acyclovir and Cross-Infection

Herpes simplex virus (HSV) infection in the burn patient is thought to occur relatively frequently. Most commonly, children with significant burns, particularly involving the head and neck, are affected. Burn related immunosuppression is thought to allow reactivation of latent HSV in most cases, although primary HSV infection has been recognized. Clinical manifestations vary from asymptomatic viral shedding, to prolonged fever with eruption of vesicles, to rare cases of systemic visceral dissemination. Healing partial thickness wounds and donor sites are most prone to infection. Laboratory confirmation of HSV infection relies on direct demonstration of the virus and/or observation of a rise in antibody titer. Treatment of an established HSV infection includes use of IV Acyclovir, meticulous wound care, and efforts to prevent nosocomial spread. The vast majority of cases resolve without sequelae unless complicated by systemic, multiorgan HSV infection.

Topics: Acyclovir; Antibodies, Viral; Antiviral Agents; Burns; Cross Infection; Female; Herpes Simplex; Herpesvirus 1, Human; Humans; Infant; Injections, Intravenous; Skin Transplantation; Wound Healing; Wound Infection

New knowledge of the relationship between the varicella-zoster virus and its host suggests a heretofore unappreciated dynamic pattern. Molecular finger-printing has demonstrated a degree of heterogeneity between different strains of virus. It is probable that exogenous reinfection with different strains and endogenous reactivation are commonplace events, although usually asymptomatic. The lability of the endogenous interaction inversely parallels the responsiveness of the cell-mediated immune system--a major factor in viral containment by the human host. Thus, the therapeutic use of immunosuppressive or cytotoxic substances increases the morbidity and mortality associated with varicella-zoster. Promising new approaches to the prevention and treatment of the virus should alter the balance in favor of the host.

Topics: Acyclovir; Chickenpox; Cross Infection; Disease Outbreaks; Female; Herpes Zoster; Humans; Immune Tolerance; Immunization, Passive; Infant, Newborn; Interferons; Pregnancy; Reye Syndrome; Transfer Factor; Vaccination; Vaccines, Attenuated; Viral Vaccines

In June 2004 an 8-year-old boy was admitted to a hospital in Thessaloniki, Greece, because of high fever, tachypnea, hypotonia, diarrhea, and tonoclonic convulsions. Phlebovirus infection was diagnosed by IgG seroconversion to Toscana virus. As IgM antibodies were not detected, it is suggested that this was an acute infection caused by a phlebovirus virus distinct from Toscana virus. Complication by a hospital-acquired Pseudomonas aeruginosa pneumonia resulted in 2 months of hospitalization. Slight ataxia was still present on discharge.

Topics: Acyclovir; Anti-Bacterial Agents; Antiviral Agents; Bunyaviridae Infections; Ceftriaxone; Child; Colistin; Cross Infection; Drug Therapy, Combination; Enzyme-Linked Immunosorbent Assay; Greece; Humans; Immunoglobulin G; Male; Meningoencephalitis; Phlebovirus; Pneumonia, Bacterial; Pseudomonas aeruginosa; Pseudomonas Infections; Treatment Outcome

A 24-year-old male healthcare provider, having attended a varicella patient 2 weeks before, developed varicella himself. He had shown a positive result for anti-VZV antibodies measured with an immune adherence hemagglutination assay (1:4) 1 year before. The present case shows that a positive result with this assay does not necessarily indicate protection against VZV infection.

Topics: Acyclovir; Adult; Antibodies, Viral; Chickenpox; Cross Infection; Hemagglutination Tests; Herpesvirus 3, Human; Humans; Immune Adherence Reaction; Immunoglobulin G; Immunoglobulin M; Infectious Disease Transmission, Patient-to-Professional; Male; Valacyclovir; Valine

Varicella zoster virus is highly contagious and can cause serious complications in immunocompromised patients. To prevent people exposed to the virus from developing secondary varicella we have used oral aciclovir as post-exposure prophylaxis (PEP) since 2000. Between 2000 and 2007, there were 11 unexpected occurrences of varicella and 11 unexpected occurrences of zoster in our paediatric wards. There were 174 contacts, 131 exposed to varicella and 43 exposed to zoster. A total of 163 (94%) received PEP and 11 (6%) did not. The rates of secondary infection among contacts given prophylaxis with aciclovir only were 2.1% (3/141) for all contacts and 1.3% (1/76) for immunocompetent contacts. The rate of secondary infection among contacts not given PEP was significantly higher (18%, 2/11) (P<0.05). No adverse events due to PEP were reported. We conclude that oral aciclovir PEP following exposure to VZV on paediatric wards is both safe and effective.

Topics: Acyclovir; Administration, Oral; Chemoprevention; Chickenpox; Cross Infection; Herpes Zoster; Humans; Infant

The source of hospital-acquired chickenpox infection may be presumed from a known exposure, but has not been previously proven using genomic analysis.. Investigation of suspected VZV transmission was done using single nucleotide polymorphism genomic analysis.. Comparison was made of viral isolates from two patients with chickenpox on the same ward who were not known to have had direct contact.. An identical genotype in the variable R1 region of the VZV was isolated from the two patients.. Inapparent hospital-acquired transmission was the most likely route of infection.

Topics: Acyclovir; Adult; Antiviral Agents; Chickenpox; Cross Infection; DNA, Viral; Fluorescent Antibody Technique; Genomics; Herpesvirus 3, Human; Hospital Units; Humans; Polymerase Chain Reaction; Polymorphism, Single Nucleotide; Treatment Outcome

We report a cluster of 3 cases of nosocomial herpes simplex virus type 1 (HSV-1) pneumonia occurring in close temporal and physical proximity during a 1-week period, which suggested a common source. HSV-1 nosocomial pneumonia occurs in immunocompetent intubated patients and presents as otherwise unexplained profound and/or prolonged hypoxemia (decreased F(IO2), increased P(O2), and decreased A-a gradient) and "failure to wean." The diagnosis of HSV-1 pneumonia is determined by demonstration of characteristic cytopathologic findings (Cowdry type A inclusion bodies) in distal respiratory epithelial cells from bronchoscopic specimens. Acyclovir therapy results in rapid improvement and ability to wean.

Topics: Acyclovir; Aged, 80 and over; Antiviral Agents; Cross Infection; Female; Herpes Simplex; Herpesvirus 1, Human; Humans; Intensive Care Units; Male; Middle Aged; Pneumonia, Viral

Topics: Acyclovir; Antiviral Agents; Chickenpox; Cross Infection; Female; Humans; Infant, Newborn; Infant, Premature; Intensive Care Units, Neonatal

In December 2000, a female infant hospitalized in our Neonatal Care Centre was infected with varicella by her mother. Although prophylactic intravenous acyclovir was administered at a dose of 15 mg/kg daily, she later developed varicella during her hospital stay. We therefore initiated control procedures to prevent further hospital-acquired infections. Oral acyclovir (40 mg/kg daily divided into four doses) was administered prophylactically to six preterm infants in contact with the varicella patient. None of six preterm infants subsequently developed clinical varicella or had any adverse effects associated with acyclovir administration. It is suggested that prophylactic administration of oral acyclovir (40 mg/kg daily) might prevent hospital-acquired varicella-zoster virus (VZV) infections, and that oral acyclovir may be an option for VZV prophylaxis in situations where VZV immunoglobulin is not available.

Topics: Acyclovir; Administration, Oral; Antiviral Agents; Chemoprevention; Cross Infection; Environmental Exposure; Female; Herpesviridae Infections; Herpesvirus 3, Human; Humans; Infant, Newborn; Intensive Care Units, Neonatal

Over an eight-month period from October 1997 to May 1998, four patients who had received a bone marrow transplant (BMT) from an unrelated donor presented with severe mucosal cutaneous infections involving aciclovir resistant herpes simplex virus 1 (HSV-1). The emergence within a short period of resistant HSV-1 strains in the bone marrow transplantation unit raised fears of hospital-acquired infections. The hypothesis was investigated by restriction fragment length polymorphism (RFLP), sequencing of the thymidine kinase (TK) gene and genotyping of hypervariable regions of these four strains. Restriction fragment length polymorphism proved to be poorly discriminant and the TK sequence did not rule out transmission between these patients. Amplification of reiterating hypervariable genomic HSV-1 regions designated Re IV and Re VII clearly differentiated patients' strains. Thus, in this study, there was no evidence of nosocomial transmission of HSV-1 strains between the four patients.

Topics: Acyclovir; Adolescent; Bone Marrow Transplantation; Child; Cross Infection; DNA, Viral; Drug Resistance, Microbial; Female; France; Genotype; Herpes Simplex; Herpesvirus 1, Human; Humans; Male; Polymorphism, Restriction Fragment Length; Sequence Analysis, DNA; Thymidine Kinase; Tissue Donors; Transplantation, Homologous

These recommendations represent the first statement by the Advisory Committee on Immunization Practices (ACIP) on the use of live, attenuated varicella virus vaccine--VARIVAX--manufactured by Merck and Company, Inc. and licensed in March 1995 for use in healthy persons > or = 12 months of age. In addition to presenting information regarding vaccine, this statement updates previous recommendations concerning the use of varicella zoster immune globulin (VZIG) as prophylaxis against varicella (MMWR 1984; 33:84-90, 95-100).

Topics: Acyclovir; Adolescent; Adult; Age Distribution; Aged; Antibodies, Viral; Antiviral Agents; Chickenpox; Chickenpox Vaccine; Child; Child, Preschool; Contraindications; Cost-Benefit Analysis; Cross Infection; Drug Storage; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Immune Sera; Immunization, Passive; Incidence; Infant; Infant, Newborn; Middle Aged; Pregnancy; Product Surveillance, Postmarketing; Serologic Tests; Vaccination; Vaccines, Attenuated; Viral Vaccines

Primary varicella-zoster virus infection in children with haematological malignancy is a life threatening disease. In one year, there were 10 cases of varicella and 2 cases of zoster among these children as well as 5 mothers who were accompanying their children who developed varicella in the oncology ward. Two children died of fulminating disease despite aggressive antiviral and supportive treatment. Acyclovir can be used in treatment and prophylaxis in exposed susceptible children. Varicella -zoster immune globulin is not available in this country. Vaccination with live virus has been shown to be protective in immunocompromised children and needs consideration.

Topics: Acute Disease; Acyclovir; Chickenpox; Chickenpox Vaccine; Child; Child, Preschool; Cross Infection; Disease Outbreaks; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunocompromised Host; Infection Control; Leukemia, Myelogenous, Chronic, BCR-ABL Positive; Leukemia, Myeloid; Male; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Severity of Illness Index; Survival Rate; Treatment Outcome; Vaccines, Attenuated; Viral Vaccines

The prophylactic effect of acyclovir (ACV) on varicella-zoster virus (VZV) infection in leukaemia patients who have undergone bone marrow transplantation (BMT) was reviewed. The benefits of the use of the laminar air flow (LAF) room in the prevention of nosocomial VZV infections in the haematological ward are also discussed. Since 1986 ACV has been administered to BMT patients to prevent herpes simplex virus (HSV) infections. Of 98 patients with leukaemia who underwent BMT, 73 received ACV (200 mg five times daily) and 25 were not given ACV. In the untreated group, 9 patients (36.0%) developed VZV infection by day 67 (median) and 3 patients died due to disseminated VZV infection. In the ACV-treated group, 18 patients (24.6%) developed VZV infection by day 150 (median) and there were no deaths. From July to December 1989, nine cases of VZV infections (eight patients and one nurse) were reported in the haematological ward of the hospital. All cases originated in the conventionally ventilated areas of the ward while no VZV infections were reported in the 14 patients who occupied the LAF rooms during the same period.

Topics: Acyclovir; Adolescent; Adult; Bone Marrow Transplantation; Chickenpox; Child; Cross Infection; Environment, Controlled; Female; Herpes Zoster; Humans; Immunocompromised Host; Leukemia; Male; Middle Aged

Topics: Acyclovir; Adult; Cross Infection; Female; Herpes Simplex; Humans; Infant, Newborn; Recurrence; Socioeconomic Factors

Topics: Acyclovir; Cross Infection; Female; Herpesviridae Infections; Humans; Male

Nosocomial transmission of herpes simplex virus (HSV) has been described in intensive care units. A cluster of three patients with HSV wound infections within a 6-week period prompted temporary closure of a burn unit and suggested nosocomial cross infection. However, restriction endonuclease "fingerprint" analysis of the HSV isolates showed them to be genetically and therefore epidemiologically unrelated. This report describes these cases and the use of intravenous acyclovir in the treatment of HSV burn wound infections.

Topics: Acyclovir; Adult; Burns; Cross Infection; Herpes Simplex; Humans; Infant; Male; Risk; Seasons; Virginia; Wound Infection