acyclovir and Diarrhea

We describe a rare fulminant case of Epstein-Barr virus-associated hemophagocytic syndrome (HPS) in a 37-year-old female renal transplant patient, indistinguishable from severe sepsis clinically and in the laboratory. HPS involves rapidly escalating immune system activation, resulting in a cytokine cascade, which can, especially in immunocompromised patients, lead to multi-organ failure, and even death. Thirty-two Herpesviridae-associated HPS cases in renal transplant patients have been reported and are reviewed. Overall mortality is 47% (15/32 cases).

Topics: Acyclovir; Antiviral Agents; Diarrhea; Drug Therapy, Combination; Epstein-Barr Virus Infections; Fatal Outcome; Female; Fever; Ganciclovir; Glomerulonephritis, IGA; Herpesvirus 4, Human; Humans; Immunocompromised Host; Immunosuppressive Agents; Kidney Transplantation; Lymphohistiocytosis, Hemophagocytic; Multiple Organ Failure; Oliguria

Acyclovir is an antiviral agent that causes termination of viral DNA synthesis by inhibiting viral reverse transcriptase. Acyclovir is used therapeutically to treat herpes simplex, cytomegalovirus, Epstein-Barr, and varicella-Zoster. Although acyclovir is thought to be low in toxicity, it has caused an obstructive nephropathy from accumulation of crystals in renal tissue. A retrospective review (January 1995 through March 2000) was conducted of acyclovir toxicoses in dogs reported to the ASPCA National Animal Poison Control Center. Of 105 ingestions, 10 were considered cases of acyclovir toxicosis. The most common signs seen were vomiting, diarrhea, anorexia, and lethargy. Ingested dosages ranged from 40 to 2195 mg/kg bw. Polyuria and polydipsia were reported in I dog. In 6/10 cases, signs developed within 3 h of ingestion. Treatment included standard decontamination procedures, (ie induction of emesis, administration of activated charcoal), diuresis, and supportive care.

Topics: Acyclovir; Animals; Anorexia; Antiviral Agents; Charcoal; Diarrhea; Diuresis; Dog Diseases; Dogs; Female; Male; Polyuria; Retrospective Studies; Vomiting

An open study was conducted to evaluate the efficacy of oral acyclovir in a group of 295 Singapore Armed Forces male servicemen. The 148 patients who were willing to take acyclovir were given 800 mg orally five times per day for seven days. The other 147 who refused to take acyclovir were monitored as a control group. Each of these groups was further classified into two groups. Group A patients presented with rash within 24 hours of rash onset and Group B presented between 24 and 72 hours. Daily lesion counts, temperature, pruritus scores and laboratory tests were used to monitor disease progression. Early acyclovir intervention (Group A) reduced the time to 100% crusting from 7.19 to 5.71 days (P = 0.0001), decreased the maximum number of all lesions by 26% (P = 0.03) and the maximum number of vesicular lesions by 45% (P = 0.0004). Late therapy (Group B) was effective in reducing the maximum number of vesicular lesions by 38% (P = 0.003). The number of patients requiring antibiotics for suspected secondary skin infection, the duration of fever and paracetamol consumption were significantly reduced in both the early and late intervention groups. However, there were no effects in minimizing pruritus in either group. Serious complications such as pneumonia, encephalitis or death were not observed in this study. The most common adverse effect of acyclovir was mild diarrhoea occurring in 35% of patients treated with the drug. We conclude that early treatment with acyclovir was beneficial whereas late therapy had limited effect in reducing the severity of cutaneous lesions in patients with varicella.

Topics: Acyclovir; Administration, Oral; Adult; Chickenpox; Diarrhea; Drug Administration Schedule; Fever; Humans; Incidence; Male; Military Personnel; Pruritus; Singapore; Time Factors

A 45-year-old man was presented at the emergency department with altered neurological status and a 1-day history of diarrhoea and fever. The patient's sexual history revealed multiple male partners. As bacterial meningitis or viral encephalitis was suspected, treatment was started accordingly. Cerebrospinal fluid investigations only showed a slight increase of leucocytes, and microbiological studies remained negative. Stool culture revealed

Topics: Acyclovir; Amoxicillin; Anti-Bacterial Agents; Ceftriaxone; Diarrhea; Drug Therapy, Combination; Dysentery, Bacillary; Encephalitis; Feces; Fever; Humans; Male; Middle Aged; Sexual and Gender Minorities; Shigella flexneri; Treatment Outcome; Unsafe Sex

A 73-year-old man presented to our hospital with a sore throat (left-sided) and hiccups. The patient had mucosal swelling and erosions affecting the left posterior pillar, base of tongue, epiglottis, arytenoid, and aryepiglottic fold. As the laryngeal mucosal edema became worse, herpetic vesicles and erosions developed on the left cavum conchae, external auditory canal, and palate. The patient was treated with acyclovir and a steroid. His hiccups were treated with metoclopramide, but it had little effect, and hiccups only subsided gradually after the disappearance of erosions. His hiccups relapsed transiently with vomiting, and then resolved completely. Elevation of the CF titer after 2 weeks confirmed the diagnosis of herpes zoster. This condition should be considered in patients with unilateral sore throat and intractable hiccups, and treatment with acyclovir should be provided.

Topics: Acyclovir; Administration, Oral; Aged; Anti-Inflammatory Agents; Antiviral Agents; Diarrhea; Edema; Herpes Zoster; Hiccup; Humans; Hydrocortisone; Infusions, Intravenous; Laryngeal Mucosa; Laryngitis; Male; Metoclopramide; Retreatment; Valacyclovir; Valine

To report a case of Clostridium difficile colitis associated with valaciclovir treatment.. A 73-year-old man with lumbar herpes-zoster started valaciclovir 1 g tid. After three days he began vomiting and developed diarrhea, three to four stools per day. Symptoms worsened over the following days and he was admitted. Valaciclovir was stopped and fluid and electrolyte replacement was started. He continued 6 days later with diarrhea of 7 to 13 stools per day and a stool test for diagnosis of C. difficile infection was performed with a positive result. The patient received oral metronidazole (500 mg/t.i.d. for 10 days) and rapid improvement and eventual resolution of his diarrhea was observed after 3 days of therapy.. Although no conclusive reports of this reaction exist, we think this is a case of C difficile colitis that appeared three days after valaciclovir was initiated. Colitis improved with metronidazole. Other causes of diarrhea were excluded, such as diabetes mellitus, renal failure, intestinal surgery and intestinal obstruction. Infection was confirmed by a positive test for C. difficile. The application of Naranjo's algorithm asserts the reaction as 'probable'.. Valaciclovir-associated C. difficile colitis, although rare, can have severe consequences for the patient's health. It should be included as a possible adverse effect of valaciclovir treatment by health professionals.

Topics: Acyclovir; Aged; Antiviral Agents; Clostridioides difficile; Diarrhea; Enterocolitis, Pseudomembranous; Herpes Zoster; Humans; Male; Valacyclovir; Valine

The main non-HIV presentations at the 1995 Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC) are reviewed. Issues addressed vancomycin resistance, the use of antibiotics in overcoming drug resistance, two new classes of antibiotics that are active against resistant gram-positive bacteria, hepatitis A screening for low-risk prospective travelers to developing countries, a new antiviral agent (valaciclovir) for use against genital herpes, amphotericin B lipid therapy for invasive candidiasis, and cryptosporidium as a major cause of severe diarrhea.

Topics: Acyclovir; Amphotericin B; Anti-Bacterial Agents; Antifungal Agents; Antiviral Agents; Candidiasis; Cryptosporidium; Diarrhea; Drug Carriers; Drug Resistance, Microbial; Gram-Positive Bacteria; Hepatitis A; Herpes Genitalis; Valacyclovir; Valine; Vancomycin

The spectrum of presentation of complications in patients with human immunodeficiency virus (HIV) disease is changing, in line with their improved survival. Infection of the colon with cytomegalovirus (CMV) is now more commonly encountered in clinical practice. We have reviewed the medical records of eleven patients with clinical and pathological evidence of CMV colitis. The clinical presentation, endoscopic and histological findings, and simultaneous infection of other organs with CMV are discussed. Diarrhoea in association with abdominal pain is the most frequent symptom complex in these patients and should raise the clinical index of suspicion for CMV colitis.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; Colitis; Colon; Cytomegalovirus Infections; Diarrhea; Ganciclovir; Humans; Intestinal Mucosa; Male; Middle Aged; Rectum

Topics: Acyclovir; Administration, Oral; Adult; beta-Galactosidase; Diarrhea; Drug Tolerance; Galactosidases; Humans; Keratitis, Dendritic; Lactose Intolerance; Male

Overall, acyclovir is a remarkably safe drug considering its potent antiviral effect. The most frequent reactions with short-term use of oral acyclovir are nausea and vomiting and with 6 months' use headache, diarrhea, nausea, and vomiting. These symptoms are also seen frequently with placebos. The most frequent adverse reaction to intravenous use has been inflammation and phlebitis at the injection site. The two most important serious adverse effects are (1) encephalopathic changes with abnormal electroencephalograms and lethargy, tremors, confusion, and seizures and (2) renal precipitation of the drug because of a rapid bolus of drug administered parenterally. Safety of acyclovir for use during pregnancy and in neonates and young children has not been established.

Topics: Acyclovir; Administration, Oral; Administration, Topical; Animals; Chemical Precipitation; Diarrhea; Female; Headache; Humans; Injections, Intravenous; Kidney; Nausea; Pregnancy; Vomiting