acyclovir and Central-Nervous-System-Viral-Diseases

Opsoclonus is a rare neurological disorder in adult. The etiology of opsoclonus includes parainfectious, paraneoplastic, toxic, and metabolic disorders. We reported an old female with post-infectious opsoclonus who had a benign clinical course and reversible brain MRI lesions, and its review of the literature.. A 67-year-old woman presented with opsoclonus and truncal ataxia for two weeks. The magnetic resonance imaging (MRI) showed the hyperintensity lesions in bilateral medial thalamus, hypothalamus, and tegmentum of pons on Fluid-attenuated inversion recovery (FLAIR) imaging. Investigations of neoplasm and autoimmune disorders showed negative findings. Clinical symptoms subsided in two-week duration and MRI abnormalities also disappeared one month later.. A benign clinical course and reversible MRI lesions could be found in the patients with postinfectious opsoclonus such as our case. However, detailed investigations and long-term follow-up are needed to exclude paraneoplastic or other systemic and immunological disorders.

Topics: Acyclovir; Aged; Antiviral Agents; Brain; Central Nervous System Viral Diseases; Female; Fluorodeoxyglucose F18; Follow-Up Studies; Humans; Magnetic Resonance Imaging; Ocular Motility Disorders; Positron-Emission Tomography

Studies report that 40-100% of the general population are infected with cytomegalovirus (CMV), a virus associated with severe neurological conditions, such as CMV encephalitis, and which may have a role in some cases of Guillain-Barre syndrome. CMV infection is a particular concern among individuals with HIV, as almost all are co-infected with it. The introduction of highly active antiretroviral therapy (HAART) has provided a means of reconstituting the immune system of those with HIV/AIDS in such a way as to allow CMV infection to be controlled. In doing so, HAART has done much to reduce the mortality rate associated with CMV disease in such patients. Despite this, response to treatment in these patients remains suboptimal and many do not have access to such therapy, so, efforts to improve the treatment of CMV have been a priority. The International Herpes Management Forum (IHMF) has developed management guidelines to promote the improved diagnosis and treatment of CMV disease of the central nervous system (CNS). It is recommended that polymerase chain reaction (PCR) for viral DNA should be performed on CSF as a means of diagnosing CMV infection of the CNS. As CMV disease is always preceded by viraemia, treatment should be directed toward the prevention of CMV disease. However, if CMV disease develops, ganciclovir is recommended as therapy and continued in a maintenance fashion, which can be discontinued should CD4 count remain above 100 cells/mm3 for 6 months. In many circumstances, valganciclovir may be preferred, depending on the level of function in the patient, their ability to take oral therapy and the severity of disease. Use of foscarnet should be limited to ganciclovir-resistant cases due to the high level of toxicity associated with the drug and its intravenous mode of administration.

Topics: Acyclovir; Antiviral Agents; Central Nervous System Viral Diseases; Cytomegalovirus; Cytomegalovirus Infections; Ganciclovir; Humans; Infusions, Intravenous; Practice Guidelines as Topic; Valganciclovir

Varicella zoster virus (VZV) causes chicken pox (varicella) after which it establishes latency and can subsequently reactivate to cause herpes zoster. Central nervous system (CNS) complications can follow both primary infection and reactivation of VZV. The more serious manifestations arise when VZV invades the spinal cord or cerebral arteries after reactivation of the virus, causing diseases such as myelitis and focal vasculopathies. The International Herpes Management Forum (IHMF) has developed guidelines to aid in the diagnosis and management of CNS syndromes associated with VZV and these have focused on VZV vasculopathy. The new guidelines recommend that where VZV vasculopathy is suspected, cerebrospinal fluid (CSF) should be analysed by polymerase chain reaction (PCR) for VZV DNA. As VZV antibodies may be present in the CSF in the presence or absence of detectable VZV DNA, CSF should also be analysed for VZV-specific antibody if there is a high likelihood of CNS disease. Early diagnosis of these serious complications is important, as aggressive antiviral treatment can be effective. Patients with VZV focal vasculopathy should be treated with intravenous aciclovir (10 mg/kg every 8 h for adults, 500 mg/m2 body surface area for children) for 7 days. The immunocompromised patient may require longer treatment. However, treatment should be discontinued if negative results are obtained for both VZV DNA and anti-VZV antibody in CSF. Steroid therapy (prednisone 60-80 mg/day for 3-5 days) should be considered in VZV vasculopathy to reduce inflammation.

Topics: Acyclovir; Antiviral Agents; Central Nervous System Viral Diseases; Herpes Zoster; Herpesvirus 3, Human; Humans; Infusions, Intravenous; Practice Guidelines as Topic

Herpes simplex virus (HSV) infections are among the infections most frequently encountered by humans. Two types of HSV infections have been identified-HSV-1, which usually causes orolabial disease, and HSV-2, which is associated more frequently with genital and newborn infections. Usually, HSV causes mild and self-limited disease of the mouth and lips or at genital sites. However, on occasion, the disease can be life-threatening. Such is the case with neonatal HSV infection and HSV infections of the central nervous system. Furthermore, in the immunocompromised host, severe infection has been encountered and is a source of morbidity. Even in the immunocompetent host, frequent recurrences, particularly those of the genital tract, can be debilitating. Because HSV does cause genital ulcerative disease, it is associated with an increased risk of acquiring a human immunodeficiency virus infection. During the past 2 decades, selective and specific inhibitors of HSV replication have been developed. These agents, acyclovir, valaciclovir, and famciclovir, all accelerate the events of healing and decrease the probability of excreting the virus when they are taken in a suppressive fashion. The long-term safety of acyclovir has been unequivocally established. Its prodrug, valaciclovir, and the prodrug of penciclovir, famciclovir, have not been used in practice as long and, therefore, less is known about these agents; however, neither is available as a pediatric formulation.

Topics: 2-Aminopurine; Acquired Immunodeficiency Syndrome; Acyclovir; Administration, Oral; Adult; Antiviral Agents; Central Nervous System Viral Diseases; Child, Preschool; Drug Resistance, Viral; Famciclovir; Herpes Genitalis; Herpes Labialis; Herpes Simplex; Humans; Infant; Infant, Newborn; Injections, Intravenous; Simplexvirus; Valacyclovir; Valine; Virus Replication

Seventeen-day-old twins were hospitalized for neonatal herpes simplex virus 1 (HSV-1) with central nervous system disease and internal capsule and thalamic lesions on magnetic resonance imaging (MRI). They were treated with the usual intravenous (IV) treatment and oral therapy for 6 months. The clinical course was good in both children with negative HSV polymerase chain reaction on completion of IV therapy. The neurological condition recurred in one child with new radiological lesions at 7 months of age, 2 weeks after discontinuation of oral treatment. Cerebral lesions highlighted on the MRI scan are specific to the neonatal period and impact long-term prognosis. The likely genetic predisposition in this case is interesting and requires further investigation. In addition, this case raises questions about the duration of oral acyclovir suppressive therapy.

Topics: Acyclovir; Antiviral Agents; Central Nervous System Viral Diseases; Diseases in Twins; Electroencephalography; Female; Herpes Simplex; Herpesvirus 1, Human; Humans; Infant; Infant, Newborn; Magnetic Resonance Imaging; Male; Recurrence

Japanese encephalitis (JE) is a clinical disease caused by inflammation of the central nervous system. The symptoms of this disease range broadly in severity from mild febrile illness to acute meningomyeloencephalitis. JE has been associated with a variety of neurological abnormalities, such as altered sensorium, seizures, focal neurological deficit, and acute flaccid paralysis (AFP). However, to date, AFP has never been reported as an initial manifestation of JE. Here, we present a case of AFP manifesting as the initial symptom of JE in a Chinese patient. A 30-year-old Chinese man was admitted to the West China Hospital of Sichuan University after experiencing AFP in the right upper limb, followed by hyperpyrexia and unconsciousness. Assay of cerebrospinal fluid from a lumbar puncture revealed high levels of proteins and anti- JE virus IgM antibodies. Intravenous acyclovir was administered; however, the weakness persisted and more extensive muscle wasting from the proximal to distal right upper limb occurred over 7 months. This case report highlights that JE needs to be added to the differential diagnosis of AFP in adults, especially in JE endemic seasons and areas.

Topics: Acyclovir; Administration, Intravenous; Adult; Antibodies, Viral; Antiviral Agents; Central Nervous System Viral Diseases; China; Encephalitis Virus, Japanese; Encephalitis, Japanese; Humans; Immunoglobulin M; Male; Myelitis; Neuromuscular Diseases; Treatment Outcome

Central nervous system (CNS) viral infections are an important cause of morbidity and mortality. No data are available regarding their epidemiology in Qatar.. We retrospectively evaluated all cerebrospinal fluid findings from January 2011-March 2015 at Hamad Medical Corporation. Those with abnormal CSF finding were included in our study. We excluded those with missing medical records, no clinical evidence of viral CNS infection, or proven bacterial, fungal or tuberculosis CNS infection. CNS clinical findings were classified as meningitis, encephalitis or myelitis.. Among 7690 patients with available CSF results, 550 cases met the inclusion criteria (meningitis 74.7%; encephalitis 25%; myelitis 0.4%). Two-thirds (65%) were male and 50% were between 16-60 years old. Viral etiology was confirmed in 38% (enterovirus, 44.3%; Epstein-Barr virus, 31%; varicella zoster virus, 12.4%). The estimated incidence was 6.4 per 100,000 population. Two persons died and the rest were discharged to home. Among those with confirmed viral etiology, 83.8% received ceftriaxone (mean duration 7.3±5.2 days), 38% received vancomycin (mean duration 2.7±5.4 days) and 38% received at least one other antibiotic. Intravenous acyclovir was continued for more than 48h in patients with confirmed negative viral etiology (mean duration 5±5.6 days).. Viral etiology is not uncommon among those evaluated for CNS infection in Qatar. Clinical outcomes are excellent in this group of patients. Antibiotics and acyclovir are overly used even when a viral etiology is confirmed. There is a need for clinician education regarding etiology and treatment of viral CNS infections.

Topics: Acyclovir; Adolescent; Adult; Central Nervous System Viral Diseases; Female; Humans; Incidence; Male; Middle Aged; Qatar; Retrospective Studies; Young Adult

We retrospectively analyzed 80 instances of varicella zoster virus (VZV) disease in 72 patients who underwent allogeneic hematopoietic stem cell transplantation (HSCT) and examined the clinical differences between localized and disseminated disease. Risk factors for developing VZV dissemination were also evaluated.. Of the 80 instances, 54 instances were localized diseases and 26 were disseminated diseases. Patient characteristics did not differ significantly between the 2 groups, except for the first-line therapy and the duration from symptom onset to treatment. In the disseminated group, intravenous acyclovir was used as the first-line therapy more frequently, and more time elapsed before beginning antiviral therapy compared with the localized group. In multivariate analyses, the duration from symptom onset to treatment was identified as an independent risk factor that significantly affected the development of VZV dissemination. Gender, total body irradiation, and chronic graft-versus-host disease, of which the latter 2 factors were reported as risk factors for the development of VZV disease after HSCT, did not affect the development of VZV dissemination.. Our results suggest that VZV infection or reactivation may easily progress to viremia with delayed use of antiviral agents and may result in VZV dissemination in immunocompromised patients.

Topics: Acyclovir; Adolescent; Adult; Aged; Antiviral Agents; Central Nervous System Viral Diseases; Chickenpox; Disease-Free Survival; Female; Hematopoietic Stem Cell Transplantation; Herpes Zoster; Herpesvirus 3, Human; Humans; Male; Middle Aged; Retrospective Studies; Risk Factors; Survival Rate; Time-to-Treatment; Valacyclovir; Valine; Virus Activation; Young Adult

Neonatal herpes simplex virus infections are uncommon, but because of the morbidity and mortality associated with the infection they are often considered in the differential diagnosis of ill neonates. The use of polymerase chain reaction for diagnosis of central nervous system infections and the development of safe and effective antiviral therapy has revolutionized the diagnosis and management of these infants. Initiation of long-term antiviral suppressive therapy in these infants has led to significant improvement in morbidity. This article summarizes the epidemiology of neonatal herpes simplex virus infections and discusses clinical presentation, diagnosis, management, and follow up of infants with neonatal herpes disease.

Topics: Acyclovir; Adult; Antiviral Agents; Central Nervous System Viral Diseases; Developmental Disabilities; Diagnosis, Differential; Evidence-Based Medicine; Female; Herpes Genitalis; Herpes Simplex; Herpes Simplex Virus Vaccines; Humans; Infant, Newborn; Morbidity; Mothers; Polymerase Chain Reaction; Practice Guidelines as Topic; Pregnancy; Pregnancy Complications, Infectious; Prognosis; Recurrence; Risk Factors; Severity of Illness Index; Simplexvirus

Topics: Acyclovir; Anticonvulsants; Antiviral Agents; Central Nervous System Viral Diseases; Clonazepam; Combined Modality Therapy; Herpes Simplex; Herpesvirus 1, Human; Humans; Magnetic Resonance Imaging; Male; Mesencephalon; Middle Aged; Severity of Illness Index; Tremor

Topics: Acyclovir; Analgesics, Non-Narcotic; Animals; Antibodies, Viral; Antiviral Agents; Central Nervous System Viral Diseases; Clonixin; Diagnosis, Differential; Dimethyl Sulfoxide; Female; Fluid Therapy; Herpesviridae Infections; Herpesvirus 1, Equid; Horse Diseases; Horses

Neonatal herpes simplex virus (HSV) infection is a severe disease with high mortality and morbidity. Recurrence of skin vesicles is common.. To determine the features of relapse and identify the factors related to relapse.. Thirty two surviving patients with neonatal herpes virus infections were enrolled. All patients received acyclovir treatment. Clinical and virological data were analysed and compared between relapsed and non-relapsed cases.. Thirteen (41%) had either local skin or central nervous system relapse between 4 and 63 days after completing the initial antiviral treatment. Nine patients exhibited local skin relapses, and four developed central nervous system relapses. In one skin and two central nervous system relapse cases, neurological impairment later developed. Type 2 virus infection was significantly related to relapse (odds ratio 10.4, 95% confidence interval 1.1 to 99.0). Patients with relapse had worse outcomes than those without relapse.. Neonates with HSV type 2 infections have a greater risk of relapse. Relapsed patients have poorer prognoses.

Topics: Acyclovir; Antiviral Agents; Central Nervous System Viral Diseases; Female; Gestational Age; Herpes Simplex; Humans; Infant, Newborn; Male; Recurrence; Skin Diseases, Infectious; Treatment Outcome; Viral Load