acyclovir and Diabetes-Mellitus--Type-2

An 83-year-old Japanese man had a 29-year history of well-controlled diabetes mellitus. His HbA1c level was approximately 6.0%, with no microalbuminuria and a serum creatinine level seven days before admission of 0.8 mg/dl (eGFR: 69.67 ml/min/1.73 m(2)). Five days before admission, he visited an ophthalmologist with inflammation of the right palpebra and conjunctiva and began taking valacyclovir at a dose of 3,000 mg for the treatment of herpes zoster. Two days before admission, he was prescribed loxoprofen at a dose of 180 mg for a headache. One day prior to admission, he developed dysarthria, wandering and loss of appetite. He was subsequently admitted to our hospital with progressive deterioration of consciousness (Japan Coma Scale: II-20). On admission, he exhibited renal dysfunction, with a serum creatinine level of 5.11 mg/dl (eGFR: 9.16 ml/min/1.73 m(2)). Based on his diverse symptoms and current treatment with valacyclovir, the patient was diagnosed with acyclovir-induced neurotoxicity and his symptoms rapidly improved after hemodialysis. The serum acyclovir level on admission was found to be 9.25 μg/ml. Although acyclovir-induced neurotoxicity is commonly seen in elderly patients with renal dysfunction, there are also reports of this condition in patients with a normal renal function. Valacyclovir is frequently prescribed to the elderly to treat diseases such as herpes zoster. As valacyclovir induces renal dysfunction, which raises the serum acyclovir level to the toxic range, special attention must be paid when administering this drug in elderly subjects.

Topics: Acute Kidney Injury; Acyclovir; Aged, 80 and over; Antiviral Agents; Consciousness Disorders; Diabetes Complications; Diabetes Mellitus, Type 2; Humans; Male; Valacyclovir; Valine

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

BACKGROUND Herpes simplex virus-2 (HSV-2) affects nearly 1 in 5 adults in the United States. Complications such as viral hepatitis and dissemination are rare in immunocompetent hosts. In this report, we describe a case of viral hepatitis secondary to disseminated HSV-2 in an immunocompetent patient with recurrent fevers and elevated aminotransferases. CASE REPORT A 57-year-old man with a history of type 2 diabetes and hypertension was admitted with a right index finger lesion concerning for an abscess. He underwent successful incision and drainage and was started on ampicillin-sulbactam. On Day 2 of hospitalization, he developed recurrent fevers and elevated aminotransferases and inflammatory markers. An extensive infectious, rheumatologic, and malignancy workup were pursued without immediate findings. Imaging demonstrated cirrhotic morphology of the liver and splenomegaly, but lab markers were intact for liver synthetic function. On Day 7 of hospitalization, fever frequency decreased, and HSV-2 titers resulted, with positive IgM and negative IgG. He subsequently developed erythematous, raised lesions in multiple dermatomes. Nucleic acid amplification testing of biopsied lesions was positive for HSV-2, confirming viral hepatitis secondary to disseminated HSV-2. He was started on intravenous acyclovir and discharged on valacyclovir following improvement in symptoms. CONCLUSIONS We report a case of viral hepatitis secondary to disseminated HSV-2 in an immunocompetent host. Up to 25% of cases occur in immunocompetent hosts and many patients do not develop characteristic skin lesions. Early diagnosis and treatment of viral hepatitis secondary to disseminated HSV remains vital to minimize morbidity and mortality.

Topics: Acyclovir; Adult; Antiviral Agents; Diabetes Mellitus, Type 2; Hepatitis, Viral, Human; Herpes Simplex; Herpesvirus 2, Human; Humans; Male; Middle Aged

Topics: Acyclovir; Aged; Antineoplastic Agents; Antiviral Agents; Cerebrospinal Fluid; Colonic Neoplasms; Diabetes Mellitus, Type 2; Encephalitis, Herpes Simplex; Herpesvirus 1, Human; Humans; Immunocompromised Host; Male

A 71-year old man presented with painful hemorrhagic vesicles and papules over the entire body that had persisted for three days. Type 2 diabetes mellitus type 2 had been diagnosed 20 years ago and had not been treated for the last 5 years. Therapy had been discontinued by the patient.. HbA1c (11,9%) and blood glucose levels (up to 360 mg/dl) were abnormal. Varicella-zoster-DNA was replicated by PCR from the vesicle fluid.. After the clinical diagnosis of disseminated herpes zoster had been confirmed systemic therapy with aciclovir 10 mg/kg day was started. There was no evidence of malignancy. Insulin therapy was initiated.. Dissemination is a rare complication of herpes zoster, aided by immunosuppression. In the presented case there was no evidence of malignancy or other cause of immunosuppression, but the patient also had type 2 diabetes with very high blood glucose levels. The diabetes was thought to be causally related to the ineffective immune response to varicella zoster virus. There has been no previous published report of this relationship.

Topics: Acyclovir; Administration, Topical; Aged; Antiviral Agents; Biguanides; Blood Glucose; Diabetes Mellitus, Type 2; DNA, Viral; Follow-Up Studies; Glycated Hemoglobin; Herpes Zoster; Herpesvirus 3, Human; Humans; Insulin; Male; Ointments; Polymerase Chain Reaction; Time Factors; Treatment Outcome

Severity of varicella infection in 54 patients with diabetes mellitus seen in Arar Central Hospital, Saudi Arabia, between January 1992 and December 1994 was compared with that in 55 apparently healthy controls, seen during the same period. Persistent fever, defined as fever lasting more than five days; extensive skin eruption, defined as affecting more than 50% of the body surface; and secondary bacterial skin infection evidenced by a positive skin culture of Staphylococcus aureus or Streptococcus pyogenes occurred significantly more in diabetics than in healthy controls. The mean duration of the illness in diabetics was 16.8 +/- 3.24 days as compared to 13.6 +/- 3.32 days in healthy controls. These findings suggest that varicella runs a more aggressive course in diabetic patients compared to otherwise healthy individuals. Treatment with the anti-viral agent, acyclovir may be indicated in diabetics with varicella infection.

Topics: Acyclovir; Adolescent; Adult; Antiviral Agents; Case-Control Studies; Chickenpox; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Female; Humans; Male; Saudi Arabia; Severity of Illness Index; Skin Diseases, Bacterial