acyclovir and Deglutition-Disorders

Herpetic gingivostomatitis (HGS) is the predominant manifestation of cutaneomucosal herpes in children with HSV1 primary infection before the age of 3 years. The infection is self limiting and lasts 10 to 14 days. Pain and dysphagia are particularly important during the first week of infection and may necessitate parenteral rehydratation and administration of antalgesics. HGS in the young child causes substantial morbidity leading to hospital and social costs (work stoppage for parents). The clinical course is generally benign with the exception of forms with important extension, eczema, herpeticum Kaposi-Juliusberg pustulosis observed at this age only in children with atopic dermititis. Other severe forms are observed in the neonate and immunodepressed subject, which can also be caused by HSV1. Forms with little or not clinical manifestation predominate and generally go undiagnosed, explaining the asymptomatic viral excretion observed in the saliva or other secretions (ocular, genital secretions). Despite the sterotypic nature of the clinical expression, HGS is still often undiagnosed both by general practitioners and pediatricians. This lack of diagnosis generally has few consequences due to the benign course in a few days, but the infection can have an important psychological and social leading to significant healthcare costs. Moderate and severe forms require medical care. Aciclovir should be prescribed if the diagnosis is made early (3 days) in combination with symptomatic care. Studies of the medical and economic impact of herpetic gingivostomatis should be conducted.

Topics: Acyclovir; Antiviral Agents; Child, Preschool; Costs and Cost Analysis; Deglutition Disorders; Herpesvirus 1, Human; Humans; Pain; Physical Examination; Stomatitis, Herpetic

Topics: Acyclovir; Aged; Antiviral Agents; Deglutition Disorders; Diagnosis, Differential; Facial Paralysis; Female; Herpes Zoster Oticus; Humans

Cranial polyneuropathy is commonly caused by Lyme disease. We discuss the case of a man who presented with cranial nerve deficits causing dysphagia, dysphonia and facial weakness. This diagnostic dilemma stemmed from a workup that ruled out Lyme and vascular causes leading to an expanded search for infectious explanations, which revealed varicella zoster in the cerebrospinal fluid. On review, this phenomenon is rarely reported, but has been observed with a number of herpes family viruses. In emergency department settings, clinical suspicion should be raised for VZV infection even in the absence of rash in patients that present with multiple cranial nerve palsies.

Topics: Acyclovir; Antiviral Agents; Cranial Nerve Diseases; Deglutition Disorders; Dysphonia; Emergency Service, Hospital; Facial Muscles; Herpes Zoster; Herpesvirus 3, Human; Humans; Male; Middle Aged; Muscle Weakness; Polyneuropathies

Topics: Acyclovir; Aged; Antiviral Agents; Coinfection; Cytomegalovirus Infections; Deglutition Disorders; Esophagitis; Esophagoscopy; Female; Ganciclovir; Herpes Simplex; Humans; Hypoalbuminemia; Immunocompetence; Pain; Parenteral Nutrition; Ulcer

Ramsay-Hunt's syndrome (RHS) is a disorder characterized by facial paralysis, herpetic eruptions on the auricle, and otic pain due to the reactivation of latent varicella zoster virus in the geniculate ganglion. A few cases of multiple cranial nerve invasion including the vestibulocochlear nerve, glossopharyngeal nerve and vagus nerve have been reported. However, there has been no report about RHS with delayed onset multiple cranial nerve involvement causing severe aspiration, and a clinical course that improved after more than one year of dysphagia rehabilitation and percutaneous endoscopic gastrostomy (PEG). Here, we report on a 67-year old male with delayed onset swallowing difficulty after 16 days of RHS development.. Severe aspiration during swallowing.. Severe dysphagia caused by RHS with multiple cranial nerve involvement.. Application of percutaneous endoscopic gastrostomy (PEG) and rehabilitation therapy of dysphagia.. After 13 months from symptom onset, his PAS improved from 7 to 2 in follow-up video-fluoroscopic swallowing study (VFSS). Then, he was re-admitted, and the PEG tube was removed and oral feeding was started.. This case gives us the lesson that optimal doses of acyclovir and corticosteroids are important to prevent progression of multiple cranial involvement in RHS, and swallowing difficulty in RHS patients with multiple cranial nerve involvement can be improved through long-term rehabilitation even if there is no improvement for more than one year.

Topics: Acyclovir; Adrenal Cortex Hormones; Aged; Antiviral Agents; Combined Modality Therapy; Cranial Nerve Diseases; Deglutition Disorders; Exercise Therapy; Gastrostomy; Herpes Zoster Oticus; Humans; Male; Respiratory Aspiration; Treatment Outcome

Topics: Acyclovir; Aged; Antiviral Agents; Deglutition Disorders; Esophagitis; Esophagoscopy; Female; Herpes Simplex; Herpesvirus 1, Human; Humans; Ulcer; Valacyclovir; Valine

Herpes zoster is a neurocutaneous disease resulting from the reactivation of endogenous varicella-zoster virus (VZV) in dorsal sensory or cranial nerve ganglia. Rarely, this infection manifests without the characteristic dermatomal rash, a condition termed zoster sine herpete. Viral spreading of herpes zoster in the head and neck may manifest as various signs and symptoms because of the multiple possible combinations of cranial neuropathies. With only six cases reported in the English literature up to now, isolated neuropathies of the vagus nerve in the absence of cutaneous lesions tend to be misdiagnosed as idiopathic laryngeal paralysis.. We report a case of herpes zoster of the larynx in an 80-year-old man presenting with sore throat, dysphagia, and hoarseness.. Endoscopic examination revealed unilateral vocal fold paralysis, pooling of secretions, and mucosal vesicles of the hemilarynx. After the diagnosis of VZV infection with polymerase chain reaction (PCR) testing, the patient was treated with valacyclovir and corticosteroids, leading to complete recovery after 2 months.. Herpes zoster of the larynx is an uncommon condition that should be included in the differential diagnosis of laryngeal paralysis of idiopathic cause. We recommend performing a thorough examination of the pharyngolaryngeal structures and ordering PCR testing as the diagnostic method of choice.

Topics: Acyclovir; Aged, 80 and over; Antiviral Agents; Deglutition Disorders; Herpes Zoster; Herpesvirus 3, Human; Hoarseness; Humans; Laryngoscopy; Male; Pharyngitis; Polymerase Chain Reaction; Predictive Value of Tests; Remission Induction; Steroids; Time Factors; Treatment Outcome; Valacyclovir; Valine; Virus Activation; Vocal Cord Paralysis

Topics: Acyclovir; Adult; Deglutition Disorders; Diagnosis, Differential; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Laryngitis; Laryngoscopy; Pain; Pharyngitis; Virus Activation

Topics: Acyclovir; Aged; Antiviral Agents; Combined Modality Therapy; Deglutition Disorders; Female; Fluoroscopy; Follow-Up Studies; Herpes Zoster; Herpes Zoster Oticus; Herpesvirus 3, Human; Humans; Occupational Therapy; Prednisolone; Risk Assessment; Severity of Illness Index; Treatment Outcome; Video Recording

Topics: Acyclovir; Adult; Carbamazepine; Deglutition Disorders; Dexamethasone; Herpes Zoster Oticus; Humans; Magnetic Resonance Imaging; Male; Vitamin B 12

Topics: Acyclovir; Adolescent; Antiviral Agents; Deglutition Disorders; Diagnosis, Differential; Esophagoscopy; Herpes Simplex; Humans; Male; Pain; Simplexvirus

We report a patient with the varicella zoster viral (VZV) infection of multiple cranial nerves mimicking Garcin syndrome, who initially presented with Ramsay Hunt syndrome (herpes zoster oticus). A 78-year-old man showed left facial palsy with zosteric eruptions in his left auricle and dysphagia, followed by left total ophthalmoplegia. His serum anti-VZV antibody titer was elevated. Cerebrospinal fluid examination revealed pleocytosis with a slightly elevated protein level. He was treated with intravenous acyclovir and corticosteroids. His tongue weakness resolved, and then ocular movement improved. The improvement of facial palsy and swallowing difficulty was delayed. VZV infection should be considered even in patients who show unilateral multiple cranial neuropathy mimicking Garcin syndrome because it is treatable.

Topics: Acyclovir; Aged; Cranial Nerve Diseases; Deglutition Disorders; Drug Therapy, Combination; Facial Paralysis; Follow-Up Studies; Herpes Zoster; Herpes Zoster Oticus; Humans; Hydrocortisone; Male; Methylprednisolone; Neurologic Examination; Ophthalmoplegia; Prednisolone; Vocal Cord Paralysis

A 66-year-old woman was admitted to our hospital because of hoarseness and dysphagia after right earache and pharyngalgia. She showed right glossopharyngeal nerve and vagus nerve palsies, but no other neurological deficits. There was no skin rash within the regions of her ear, oral cavity, pharynx and larynx. Slight increase of mononuclear cells was noted in the cerebrospinal fluid. MR brain imaging was normal. We diagnosed her as zoster sine herpete (ZSH) and treated her with acyclovir, after which she almost completely recovered. The examination of antibodies and DNA of varicella zoster virus (VZV) in the serum and cerebrospinal fluid revealed a pattern of previous zoster infection without evidences of reactivation. However, VZV DNA was detected in auricular skin exudates with PCR. We conclude that PCR analysis of VZV DNA in auricular skin exudates can be a useful diagnostic tool for the diagnosis of zoster sine herpete presenting with painful glossopharyngeal nerve and vagus nerve palsies.

Topics: Acyclovir; Aged; Antiviral Agents; Deglutition Disorders; DNA, Viral; Ear; Earache; Exudates and Transudates; Female; Glossopharyngeal Nerve Diseases; Herpesvirus 3, Human; Humans; Polymerase Chain Reaction; Skin; Treatment Outcome; Zoster Sine Herpete

Herpes simplex encephalitis in adults and young patients carries a high mortality and morbidity. Its presentation may be nonspecific, sometimes hampering early diagnosis. Two young children are reported with herpes simplex encephalitis in whom the operculum syndrome was an outstanding feature. This syndrome is caused by focal, bilateral cortical damage to the anterior opercular regions resulting in anarthria and impairment of mastication and swallowing. After initiation of treatment with acyclovir in the early stage of the disease, the outcomes in both patients were characterized by good general recovery with persistence of deficits of speech, mastication, and swallowing, more pronounced in the patient who was comatose during the illness. Early recognition of the operculum syndrome as a presenting feature of herpes simplex encephalitis may expedite the diagnosis and thereby improve the prognosis.

Topics: Acyclovir; Cerebral Cortex; Child, Preschool; Deglutition Disorders; Dysarthria; Encephalitis, Viral; Female; Follow-Up Studies; Herpes Simplex; Humans; Infant; Magnetic Resonance Imaging; Male; Neurologic Examination; Syndrome; Tomography, X-Ray Computed

Topics: Acyclovir; Deglutition Disorders; Herpes Zoster; Humans; Laryngeal Diseases; Laryngeal Neoplasms; Sleep Apnea Syndromes; Tracheal Diseases; Tracheal Stenosis