acyclovir and Chronic-Disease

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

After herpes zoster, immunocompetent persons frequently experience chronic pain and considerable suffering. Zoster-associated pain has a complex pathophysiology that begins with viral damage and increased sensitization of peripheral sensory neurons. The enhanced afferent barrage from these neurons sensitizes spinal neurons and leads to loss of synapses from descending inhibitory fibers, resulting in central neuropathic pain and allodynia. Antiviral therapy of acute zoster limits this sequence of pathophysiologic mechanisms. There is no clear consensus regarding the optimal means of determining the benefits of antiviral therapy in the management of pain of herpes zoster. A novel statistical approach utilizing rates of disappearance of pain of differing pathophysiologic mechanisms is proposed.

Topics: 2-Aminopurine; Acyclovir; Analgesics; Antiviral Agents; Chronic Disease; Clinical Trials as Topic; Famciclovir; Herpes Zoster; Herpesvirus 3, Human; Humans; Meta-Analysis as Topic; Pain; Pain Measurement; Proportional Hazards Models; Treatment Outcome; Valacyclovir; Valine

Herpes simplex virus infection is increasingly common in the United States. New antiviral medications have expanded treatment options for the two most common cutaneous manifestations, orolabial and genital herpes. Acyclovir therapy remains an effective and often less expensive option. Famciclovir and valacyclovir offer improved oral bioavailability and convenient oral dosing schedules but are more expensive than acyclovir. Patients who have six or more recurrences of genital herpes per year can be treated with one of the following regimens: acyclovir, 400 mg twice daily; valacyclovir, 1 g daily; or famciclovir, 250 mg twice daily. These regimens are effective in suppressing 70 to 80 percent of symptomatic recurrences. Episodic treatment of recurrent genital herpes is of questionable benefit, but it may be helpful in appropriately selected patients. There is little evidence indicating benefit from treatment of recurrent orolabial herpes, which tends to be mild and infrequent.

Topics: 2-Aminopurine; Acyclovir; Antiviral Agents; Chronic Disease; Diagnosis, Differential; Drug Costs; Famciclovir; Herpes Genitalis; Herpes Labialis; Herpes Simplex; Humans; Patient Education as Topic; Teaching Materials; Valacyclovir; Valine

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

Herpes simplex viruses (HSV) 1 and 2 are responsible for genital herpes which is usually recognized as vesicles that ulcerate and eventually heal but recur periodically. Atypical genital herpes is often described in immunocompromised patients and can present as large, chronic, hyperkeratotic ulcers. Acyclovir-resistant HSV is occasionally isolated from such ulcers. Most cases of HSV infection reproduce subtle signs and symptoms, or more commonly, asymptomatic viral shedding. Such subclinical presentations may be responsible for most of the 30% increase in the prevalence of genital herpes in the United States during the past two decades.

Topics: Acyclovir; AIDS-Related Opportunistic Infections; Chronic Disease; Drug Resistance, Microbial; Herpes Genitalis; Herpesvirus 2, Human; Humans; Immunocompromised Host; Keratosis; Prevalence; Recurrence; Simplexvirus; Ulcer; Virus Shedding

Severe renal disease in the setting of Epstein-Barr virus (EBV) infection is exceedingly rare. We report here the case of a 22-year-old man with acute EBV infection associated with severe interstitial nephritis. The patient developed chronic fatigue and chronic renal failure with a serological profile typical of primary EBV infection. Clinical improvement with anti-EBNA seroconversion occurred after acyclovir therapy. Our patient illustrates that chronic fatigue with major organ dysfunction and a serological profile of primary infection can be seen in chronic EBV infection. In such a case, acyclovir may prove beneficial.

Topics: Acyclovir; Adult; Antiviral Agents; Chronic Disease; Fatigue Syndrome, Chronic; Humans; Infectious Mononucleosis; Male; Nephritis, Interstitial

Topics: Acyclovir; Antiviral Agents; Chronic Disease; Combined Modality Therapy; Female; Humans; Immunocompromised Host; Immunosuppressive Agents; Kidney Transplantation; Middle Aged; Periodontitis; Recurrence; Stomatitis, Herpetic

This paper presents an overview of the clinical conditions associated with a herpetic lesion at the time of the primary infection, as a true primary infection or a first herpetic accident, or during recurrences. The virus responsible, its anatomy and its functioning are detailed. The etiology and transmission of herpetic viral infection, its evolution and complications, as well as diagnostic aids are also discussed. To complete the discussion of this chronic disease which can cause acute annoyances treatment, particularly for children is reviewed, and suggestions are made to prevent it.

Topics: Acyclovir; Child; Child, Preschool; Chronic Disease; Herpesvirus 1, Human; Humans; Infant; Mouthwashes; Recurrence; Stomatitis, Herpetic

Topics: Acyclovir; Chronic Disease; Hepatitis, Viral, Human; Humans; Nucleosides; Ribavirin; Vidarabine

Chronic zoster represents an infrequent presentation of varicella zoster virus infection. It is observed with increased frequency in patients infected with human immunodeficiency virus, especially when their lymphocyte counts are depressed. We report a child infected with human immunodeficiency virus who showed a long-standing cutaneous zoster lesion and was treated for a prolonged period of time with acyclovir. The occurrence of resistance to acyclovir by varicella zoster virus was suspected based on the clinical picture. The clinical and laboratory features of this case and a review of the literature are presented.

Topics: Acyclovir; Child; Chronic Disease; Herpes Zoster; HIV Infections; Humans; Male; Skin; Skin Diseases, Infectious

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Antiviral Agents; Chickenpox; Child; Chronic Disease; Herpes Zoster; Herpesvirus 3, Human; Humans; Immune Tolerance; Neoplasms; Pneumonia, Viral

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

Topics: Acyclovir; BCG Vaccine; Chronic Disease; Drug Therapy, Combination; Hepatitis B; Hepatitis B Antibodies; Humans; Interferons; Levamisole; Transfer Factor; Vidarabine; Vidarabine Phosphate

Topics: Acyclovir; Adrenal Cortex Hormones; Antiviral Agents; Azathioprine; Chronic Disease; Guanine; Hepatitis B; Humans; Immunoglobulins; Interferons; Levamisole; Ribavirin; Transfer Factor; Vidarabine; Vidarabine Phosphate

Single-day, high-dose systemic antiviral drugs are effective in the treatment of labial herpes (herpes labialis [HL]). Aciclovir Lauriad® mucoadhesive buccal tablet (ABT) is an innovative drug delivery system providing high and prolonged exposure to aciclovir in the oral cavity, supporting its evaluation as a single low dose in HL.. In this multicenter double-blind placebo-controlled patient-initiated trial, 775 patients with recurrent HL were randomly assigned to either a single application of ABT 50 mg or a matching placebo as soon as prodromal symptoms occurred. The primary endpoint was the time to healing (TTH) of primary vesicular lesion (modified intention-to-treat population). Other endpoints included incidence of blocked episodes, duration of herpes episodes, and incidence and time to next recurrence evaluated during a 9-month follow-up period (intention-to-treat population).. With ABT 50 mg, median TTH of primary vesicular lesion was reduced (7 days vs 7.3 days, P=.015), the incidence of blocked herpes episodes was increased by 24.2% (34.9% vs 28.1%; P=.042), and the median duration of herpes episodes was reduced (5.6 days vs 6.4 days, P=.003). During the 9-month follow-up period, recurrence of herpes lesions was less frequent (64.2% vs 73.6%; P=.027) and delayed (205 days vs 165 days, P=.041) in the ABT 50 mg. Both treatments were safe.. A single application of ABT improves all endpoints of HL and might modify its clinical course in decreasing the incidence and delaying the onset of the next recurrence.

Topics: Acyclovir; Adhesiveness; Administration, Buccal; Adolescent; Adult; Aged; Aged, 80 and over; Antiviral Agents; Chronic Disease; Double-Blind Method; Drug Delivery Systems; Female; Follow-Up Studies; Herpes Labialis; Humans; Male; Middle Aged; Recurrence; Tablets; Treatment Outcome; Young Adult

Host defense and latency determinants in viral recurrent dermatologic infections are not entirely understood, as conventional protocols are inadequate to achieve fast healing and relapse prevention. Endogenously produced oxygen/nitrogen reactive species (ROS/RNS) are essential for antiviral immune defense, while their excess may aggravate skin inflammation. Here, we sought a nutritional approach capable of controlling ROS/RNS balance to accelerate recovery and inhibit recurrences of two mucocutaneous chronic DNA-virus infections.. Two controlled clinical trials evaluated the feasibility of ROS/RNS-modulating nutriceutical dosages of coenzyme Q(10), RRR-α-tocopherol, selenium aspartate, and L-methionine associated with established therapies. Clinical trial 1 evaluated 68 patients with relapsing human papillomavirus skin warts treated with cryotherapy followed by 180 d of nutriceutical/placebo administration. Clinical trial 2 compared the combination of acyclovir followed by 90 d of nutriceutical administration versus acyclovir alone in patients with recurrences of herpes simplex genitalis (n = 60) or herpes zoster (n = 29). Viral DNA levels were assessed by polymer chain reaction, biomarkers of antiviral defense (peroxynitrite and IFNα/γ) and antioxidant capacity (lipophilic antioxidants and glutathione) were assayed by biochemical/enzyme-linked immunosorbent assay techniques in blood fractions.. In both trials, the nutriceutical induced significantly faster healing (P < 0.01-0.05) with reduced incidence of relapses (P < 0.05) as compared to control groups, which was confirmed by decreased viral load and increased antiviral cytokine and peroxynitrite plasma levels. Plasma antioxidant capacity was higher (P < 0.01) in the experimental versus control groups.. Results document positive clinical outcomes of the selected nutriceutical associated with conventional protocols in the management of relapsing mucocutaneous human papillomavirus and herpes infections.

Topics: Acyclovir; Administration, Oral; Adult; alpha-Tocopherol; Alphapapillomavirus; Antioxidants; Antiviral Agents; Chronic Disease; Cryotherapy; Dietary Supplements; DNA Virus Infections; DNA, Viral; Double-Blind Method; Enzyme-Linked Immunosorbent Assay; Female; Herpes Genitalis; Herpes Zoster; Host-Pathogen Interactions; Humans; Male; Methionine; Middle Aged; Reactive Nitrogen Species; Reactive Oxygen Species; Recurrence; Selenium; Skin Diseases, Infectious; Ubiquinone; Viral Load; Vitamin E; Young Adult

Varicella-zoster virus (VZV) disease occurs in 30% of allogeneic hematopoietic cell transplant recipients who had a history of VZV infection. A safe and effective prevention strategy has not been established. In a double-blind controlled trial, 77 hematopoietic cell transplant recipients at risk for VZV reactivation were randomized to acyclovir 800 mg twice daily or placebo given from 1 to 2 months until 1 year after transplantation. VZV disease at 1 year was the primary end point; VZV disease after discontinuation of prophylaxis, VZV-specific T-cell immunity, herpes simplex virus (HSV) infection, cytomegalovirus (CMV) disease, survival, and safety were secondary end points. Acyclovir significantly reduced VZV infections at 1 year after transplantation (HR, 0.16; 95% CI, 0.035-0.74; P = .006). In the post-intervention observation period, this difference was not statistically significant (2 years: HR, 0.52; 95% CI, 0.21-1.3; 5 years: HR, 0.76; 95% CI, 0.36-1.6). There was no statistically significant difference in reconstitution of VZV-specific T-helper cell responses, HSV infections, CMV disease, chronic graft-versus-host disease, and overall survival between the groups. Acyclovir was well tolerated. Post-study VZV disease predominantly occurred in patients with continued need for systemic immunosuppression. In conclusion, acyclovir effectively and safely prevents VZV disease during the first year after hematopoietic cell transplantation. Periods of prophylaxis longer than 12 months may be beneficial for those hematopoietic cell transplant recipients on continued immune suppression.

Topics: Acyclovir; Adolescent; Adult; Aged; Child; Chronic Disease; Cytomegalovirus; Cytomegalovirus Infections; Double-Blind Method; Female; Follow-Up Studies; Graft vs Host Disease; Hematologic Neoplasms; Hematopoietic Stem Cell Transplantation; Herpes Simplex; Herpes Zoster; Humans; Male; Middle Aged; Simplexvirus; T-Lymphocytes, Helper-Inducer; Transplantation, Homologous; Virus Activation

Twenty-six AIDS patients were enrolled in an open label pilot study to evaluate the efficacy and toxicity of topical 1 percent ophthalmic trifluridine solution for the treatment of chronic mucocutaneous herpes simplex virus disease unresponsive to at least 10 days of acyclovir therapy. Susceptibility testing to acyclovir, trifluridine, and foscarnet was determined by plaque reduction assay. Twenty-four patients were evaluable for efficacy and 25 for toxicity analyses. Seven patients (29 percent) had complete healing of lesions. The overall estimated median time to complete healing was 7.1 weeks. An additional seven patients had > or = 50 percent reduction in lesion area. The overall estimated median time to 50 percent healing was 2.4 weeks. Ten (42 percent) patients discontinued treatment for reasons other than primary treatment failure and seven (29 percent) for failure to respond to therapy. Baseline patient characteristics associated with greater reduction in lesion area included higher Karnofsky score (p = 0.05), fewer lesions (p = 0.07), smaller lesion area (p = 0.11), and trifluridine susceptibility (p = 0.07). Eight (33 percent) patients developed new lesions outside of the treatment area while on study, reflecting the local nature of this therapy. No dose-limiting toxicity attributable to trifluridine was reported. Given the limited options for the treatment of acyclovir-resistant herpes simplex disease, topical trifluridine may be a useful alternative in selected patients.

Topics: Acyclovir; Administration, Topical; Adult; AIDS-Related Opportunistic Infections; Antiviral Agents; Chronic Disease; Drug Resistance, Microbial; Female; Herpes Simplex; Humans; Male; Middle Aged; Pilot Projects; Safety; Trifluridine

To determine the effect of acyclovir and prednisone treatment of herpes zoster on chronic pain and quality-of-life outcomes.. Randomized, double-blind, placebo-controlled study with a 2 x 2 factorial design.. 15 university hospitals or affilliated clinics.. 208 immunocompetent patients older than 50 years of age who had localized herpes zoster that developed less than 72 hours before study enrollment.. Acyclovir or a matched placebo was administered orally, 800 mg five times daily, for 21 days. Prednisone or a matched placebo was administered orally at 60 mg/d for the first 7 days, 30 mg/d for days 8 to 14, and 15 mg/d for days 15 to 21. The four treatments regimens given were acyclovir plus prednisone; acyclovir plus prednisone placebo; prednisone plus acyclovir placebo; and placebos for both acyclovir and prednisone.. Patients were monitored daily for the first 28 days for lesion healing, resolution of pain, return to usual activity, and return to uninterrupted sleep. Monitoring was then done monthly for 6 months. Patients documented analgesic requirements each day, and adverse events and laboratory abnormalities were recorded at each clinical visit. An intention-to-treat analysis was used.. Patients were randomly allocated to receive one of the four regimens. Demographic characteristics were similar for each group. Time to total crusting and healing was accelerated for patients receiving acyclovir plus prednisone compared with patients receiving two placebos; the risk ratios were 2.27 (95% Cl, 1.46 to 3.55) for total crusting and 2.07 (Cl, 1.26 to 3.38) for healing. Similarly, compared with the placebo group, patients receiving acyclovir plus prednisone had accelerated time to cessation of acute neuritis (risk ratio, 3.02 [Cl, 1.42 to 6.41]), time to return to uninterrupted sleep (risk ratio, 2.12 [Cl, 1.25 to 3.58]); time to return to usual daily activity (risk ratio, 3.22 [Cl, 1.92 to 5.40]); and time to cessation of analgesic therapy (risk ratio, 3.15 [Cl, 1.69 to 5.89]). In the acyclovir plus prednisone group, resolution of pain during the 6 months after disease onset did not statistically differ from that in the other groups. No important clinical or laboratory adverse events occurred in any group.. In relatively healthy persons older than 50 years of age who have localized herpes zoster, combined acyclovir and prednisone therapy can improve quality of life.

Topics: Acyclovir; Aged; Antiviral Agents; Chronic Disease; Drug Therapy, Combination; Female; Glucocorticoids; Herpes Zoster; Humans; Male; Middle Aged; Pain; Placebos; Prednisone; Quality of Life; Regression Analysis

Ten patients with chronic type B hepatitis were treated for four weeks with a rapidly tapered dose of oral prednisone (initial dose, 40 mg/d) followed by two weeks of no therapy followed by four weeks of oral acyclovir (600 mg/d). Liver biochemistry, HBsAg, HBeAg, DNA-polymerase and HBV-DNA levels in serum were determined prior to, during and for six months following therapy. The mean age +/- SD of the study population was 33 +/- 15 years (range 18-58). Nine of the patients were male. Four patients were Caucasian and six of Southeast Asian origin. Three patients were homosexual, all HIV antibody negative. The mean ALT level prior to treatment was 89 +/- 62 IU/L (range: 30-214). During the six month post-treatment follow-up period, 5/8 (63%) patients became DNA-P negative and 6/10 (60%) HBV-DNA negative. One responder reverted to DNA-P positive (final response, 50%) and another to HBV-DNA positive (final response, 50%) prior to completion of the study. Patients were more likely to become DNA-P or HBV-DNA negative if they had elevated pre-treatment ALT values and low levels of DNA-P and HBV-DNA. HBeAg became undetectable in 3/10 (30%) individuals, one of whom reverted to positive at the end of the follow-up period (final response, 20%). All patients remained HBsAg positive. Mild fatigue, which occurred in four individuals, was the most common side effect. The results of this study suggest that a controlled clinical trial of oral prednisone/acyclovir is warranted in the treatment of adults with chronic type B hepatitis.

Topics: Acyclovir; Administration, Oral; Adolescent; Adult; Alanine Transaminase; Chemical and Drug Induced Liver Injury; Chronic Disease; DNA-Directed DNA Polymerase; DNA, Viral; Drug Administration Schedule; Female; Hepatitis B; Hepatitis B e Antigens; Hepatitis B Surface Antigens; Hepatitis B virus; Humans; Liver; Male; Middle Aged; Pilot Projects; Prednisone; Substance Withdrawal Syndrome

Twenty-seven adults with a diagnosis of the chronic fatigue syndrome were enrolled in a double-blind, placebo-controlled study of acyclovir therapy. The patients had had debilitating fatigue for an average of 6.8 years, accompanied by persisting antibodies to Epstein-Barr virus early antigens (titers greater than or equal to 1:40) or undetectable levels of antibodies to Epstein-Barr virus nuclear antigens (titers less than 1:2) or both. Each course of treatment consisted of intravenous placebo or acyclovir (500 mg per square meter of body-surface area) administered every eight hours for seven days. The same drug was then given orally for 30 days (acyclovir, 800 mg four times daily). There were six-week observation periods before, between, and after the treatments. Three patients had acyclovir-induced nephrotoxicity and were withdrawn from the study. Of the 24 patients who completed the trial, similar numbers improved with acyclovir therapy and with placebo (11 and 10, respectively). Neither acyclovir treatment nor clinical improvement correlated with alterations in laboratory findings, including titers of antibody to Epstein-Barr virus or levels of circulating immune complexes or of leukocyte 2',5'-oligoadenylate synthetase. Subjective improvement correlated with various measures of mood. We conclude that acyclovir, as used in this study, does not ameliorate the chronic fatigue syndrome. We believe that the clinical improvement observed in most patients reflected either spontaneous remission of the syndrome or a placebo effect.

Topics: Acyclovir; Adult; Affect; Antibodies, Viral; Antigens, Viral; Body Temperature; Chronic Disease; Clinical Trials as Topic; Fatigue; Female; Herpesviridae Infections; Herpesvirus 4, Human; Humans; Male; Rest; Syndrome

Patients with chronic hepatitis B with active viral replication had a significantly greater fall in DNA polymerase and hepatitis-Be antigen when treated with interferon and acyclovir together than when treated with either interferon or acyclovir alone. Apart from fatigue and thrombophlebitis, tolerance of the combination therapy was excellent. The combination therapy appears the most promising for conversion of a state of active viral replication into virus latency.

Topics: Acyclovir; Chronic Disease; Drug Therapy, Combination; Female; Hepatitis B; Hepatitis B e Antigens; Hepatitis B virus; Humans; Interferon Type I; Male; Nucleic Acid Synthesis Inhibitors; Virus Replication

Six patients with hepatitis B virus (HBV) related chronic liver disease were treated with acyclovir, 5-15 mg/kg 8 hourly, given as an iv bolus or iv infusion over 1 h for up to 7 days. Two patients treated with 10 and 15 mg/kg 8 hourly showed a decrease in HBV-DNA polymerase and HBV-DNA when mean trough acyclovir plasma concentrations of 5.0 +/- 0.6 and 13.2 +/- 3.0 microM were attained. Inhibition of viral replication was not seen in patients treated with lower doses. Transient renal impairment was seen in two patients who received high dosage by the iv bolus mode of administration. This complication may be prevented by a high oral fluid intake or iv infusion of the drug over 1 h. Further study with acyclovir 15 mg/kg 8-hourly given as an iv infusion for longer periods is warranted.

Topics: Acyclovir; Adolescent; Adult; Chronic Disease; DNA, Viral; Hepatitis B; Humans; Injections, Intravenous; Kidney Diseases; Time Factors; Virus Replication

Thygeson's superficial punctate keratitis (TSPK) is a recurrent bilateral corneal epithelial disease. Typically, small, multiple discrete epithelial lesions occur in the central cornea. However, dendritic corneal lesions are rare. Herein, we report a rare case of TSPK in both eyes after a unilateral dendritic corneal lesion. A 42-year-old woman presented with decreased vision and foreign body sensation in her right eye that persisted for 1 month. Her uncorrected visual acuity and best-corrected visual acuity (BCVA) were 20/160 in the right eye. Slit-lamp microscopy revealed a dendritic lesion in the central cornea of the right eye. No abnormalities were observed in her left eye. Herpetic keratitis in the right eye was diagnosed and systemic acyclovir was prescribed, along with topical acyclovir ointment and steroids. After one week, most of the corneal lesions had disappeared, and the BCVA in the right eye had improved to 20/25. The corneal epithelium completely recovered after 2 weeks. However, 2 weeks later, the patient visited the hospital with decreased visual acuity in the right eye, and the BCVA decreased to 20/40. Multiple fine corneal lesions were observed under a slit-lamp microscope. The patient was diagnosed with TSPK of the right eye. Topical steroids were started, and after 7 days, the corneal condition improved. However, after 6 weeks, visual acuity decreased in the left eye, and a corneal lesion similar to that in the right eye was observed; therefore, the patient was diagnosed with bilateral TSPK. Short-term topical steroids and long-term topical cyclosporine A 0.1% were used in both eyes, and the disease was maintained without recurrence for 3 months. TSPK can appear as a unilateral dendritic corneal lesion similar to herpetic keratitis. Therefore, in case of unilateral dendritic corneal lesions, it should be considered that TSPK may develop later.

Topics: Acyclovir; Adult; Chronic Disease; Cornea; Female; Humans; Keratitis, Herpetic; Visual Acuity

Type 2 diabetes (T2D) is an increasingly dominant disease. Interventions are more effective when carried out by a prepared and proactive team within an organised system - the integrated care (IC) model. The Chronic Care Model (CCM) provides guidance for its implementation, but scale-up of IC is challenging, and this hampers outcomes for T2D care. In this paper, we used the CCM to investigate the current implementation of IC in primary care in Flanders (Belgium) and its variability in different practice types.. Belgium contains three different primary-care practice types: monodisciplinary fee-for-service practices, multidisciplinary fee-for-service practices and multidisciplinary capitation-based practices. Disproportional sampling was used to select a maximum of 10 practices for each type in three Flemish regions, leading to a total of 66 practices. The study employed a mixed methods design whereby the Assessment of Chronic Illness Care (ACIC) was complemented with interviews with general practitioners, nurses and dieticians linked to the 66 practices.. The ACIC scores of the fee-for-service practices - containing 97% of Belgian patients - only corresponded to basic support for chronic illness care for T2D. Multidisciplinary and capitation-based practices scored considerably higher than traditional monodisciplinary fee-for-service practices. The region had no significant impact on the ACIC scores. Having a nurse, being a capitation practice and having a secretary had a significant effect in the regression analysis, which explained 75% of the variance in ACIC scores. Better-performing practices were successful due to clear role-defining, task delegation to the nurse, coordination, structured use of the electronic medical record, planning of consultations and integration of self-management support, and behaviour-change intervention (internally or using community initiatives). The longer nurses work in primary care practices, the higher the chance that they perform more advanced tasks.. Besides the presence of a nurse or secretary, also working multidisciplinary under one roof and a capitation-based financing system are important features of a system wherein IC for T2D can be scaled-up successfully. Belgian policymakers should rethink the role of paramedics in primary care and make the financing system more integrated. As the scale-up of the IC varied highly in different contexts, uniform roll-out across a health system containing multiple types of practices may not be successful.

Topics: Acyclovir; Belgium; Chronic Disease; Diabetes Mellitus, Type 2; Humans; Primary Health Care

Recurrent erythema multiforme is a chronic relapsing disease that represents a therapeutic challenge. Our objective was to retrospectively evaluate the clinical-epidemiological characteristics and therapeutic response of patients with recurrent erythema multiforme and suggest a therapeutic protocol. We included patients with recurrent erythema multiforme diagnosed between January 2000 and December 2019. Clinical symptoms and a positive serology for herpes simplex virus were the inclusion criteria to initiate acyclovir in monotherapy or a combined treatment with dapsone, thalidomide, or immunosuppressants in refractory cases. Thirty-five patients were included and 71.4% were female. The median disease onset age was 35.7 years and the mean follow-up was 7.58 years. The skin was the most affected site (91.4%). Herpes simplex virus immunoglobulin (Ig)G serology was positive in 91.1% of cases. Acyclovir treatment was used in 33 of 35 patients, and complete remission was achieved in 22 of 33 after the first therapeutic course; 16 of 22 relapsed and required a second acyclovir cycle. Combined treatment with dapsone was required in nine of 33 due to partial response to acyclovir; thalidomide was an adjuvant drug in four of 33 due to adverse effects to dapsone. After the first cycle of acyclovir with or without combined therapy, 19 of 33 patients relapsed and received 2-6 additional cycles. Our results suggest that recurrent erythema multiforme presents a good response to acyclovir in monotherapy or in combined therapy with dapsone or thalidomide in the majority of patients. We propose a long-term therapeutic protocol to enable disease remission.

Topics: Acyclovir; Adult; Chronic Disease; Erythema Multiforme; Female; Herpes Simplex; Humans; Recurrence; Retrospective Studies

Topics: Acyclovir; Anti-HIV Agents; Antiviral Agents; Chronic Disease; HIV Infections; HIV-1; Humans; Male; Penile Diseases; Skin Ulcer; Valacyclovir; Valine; Young Adult

Herpes labialis remains a common worldwide affliction. Recent advances in understanding the basic pathogenesis have led to new therapeutic intervention, both on-label and off-label. Aside from reducing the duration and symptomatology of acute outbreaks, another goal of treatment is to decrease the frequency of future episodes. Oral and topical acyclovir and its analogues are the mainstay of both chronic suppressive and episodic therapy. A new muco-adhesive formulation of acyclovir provides a decrease in outbreaks, probably due to a diminution of herpesvirus load in all reservoir sites. Acyclovir-resistant strains are rare in immunocompetent hosts; parenteral foscarnet and cidofovir are administered in this situation. Parenteral acyclovir is the drug of choice for eczema herpeticum, which may begin as herpes labialis in an atopic dermatitis patient. Thermotherapy may be beneficial, and a certified device to deliver heat is available outside the United States.

J Drugs Dermatol. 2017;16(3 Suppl):s49-53.

Topics: Acyclovir; Administration, Oral; Administration, Topical; Adult; Antiviral Agents; Chronic Disease; Cidofovir; Cytosine; Drug Resistance, Viral; Foscarnet; Herpes Labialis; Herpesvirus 1, Human; Humans; Hyperthermia, Induced; Infusions, Parenteral; Organophosphonates; Recurrence; Stomatitis, Herpetic; Viral Load

Topics: Acyclovir; Administration, Intravenous; Antiviral Agents; Chronic Disease; Hematopoietic Stem Cell Transplantation; Herpes Labialis; Humans; Male; Transplantation, Homologous; Young Adult

Chronic cutaneous varicella zoster virus (VZV) infection has not been previously reported or characterized as a complication of dermatomyositis. Two patients with non-malignancy-associated dermatomyositis, treated with long-term prednisone and methotrexate, developed persistent, painless ulcers ultimately established to be secondary to chronic VZV. The absence of pain or a history suggestive of acute VZV, and the lack of characteristic histopathology, resulted in a lengthy delay in diagnosis. Polymerase chain reaction and tissue immunohistochemistry were positive for VZV, and treatment with valacyclovir resulted in complete clearance. Diagnostic testing for VZV should thus be considered in the evaluation of ulcerative lesions in patients with dermatomyositis. The increased incidence of acute VZV in combination with the nature and duration of immunosuppressive treatment in this patient population may be contributory.

Topics: Acyclovir; Aged; Antiviral Agents; Chronic Disease; Dermatomyositis; Female; Herpesviridae Infections; Herpesvirus 3, Human; Humans; Immunosuppressive Agents; Skin Diseases, Viral; Valacyclovir; Valine

The purpose of this study was to develop a consensus regarding the appropriate regimen to evaluate long-term suppressive antiviral treatment to reduce complications from herpes zoster ophthalmicus (HZO) and identify potential study sites.. In January 2013, a survey of 13 questions was distributed among cornea fellowship directors, board members of the Cornea Society and Ocular Microbiology and Immunology Group, and Kera-net Listserv members. Questions identified respondents' preferred antiviral regimens to administer for chronic or recurrent HZO, gauged the level of interest in participation in a planned randomized clinical trial, and assessed the number of HZO patients treated among specialists in the past year.. Of the 171 respondents who completed the questionnaire, the majority identified as Kera-net Listserv members (107 of 171, 63%) and cornea fellowship directors (46 of 171, 27%). First choice of treatment was valacyclovir 500 mg 2 times per day (61 of 171, 36%), followed by acyclovir 800 mg 2 times per day (56 of 171, 33%), and then valacyclovir 1,000 mg daily (26.9%, 46 of 171). Among the choices, famciclovir consistently placed last among all the respondents (7 of 171, 4%). A majority (106 of 171, 62%) of all respondents, including 70% (26 of 37) of U. S. respondents of the high-volume practices, were interested in participating in a future randomized clinical trial evaluating whether treatment with oral antiviral medications for 1 year decreases complications of HZO.. This survey highlights the strong interest in and support for further study of suppressive antiviral treatment regimens to reduce complications of HZO.

Topics: 2-Aminopurine; Acyclovir; Adult; Antiviral Agents; Attitude of Health Personnel; Chronic Disease; Famciclovir; Female; Health Care Surveys; Herpes Zoster Ophthalmicus; Humans; Male; Middle Aged; Neuralgia, Postherpetic; Practice Patterns, Physicians'; Surveys and Questionnaires

Hydroa vacciniforme is one of the rarest forms of photosensitivity disorders of the skin. Effective treatment options are scarce and mainly constitute of strict sun protection. Lately, hydroa vacciniforme has been associated with Epstein-Barr virus infection. We present a patient with hydroa vacciniforme and concomitant previous/chronic Epstein-Barr virus infection. In this case, antiviral treatment was successful.

Topics: Acyclovir; Antiviral Agents; Child; Chronic Disease; Epstein-Barr Virus Infections; Humans; Hydroa Vacciniforme; Male; Valacyclovir; Valine

A 45-year-old man who had undergone splenectomy 20 years earlier for immune thrombocytopenia (ITP) presented with a fever, arthralgia and vesicular skin rash. The skin rash was typical for varicella, as confirmed on serological studies. He exhibited isolated thrombocytopenia and was diagnosed with ITP. In addition, an accessory spleen was detected. The platelet count responded to treatment with prednisolone (PSL), and the varicella subsided uneventfully following therapy with acyclovir. Furthermore, the platelet count was maintained after PSL was discontinued. This case suggests an etiological link between varicella and very late relapse of ITP after initial splenectomy.

Topics: Acyclovir; Antiviral Agents; Arthralgia; Chickenpox; Chronic Disease; Fever; Humans; Male; Middle Aged; Platelet Count; Prednisolone; Purpura, Thrombocytopenic, Idiopathic; Recurrence; Splenectomy; Time Factors; Treatment Outcome

Varicella zoster virus (VZV) disease is one of the major infectious complications that can occur after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Many reports have shown visceral VZV infection, a special type of VZV disease, to be rare. However, few studies so far have included a large number of patients.. Visceral VZV infection was found in 20 (0.8%) of 2411 patients who underwent allo-HSCT at our hospitals. Seventeen (85%) patients were taking immunosuppressive agents at the time of presentation with zoster. The presenting symptom was abdominal pain in 16 patients (80%), unconsciousness in 3 patients (15%), and no symptoms in 1 patient. The mean time interval from allo-HSCT to symptomatic visceral VZV infection was 273 days (103-800 days). The eruptions appeared within 3 days (0-13) after the first symptoms. Treatment with intravenous acyclovir was initiated before the appearance of eruptions in 3 of 18 patients (all 3 survived) with vesicular eruptions, the same day in 12 patients (11 survived, 1 died), and after the appearance in 3 patients (1 survived, 2 died). The overall mortality was 20%.. In conclusion, these data confirm that the incidence of visceral VZV infection is infrequent, but this disease is serious. When patients being treated with immunosuppressive agents demonstrate abdominal pain or unconsciousness, the possibility of visceral VZV infection should be considered as well as earlier therapeutic intervention.

Topics: Abdominal Pain; Acyclovir; Adult; Antiviral Agents; Chronic Disease; Female; Graft vs Host Disease; Hematopoietic Stem Cell Transplantation; Herpes Zoster; Herpesvirus 3, Human; Humans; Incidence; Male; Middle Aged; Transplantation, Homologous; Unconsciousness; Virus Activation; Viscera; Young Adult

Although varicella zoster virus latency has been demonstrated in several sensory ganglia, herpes zoster usually effects only one single, either left or right, dermatome in half of the body. In immunocompromised patients, more than one contiguous unilateral dermatome may be involved. Bilateral non-contiguous herpes zoster, also termed herpes zoster duplex, is rarely reported. Chronic varicella zoster virus skin infection is another rare entity encountered in HIV-infected and immunocompromised patients, often associated with aciclovir resistance. We describe here a patient with chronic lymphocytic leukaemia, who presented simultaneously non-contiguous bilateral and chronic herpes zoster lasting for more than 2 months, with resistance to aciclovir. To our knowledge, this is the first report of chronic herpes zoster duplex bilateralis. Physicians should be aware of and recognize these atypical manifestations of varicella zoster virus.

Topics: Acyclovir; Aged; Antiviral Agents; Bronchopneumonia; Chronic Disease; Drug Resistance, Viral; Fatal Outcome; Herpes Zoster; Humans; Immunocompromised Host; Leukemia, Lymphocytic, Chronic, B-Cell; Male; Skin Diseases, Viral

The objective of this study was to determine current practices and opinions among cornea specialists for treating and preventing recurrences of herpes zoster ophthalmicus (HZO).. In November 2010, a survey of 15 questions was distributed to The Cornea Society listserv. Questions identified respondents' treatment practices for recurrent HZO and opinions regarding prolonged antiviral prophylaxis and zoster vaccine.. Of 100 respondents, the majority were cornea specialists (83 of 98, 85%). Eighty-seven percent (84 of 97) reported treating recurrent or chronic cases of HZO in the last year. The most common choice of treatment in the posed recurrent HZO clinical scenario was a combination of oral antiviral and topical corticosteroid (63 of 100, 63%), although significant variability existed in the duration of oral antiviral administration. Fifty-four respondents (56%) believed that prolonged acyclovir prophylaxis could reduce recurrent signs of HZO; 28% (27 of 98) believed that recurrences of HZO could be reduced after the period of acyclovir administration. For patients with a history of HZO, most respondents reported not recommending the adult zoster vaccine (63 of 98, 64%), but 46% (43 of 94) believed that the vaccine could reduce recurrent signs or did not know.. Many cornea specialists are managing recurrent or chronic cases of HZO, but there is variability in the use of topical corticosteroids and antivirals. Additionally, no consensus exists on the efficacy of prolonged antiviral therapy or the adult zoster vaccine to reduce chronic or recurrent disease. These results demonstrate the need for further systematic study of treatment and prophylaxis for recurrent and chronic HZO.

Topics: Acyclovir; Administration, Oral; Administration, Topical; Adult; Antiviral Agents; Attitude of Health Personnel; Chronic Disease; Drug Therapy, Combination; Glucocorticoids; Health Care Surveys; Herpes Zoster Ophthalmicus; Herpes Zoster Vaccine; Humans; Keratitis, Herpetic; Ophthalmology; Practice Guidelines as Topic; Practice Patterns, Physicians'; Recurrence; Surveys and Questionnaires; Treatment Outcome

Meningitis or encephalitis by varicella-zoster virus (VZV) after hematopoietic stem cell transplantation (HSCT) is rarely reported. We encountered a case of meningoencephalitis with VZV re-activation 18 months after related bone marrow transplantation for recurrent acute lymphoblastic leukemia. The patient had been administered steroid and cyclosporine for chronic graft-versus-host disease. A high DNA copy number of VZV, 4.9×10(7) copies was detected in the cerebrospinal fluid. VZV also caused severe pneumonia and acute renal failure soon after the onset of meningoencephalitis. The patient was successfully treated with acyclovir, although he was left with persistent neurological sequelae. Both prompt diagnosis and early treatment of VZV reactivation are important to avoid a fatal outcome.

Topics: Acute Kidney Injury; Acyclovir; Adult; Antiviral Agents; Bone Marrow Transplantation; Chronic Disease; Cyclosporine; Encephalitis, Varicella Zoster; Graft vs Host Disease; Herpesvirus 3, Human; Humans; Immunosuppressive Agents; Male; Pneumonia; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Prednisolone; Recurrence; Time Factors; Virus Activation

Valacyclovir, the L-valyl ester prodrug of acyclovir (ACV), is widely prescribed to treat infections caused by varicella-zoster virus or herpes simplex virus. Rarely, treatment is complicated by reversible neuropsychiatric symptoms. By mechanisms not fully understood, this occurs more frequently in the setting of renal impairment. We characterized the steady-state pharmacokinetics of ACV and its metabolites 9-[(carboxymethoxy)methyl]guanine (CMMG) and 8-hydroxy-acyclovir (8-OH-ACV) in cerebrospinal fluid (CSF) and the systemic circulation. We administered multiple doses of high-dose valacyclovir to 6 subjects with normal renal function and 3 subjects with chronic renal impairment (creatinine clearance [CrCl], approximately 15 to 30 ml/min). Dosages were 2,000 mg every 6 h and 1,500 mg every 12 h, respectively. Indwelling intrathecal catheters allowed serial CSF sampling throughout the dosing interval. The average steady-state concentrations of acyclovir, CMMG, and 8-OH-ACV were greater in both the systemic circulation and the CSF among subjects with impaired renal function than among subjects with normal renal function. However, the CSF penetration of each analyte, reflected by the CSF-to-plasma area under the concentration-time curve over the 6- or 12-h dosing interval (AUC(tau)) ratio, did not differ based on renal function. Renal impairment does not alter the propensity for ACV or its metabolites to distribute to the CSF, but the higher concentrations in the systemic circulation, as a result of reduced elimination, are associated with proportionally higher concentrations in CSF.

Topics: Acyclovir; Adult; Aged; Antiviral Agents; Chronic Disease; Female; Guanine; Humans; Kidney; Kidney Diseases; Kidney Function Tests; Male; Medical Futility; Middle Aged; Prodrugs; Valacyclovir; Valine; Young Adult

The role of infectious agents as a cause of chronic idiopathic urticaria (CIU) is uncertain. The objective of this study was to investigate whether genital herpes simplex infection is causally related to CIU. We identified two patients with recurrent genital herpes simplex infections associated with CIU. Episodes of genital herpes were especially associated with acute exacerbation of urticaria. Anti-herpes simplex 2 antibodies and Tzanck smears were done in both patients, along with other relevant investigations for CIU. Acyclovir was added to antihistamine therapy. Both patients were apparently in good health and appeared clinically immunologically stable, though one of them was found to be diabetic. Clinical and laboratory investigations for genital lesions supported a diagnosis of herpes simplex. Anti-herpes simplex 2 antibodies were markedly raised in both patients. The Tzanck smear was positive in one case and negative in the other, despite a definitive clinical diagnosis of herpes progenitalis. CIU, which was inadequately controlled with antihistamines alone, responded dramatically to the addition of acyclovir therapy. Our results may not be applicable to other patients with CIU, especially when there is inadequate evidence of an association with genital herpes. CIU may be associated with recurrent genital herpes simplex infection. In such situations, the addition of acyclovir to therapy may be beneficial.

Topics: Acyclovir; Adult; Antiviral Agents; Chronic Disease; Herpes Genitalis; Histamine Antagonists; Humans; Male; Middle Aged; Recurrence; Treatment Outcome; Urticaria

Herpes simplex virus type 1 is a sporadic cause of viral encephalitis. Relapse of encephalitis occurs in up to 10% of patients, manifested by recurrent symptoms, clinical and MRI findings, and the presence of herpes simplex virus type 1 DNA in the cerebrospinal fluid (CSF).. We describe the clinical features, MRI findings and outcome in 2 patients with herpes simplex encephalitis during the acute phase and 6 months after the onset of encephalitis.. Both patients had a good response to treatment and an excellent recovery. Despite clinical recovery, in a 6-month follow-up MRI lesions consistent with recurrence were disclosed, without any clinical findings or CSF abnormalities.. The mechanism underlying this MRI deterioration is unclear and an immune-mediated mechanism may be involved. Thus, MRI deterioration after herpes simplex encephalitis should be interpreted with caution and it does not always represent a relapse, especially when the imaging studies do not correlate with the clinical and CSF findings.

Topics: Acyclovir; Anticonvulsants; Antiviral Agents; Brain; Cerebral Cortex; Chronic Disease; Disease Progression; Encephalitis, Herpes Simplex; Female; Frontal Lobe; Gyrus Cinguli; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Nerve Fibers, Myelinated; Recovery of Function; Recurrence; Retrospective Studies; Temporal Lobe; Tomography, X-Ray Computed; Treatment Outcome

To characterize in detail persistent and recalcitrant infectious scleritis resulting from herpes simplex virus (HSV).. Retrospective and interventional clinical and immunopathologic case series.. Nine patients with chronic scleral redness, edema, and pain refractory to conventional therapy underwent a scleroconjunctival biopsy for routine histopathologic evaluation and definitive immunodiagnosis for the presence of HSV. Immunofluorescent probing for HSV was performed on the patient specimens. Negative controls for HSV included elimination of anti-HSV and anti-varicella zoster virus antibody in the probing process and the use of normal human conjunctiva and sclera as substrates. Response to therapy with acyclovir was monitored and recorded.. The average age of the affected patients was 50.2 years, and the average duration of symptoms before tissue diagnosis of herpetic scleritis was 3.2 years (median, 4 years). Three histopathologic patterns were discovered: granulomatous inflammation (2 cases), plasma cell-rich pyogenic granuloma-like pattern (1 case), and reactive fibroinflammatory pattern (6 cases). Herpes antigen was demonstrated uniformly by immunofluorescence in a perivascular distribution and less commonly in the interstitium. Varicella zoster virus was not detected, and all controls for nonspecific antibody reagent binding to tissue showed negative results. Acyclovir caused a dramatic improvement in the chronic or recurrent ocular inflammation in all instances, with an average duration of improvement of inflammation of 15.3 months.. Unrecognized HSV infection can cause longstanding scleritis. Histopathologic features of HSV scleritis are varied and nonspecific; immunofluorescent demonstration of HSV protein can make a definitive diagnosis. Prolonged administration of acyclovir is required for effective therapy.

Topics: Acyclovir; Adult; Aged; Antigens, Viral; Antiviral Agents; Chronic Disease; Eye Infections, Viral; Female; Fluorescent Antibody Technique, Indirect; Herpes Simplex; Humans; Male; Middle Aged; Retrospective Studies; Scleritis; Simplexvirus; Time Factors

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

A 21-month-old girl with neuroblastoma developed chronic verrucous Oka strain varicella-zoster infection during chemotherapy. Virus isolated from the patient demonstrated high-level acyclovir resistance, and its thymidine kinase had no in vitro enzymatic activity. After foscarnet therapy, she underwent stem cell transplantation without varicella reactivation. This is only the second reported case of resistant varicella zoster virus caused by Oka strain virus.

Topics: Acyclovir; Antineoplastic Agents; Antiviral Agents; Chickenpox; Chickenpox Vaccine; Chronic Disease; Drug Resistance, Viral; Female; Herpesvirus 3, Human; Humans; Immunocompromised Host; Infant; Neuroblastoma

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

Reactivation of latent varicella zoster virus is one infectious complication associated with the extensive immunosuppression necessary for hematopoietic stem cell transplant. Most cases are limited to skin and mortality is low. Isolated visceral zoster is rare, presenting with ileus/abdominal pain, hepatitis, and/or hyponatremia. We present 2 cases of visceral varicella zoster virus in adolescents with chronic graft-versus-host disease after hematopoietic stem cell transplant. Both presented with elevated liver enzymes, severe abdominal pain, and hyponatremia but lacked cutaneous involvement. Both received high-dose acyclovir and showed improvement, but eventually expired from hepatic failure. The diagnosis of visceral zoster can be difficult especially without cutaneous manifestations. Vigilance is necessary in patients with chronic graft-versus-host disease, abdominal pain, and/or hepatitis and antiviral therapy should be initiated promptly.

Topics: Acyclovir; Antiviral Agents; Chronic Disease; Fatal Outcome; Female; Graft vs Host Disease; Hematopoietic Stem Cell Transplantation; Herpes Zoster; Herpesvirus 3, Human; Humans; Leukemia, Myeloid, Acute; Opportunistic Infections; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Transplantation, Homologous; Virus Activation; Viscera; Young Adult

To report the case of an immunocompetent child with herpes simplex virus-2 (HSV-2) acute retinal necrosis (ARN) syndrome, who was considered to have an idiopathic unilateral panuveitis sensitive to steroid treatment.. Polymerase chain reaction for detection of viral DNA was applied to ocular fluids and in situ hybridization was performed on a retinal sample. HSV serology was performed using the ELISA and Western blot techniques, and an in-house indirect immunofluorescence technique.. In addition to the atypical clinical presentation, the serological assays for HSV were negative using ELISA at the time of diagnosis of ARN and 1 year after. HSV2 infection was confirmed by using polymerase chain reaction of aqueous humor specimen and in situ hybridization of a retinal biopsy. Retrospective analysis with the Western blot technique detected low titers of anti-HSV antibodies, when the sera were concentrated 5-fold.. Herpes virus infections must be investigated in children with posterior or panuveitis. PCR analysis is a reliable technique for diagnosis. This case emphasizes that clinical presentation can be atypical and that a negative viral serology does not exclude an acute or a past herpetic infection.

Topics: Acyclovir; Antibodies, Viral; Antiviral Agents; Aqueous Humor; Child, Preschool; Chronic Disease; DNA, Viral; Enzyme-Linked Immunosorbent Assay; Eye Infections, Viral; Herpes Simplex; Herpesvirus 2, Human; Humans; In Situ Hybridization; Male; Panuveitis; Polymerase Chain Reaction; Retinal Necrosis Syndrome, Acute; Valacyclovir; Valine

Topics: Acyclovir; Antiviral Agents; Chronic Disease; DNA, Viral; Epithelium, Corneal; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Keratitis, Dendritic; Polymerase Chain Reaction; Recurrence

Infections by herpesviruses may have severe complications in liver transplant patients. Although prophylactic varicella zoster virus vaccination is strongly recommended and widely applied, severe infection may still occur. We report the case of systemic chronic varicella, which developed in a liver allograft recipient, unresponsive to antiviral drug treatment, successfully treated by varicella zooster-specific CTL. Graft failure ensued, likely, because of massive cytolysis of infected hepatocytes. The patient, who was re-transplanted in the absence of signs of varicella zooster reactivation, is now well and disease free 3 yr after second liver transplant.

Topics: Acyclovir; Antiviral Agents; Biliary Atresia; Chickenpox; Child, Preschool; Chronic Disease; Female; Humans; Liver; Liver Function Tests; Liver Transplantation; Reoperation; T-Lymphocytes, Cytotoxic; Transplantation, Homologous

Topics: Acyclovir; Adult; Antiviral Agents; Chronic Disease; Female; Herpes Genitalis; HIV Infections; Humans; Vulvar Diseases

Topics: Acyclovir; Administration, Topical; Antiretroviral Therapy, Highly Active; Antiviral Agents; Chronic Disease; Cidofovir; Cytosine; Drug Resistance, Viral; Drug Therapy, Combination; Foscarnet; Herpes Genitalis; HIV Infections; Humans; Male; Middle Aged; Organophosphonates

To introduce into the clinical nomenclature a sign frequently observed in our patients with persistent corneal inflammation associated with herpetic stromal keratitis.. Case reports and review of the literature.. Four representative patients with herpesvirus stromal keratitis are presented. Herpes simplex virus-1 (HSV-1) was confirmed by culture in 1 case and by polymerase chain reaction in a second case. In the remaining 2 cases, the diagnosis was made based on characteristic clinical findings for herpes simplex virus and varicella zoster virus (VZV). On clinical examination, all 4 representative cases of stromal keratitis revealed a well-defined, localized region of intertwined, metallic-like, polychromatic material in the corneal stroma, a sign we have termed steel wool keratopathy. We have only rarely observed this finding in patients with stromal keratitis not caused by a herpesvirus.. Steel wool keratopathy seems to represent a focal region of stromal degeneration or deposition associated with chronic inflammation. Although we most often observe this finding in patients with stromal keratitis secondary to HSV or VZV, we cannot exclude the possibility that this sign represents the sequelae of chronic/recurrent inflammation rather than a specific pathologic response to herpetic antigens.

Topics: Acyclovir; Adult; Aged; Antiviral Agents; Chronic Disease; Corneal Stroma; DNA, Viral; Female; Herpes Zoster Ophthalmicus; Herpesvirus 1, Human; Herpesvirus 3, Human; Humans; Keratitis, Dendritic; Middle Aged; Polymerase Chain Reaction

To report a case of chronic recurrent varicella virus epithelial keratitis in a child.. Case report.. Clinical examination and polymerase chain reaction analysis of corneal epithelium.. A 10-year-old healthy child developed chronic recurrent varicella virus keratitis with pseudodendrites after recovering from systemic varicella. Analysis of the debrided pseudodendrites was repeatedly positive for VZV DNA and negative for HSV DNA. Treatment with oral acyclovir and topical corticosteroid drops was effective in eliminating the pseudodendrites; however, recurrences occurred once the medications were discontinued.. Varicella virus epithelial keratitis in children can be a recurrent chronic condition requiring prolonged treatment.

Topics: Acyclovir; Antiviral Agents; Child; Chronic Disease; DNA, Viral; Epithelium, Corneal; Female; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Keratitis, Dendritic; Polymerase Chain Reaction; Recurrence

A chronic osseous Bankart lesion has traditionally been treated with soft-tissue repair and/or open bone-grafting for a large glenoid defect. We developed an arthroscopic method of osseous reconstruction of the glenoid without bone-grafting. The purpose of this study was to evaluate the postoperative outcomes of our technique for chronic recurrent traumatic anterior glenohumeral instability.. A consecutive series of forty-two shoulders in forty-one patients with chronic recurrent traumatic glenohumeral instability underwent an arthroscopic osseous Bankart repair. All shoulders were evaluated preoperatively with three-dimensionally reconstructed computed tomography, which confirmed an osseous fragment at the anteroinferior portion of the glenoid. The average bone loss in the glenoid was 24.8% (range, 11.4% to 38.6%), and the average fragment size was 9.2% (range, 2.1% to 20.9%) of the glenoid fossa. In all shoulders, a displaced osseous fragment, firmly attached to the labroligamentous complex, was separated from the glenoid neck before reduction and fixation in the optimal position with use of suture anchors. All patients were assessed with use of the scoring systems of Rowe et al. and the University of California at Los Angeles preoperatively and at the final evaluation.. The mean duration of follow-up was thirty-four months. At that time, thirty-nine of the forty-two shoulders were rated as having a good or excellent result. The mean Rowe score improved from 33.6 points preoperatively to 94.3 points postoperatively (p < 0.01). The mean score on the University of California at Los Angeles system improved from 20.5 points preoperatively to 33.6 points at the final evaluation (p < 0.01). The average passive external rotation was 75 degrees with the arm at the side and 93 degrees with the arm at 90 degrees of abduction. Two patients had a reinjury. Eventually, thirty-five of thirty-seven patients who were active participants in sports returned to the sport they had played before the injury.. Arthroscopic osseous Bankart repair with use of suture anchors yields a successful outcome even in shoulders with a chronic large glenoid defect.

Topics: Acyclovir; Adolescent; Adult; Arthroscopy; Chronic Disease; Female; Humans; Image Processing, Computer-Assisted; Joint Instability; Male; Postoperative Care; Recovery of Function; Recurrence; Shoulder Joint; Suture Techniques; Treatment Outcome

We report on a chronic asymptomatic hepatitis B surface antigen (HBsAg) carrier who developed an increase in aminotransferase and HBsAg levels 1 year after lung transplantation. During treatment for cutaneous herpes simplex virus (HSV) infection with oral valaciclovir there was a marked decrease in replicating hepatitis B virus (HBV)-DNA and aminotransferase levels, which was sustained for 9 months by continuing low-dose valaciclovir. A second rise in aminotransferase levels again responded to a valaciclovir dose increase and the HBV-DNA levels declined further. Although we cannot exclude a spontaneous variation of the serologic parameters, our observation suggests that valaciclovir may represent a valuable therapeutic option in the treatment of chronic hepatitis B after lung transplantation.

Topics: Acyclovir; Bronchiectasis; Carrier State; Chronic Disease; Female; Follow-Up Studies; Graft Survival; Hepatitis B Surface Antigens; Hepatitis B, Chronic; Humans; Lung Transplantation; Middle Aged; Postoperative Complications; Preoperative Care; Risk Assessment; Serologic Tests; Treatment Outcome; Valacyclovir; Valine

Postherpetic neuralgia (PHN) is dermatomal distribution pain that persists for months to years after the resolution of herpes zoster rash. The cause of PHN is unknown. Herein, we report clinical, molecular virological, and immunological findings over an 11-year period in an immunocompetent elderly woman with PHN. Initially, blood mononuclear cells (MNCs) contained varicella-zoster virus (VZV) DNA on two consecutive occasions. Random testing after treatment with famciclovir to relieve pain did not detect VZV DNA. However, the patient was reluctant to continue famciclovir indefinitely and voluntarily stopped drug treatment five times. Pain always recurred within 1 week, and blood MNCs contained many, but not all, regions of the VZV genome on all five occasions. Immunological analysis revealed increased cell-mediated immunity to VZV. Chronic VZV ganglionitis-induced PHN best explains the recurrence of VZV DNA in MNCs whenever famciclovir was discontinued; the detection of only some regions of the viral genome in MNCs, compared to the detection of all regions of the VZV genome in latently infected ganglia; the increased cell-mediated immunity to VZV; and a gratifying clinical response to famciclovir. The presence of fragments of VZV DNA in MNCs likely represents partial degradation of viral DNA in MNCs that trafficked through ganglia during productive infection.

Topics: 2-Aminopurine; Acyclovir; Amitriptyline; Analgesics, Non-Narcotic; Antibodies, Viral; Antiviral Agents; Chronic Disease; DNA, Viral; Dysgeusia; Exanthema; Facial Neuralgia; Facial Paralysis; Famciclovir; Female; Follow-Up Studies; Herpes Zoster Oticus; Herpesvirus 3, Human; Humans; Hyperacusis; Immunoglobulin G; Leukocytes, Mononuclear; Middle Aged; Scalp

Clinical presentations of varicella-zoster virus (VZV) infection may vary widely among healthy and immunocompromised patients. In addition, the recurrence of VZV infection with cutaneous manifestations in both of these populations is more common than was once believed. Most cases of verrucous varicella infection have been reported in patients with documented immunosuppression (most commonly HIV/AIDS). We present an unusual case of persistent verrucous varicella, which was the initial manifestation of HIV infection, in a previously "healthy" 3-year-old girl with a strong family history of Wiskott-Aldrich Syndrome. Current research, therapeutic options, and differential diagnoses with regard to VZV infection are briefly reviewed.

Topics: Acyclovir; Antiviral Agents; Child, Preschool; Chronic Disease; Female; Follow-Up Studies; Herpes Zoster; Herpesvirus 3, Human; HIV Infections; HIV Seropositivity; Humans; Immunocompromised Host; Risk Assessment; Treatment Outcome

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

In 1983, varicella zoster virus (VZV) disease was first recognized in the context of infection with the human immunodeficiency virus (HIV). Since that time, there have been many reports discussing the occurrence and clinical manifestations of hepes zoster in HIV-infected patients. We describe the development of prolonged herpes zoster in a patient with acquired immunodeficiency syndrome (AIDS) over the course of 104 days. Viral isolates at the three different clinical stages of the skin lesions were sensitive in vitro to acyclovir, and supposed to be a same strain by polymerase chain reaction (PCR) analysis. We also discuss an effective treatment for prolonged cases of zoster.

Topics: Acyclovir; Adult; AIDS-Related Opportunistic Infections; Antiviral Agents; Back; Chronic Disease; DNA, Viral; Herpes Zoster; Humans; Male; Polymerase Chain Reaction; Skin Diseases, Viral

To describe presumed activation of herpetic keratouveitis after argon laser peripheral iridotomy.. Case report.. A 68-year-old man developed chronic, unilateral, anterior uveitis associated with decreased corneal sensation, focal keratitis, and increased intraocular pressure after argon laser peripheral iridotomy. Treatment with oral acyclovir and discontinuation of topical latanoprost resulted in prompt and continued control of both the intraocular inflammation and pressure.. Herpetic keratouveitis may occur after argon laser iridotomy, and it should be considered when postoperative inflammation persists despite appropriate use of topical corticosteroids, particularly in patients with a history of herpetic eye disease.

Topics: Acyclovir; Aged; Antiviral Agents; Chronic Disease; Glaucoma; Herpesvirus 1, Human; Humans; Intraocular Pressure; Iris; Keratitis, Herpetic; Laser Therapy; Latanoprost; Male; Prostaglandins F, Synthetic; Uveitis, Anterior; Virus Activation

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

Topics: Acyclovir; Adult; Antiviral Agents; Atlantic Islands; Causalgia; Chronic Disease; Female; Fibromyalgia; Herpesviridae Infections; Humans; Male; Middle Aged; Pain; Pain Management; Phantom Limb; Risk Factors; Spain; Syndrome; Time Factors

A 34-year-old healthy woman presented with a 15-month history of persistent, nonhealing vulvar ulcerations due to herpes simplex virus (HSV) type 2. Extensive dermatologic workup and serial skin biopsies failed to reveal an underlying vulvar dermatosis or autoimmune bullous disorder. Virologic studies revealed resistance to acyclovir in vitro due to deficiency in thymidine kinase activity. Serum antibody to human immunodeficiency virus was negative on two occasions, separated by 1 year. Immunologic evaluation showed normal HSV-specific proliferative and CD8 cytotoxic T lymphocyte responses as well as normal NK cell function. Vulvar lesions failed to heal in association with trials of topical trifluorothymidine and oral valacyclovir but resolved completely with the application of 1% foscarnet cream. No recurrence of HSV has been observed in 24 months of follow-up to date.

Topics: Acyclovir; Antiviral Agents; Chronic Disease; Drug Resistance, Microbial; Female; Foscarnet; Humans; Immunocompetence; Simplexvirus; Thymidine Kinase; Ulcer; Valacyclovir; Valine; Vulvar Diseases

To describe the clinical features of a disorder characterized by chronic multifocal retinal infiltrates and uveitis in individuals with human immunodeficiency virus (HIV) disease.. We reviewed the medical records of HIV-infected patients with multifocal retinal infiltrates of unknown cause seen by investigators at four institutions. The following data were collected: demographic characteristics, presenting signs and symptoms, laboratory test results, and course of disease.. We identified 26 HIV-infected patients (50 involved eyes) with this syndrome. Median CD4+ T-lymphocyte count at presentation was 272 per microl (range, 7 to 2,118 per microl). The most common presenting symptom was floaters. Median visual acuity of involved eyes at presentation was 20/20 (range, 20/15 to 20/100) and remained stable (median, 20/20; range, 20/15 to 20/70) after a median follow-up period of 9 months (range, 0 to 110 months). Typical retinal lesions were gray-white or yellow, irregular in shape, and less than 200 microm in greatest dimension. All were located in the midperiphery or anterior retina and enlarged slowly or remained static in size. Mild to moderate anterior chamber or vitreous humor inflammatory cells were present in 47 of 50 eyes (26 of 26 patients). Retinal lesions possibly responded to zidovudine but not to acyclovir or ganciclovir. Anterior chamber and vitreous humor inflammatory reactions responded to topical or periocular injections of corticosteroid.. Uveitis with chronic multifocal retinal infiltrates is a distinct clinical entity of unknown cause that occurs in HIV-infected patients. Retinal lesions may respond to antiretroviral therapy. Visual prognosis is good.

Topics: Acyclovir; Adult; Anti-HIV Agents; CD4 Lymphocyte Count; CD4-Positive T-Lymphocytes; Chronic Disease; Fundus Oculi; Ganciclovir; HIV Infections; Humans; Male; Middle Aged; Retinal Diseases; Syndrome; Uveitis; Visual Acuity; Zidovudine

Herpes simplex virus (HSV) and Varicella-zoster virus (VZV) are responsible for various atypical mucocutaneous manifestations in the immunosuppressed population. One of the causative pathomechanisms suggests an altered virus-host cell relationship.. This report investigates by histology, immunohistochemistry and in situ hybridization the histological and virological features of 6 protracted, indolent HSV infections and 2 prolonged zoster infections.. Histopathology revealed a lichenoid dermatitis in all patients. Specific HSV-1, HSV-2 and VZV in situ hybridization proved the viral origin of the cutaneous lesions. Immunohistochemical assessment demonstrated the intracellular presence of the HSV glycoproteins gB, gC and gD in epidermal keratinocytes which did not exhibit cytolysis. Similar findings were obtained for the VZV gE and gB.. These results suggest that in some instances HSV and VZV infections may present a protracted disease course associated with a lichenoid inflammatory pattern and a non-cytolytic virus-host cell relationship.

Topics: Acyclovir; Adult; Aged; Antiviral Agents; Belgium; Chronic Disease; Female; Herpesviridae Infections; Herpesvirus 1, Human; Herpesvirus 2, Human; Herpesvirus 3, Human; Humans; Immunohistochemistry; In Situ Hybridization; Lichenoid Eruptions; Male; Middle Aged; Skin

Topics: Acyclovir; Administration, Oral; Antiviral Agents; Child; Chronic Disease; Herpes Labialis; Humans; Leukocyte Count; Male; Neutropenia; Neutrophils; Patient Selection; Platelet Count; Practice Guidelines as Topic; Thrombocytopenia; Time Factors

Ducks congenitally infected with duck hepatitis B virus (DHBV) were treated with the antiviral guanine nucleoside analog penciclovir for 12 or 24 weeks at a dosage of 10 mg/kg of body weight per day. By the completion of both 12 and 24 weeks of therapy, molecular hybridization studies of the liver tissue revealed that the viral DNA, RNA, and protein levels were significantly reduced compared to those in the placebo-treated controls. Penciclovir treatment for 12 or 24 weeks was not associated with any toxicity, establishing the efficacy and safety of long-term penciclovir therapy in chronic DHBV infection.

Topics: Acyclovir; Animals; Antiviral Agents; Chronic Disease; DNA, Viral; Ducks; Guanine; Hepadnaviridae Infections; Hepatitis B Virus, Duck; Viral Proteins

To characterize further a chronic epithelial keratitis caused by varicella-zoster virus infection in patients with acquired immunodeficiency syndrome (AIDS).. Patients with AIDS and chronic epithelial keratitis associated with varicella-zoster virus from 3 institutions were identified. Patient records were reviewed retrospectively for the following data: medical and demographic characteristics, techniques of diagnosis, physical findings, course, response to treatment, and outcome.. Sixteen patients were studied. CD4+ T-lymphocyte cell counts were available in 11 patients, with a median of 0.034 x 10(9)/L (range, 0-0.094 x 10(9)/L). Two patients had no history of a zosteriform rash. In the remaining patients, the interval between rash and keratitis ranged from 0 days to 6 years. In all cases, the keratitis was chronic and characterized by gray, elevated, dendriform epithelial lesions that stained variably with fluorescein and rose bengal. The peripheral and midperipheral cornea was most commonly affected, and, in 13 of the 16 patients, the lesions crossed the limbus. Pain was a prominent feature, occurring in 12 of 16 patients. In 9 of 12 patients tested, varicella-zoster virus was identified by culture, direct fluorescent antibody testing, polymerase chain reaction testing, or a combination of these studies, with direct fluorescent antibody testing (6 of 8 positive results) and polymerase chain reaction testing (3 of 3 positive results) appearing to be the most sensitive. Response to antiviral medication was variable.. In patients with AIDS, varicella-zoster virus may cause a chronic infection of the corneal epithelium. The keratitis is characterized by dendriform lesions, prolonged course, and frequently by extreme pain. It can occur without an associated dermatitis.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; Aged; Antiviral Agents; Arabinofuranosyluracil; CD4 Lymphocyte Count; Chronic Disease; Epithelium, Corneal; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Keratitis, Dendritic; Male; Middle Aged; Retrospective Studies

Topics: Acyclovir; Chronic Disease; Diagnosis, Differential; Humans; Immunoglobulin A; Infant; Male; Skin Diseases, Vesiculobullous

Angioedema and chronic urticaria result from a variety of causes. Our purpose was to study the therapeutic effect of oral acyclovir on selected patients, by observing the effect of acyclovir in a dosage of from 100 mg every six hours to 800 mg every four hours in fourteen patients with angioedema or chronic urticaria. Five of twelve patients with chronic urticaria and one patient each with hereditary angioedema and idiopathic angioedema noted complete remission with acyclovir therapy. Discontinuation of the acyclovir resulted in reappearance of the hives. Since these patients had high antibody titers to either herpes simplex virus or Epstein-Barr virus, we conclude that acyclovir produced its therapeutic effect by suppressing a circulating viral antigen.

Topics: Acyclovir; Adult; Aged; Angioedema; Antiviral Agents; Chronic Disease; Female; Follow-Up Studies; Humans; Infant; Male; Middle Aged; Prognosis; Urticaria

Topics: Acyclovir; Animals; Antiviral Agents; Cells, Cultured; Chronic Disease; Dose-Response Relationship, Drug; Drug Synergism; Drug Therapy, Combination; Guanine; Hepatitis B; Hepatitis B Virus, Duck; Humans; Lamivudine; Liver; Virus Replication

The frequency and severity of chronic herpes simplex virus (HSV-1) ulcerative infections were recorded in six HIV-infected children with severe immunodeficiency (mean CD4 + T lymphocytes/cmm = 39.4: range 8-66). The first episode of HSV infection consisted of vesicular-crusty lesions affecting the centro-facial cutis area. In five cases, relapses occurred 4 months later in the form of chronic ulcerative lesions that were always accompanied by a significant loss of tissue. Furthermore, three of the six children also showed perianal ulcerative lesions. Cytodiagnostic analysis revealed the typical cells in balloon degeneration; all of the children had HSV-1-positive vesicular fluid sample cultures. In our experience, chronic ulcerative HSV infection is relatively frequent in HIV-infected children (6.6%), and has unusual clinical manifestations with a good initial response to acyclovir treatment. Relapses are common and become increasingly worse and less responsive to treatment.

Topics: Acyclovir; AIDS-Related Opportunistic Infections; Antiviral Agents; CD4 Lymphocyte Count; Child; Child, Preschool; Chronic Disease; Cytodiagnosis; Fatal Outcome; Female; Herpes Simplex; Humans; Infant; Male; Recurrence

Sixteen patients with relapsing or chronic HSV keratouveitis were treated during a new attack by acyclovir 15 mg/kg/day by the i.v. route for 5 days with local combination of acyclovir 3% ung. and steroids. In all 16 patients improvement of signs of keratouveitis occurred on the fourth day of therapy, in 10 patients with improvement of visual acuity. In 5 patients perforating keratoplasty was performed on account of turbidity of the cornea. The authors observed four relapses of the disease in the course of 12 months after termination of treatment.

Topics: Acyclovir; Administration, Topical; Adult; Aged; Antiviral Agents; Chronic Disease; Female; Humans; Infusions, Intravenous; Keratitis, Herpetic; Male; Middle Aged; Recurrence; Uveitis

A 39-year-old HIV-infected man had manifested a typical varicella successfully treated with intravenous acyclovir. Despite oral acyclovir, he developed 10 days later a widespread eruption of pinpoint-sized erythematous papular lesions. Histologic examination and viral culture showed a persistent varicella-zoster virus (VZV) infection. Intravenous acyclovir and foscarnet were both efficient. However, each withdrawal of intravenously administered treatment resulted in a rapid relapse. Among the atypical forms of chronic varicella, this eruption appears to be unique. As in our case, chronic VZV infection appears often to be a difficult therapeutic challenge.

Topics: Acyclovir; Adult; AIDS-Related Opportunistic Infections; Antiviral Agents; Chickenpox; Chronic Disease; Fatal Outcome; Foscarnet; Humans; Male; Recurrence

Topics: Acyclovir; Chronic Disease; Drug Resistance, Microbial; Female; Herpes Genitalis; Herpesvirus 2, Human; Humans; Immunocompetence; Middle Aged; Recurrence; Vulvar Diseases

Topics: Acyclovir; Chronic Disease; Cytomegalovirus Infections; Graft Rejection; Humans; Kidney Transplantation

We describe a fatal case of varicella-zoster virus myelitis that was preceded by neurological symptoms for 10 months in a patient with human immunodeficiency virus infection and an extremely low CD4 cell count (20/microL). The patient was also receiving chronic acylovir therapy for suppression of herpes complex. Despite chronic unilateral periauricular and facial pain, which was later accompanied by upper- and lower-extremity weakness, a cutaneous eruption never developed. It is hypothesized that a blunted inflammatory response in the spinal cord--possibly related to a very low CD4 cell count--and long-term acylovir administration might have contributed to the atypical manifestation might have contributed to the atypical manifestation of varicella-zoster virus-related neurological disease in this immunocompromised patient.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; Chronic Disease; Fatal Outcome; Herpes Zoster; Herpesvirus 3, Human; Humans; Male; Myelitis, Transverse

We describe a 28-year-old HIV-infected woman with AIDS, defined by cerebral toxoplasmosis and a CD4-count of less than 10 x 10(6) cells/I, who, after several eruptions of genital herpes and typical dermatomal herpes zoster, all successfully treated with acyclovir, developed chronic cutaneous ulcerating lesions on a finger and on the tibia. The lesions were found to contain varicella zoster virus antigen but repeated treatment courses with acyclovir were unsuccessful. After a course of intravenous foscarnet the lesions resolved. They recurred after discontinuation of foscarnet but finally responded to a second course of treatment.

Topics: Acyclovir; Adult; AIDS-Related Opportunistic Infections; Antiviral Agents; Chronic Disease; Drug Resistance, Microbial; Female; Foscarnet; Herpes Zoster; Herpesvirus 3, Human; Humans; Skin Ulcer

The prevalence of mucocutaneous herpetic infection is especially high in patients with the acquired immunodeficiency syndrome (AIDS). In these patients, 8 p. 100 of the chronic or recurrent herpetic lesions are due to a mutant strain.. A case of very large (900 cm2) genital chronic herpetic infection is reported in a patient with AIDS (stade C3-CDC/WHO 1993). It was characterised by an acyclovir resistant strain which emerged after several anterior treatment with acyclovir. A treatment with foscarnet was administered and clinical improvement was observed as early as the fourth day, with complete reepithelialization 50 days later.. We discussed essentially the pathogenicity of the herpetic infections due to mutant strains in immunocompromised patients and on the therapeutic modalities. At the present time, foscarnet is the treatment of choice for acyclovir-resistant mucocutaneous herpes simplex.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; Buttocks; Chronic Disease; Drug Resistance; Foscarnet; Herpesviridae Infections; Humans; Male; Skin Diseases, Viral

The pharmacokinetic profile of penciclovir was determined after a single 500-mg dose of its oral precursor, famciclovir, in 9 healthy volunteers and in 14 patients with chronic hepatic disease. Plasma and urine samples were analyzed for concentrations of penciclovir and 6-deoxy-penciclovir using a reverse-phase high-performance liquid chromatography (HPLC) method. Famciclovir was not quantifiable in patients with hepatic disease, and 6-deoxy-penciclovir was quantifiable in only a limited number of specimens. The extent of systemic availability of penciclovir, as measured by AUC0-infinity, was similar in patients with hepatic disease and in healthy subjects. In contrast, Cmax was significantly lower (average decrease of 43%) in subjects with hepatic disease relative to healthy normal subjects. Median Tmax for subjects with hepatic disease was significantly increased (by 0.75 hours) compared with subjects with normal liver function. These data suggest a decrease in the rate, but not the extent, of systemic availability of penciclovir in patients with hepatic disease. It should be unnecessary to modify the dose of famciclovir for subjects with compensated hepatic disease and normal renal function.

Topics: 2-Aminopurine; Acyclovir; Administration, Oral; Adolescent; Adult; Biological Availability; Chromatography, High Pressure Liquid; Chronic Disease; Famciclovir; Female; Guanine; Humans; Liver Diseases; Male; Metabolic Clearance Rate; Middle Aged; Prodrugs

Chronic laryngitis in patients with acquired immunodeficiency syndrome may be due to infections or tumors, such as Kaposi's sarcoma and non-Hodgkin's lymphoma. We present what we believe to be the first proven case of herpes simplex virus chronic laryngitis in a man positive for human immunodeficiency virus. Direct laryngoscopy showed leukoplakic lesions on both vocal cords. Biopsy of the lesions showed squamous epithelial cells with the characteristic features of herpes simplex virus, which was confirmed by immunohistochemical stains. We discuss the differential diagnosis of chronic laryngitis in a human immunodeficiency virus infection. Herpes simplex viral infection of the vocal cords should be considered in patients with acquired immunodeficiency syndrome presenting with chronic hoarseness and leukoplakic lesions on direct laryngoscopy, especially with no evidence of Kaposi's sarcoma, tumor, or cytomegaloviral or fungal infection elsewhere. Treatment should be acyclovir, except in the face of acyclovir resistance.

Topics: Acyclovir; AIDS-Related Opportunistic Infections; Biopsy; Chronic Disease; Diagnosis, Differential; Herpes Simplex; Humans; Laryngitis; Laryngoscopy; Male; Middle Aged; Vocal Cords

A child infected with HIV who developed chronic varicella zoster virus infection resistant to acyclovir is presented. The clinical course of the infection, treatment, virological investigations, and relationship of the infection to the child's immunodeficient state are discussed.

Topics: Acyclovir; AIDS-Related Opportunistic Infections; Chickenpox; Chronic Disease; Drug Resistance, Microbial; Fatal Outcome; Follow-Up Studies; Herpes Zoster; Herpesvirus 3, Human; Humans; Infant; Male; Skin

Recurrent erythema multiforme is an uncommon disorder. We have reviewed the clinical features and treatment of 65 patients with this condition. The mean number of attacks per year was six (range 2-24), and the mean duration of the disease was 9.5 years (range 2-36) reflecting its chronicity. The majority of patients had oral mucous membrane involvement (69%). In 46 patients (71%) the condition was precipitated by a preceding herpes simplex virus infection. Acyclovir was found to be the most useful first-line treatment, with 55% of patients deriving benefit from either continuous oral acyclovir or a patient-initiated 5-day oral course at the onset of herpes simplex virus infection. Of those failing to respond to acyclovir, a small proportion responded to dapsone. The most resistant patients (11) were treated with azathioprine, with complete disease suppression in all cases.

Topics: Acyclovir; Administration, Oral; Adolescent; Adult; Aged; Azathioprine; Child; Child, Preschool; Chronic Disease; Dapsone; Drug Administration Schedule; Erythema Multiforme; Female; Herpes Simplex; Humans; Immunization, Passive; Immunoglobulins; Infant; Male; Middle Aged; Recurrence

We report a rare adult case of chronic active Epstein-Barr virus (EBV) infection. A 54-year-old woman was admitted to our hospital with intermittent fever, weight loss, hepatosplenomegaly, pancytopenia and liver disturbance. In serological tests for EBV, anti-virus capsid antigen (VCA)-IgG antibody and anti-early antigen (EA)-IgG antibody were markedly elevated and anti-EBV nuclear antigen (EBNA) antibody was negative. EBV genome was detected in the bone marrow nucleated cells and peripheral lymphocytes by Southern blot hybridization. The patient developed left facial edema, bilateral breast tumor and pneumonia. She died one year after admission in spite of the administration of prednisolone, interferon and acyclovir.

Topics: Acyclovir; Antigens, Viral; Blotting, Southern; Breast Neoplasms; Capsid Proteins; Chronic Disease; DNA-Binding Proteins; Edema; Epstein-Barr Virus Nuclear Antigens; Female; Hepatitis; Herpesviridae Infections; Herpesvirus 4, Human; Humans; Immunoglobulin A; Immunoglobulin G; Immunoglobulin M; Interferon-alpha; Liver; Middle Aged; Prednisolone

Concern about neonatal herpes often leads to cesarean delivery of infants in women with a history of genital herpes. The antiviral drug acyclovir has been used effectively to suppress genital herpes simplex virus recurrences in nonpregnant adults. Its administration to pregnant women with recurrent genital herpes may reduce herpes simplex virus recurrences and thus may decrease the cesarean section rate among this population. To study the pharmacokinetics, safety, and patient tolerance of suppressive oral acyclovir, either 200 mg (n = 7) or 400 mg (n = 8) was administered orally every 8 hours to pregnant women with a history of recurrent herpes simplex virus, from 38 weeks' gestation until delivery. The mean +/- SD plasma levels for the 200 and 400 mg groups, respectively, were: first dose peak, 1.7 +/- 0.6 and 2.3 +/- 1.0 mumol/L; steady-state trough, 0.7 +/- 0.3 and 0.8 +/- 0.6 mumol/L; steady-state peak, 1.9 +/- 1.0 and 3.3 +/- 1.0 mumol/L. In late gestation maternal acyclovir pharmacokinetics were similar to those of nonpregnant adults from other studies. Acyclovir was concentrated in the amniotic fluid; however, there was no accumulation in the fetus (mean maternal/infant plasma ratio at delivery was 1.3). Acyclovir was well tolerated, and no toxicity was seen in the mothers or infants. The administration of acyclovir, 400 mg every 8 hours, appears appropriate for use in an efficacy and safety study regarding suppression of herpes simplex virus recurrences during the last weeks of pregnancy.

Topics: Acyclovir; Adult; Chronic Disease; Dose-Response Relationship, Drug; Drug Evaluation; Drug Tolerance; Female; Herpes Genitalis; Humans; Infant, Newborn; Postpartum Period; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Trimester, Third; Recurrence; Simplexvirus; Time Factors

In a prospective open trial 40 patients suffering from acute herpes zoster ophthalmicus were treated with systemic acyclovir. An additional 10 patients were treated by topical acyclovir alone and dexamethasone eye-drops were administered to 5 of them to suppress ocular inflammation. In the topical treatment group the period of new skin lesion formation and progression of ocular inflammatory signs were significantly prolonged. Therapy with systemic acyclovir however resulted in a quick and complete resolution of ocular inflammation in all patients. Chronic ocular inflammation developed in 4 out of 10 patients treated with topical acyclovir. We consider chronic ocular zoster as a distinct clinical entity, possibly expressing a failing local immune response against VZV.

Topics: Acyclovir; Adolescent; Adult; Aged; Aged, 80 and over; Antiviral Agents; Bromodeoxyuridine; Chronic Disease; Conjunctivitis; Dexamethasone; Drug Administration Routes; Female; Herpes Zoster Ophthalmicus; Humans; Keratitis, Dendritic; Male; Middle Aged; Prospective Studies; Scleritis; Skin Diseases; Uveitis, Anterior

We described the development of prolonged disseminated cutaneous herpes zoster in two patients with acquired immunodeficiency syndrome. Both patients developed hyperkeratotic, verrucous lesions that progressed despite acyclovir therapy. The biopsy specimens were typical of herpes infection. The development of acyclovir-resistant varicella-zoster virus during therapy was suspected clinically in the first patient and documented in vitro in the second patient. The inability to mount an effective cell-mediated immune response contributed to the prolonged course of cutaneous zoster in our patients. The hyperkeratotic nature of the skin lesions may reflect their chronic nature. Treatment with inadequate doses of acyclovir, allowing viral persistence and the selection of resistant strains of virus, may also be implicated. We recommend prolonged high-dose intravenous acyclovir therapy in the initial management of herpes zoster in patients with acquired immunodeficiency syndrome.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Administration, Oral; Adult; Chronic Disease; Drug Resistance, Microbial; Herpes Zoster; Herpesvirus 3, Human; Humans; Injections, Intravenous; Male; Recurrence; Skin Diseases, Infectious

Only one herpes simplex virus type 1 (HSV-1) gene is expressed in sensory neurons of latently infected animals and humans, yielding two RNAs, called latency-associated transcripts (LATs). The LATs appear to modulate virus reactivation. In mice and rabbits the 5' origins, kinetics of synthesis, and splicing pattern of the LATs are well established. Because these details of LAT structure and expression have not been defined in humans, we sought to do so. Using primer extension and Northern hybridization analyses, we demonstrate that in human trigeminal ganglia, the smaller (1.35 kb) HSV-1 transcript differs from the larger (1.85 kb) LAT by excision of an intron near its 5' end; they are otherwise colinear, and 5' coterminal. In infected cells only the 1.85 kb LAT is detected. Its expression is inhibited by cycloheximide or acyclovir, indicating this LAT is synthesized late in the viral replicative cycle. All of these features of the LATs in humans are consistent with those reported in rabbits and mice and further validate the animal models of human HSV-1 infection.

Topics: Acyclovir; Animals; Base Sequence; Blotting, Northern; Chronic Disease; Gene Expression; Herpes Simplex; Humans; Molecular Sequence Data; Oligonucleotide Probes; RNA Splicing; RNA, Messenger; RNA, Viral; Transcription, Genetic; Trigeminal Ganglion; Vero Cells

Topics: Acyclovir; Azathioprine; Chronic Disease; Drug Evaluation; Drug Therapy, Combination; Hepatitis; Hepatitis, Chronic; Hepatitis, Viral, Human; Humans; Prednisone; Vidarabine

Topics: Acyclovir; Chronic Disease; Fatigue; Humans; Infectious Mononucleosis; Syndrome

Topics: Acyclovir; Adrenal Cortex Hormones; Chronic Disease; Drug Therapy, Combination; Hepatitis B; Humans; Interferons; Vidarabine

Topics: Acyclovir; Adult; Chronic Disease; Female; Herpesviridae Infections; Herpesvirus 4, Human; Humans; Prognosis; Syndrome

Chronic Epstein-Barr virus infection was confirmed serologically in a 27-year-old man with pneumonia, splenomegaly, pancytopenia, arthritis, neuropathy and psychological changes. Immunological tests revealed a defect in the cytotoxic activity of the natural killer cells. Treatment with high doses of acyclovir intravenously and of antimycotic drugs dramatically and lastingly improved the patient's condition.

Topics: Acyclovir; Adult; Chronic Disease; Cytotoxicity Tests, Immunologic; Diagnosis, Differential; Herpesviridae Infections; Herpesvirus 4, Human; Humans; Killer Cells, Natural; Male

Chronic cutaneous herpes simplex virus infection is described in a 68-year-old man who was immunocompromised because of chronic lymphocytic leukemia. The herpes infection was not amenable to therapy with acyclovir. Clinical isolates of herpes simplex virus were assessed for viral thymidine kinase activity, which was markedly decreased in two isolates. By the method of viral plaque autoradiography, these isolates were determined to be composed primarily of mutant thymidine kinase-negative herpes simplex virus mixed with occasional standard thymidine kinase-positive herpes simplex virus. Viral plaque autoradiography permitted the quantitation of proportions of thymidine kinase-negative and thymidine kinase-positive herpes simplex virus in the mixed virus populations. The chronic cutaneous infection persisted, unlike other reported infections by thymidine kinase-negative herpes simplex virus.

Topics: Acyclovir; Aged; Chronic Disease; Drug Resistance, Microbial; Herpes Simplex; Humans; Lip; Male; Simplexvirus; Skin Diseases, Infectious; Thymidine Kinase

Topics: Acyclovir; Antiviral Agents; Bromodeoxyuridine; Chronic Disease; Foscarnet; Humans; Immunosuppression Therapy; Leukemia, Lymphoid; Male; Middle Aged; Phosphonoacetic Acid; Stomatitis, Herpetic; Vidarabine

Ocular involvement with acute Epstein-Barr virus infection is usually limited to a transient follicular conjunctivitis, although other lesions have been reported. Chronic Epstein-Barr virus infection has recently gained attention, but ocular manifestations have not been emphasized. We describe three patients with chronic infection with prominent ocular involvement. Bilateral uveitis was noted in all patients, ranging from an anterior uveitis that was responsive to steroids to a severe panuveitis with vitritis, cataract, optic disc swelling, and macular edema. In one patient, topical acyclovir ointment resulted in a substantial decrease in the inflammatory reaction when added to systemic acyclovir therapy. Another patient displayed a keratitis that resolved with topical steroid therapy. Cataract and vitreous surgery were also beneficial in the management of these patients.

Topics: Acyclovir; Administration, Topical; Adolescent; Adult; Cataract; Cataract Extraction; Chronic Disease; Female; Herpesvirus 4, Human; Humans; Infectious Mononucleosis; Keratitis, Dendritic; Male; Uveitis

Chronic mucocutaneous or cutaneous herpes simplex is a rare syndrome associated with immunosuppression. We report the first case associated with X-linked hypogammaglobulinemia and illustrate the effectiveness of oral acyclovir in this potentially serious illness.

Topics: Acyclovir; Administration, Oral; Agammaglobulinemia; Child; Chronic Disease; Genetic Linkage; Herpes Simplex; Humans; Male; Sex Chromosome Aberrations; Skin Diseases; X Chromosome

Topics: Acyclovir; Animals; Antiviral Agents; Chronic Disease; Female; Hepatitis B; Humans; Interferons; Male; Vidarabine

Two patients developed fever, interstitial pneumonitis, and pancytopenia associated with extremely high titers of antibody to replicative antigens of the Epstein-Barr virus. In contrast to most patients seropositive for Epstein-Barr virus, neither patient had an antibody response to the Epstein-Barr nuclear antigen K polypeptide. In addition, virus isolated from one patient had a deletion of the B95-8 type in the EcoRI C region of the genome. An etiologic relation between Epstein-Barr virus replication and the clinical manifestations of this syndrome is further shown by the response of each patient to acyclovir therapy. These patients have a new Epstein-Barr-virus-associated syndrome and provide additional evidence that acyclovir may play a role in therapy for selected patients with Epstein-Barr virus infection.

Topics: Acyclovir; Adolescent; Antibodies, Viral; Chronic Disease; Female; Fever; Genes, Viral; Herpesviridae Infections; Herpesvirus 4, Human; Humans; Immunoglobulin A; Immunoglobulin G; Lung; Pulmonary Fibrosis; Virus Replication

The authors report a case of chronic herpes virus infection of the face which developed in a 70-year old man already affected with chronic lymphocytic leukaemia of the B-cell type (CLL-B) with specific cutaneous localisations. Immunodepression was indicated only by marked hypogammaglobulinaemia. Cell-mediated immunity was preserved. The cutaneous lesions of the face were chronic and presented as pyodermatitis vegetans. A one-week course of acyclovir administered by intravenous infusion in doses of 5 mg/kg three times a day resulted in rapid and dramatic cure, but this result proved transient, since the virus infection relapsed 2 1/2 months later. The new episode also was successfully treated with a second course of acyclovir. The herpes virus infection had developed only on those skin areas that were specifically affected by the leukaemia; after treatment and eradication of the virus, massive lymphocytic infiltration of the dermis persisted in these areas. Involvement of the skin is rare in CLL-B and has been reported mainly in CLL-T. The lesions most frequently encountered are tuberous and papular lesions and infiltrated plaques on the forehead and ears. The pyodermatitis vegetans presentation is unusual. The reasons why viral skin lesions develop on those caused by leukaemia are unknown.

Topics: Acyclovir; Aged; B-Lymphocytes; Chronic Disease; Facial Dermatoses; Herpes Simplex; Humans; Immune Tolerance; Leukemia, Lymphoid; Male; Pyoderma; Skin Neoplasms

We have reported a case of severe erythema multiforme caused by outbreaks of recurrent HSV-2 infection. The EM was debilitating and responded to the treatment of HSV with oral acyclovir. On stopping the oral acyclovir, the HSV and the EM both recurred. We recommend a trial of oral acyclovir in cases of severe EM caused by recurrent HSV.

Topics: Acyclovir; Administration, Oral; Chronic Disease; Erythema Multiforme; Female; Herpes Simplex; Humans; Middle Aged; Recurrence

Recurrent herpes simplex virus infection is usually benign and self-limiting, but in immunosuppressed patients it can be a chronic destructive process. Eight patients with chronic aggressive herpes simplex virus infection of the oral mucosa are described. All cases occurred in immunocompromised patients. The distinctive clinical presentation of the oral lesions, the diagnosis, and treatment are discussed.

Topics: Acyclovir; Adult; Aged; Chronic Disease; Female; Humans; Immunosuppression Therapy; Male; Middle Aged; Recurrence; Stomatitis, Herpetic

In view of the enormous public health concern about chronic hepatitis B, the lack of available therapies and because no good in vitro or in vivo screening tests exist new antiviral agents have been tried empirically in this disease. Several agents, including acyclovir, have now been studied with some apparent success though none have yet been subjected to adequately controlled trials. Acyclovir has the advantage of being better tolerated but to date has been limited by having to be given intravenously. New prodrugs of acyclovir may facilitate its oral administration but the ultimate role of these in the management of chronic hepatitis B, either as single or combined therapy, remains to be determined.

Topics: Acyclovir; Administration, Oral; Chronic Disease; DNA-Directed DNA Polymerase; Drug Therapy, Combination; Hepatitis B; Humans; Injections, Intravenous; Interferon Type I; Virus Replication

Five patients with chronic non-A, non-B hepatitis were entered into a pilot therapeutic study of the antiviral agent acyclovir [9-(2-hydroxyethoxymethyl)guanine]. Each patient received acyclovir by slow intravenous infusion in a dosage of 5 mg/kg every 8 hr for 10 days. During therapy, serum aminotransferase levels decreased by more than 50% in two patients, remained unchanged in two patients, and rose (by 32%) in the final patient. The two patients whose serum aminotransferase levels decreased during acyclovir treatment subsequently received a second course of drug using a higher dose (10 mg/kg every 8 hr for 10 days). Serum aminotransferase levels rose in both patients (by 54% and 121%) during the second course of therapy. Acyclovir was well tolerated in these patients, and there were no symptoms or signs attributable to drug toxicity during or after treatment. During a subsequent 12-month follow-up period, none of the five patients has manifested either a clinical or serum biochemical improvement in their chronic liver disease. Spontaneous fluctuations in serum aminotransferase levels unrelated to acyclovir therapy were noted in three of the five patients. These findings suggest that a short course of acyclovir does not have any appreciable long-term beneficial effect on the course of chronic non-A, non-B hepatitis.

Topics: Acyclovir; Adult; Alanine Transaminase; Aspartate Aminotransferases; Chronic Disease; Drug Evaluation; Female; Hepatitis C; Hepatitis, Viral, Human; Humans; Male; Middle Aged; Pilot Projects

Topics: Acyclovir; Adult; Chronic Disease; Herpes Simplex; Homosexuality; Humans; Lymphatic Diseases; Male

Topics: Acyclovir; Antiviral Agents; Chronic Disease; Drug Therapy, Combination; Encephalitis; Female; Hepatitis B; Herpes Simplex; Humans; Infant, Newborn; Interferons; Male; Nucleic Acid Synthesis Inhibitors; Simplexvirus; Vidarabine

In HBeAg positive patients with a high level of viral replication, antiviral therapy is the treatment of choice. The most promising agents at the moment are ARA-AMP and Interferon and both are being assessed in controlled clinical trials. In the anti-HBe positive patients in whom continued HBs antigenaemia is due to the presence of clones of cells containing integrated virus, some form of immune manipulation may be necessary. In rare cases in whom continuing inflammatory activity is related to an autoimmune reaction, low dose prednisolone may be beneficial. Treatment for delta infection has yet to be evaluated but antiviral agents such as interferon which inhibit both DNA and RNA viruses may prove effective. Although these forms of therapy are currently experimental, some are now entering phase III clinical trials. It seems probable that the ultimate regimen will include antiviral drugs and immune manipulation to adequately eliminate hepatocytes containing replicating and integrated virus. The latter is essential if we are to deal with the problem of neoplasia as well as infectivity and inflammatory liver disease.

Topics: Acyclovir; Animals; Chronic Disease; DNA, Viral; Hepatitis B; Hepatitis B e Antigens; Hepatitis B Surface Antigens; Humans; Interferons; Liver; Vidarabine; Virus Replication

Topics: Acyclovir; Adrenal Cortex Hormones; Chronic Disease; Drug Therapy, Combination; Humans; Keratitis, Dendritic; Ointments

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

Three patients with HBsAg-positive and DNA-polymerase-positive chronic hepatitis were treated with increasing dosages of intravenous acyclovir. A fall in DNA polymerase activity was seen with all courses of acyclovir but no dose-response relationship was evident. In only one patient did DNA polymerase fall to zero where it has remained for five months. Two out of 10 courses were associated with significant side effects with the highest dosages of acyclovir but these promptly resolved when the agent was stopped. Acyclovir's apparently partial and transient action suggests that it will not have a role in the treatment of chronic hepatitis B virus infection.

Topics: Acyclovir; Antiviral Agents; Chronic Disease; DNA-Directed DNA Polymerase; Drug Evaluation; Guanine; Hepatitis B; Hepatitis B virus; Humans