acyclovir and Communicable-Diseases

Viral meningitis may be present not only in adults but also in children. It constitutes a significant public health problem in child population. The clinical manifestation of the disease in children varies depending on the age of the child, the causative agent or the way of acquiring the infection. Thanks to the widespread availability of vaccinations, the epidemiology of central nervous system infections is changing. The methods of diagnosing and determining the causative factor have also changed. Sensitive and rapid molecular methods such as PCR tests are being used more frequently. The article contains an overview of the most common causes, clinical signs and symptoms, complications and principles of diagnosing and treating viral meningitis in children. Currently, Enteroviruses are at the top positions among the causes of sporadic and epidemic meningitis in children living in various geographic regions of the world. In European countries, the common cause of viral meningitis and/or encephalitis is tick-borne encephalitis virus. The severity of the clinical course of TBE is inversely proportional to the age of the affected children. In USA, sub-Saharan Africa and recently in southern Europe epidemic West Nile Virus (Flaviviridae family) central system infections were reported. Herpes simplex encephalitis is uncommon in children and has a severe course (especially in vertically infected infants). The mortality rate in Herpes simplex encephalitis is 20- 25% despite acyclovir treatment.

Topics: Acyclovir; Child; Communicable Diseases; Encephalitis; Encephalitis Viruses, Tick-Borne; Encephalitis, Herpes Simplex; Europe; Humans; Infant

Topics: Acyclovir; Antilymphocyte Serum; Antiviral Agents; Communicable Diseases; Cytomegalovirus Infections; Humans; Immunosuppression Therapy; Immunosuppressive Agents; Muromonab-CD3; Postoperative Complications; Syndrome; Transplantation Immunology

Topics: Acyclovir; Communicable Diseases; Herpesviridae Infections; Humans

To improve outcome of elderly patients with diffuse large B-cell lymphoma, dose-dense rituximab was evaluated in the prospective DENSE-R-CHOP-14 trial.. Rituximab (375 mg/m(2)) was given on days 0, 1, 4, 8, 15, 22, 29, 43, 57, 71, 85, and 99 together with six CHOP-14 cycles. Results were to be compared with patients who had received the same chemotherapy in combination with eight 2-week applications of rituximab in RICOVER-60.. One hundred twenty-four patients are assessable. Dose-dense rituximab resulted in considerably higher serum levels during the first 50 days of treatment, but rituximab exposure time was not prolonged. Grade 3 and 4 infections were exceptionally high in the first 20 patients without anti-infective prophylaxis, but decreased after introduction of prophylaxis with aciclovir and cotrimoxazole in the remaining 104 patients (from 13% to 6% per cycle and from 35% to 18% per patient; P = 0.007 and P = 0.125, respectively). Patients with international prognostic index = 3-5 had higher complete response/complete response unconfirmed rates (82% versus 68%; P = 0.033) than in the respective RICOVER-60 population, but this did not translate into better long-term outcome, even though male hazard was decreased (event-free survival: from 1.5 to 1.1; progression-free survival: from 1.7 to 1.1; overall survival: from 1.4 to 1.0).. Dose-dense rituximab achieved higher rituximab serum levels, but was not more effective than eight 2-week applications in the historical control population, even though minor improvements in poor-prognosis and male patients cannot be excluded. The increased, though manageable toxicity, precludes its use in routine practice. Our results strongly support anti-infective prophylaxis with aciclovir and cotrimoxazole for all patients receiving R-CHOP.

Topics: Acyclovir; Aged; Aged, 80 and over; Aging; Anti-Infective Agents; Antibodies, Monoclonal, Murine-Derived; Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Antiviral Agents; Communicable Disease Control; Communicable Diseases; Cyclophosphamide; Disease-Free Survival; Doxorubicin; Drug Administration Schedule; Female; Humans; Lymphoma, Large B-Cell, Diffuse; Male; Middle Aged; Prednisone; Prospective Studies; Rituximab; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Vincristine

The effect of an extensive prophylactic antimicrobial regimen was prospectively assessed in 126 patients after high-dose chemotherapy and autologous PBSC. They received ciprofloxacin (500 mg/12 h), acyclovir (200 mg/6 h), and itraconazole (200 mg/12 h) orally until neutrophil recovery. Febrile patients received i.v. imipenem (500 mg/6 h) to which vancomycin and amikacin were added if fever persisted for 2-3 and 5 days, respectively. Amphotericin B lipid complex was further given on day 7 or 8 of fever. Median times for a neutrophil count of >0.5 x 10(9)/l and a platelet count of >20 x 10(9)/l were 9 and 11 days. Severe neutropenia (<0.1 x 10(9)/l) lasted for a median of 5 days in which 72% of febrile episodes and 50% of cases of bacteremia occurred. Gram-positive bacteria were isolated in 30 of 40 episodes of bacteremia, 25 of which were caused by Staphylococcus epidermidis. Clinical foci were the intravascular catheter in 35 cases, respiratory infection in 11, cellulitis in two, anal abscess in one, and neutropenic enterocolitis in one. The high incidence of febrile episodes (94%) and bacteremias (31%) may be due to the lack of efficacy of antimicrobial prophylaxis and the persistence of a 5-day period of severe neutropenia.

Topics: Acyclovir; Adolescent; Adult; Anti-Infective Agents; Antifungal Agents; Antineoplastic Combined Chemotherapy Protocols; Antiviral Agents; Ciprofloxacin; Combined Modality Therapy; Communicable Diseases; Female; Hematopoietic Stem Cell Transplantation; Humans; Immunosuppression Therapy; Itraconazole; Male; Middle Aged; Neoplasms; Prospective Studies; Staphylococcal Infections; Staphylococcus epidermidis; Transplantation, Autologous; Treatment Outcome