acyclovir and Enterovirus-Infections

Viral infections in the fetus or newborn often involve the central nervous system (CNS) and can lead to significant morbidity and mortality. Substantial progress has been made in identifying interventions decreasing adverse neurodevelopmental outcomes in this population. This review highlights progress in treatment of important viruses affecting the CNS in these susceptible hosts, focusing on herpes simplex virus (HSV), cytomegalovirus (CMV), human immunodeficiency virus (HIV), and enteroviruses. The observation that high-dose acyclovir improves mortality in neonatal HSV disease culminated decades of antiviral research for this disease. More recently, prolonged oral acyclovir was found to improve neurologic morbidity after neonatal HSV encephalitis. Ganciclovir, and more recently its oral prodrug valganciclovir, is effective in improving hearing and neurodevelopment after congenital CMV infection. Increasing evidence suggests early control of perinatal HIV infection has implications for neurocognitive functioning into school age. Lastly, the antiviral pleconaril has been studied for nearly two decades for treating severe enteroviral infections, with newer data supporting a role for this drug in neonates. Identifying common mechanisms for pathogenesis of viral CNS disease during this critical period of brain development is an important research goal, highlighted by the recent emergence of Zika virus as a potential cause of fetal neurodevelopmental abnormalities.

Topics: Acyclovir; Antiviral Agents; Brain; Cognition; Cognition Disorders; Encephalitis, Herpes Simplex; Enterovirus Infections; Female; Ganciclovir; HIV Infections; Humans; Infant, Newborn; Nervous System Diseases; Oxadiazoles; Oxazoles; Pregnancy; Valganciclovir; Virus Diseases

Encephalitis and postinfectious encephalitis represent two important conditions for the neurologist, both in terms of their presentations as neurologic emergencies and their potential to cause death or serious neurologic impairment. This article reviews the major infectious and noninfectious causes of encephalitis and discusses postinfectious encephalitis as an indirect effect of systemic illness.. Encephalitis caused by herpes simplex virus type 1 and West Nile virus are of major importance. In addition, within the past few years we have gained improved understanding of the neurologic syndromes caused by varicella-zoster virus, the recognition of enterovirus 71 as a significant human pathogen, and the realization that encephalitis may also occur by autoimmune mechanisms requiring immunosuppressive therapy. We have also learned that postinfectious encephalitis may be recurrent rather than monophasic, and that children and adults initially diagnosed with postinfectious encephalitis may later develop classic multiple sclerosis.. Encephalitis and postinfectious encephalitis present as neurologic emergencies requiring prompt diagnosis and initiation of treatment. Important concerns are to identify infectious conditions requiring antibiotic or antiviral therapy and postinfectious or other autoimmune encephalitides requiring immunosuppression.

Topics: Acyclovir; Adolescent; Antiviral Agents; Brain Diseases; Encephalitis; Encephalitis, Herpes Simplex; Encephalitis, Varicella Zoster; Encephalitis, Viral; Enterovirus Infections; Fatal Outcome; Female; Hashimoto Disease; Humans; Leukoencephalitis, Acute Hemorrhagic; Magnetic Resonance Imaging; Male; Middle Aged; West Nile Fever; Young Adult

Topics: Acyclovir; Antiviral Agents; Cat-Scratch Disease; Child; Encephalitis; Encephalitis, Herpes Simplex; Encephalomyelitis, Acute Disseminated; Enterovirus Infections; Epstein-Barr Virus Infections; Humans; Influenza, Human; Pneumonia, Mycoplasma; Prognosis; Rabies; West Nile Fever

Acute viral and other infectious causes of encephalitis usually produce fever, headache, stiff neck and alterations in consciousness, focal neurologic signs and seizures. A large number of viral and nonviral agents can cause encephalitis. Arthropod-borne viruses peak in summer, the tick-borne infections occur in early summer, enterovirus infections in later summer and mumps in the winter and spring.

Topics: Acyclovir; Encephalitis; Encephalitis, Tick-Borne; Enterovirus Infections; Herpes Simplex; Humans; Mumps; Seasons

Acyclovir and suramin were examined for their efficacy alone and in combination, against duck hepatitis B virus (DHBV) in persistently infected Pekin ducks. The pharmacokinetics of acyclovir in ducks showed that the peak plasma concentration was reached 30 min after oral administration. Oral acyclovir and suramin administered intravenously suppressed the replication and production of infectious virions as measured by marked reduction of DNA polymerase activity during treatment. However, rebound of enzyme activity was observed soon after cessation of drug therapy. In contrast, sustained reduction of polymerase activity was attained by combined therapy of acyclovir followed by suramin, demonstrating a significant enhancement of anti-DHBV activity which requires confirmation in a larger experimental study. This report reviews the work with the duck model, demonstrating that it is ideal for screening antiviral compounds for treatment of infection with hepadna viruses.

Topics: Acyclovir; Animals; Antiviral Agents; Disease Models, Animal; Drug Evaluation, Preclinical; Ducks; Enterovirus Infections; Hepatitis B virus; Suramin

Topics: Acyclovir; Adult; Antiviral Agents; Burkitt Lymphoma; Chickenpox; Child; Cytomegalovirus Infections; Disease Susceptibility; Enterovirus Infections; Herpes Simplex; Herpes Zoster; Humans; Immunologic Deficiency Syndromes; Immunosuppression Therapy; Infectious Mononucleosis; Orthomyxoviridae Infections; Respirovirus Infections; Vidarabine; Virus Diseases

The aim of this study was to evaluate the role of viral polymerase chain reaction (PCR) testing in patients with aseptic meningitis and identify opportunities for improvement in clinical management. All cerebrospinal fluid samples collected in 1 year from four teaching hospitals in Sydney, Australia, were reviewed. Patients with aseptic meningitis were selected, and clinical and diagnostic features, hospital length of stay (LOS), and treatment were analyzed. Identifying a cause by viral PCR did not reduce hospital LOS (median 3 days) or antibiotic use (median 2 days), but the turnaround time of the PCR test correlated with LOS (Rs = 0.3822, p = 0.0003). Forty-one percent of patients received intravenous acyclovir treatment, which was more frequent in patients admitted under neurologists than infectious diseases physicians (56% vs. 24%; p = 0.013). The majority of patients did not have investigations for alternative causes of aseptic meningitis such as human immunodeficiency virus and syphilis if the viral PCR panel was negative. The benefit of PCR testing in aseptic meningitis in adults in reducing LOS and antibiotic use is unclear. The reasons for unnecessary aciclovir use in meningitis syndromes require further assessment.

Topics: Acyclovir; Adult; Anti-Bacterial Agents; Cerebrospinal Fluid; Enterovirus; Enterovirus Infections; Humans; Infant; Meningitis, Aseptic; Meningitis, Viral; Polymerase Chain Reaction; Retrospective Studies

Enteroviruses are one of the most important causes of viral encephalitis in the neonatal period. However, the non-specificity of the symptoms presented renders its diagnosis challenging. Intracranial MRI has been reported to be a very useful imaging modality that can detect the characteristic white matter lesions around the periventricular regions. In this study, we report a case of a patient with neonatal encephalitis who presented with normal white blood cell counts in the initial cerebrospinal fluid analysis. A lumbar puncture retap identified pleocytosis, and polymerase chain reaction assays detected enterovirus 71 in the blood and stool samples. Furthermore, MRI revealed atypical disseminated cortical and subcortical white matter lesions on diffusion weighted images, and neuroradiological re-evaluation showed necrotic changes 2 weeks later. This unique case expands our knowledge of the spectrum of neurological disorders due to enterovirus 71 infection in neonatal period.

Topics: Acyclovir; Antiviral Agents; Cerebral Cortex; Diffusion Magnetic Resonance Imaging; Encephalitis, Viral; Enterovirus A, Human; Enterovirus Infections; Humans; Infant, Newborn; Male; Neuroimaging; Spinal Puncture; White Matter

To determine the association of the use of the multiplex assay meningitis/encephalitis panel with clinical management of suspected meningitis.. A cross-sectional study was conducted with children 0 to 18 years of age who received a lumbar puncture within 48 hours of admission for an infectious workup. Patient demographic and presenting information, laboratory studies, and medication administration were collected. The primary measure was length of stay (LOS) with secondary measures: time on antibiotics, time to narrowing antibiotics, and acyclovir doses. LOS and antibiotic times were stratified for outcomes occurring before 36 hours. Logistic regression analysis was used to account for potential confounding factors associated with both the primary and secondary outcomes. A value of. Meningitis panel use was associated with a higher likelihood of a patient LOS <36 hours (. Use of the meningitis panel was associated with a decreased LOS, time to narrowing of antibiotics, and fewer acyclovir doses. This likely is a result of the rapid turnaround time as compared with cerebrospinal fluid cultures. Additional studies to examine the outcomes related to this change in management are warranted.

Topics: Acyclovir; Anti-Bacterial Agents; Antiviral Agents; Cross-Sectional Studies; Encephalitis, Herpes Simplex; Enterovirus Infections; Female; Humans; Infant; Infant, Newborn; Length of Stay; Male; Meningitis, Bacterial; Meningitis, Pneumococcal; Meningitis, Viral; Real-Time Polymerase Chain Reaction; Retrospective Studies; Roseolovirus Infections; Spinal Puncture

A 27-year-old man, immunosuppressed from recent chemotherapy for metastatic Ewing's sarcoma, presented with a 1-week history of a painful, pruritic, papulovesicular eruption on the hands and feet. A diagnosis of hand, foot and mouth disease was made based on histology, detection of Enterovirus ribonucleic acid by polymerase chain reaction on a swab from a vesicle, and a four-fold increase in Enterovirus antibody levels. At no stage however, were there lesions in the mouth. Another unusual feature in this case was a prolonged course, presumably as a result of immunosuppression. After 3 1/2 weeks he was commenced on oral aciclovir 200 mg five times daily, with subsequent resolution of all lesions within 5 days. There may be a role for systemic aciclovir in some patients with hand, foot and mouth disease.

Topics: Acyclovir; Adult; Antiviral Agents; Diagnosis, Differential; Enterovirus; Enterovirus Infections; Hand, Foot and Mouth Disease; Humans; Immunocompromised Host; Male; Sarcoma, Ewing; Treatment Outcome

Enteroviral meningitis is well documented in children but underestimated in adults. The analysis of 30 cases of adult meningitis prospectively diagnosed by enterovirus genome detection (RT-PCR) in cerebrospinal fluid (CSF) between 1999 and 2000 in routine practice showed diagnosis to be problematic. Characteristic symptoms were inconstant (the association of fever/headache/stiff neck absent in 41%) and sometimes misleading (the presence of peribuccal lesions). CSF data showed a predominance of lymphocytes in only 44% of patients. The most reliable criterion was normal constant CSF glucose levels. Thirty three per cent of patients were admitted during cold months. Management of patients varied markedly between departments, and included computed tomography (33%), and the prescription of aciclovir (20%) or antibiotics (53%). A report of positive enterovirus RT-PCR had only low impact on management because it took 6 days to obtain the results (versus 3 days in children during the same period). These findings were communicated to all hospital physicians concerned and as a result, the number of RT-PCR in adults increased significantly during 2001. Again, enteroviral meningitis was diagnosed in adults despite a much lower incidence of the illness in 2001 compared to 2000. Thus this pathology should not be underestimated in adults. Considerable medical expenditure might be avoided (cumulative numbers of 172 days in hospital and 82 days of antibiotics in this study), if rapid and accurate diagnostic techniques were available.

Topics: Acyclovir; Adult; Antiviral Agents; Diagnosis, Differential; Enterovirus; Enterovirus Infections; France; Glucose; Humans; Incidence; Meningitis, Viral; Reverse Transcriptase Polymerase Chain Reaction; Seasons

Echovirus types 4 and 33 and coxsackievirus type B1 were recovered from vesicular lesions in four adults. Patient 1 had cutaneous localized vesicles, patient 2 had a recurrent cutaneous vesicle, and patients 3 and 4 had mucosal vesicles. Three of the patients were suspected of having herpesvirus lesions. One of the patients was a human immunodeficiency virus type 1-seropositive man, and the enterovirus infection was the first clinical manifestation. Our results underline the importance of virological diagnosis before treatment with acyclovir, especially for immunocompromised patients.

Topics: Acyclovir; Adult; Enterovirus Infections; Female; Humans; Male; Skin Diseases

Topics: Acyclovir; Administration, Oral; Bone Marrow Transplantation; Coxsackievirus Infections; Enterovirus Infections; Graft vs Host Disease; Herpes Simplex; Humans; Immunoglobulins; Transplantation, Homologous