Acids; Male; Melatonin; Organophosphorus Compounds; Single-Blind Method

Pseudorabies virus (PRV) was thought to only infect animals. Recent studies have shown that it can also infect human.. We report a case of pseudorabies virus encephalitis and endophthalmitis, diagnosed 89 days after onset, confirmed with intraocular fluid metagenomic next generation sequencing (mNGS) after the result of two cerebrospinal fluid (CSF) mNGS tests were negative. Although treatment with intravenous acyclovir, foscarnet sodium, and methylprednisolone improved the symptoms of encephalitis, significant diagnostic delay resulted in permanent visual loss.. This case suggests that pseudorabies virus (PRV) DNA in the intraocular fluid may have a higher positivity than that in the CSF. PRV may persist in the intraocular fluid for an extended period and may thus require extended antiviral therapy. Patients with severe encephalitis and PRV should be examined with the focus on pupil reactivity and light reflex. A fundus examination should be performed in patients with a central nervous system infection, specifically, those in a comatose state, to help reduce eye disability.

Topics: Acyclovir; Antiviral Agents; Aqueous Humor; Blindness; Delayed Diagnosis; DNA, Viral; Encephalitis, Viral; Endophthalmitis; Foscarnet; Herpesvirus 1, Suid; High-Throughput Nucleotide Sequencing; Humans; Male; Metagenomics; Methylprednisolone; Middle Aged; Pseudorabies

A retired woman with left ophthalmic shingles of over 2 years' duration attended with bilateral vision loss and systemic upset. Acute retinal necrosis with detachment was detected on right fundus examination. Cataract in left eye precluded funduscopy. Ocular ultrasonography revealed fibrotic retinal detachment in the left eye. MRI brain and orbits also showed signals of retinal detachment. No abnormal MRI signal within the optic nerve or brain was found. Varicella zoster virus was detected in ocular aqueous and blood samples. High-dose intravenous acyclovir was administered. HIV test was positive with a very low CD4 count. Antiretroviral medications were prescribed. There was no recovery of vision. She was certified as blind, and social services were involved in seeking to provide alterations to her home in view of her severe disability. This case highlights the importance of suspecting HIV in patients with severe or chronic ophthalmic shingles. Images and implications for clinical practice are presented.

Topics: Acyclovir; AIDS-Related Opportunistic Infections; Anti-Retroviral Agents; Antiviral Agents; Blindness; Diagnosis, Differential; Female; Herpes Zoster; HIV Infections; Humans; Magnetic Resonance Imaging; Patient Safety; Retinal Detachment; Retinal Diseases; Retinal Necrosis Syndrome, Acute; Ultrasonography; Varicella Zoster Virus Infection

Topics: Acyclovir; Aged; Amnesia; Aphasia; Blindness; Diagnosis, Differential; Humans; Male; Seizures; Treatment Outcome

To report a case of progressive outer retinal necrosis (PORN) presenting as a cherry red spot.. Case report.. A 53-year-old woman with recently diagnosed HIV and varicella-zoster virus (VZV) aseptic meningitis developed rapid sequential vision loss in both eyes over 2 months. Her exam showed a "cherry red spot" in both maculae with peripheral atrophy and pigmentary changes, consistent with PORN. Due to her late presentation and the rapid progression of her condition, she quickly developed end-stage vision loss in both eyes.. PORN should be considered within the differential diagnosis of a "cherry red spot." Immune-deficient patients with a history of herpetic infection who present with visual loss warrant prompt ophthalmological evaluation.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; AIDS-Related Opportunistic Infections; Antiretroviral Therapy, Highly Active; Antiviral Agents; Blindness; Disease Progression; Eye Infections, Viral; Female; Herpes Zoster Ophthalmicus; Humans; Middle Aged; Mucolipidoses; Retinal Necrosis Syndrome, Acute; Valacyclovir; Valine

We report the case of a 53-year-old woman with uveitis in her right eye. She suffered from meningoencephalitis two years before. In the ophthalmic examination she showed no light perception, mild anterior uveitis and severe vitritis, which prevented from visualizing the retina. We suspected herpetic acute retinal necrosis (ARN), so therapy with intravenous acyclovir was started and a diagnostic vitrectomy was performed. Peripheral retinal necrosis and pallor of the optic disc were observed. PCR of the vitreous was positive for herpes simplex virus type I.. This is probably a case of brain-to-eye virus transmission. According to this, the ARN would support the etiologic suspicion of the previous encephalitis.

Topics: Acyclovir; Antiviral Agents; Blindness; Diagnosis, Differential; DNA, Viral; Encephalitis, Herpes Simplex; Eye Infections, Viral; Female; Herpes Simplex; Herpesvirus 1, Human; Humans; Magnetic Resonance Imaging; Middle Aged; Polymerase Chain Reaction; Retinal Necrosis Syndrome, Acute; Vitreous Body

To report two cases of progressive outer retinal necrosis occurring in immunocompetent individuals after treatment with corticosteroids for presumed optic neuropathy.. Observational case report.. University-based tertiary eye hospital.. Retrospective review of existing clinical records.. Two patients were treated empirically with systemic corticosteroids for suspected inflammatory papillopathy. Subsequently, both were diagnosed with necrotizing herpetic retinitis with features of progressive outer retinal necrosis. Anterior chamber paracentesis confirmed varicella-zoster infection. Both patients were human immunodeficiency virus negative; one patient with rheumatoid arthritis was taking etanercept. Both became completely blind in one eye despite intensive treatment with antiviral medication intravenously and intravitreally.. Progressive outer retinal necrosis is not confined to patients with underlying severe immunodeficiency, such as acquired immune deficiency syndrome. Initial treatment of acute, unexplained vision loss with systemic corticosteroids may lead to catastrophic visual loss in patients with evolving necrotizing herpetic retinopathy.

Topics: Acyclovir; Aged; Antiviral Agents; Aqueous Humor; Blindness; DNA, Viral; Drug Therapy, Combination; Female; Foscarnet; Ganciclovir; Glucocorticoids; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Immunocompromised Host; Middle Aged; Multiple Sclerosis; Optic Neuritis; Polymerase Chain Reaction; Prednisone; Pupil Disorders; Retinal Necrosis Syndrome, Acute; Retrospective Studies

The bilateral simultaneous optic neuritis is rarely associated with multiple sclerosis. Diagnosis and prognosis have to be dealt with independently.. A 45-year-old woman presented with an acute bilateral simultaneous amaurosis which developed within one day with bilateral papilledema. Initially there were positive antinuclear and anticytoplasmatic antibodies and antibodies against heart and skeletal muscles. The serum titer was elevated for immunoglobulin A, lowered for complement factors C3 and C4. Antigens for polio-virus type 3 and coxsackievirus type B5 and B3 were borderline positive. An oncologic, toxic or vascular cause of the neuritis was unlikely.. The amaurosis lasted for 4 days. Vision improved gradually under a combined therapy with steroids, antibiotics and virostatics. Nineteen months later the vision was 20/25 OD and 20/200 OS.. The acute bilateral neuritis was probably of autoimmunological origin. Under combined antiinfectious and steroidal therapy vision improved more than expected.

Topics: Acyclovir; Autoantibodies; Autoimmune Diseases; Blindness; Cardiolipins; Ceftriaxone; Complement C3; Complement C4; Diagnosis, Differential; Drug Therapy, Combination; Female; Fluorescein Angiography; Humans; Immunoglobulin A; Methylprednisolone; Middle Aged; Optic Neuritis; Visual Acuity; Visual Fields

Topics: Acyclovir; Adrenal Cortex Hormones; Adult; Blindness; Cataract; Female; Humans; Retinal Necrosis Syndrome, Acute; Retinitis

Topics: Acyclovir; Adult; Blindness; Herpes Zoster Ophthalmicus; Humans; Male; Optic Atrophy; Optic Neuritis