acyclovir and Cystitis

(1) To describe the demographic features of patients with voiding dysfunction associated with herpes zoster; (2) to discuss the pathophysiology of voiding dysfunction associated with herpes zoster; and (3) to suggest the best management policy.. A retrospective study.. A university-affiliated medical center in Taiwan.. Four hundred twenty-three patients (mean age, 55.5y) admitted with the diagnosis of herpes zoster from 1988 to 2000.. Not applicable.. Dermatomal distribution of skin eruptions, urologic symptoms, treatment (catheterization, urecholine), clinical course of voiding dysfunction, and outcome.. Seventeen (mean age, 61.2+/-14.1y) of 423 patients (4.02%) with voiding dysfunction related to this virus infection were identified. Ten (58.8%) were men, and 7 (41.2%) were women. The incidence of dysfunction was as high as 28.6% if only lumbosacral dermatome-involved patients were considered. We classified urologic manifestations caused by herpes zoster into 3 groups: cystitis-associated (n=12), neuritis-associated (n=4), and myelitis-associated (n=1). Urinalysis revealed pyuria in all patients with cystitis-associated voiding dysfunction and microscopic hematuria in all patients with neuritis-associated voiding dysfunction. All patients, although receiving different treatment regimens for voiding dysfunction, regained a normal or balanced bladder within 8 weeks. No major urologic sequelae were noted.. Voiding dysfunction, although a transient course, is not uncommon in patients with herpes zoster involving lumbosacral dermatomes. Treatment with intermittent catheterization (our preferred choice) or indwelling catheter placement is recommended if the patients have prolonged difficulty in urination. This disease entity usually has a benign clinical course, and almost every patient will either regain normal voiding or, at least, balanced bladder function.

Topics: Academic Medical Centers; Acyclovir; Adult; Aged; Antiviral Agents; Bethanechol; Cystitis; Diagnosis, Differential; Electrodiagnosis; Female; Herpes Zoster; Humans; Lumbosacral Region; Male; Middle Aged; Parasympathomimetics; Remission, Spontaneous; Retrospective Studies; Risk Factors; Taiwan; Urinalysis; Urinary Bladder, Neurogenic; Urinary Catheterization; Urodynamics

Herpes simplex virus (HSV)-1/2 can still be reactivated after allogeneic haematopoietic stem cell transplantation (allo-HSCT) even when the prophylactic acyclovir is used. However, the risk factors for HSV-1/2 viremia and the clinical outcomes following unmanipulated haploidentical HSCT remain unknown.. Nineteen patients with HSV-1/2 viremia and fifty-seven patients without HSV-1/2 viremia which were selected using the case-pair method after undergoing haploidentical HSCT were enrolled. We analysed the risk factors for HSV-1/2 viremia and compared the clinical outcomes between the two groups.. The risk factors for HSV-1/2 viremia included HLA disparity ≥2 loci (p=0.049) and cytomegalovirus (CMV) reactivation (p=0.028). The incidences of platelet engraftment, oral mucositis and severe haemorrhagic cystitis (HC) in patients with and without HSV-1/2 viremia were 77% and 94% (p=0.003), 78% and 13% (p=0.000), and 25% and 6% (p=0.04), respectively. Moreover, the median time to platelet engraftment in patients with and without HSV-1/2 viremia was +25days (range, +11-+80) and +17days (range, +8-+67) (p=0.004), respectively. According to the multivariate analyses, HSV-1/2 viremia was associated with delayed platelet engraftment (p=0.038), a higher incidence of oral mucositis (p=0.000) and severe HC (p=0.038). However, HSV-1/2 viremia was not associated with non-relapse mortality (34.0% vs. 31.5%, p=0.26), leukaemia-free survival (60.9% vs. 57.9%, p=0.46) and overall survival (61.2% vs. 60.7%, p=0.37).. Based on our study results, we recommend that HSV-1/2 PCR should be performed upon clinical suspicion of HSV-1/2 infection.

Topics: Acyclovir; Adolescent; Adult; Child; Child, Preschool; Cystitis; Cytomegalovirus; Cytomegalovirus Infections; Female; Graft vs Host Disease; Hematopoietic Stem Cell Transplantation; Herpes Simplex; Herpesvirus 1, Human; Herpesvirus 2, Human; Humans; Incidence; Male; Middle Aged; Real-Time Polymerase Chain Reaction; Retrospective Studies; Risk Factors; Transplantation, Haploidentical; Viremia; Young Adult

Topics: Acyclovir; Afatinib; Aged; Antineoplastic Agents; Antiviral Agents; Carcinoma, Non-Small-Cell Lung; Cystitis; ErbB Receptors; Esophagitis; Hematuria; Herpes Simplex; Humans; Intestinal Perforation; Lung Neoplasms; Male; Molecular Targeted Therapy; Neoplasm Proteins; Peritonitis; Protein Kinase Inhibitors; Quinazolines; Valacyclovir; Valine; Viremia; Virus Activation

Viral infections are common complications following renal transplantation. However, there have been few reported cases of viral cystitis secondary to herpes simplex virus or adenovirus infection. Herein, we have reported four cases of hemorrhagic cystitis secondary to infections with herpes simplex virus and adenovirus following renal transplantation. The etiology was adenovirus in three cases and herpes simplex virus in the remaining case. In all four cases, the primary cause of the renal dysfunction was diabetic nephropathy. All four patients presented with a clinical profile characterized by dysuria, pollakiuria, macroscopic hematuria, and graft dysfunction. Three of the four patients developed these symptoms within the first 3 months after renal transplantation. In all four cases, there was an increase, albeit slight, in creatinine levels, which returned to normal or near-normal values upon resolution of the symptoms. Acute cellular rejection was observed in only one case. Although rare, hemorrhagic cystitis secondary to infection, which typically occurs early in the posttransplant period, causes pronounced symptoms. The infection appears to be self-limiting, resolving completely within 4 weeks.

Topics: Acyclovir; Adenovirus Infections, Human; Aged; Aged, 80 and over; Antiviral Agents; Cystitis; Diabetic Nephropathies; Herpes Simplex; Humans; Kidney Transplantation; Male; Middle Aged; Treatment Outcome; Valacyclovir; Valine

When adenovirus causes haemorrhagic cystitis in immunocompromised patients, vidarabine is used for its treatment because therapeutic choice is limited. Although vidarabine has been reported to be effective for these patients, its therapeutic basis has not yet been established. Vidarabine dose-dependently inhibited viral replication as assessed by a yield reduction assay. Viral protein synthesis was dose-dependently inhibited by vidarabine but not at all by acyclovir, and the degree of inhibition by vidarabine was different for each of the viral proteins, ranging from 0-40% of the untreated control. These results indicated the specificity and mechanism of action of vidarabine against adenovirus. The concentration of vidarabine and its metabolite in the bladder is suggested to exhibit effective anti-adenoviral activity in suppressing the replication of adenovirus. Thus, our results support vidarabine therapy as a possible candidate for adenovirus-induced haemorrhagic cystitis in immunocompromised patients.

Topics: Acyclovir; Adenoviridae; Adenoviridae Infections; Antiviral Agents; Cystitis; Dose-Response Relationship, Drug; Hemorrhage; Humans; Immunocompromised Host; Urinary Bladder; Vidarabine; Viral Proteins