acyclovir and Fever
acyclovir has been researched along with Fever* in 90 studies
Reviews
6 review(s) available for acyclovir and Fever
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Fulminant Epstein-Barr virus-associated hemophagocytic syndrome in a renal transplant patient and review of the literature.
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 | 2016 |
Neonate with Mycoplasma hominis meningoencephalitis given moxifloxacin.
Mycoplasma hominis is a commensal organism in the genitourinary tract that can cause life-threatening CNS infections in neonates after intrauterine infection or through vertical transmission during birth. We present a case of an 11-day-old neonate presenting with fever and supporting laboratory evidence of a CNS infection. No systemic maternal infection or maternal genitourinary tract infection occurred at the time of delivery. Empirical treatment was initiated, consisting of amoxicillin, cefotaxime, and aciclovir. After clinical deterioration, 16S ribosomal DNA PCR in cerebrospinal fluid detected M hominis, antibiotic treatment was switched to moxifloxacin, and pharmacokinetic data were obtained. This Grand Round illustrates the challenges that exist in the diagnosis and treatment of M hominis meningoencephalitis: bacterial cultures are often negative and recommended empirical antimicrobials do not provide adequate antimicrobial coverage. Optimal antimicrobial treatment regimens for M hominis meningoencephalitis are unknown. Although we describe successful treatment of a neonate with a complicated M hominis meningoencephalitis with moxifloxacin, caution with fluoroquinolone monotherapy (including moxifloxacin) has to be taken into account because resistance to fluoroquinolones has previously been described. Topics: Acyclovir; Amoxicillin; Anti-Bacterial Agents; Antiviral Agents; Cefotaxime; Cerebrospinal Fluid; Female; Fever; Fluoroquinolones; Humans; Infant, Newborn; Meningoencephalitis; Moxifloxacin; Mycoplasma hominis; Polymerase Chain Reaction | 2016 |
Evaluation of the febrile young infant: an update.
The febrile young infant is commonly encountered in the emergency department, and the incidence of serious bacterial infection in these patients is as high as 15%. Undiagnosed bacterial infections such as meningitis and bacteremia can lead to overwhelming sepsis and death or neurologic sequelae. Undetected urinary tract infection can lead to pyelonephritis and renal scarring. These outcomes necessitate the evaluation for a bacterial source of fever; therefore, performance of a full sepsis workup is recommended to rule out bacteremia, urinary tract infection, and bacterial meningitis in addition to other invasive bacterial diseases including pneumonia, bacterial enteritis, cellulitis, and osteomyelitis. Parents and emergency clinicians often question the necessity of this approach in the well-appearing febrile young infant, and it is important to understand and communicate the evidence that guides the approach to these patients. Recent studies examining the risk of serious bacterial infection in young infants with bronchiolitis and the role of viral testing in the febrile young infant will also be discussed in this review. Topics: Acyclovir; Anti-Bacterial Agents; Antiviral Agents; Biomarkers; Clinical Laboratory Techniques; Critical Pathways; Diagnosis, Differential; Emergency Medicine; Emergency Service, Hospital; Fever; Herpes Simplex; Humans; Infant; Physical Examination; Radiography, Thoracic; Risk Management | 2013 |
80-year-old man with fever and ear pain.
Topics: Acetates; Acyclovir; Age Factors; Aged; Aged, 80 and over; Amines; Analgesics; Antiviral Agents; Cyclohexanecarboxylic Acids; Diagnosis, Differential; Earache; Fever; Gabapentin; gamma-Aminobutyric Acid; Herpes Zoster; Humans; Male; Oxycodone; Pain; Patient Selection; Polymerase Chain Reaction; Risk Factors; Valacyclovir; Valine | 2004 |
Evaluation of encephalitis in the toddler: what part of negative don't you understand?
Topics: Acyclovir; Aphasia; Brain; Encephalitis, Viral; Fever; Herpes Simplex; Humans; Infant; Male; Seizures; Simplexvirus; Tomography, X-Ray Computed; Treatment Outcome; Vomiting | 2004 |
Acyclovir for treating varicella in otherwise healthy children and adolescents: a systematic review of randomised controlled trials.
Acyclovir has the potential to shorten the course of chickenpox which may result in reduced costs and morbidity. We conducted a systematic review of randomised controlled trials that evaluated acyclovir for the treatment of chickenpox in otherwise healthy children.. MEDLINE, EMBASE, and the Cochrane Library were searched. The reference lists of relevant articles were examined and primary authors and Glaxo Wellcome were contacted to identify additional trials. Two reviewers independently screened studies for inclusion, assessed study quality using the Jadad scale and allocation concealment, and extracted data. Continuous data were converted to a weighted mean difference (WMD). Overall estimates were not calculated due to differences in the age groups studied.. Three studies were included. Methodological quality was 3 (n = 2) and 4 (n = 1) on the Jadad scale. Acyclovir was associated with a significant reduction in the number of days with fever, from -1.0 (95% CI -1.5,-0.5) to -1.3 (95% CI -2.0,-0.6). Results were inconsistent with respect to the number of days to no new lesions, the maximum number of lesions and relief of pruritus. There were no clinically important differences between acyclovir and placebo with respect to complications or adverse effects.. Acyclovir appears to be effective in reducing the number of days with fever among otherwise healthy children with chickenpox. The results were inconsistent with respect to the number of days to no new lesions, the maximum number of lesions and the relief of itchiness. The clinical importance of acyclovir treatment in otherwise healthy children remains controversial. Topics: Acyclovir; Antiviral Agents; Chickenpox; Child; Fever; Humans; Randomized Controlled Trials as Topic; Time Factors | 2002 |
Trials
10 trial(s) available for acyclovir and Fever
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Efficacy of the early administration of valacyclovir hydrochloride for the treatment of neuropathogenic equine herpesvirus type-1 infection in horses.
OBJECTIVE To determine whether prophylactic administration of valacyclovir hydrochloride versus initiation of treatment at the onset of fever would differentially protect horses from viral replication and clinical disease attributable to equine herpesvirus type-1 (EHV-1) infection. ANIMALS 18 aged mares. PROCEDURES Horses were randomly assigned to receive an oral placebo (control), treatment at detection of fever, or prophylactic treatment (initiated 1 day prior to viral challenge) and then inoculated intranasally with a neuropathogenic strain of EHV-1. Placebo or valacyclovir was administered orally for 7 or 14 days after EHV-1 inoculation or detection of fever (3 horses/group). Effects of treatment on viral replication and clinical disease were evaluated. Plasma acyclovir concentrations and viremia were assessed to determine inhibitory concentrations of valacyclovir. RESULTS Valacyclovir administration decreased shedding of virus and viremia, compared with findings for control horses. Rectal temperatures and clinical disease scores in horses that received valacyclovir prophylactically for 2 weeks were lower than those in control horses. The severity of but not the risk for ataxia was decreased by valacyclovir administration. Viremia was decreased when steady-state trough plasma acyclovir concentrations were > 0.8 μg/mL, supporting the time-dependent activity of acyclovir. CONCLUSIONS AND CLINICAL RELEVANCE Valacyclovir treatment significantly decreased viral replication and signs of disease in EHV-1-infected horses; effects were greatest when treatment was initiated before viral inoculation, but treatment was also effective when initiated as late as 2 days after inoculation. During an outbreak of equine herpesvirus myeloencephalopathy, antiviral treatment may be initiated in horses at various stages of infection, including horses that have not yet developed signs of viral disease. Topics: Acyclovir; Animals; Antiviral Agents; Female; Fever; Herpesviridae Infections; Herpesvirus 1, Equid; Horse Diseases; Horses; Premedication; Valacyclovir; Valine; Viremia; Virus Replication | 2017 |
Acyclovir prophylaxis and fever during remission-induction therapy of patients with acute myeloid leukemia: a randomized, double-blind, placebo-controlled trial.
A randomized, double-blind, placebo-controlled trial was performed to estimate the preventive effect of the antiherpetic drug acyclovir on fever, incidence of bacteremia, use of antibiotics, and presentation of infections in patients with acute myeloid leukemia (AML).. Ninety herpes simplex virus (HSV)-seropositive patients aged 18 to 84 years were included. Forty-five patients received acyclovir (800 mg by mouth daily) and 45 placebo. The patients were examined daily for 28 days from the initiation of remission-induction chemotherapy.. Fever developed in all patients in both groups. Acyclovir prophylaxis postponed the development of an oral temperature > or = 38.0 degrees C by 3 days (95% confidence interval [CI], 1 to 4 days; P = .03) and the initiation of antibacterial treatment by 3 days (95% CI, 1 to 5 days; P = .008). The duration of fever, use of antibacterial treatment, incidence of bacteremia, and need for systemic antifungal therapy were not affected by acyclovir prophylaxis. At fever development, acyclovir prophylaxis affected the incidence and localization pattern of oral ulcers. Thus, in the acyclovir group, the number of nonfungal oral infections was reduced (relative risk, 0.45 [95% CI, 0.24 to 0.85]) and mainly located on the soft palate (relative risk, 2.49 [95% CI, 1.19 to 5.22]).. Acyclovir prophylaxis has an impact on fever development, but not on the duration of fever or the need for antibiotics. It does not reduce the incidence of bacteremia, but the presentation of acute oral infections is changed. Topics: Acyclovir; Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Antineoplastic Agents; Antiviral Agents; Bacteremia; Double-Blind Method; Female; Fever; Herpes Simplex; Humans; Leukemia, Myeloid, Acute; Male; Middle Aged; Remission Induction; Simplexvirus | 1997 |
Treatment of herpes simplex gingivostomatitis with aciclovir in children: a randomised double blind placebo controlled study.
To examine the efficacy of aciclovir suspension for treating herpetic gingivostomatitis in young children.. Randomised double blind placebo controlled study.. Day care unit of a tertiary paediatric hospital.. 72 children aged 1-6 years with clinical manifestations of gingivostomatitis lasting less than 72 hours; 61 children with cultures positive for herpes simplex virus finished the study.. Duration of oral lesions, fever, eating and drinking difficulties, and viral shedding.. Aciclovir suspension 15 mg/kg five times a day for seven days, or placebo.. Children receiving aciclovir had oral lesions for a shorter period than children receiving placebo (median 4 v 10 days (difference 6 days, 95% confidence interval 4.0 to 8.0)) and earlier disappearance of the following signs and symptoms: fever (1 v 3 days (2 days, 0.8 to 3.2)); extraoral lesions (lesions around the mouth but outside the oral cavity) (0 v 5.5 days (5.5 days, 1.3 to 4.7)); eating difficulties (4 v 7 days (3 days, 1.31 to 4.69)); and drinking difficulties (3 v 6 days (3 days, 1.1 to 4.9)). Viral shedding was significantly shorter in the group treated with aciclovir (1 v 5 days (4 days, 2.9 to 5.1)).. Oral aciclovir treatment for herpetic gingivostomatitis, started within the first three days of onset, shortens the duration of all clinical manifestations and the infectivity of affected children. Further studies are needed to evaluate the ideal dose and length of treatment. Topics: Acyclovir; Administration, Oral; Antiviral Agents; Child; Child, Preschool; Double-Blind Method; Feeding and Eating Disorders; Fever; Herpesvirus 1, Human; Hospitalization; Humans; Infant; Patient Compliance; Recurrence; Stomatitis, Herpetic; Time Factors; Treatment Outcome | 1997 |
Oral acyclovir in the treatment of adult varicella.
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 | 1995 |
Monotherapy for fever and neutropenia in cancer patients: a randomized comparison of ceftazidime versus imipenem.
To compare the efficacy of ceftazidime and imipenem monotherapy for fever and neutropenia, and to determine whether fewer antimicrobial modifications (additions or changes) are required by the broader-spectrum agent, imipenem.. Adult and pediatric patients undergoing chemotherapy for solid tumors, leukemias, or lymphomas were randomized to receive open-label ceftazidime or imipenem on presentation with fever and neutropenia. Success with or without modifications of the initial antibiotic was defined as survival through neutropenia; failure was death due to infection. Comparisons were based on numbers of modifications made to each monotherapy during the course of neutropenia, in patients stratified as having unexplained fever or a documented infection.. Among 204 ceftazidime and 195 imipenem recipients, the overall success rate with or without modification was more than 98%, regardless of initial antibiotic regimen. Modifications occurred in half of all episodes, primarily in patients with documented infections on either monotherapy. Antianaerobic agents were more frequently added to ceftazidime (P < .001), but addition of other antibiotics, including vancomycin and aminoglycosides, was similar between the two monotherapy groups. Imipenem therapy was associated with significantly greater toxicity, manifested by Clostridium difficile-associated diarrhea and by nausea and vomiting, which required discontinuation of imipenem in 10% of recipients.. Ceftazidime and imipenem are both effective in the management of fever and chemotherapy-related neutropenia, provided that modifications are made in response to clinical and microbiologic data that emerge during the course of neutropenia. Imipenem, despite its broader antimicrobial spectrum, does not significantly decrease the overall need for antibiotic modifications and is more often complicated by gastrointestinal toxicity. Topics: Acyclovir; Adolescent; Adult; Aged; Bacterial Infections; Cause of Death; Ceftazidime; Child; Child, Preschool; Female; Fever; Fever of Unknown Origin; Humans; Imipenem; Male; Middle Aged; Neoplasms; Neutropenia; Prospective Studies; Vancomycin | 1995 |
Randomized trial of the addition of gram-positive prophylaxis to standard antimicrobial prophylaxis for patients undergoing autologous bone marrow transplantation.
The purpose of the study reported here was to investigate the impact of prophylaxis against gram-positive infections in patients undergoing high-dose chemotherapy and autologous bone marrow transplantation in a randomized trial. Forty-three patients undergoing high-dose chemotherapy with autologous bone marrow transplant were enrolled in a nonblinded randomized trial to receive or not to receive prophylaxis for gram-positive infections with 10(6) U of penicillin intravenously (i.v.) every 6 h (q6h) (if penicillin allergic, 750 mg of vancomycin i.v. q12h) in addition to standard antimicrobial prophylaxis with 400 mg of norfloxacin orally three times a day, 200 mg of fluconazole orally once a day, and 5 mg of acyclovir per kg of body weight i.v. q12h. The patients were being treated for germ cell cancer (n = 15), breast cancer (n = 16), Hodgkin's disease (n = 3), non-Hodgkin's lymphoma (n = 4), acute myeloid leukemia (n = 1), acute lymphoblastic leukemia (n = 1), and ovarian cancer (n = 3). The trial was stopped because of excess morbidity in the form of streptococcal septic shock in the group not receiving gram-positive prophylaxis. There were significantly fewer overall infections (10 versus 3; P = 0.016) and streptococcal infections (9 versus 1; P = 0.0078) in the group receiving gram-positive prophylaxis. There were no significant differences in the numbers of deaths, duration of broad-spectrum antibiotics, or incidence of neutropenic fever between the two groups. Prophylaxis for gram-positive infections with penicillin or vancomycin is effective in reducing the incidence of streptococcal infections in patients undergoing high-dose chemotherapy and autologous bone marrow transplant. However, this approach may carry a risk of fostering resistance among streptococci to penicillin or vancomycin. Topics: Acyclovir; Adult; Bacteremia; Bone Marrow Transplantation; Female; Fever; Fluconazole; Gram-Positive Bacterial Infections; Humans; Male; Middle Aged; Neoplasms; Norfloxacin; Penicillins; Premedication; Streptococcal Infections; Vancomycin | 1994 |
Viral prophylaxis in hepatic transplantation: preliminary report of a randomized trial of acyclovir and gancyclovir.
Topics: Actuarial Analysis; Acyclovir; Adult; Cytomegalovirus Infections; Fever; gamma-Globulins; Ganciclovir; Graft Rejection; Humans; Immunosuppressive Agents; Liver Function Tests; Liver Transplantation; Postoperative Complications; Survival Analysis; Virus Diseases | 1993 |
Oral acyclovir as prophylaxis for bacterial infections during induction therapy for acute leukaemia in adults. The Leukemia Group of Middle Sweden.
We prospectively tested the hypothesis that prevention of herpes simplex virus infection with acyclovir might also reduce the incidence of bacterial infections in adult patients with acute leukaemia. During the first induction therapy a double-blind, randomized and placebo-controlled study was undertaken. Fifty-two patients were treated with 200 mg acyclovir orally four times daily throughout the induction period, whereas 55 patients received placebo. The groups were comparable with regard to age, cytotoxic chemotherapy and duration of neutropenia. Bacteraemias were significantly fewer in the acyclovir group (20 versus 41 episodes; P = 0.007). The number of isolated microorganisms causing bacterial or fungal infections was also lower during acyclovir prophylaxis (52 isolates, versus 93 isolates; P = 0.02). There was no significant difference between the groups with regard to the number of clinically documented infections or fevers of unknown origin. Herpes simplex virus isolations occurred only in the placebo group (P = 0.001). Thus, oral acyclovir prophylaxis was associated with reductions of all microbiologically documented infections suggesting that prevention of herpes simplex virus reactivation in acute leukaemia patients may reduce the occurrence of other infections. Topics: Acyclovir; Administration, Oral; Adolescent; Adult; Aged; Bacteremia; Bacterial Infections; Double-Blind Method; Fever; Herpes Simplex; Humans; Incidence; Ketoconazole; Middle Aged; Mycoses; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Prospective Studies | 1993 |
Treatment of adult varicella with oral acyclovir. A randomized, placebo-controlled trial.
To assess the efficacy of oral acyclovir in treating adults with varicella and to describe the natural history of adult varicella.. Double-blind, placebo-controlled randomized trial.. A naval hospital.. One hundred forty-eight of 206 consecutive adult active duty Navy and Marine Corps personnel who were hospitalized for isolation and inpatient therapy of varicella and who could be treated within 72 hours of rash onset completed the study. The diagnosis of varicella was confirmed by acute and convalescent serology in 143 of 144 patients with available paired sera.. Patients were randomly assigned to receive either acyclovir, 800 mg orally five times per day for 7 days, or an identical placebo. Separate randomization codes were used for patients presenting within 24 hours of rash onset and for those presenting 25 to 72 hours after rash onset.. Daily lesion counts, symptom scores, temperature measurements, and laboratory tests were used to monitor the course of the illness.. Early treatment (initiated within 24 hours of rash onset) reduced the total time to (100%) crusting from 7.4 to 5.6 days (P = 0.001) and reduced the maximum number of lesions by 46% (P = 0.04). Duration of fever and severity of symptoms were also reduced by early therapy. Late therapy (25 to 72 hours after rash onset) had no effect on the course of illness. Only four patients had pneumonia, and no encephalitis or mortality was noted.. Early therapy with oral acyclovir decreases the time to cutaneous healing of adult varicella, decreases the duration of fever, and lessens symptoms. Initiation of therapy after the first day of illness is of no value in uncomplicated cases of adult varicella. The low frequency of serious complications of varicella (pneumonia, encephalitis, or death) precluded any evaluation of the possible effect of acyclovir on these outcomes. Topics: Acyclovir; Administration, Oral; Adolescent; Adult; Antibodies, Viral; Chickenpox; Double-Blind Method; Female; Fever; Herpesvirus 3, Human; Humans; Immunoglobulin G; Male; Skin Diseases, Infectious | 1992 |
Treatment of herpes zoster. Recombinant alpha interferon versus acyclovir.
Sixty-four patients received systemic alpha-interferon (10 million units subcutaneously daily) and 63 received systemic acyclovir (5 mg/kg body weight intravenously thrice daily) in a randomized study of acute herpes zoster. Start of healing, complete healing, development of new skin lesions in the primarily affected and in other dermatomes, and degree and duration of pain were evaluated. Both drugs proved equally clinically efficient without statistically different findings between the two groups; herpes zoster neuralgia was not prevented by either interferon or acyclovir therapy. Minor clinical side effects occurred slightly more frequently during interferon treatment and included fever and nausea. Transient and moderate leukopenia was observed in nearly all patients in the interferon group. Topics: Acyclovir; Aged; Clinical Trials as Topic; Female; Fever; Herpes Zoster; Humans; Interferon Type I; Leukopenia; Male; Middle Aged; Nausea; Random Allocation; Recombinant Proteins | 1988 |
Other Studies
74 other study(ies) available for acyclovir and Fever
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Impact of CSF Meningitis and Encephalitis Panel on Resource Use for Febrile Well-Appearing Infants.
To determine whether the BioFire FilmArray Meningitis/Encephalitis (ME) panel is associated with decreased resource use for febrile infants. The ME panel has a rapid turnaround time (1-2 hours) and may shorten length of stay (LOS) and antimicrobial use for febrile well-appearing infants.. Retrospective cohort study of febrile well-appearing infants ≤60 days with cerebrospinal fluid culture sent in the emergency department from July 2017 to April 2019. We examined the frequency of ME panel use and its relationship with hospital LOS and initiation and duration of antibiotics and acyclovir. We used nonparametric tests to compare median durations.. The ME panel was performed for 85 (36%) of 237 infants. There was no difference in median hospital LOS for infants with versus without ME panel testing (42 hours, interquartile range [IQR] 36-52 vs 40 hours, IQR: 35-47, P = .09). More than 97% of infants with and without ME panel testing were initiated on antibiotics. Patients with ME panel were more likely to receive acyclovir (33% vs 18%; odds ratio: 2.2, 95%: confidence interval 1.2-4.0). There was no difference in median acyclovir duration with or without ME panel testing (1 hour, IQR: 1-7 vs 4.2 hours, IQR: 1-21, P = .10). When adjusting for potential covariates, these findings persisted.. ME panel use was not associated with differences in hospital LOS, antibiotic initiation, or acyclovir duration in febrile well-appearing infants. ME panel testing was associated with acyclovir initiation. Topics: Acyclovir; Anti-Bacterial Agents; Encephalitis; Fever; Humans; Infant; Meningitis; Retrospective Studies | 2022 |
A febrile patient with an unusual eruption.
Topics: Acyclovir; Exanthema; Fever; Humans; Kaposi Varicelliform Eruption | 2021 |
Prolonged fever and hyperferritinaemia: a puzzling diagnosis of neonatal herpes simplex virus infection during COVID-19 pandemic.
Neonatal herpes simplex virus (HSV) infection is rare, with an estimated incidence of 3.58 per 100 000 live births in the UK and should be suspected in any newborn with fever and bacterial culture-negative sepsis. We describe a case of a previously well full-term male neonate who presented with persistent fever and elevated ferritin level that was carried out during the era of the COVID-19 pandemic as part of SARS-CoV-2 panel investigations. Despite the initial negative HSV serology, HSV-1 PCR from a scalp lesion returned positive. He made a full recovery after acyclovir therapy. This case highlights the importance of maintaining a high clinical index of suspicion of HSV infection in any febrile neonate even with absence of maternal history and negative serology, particularly if associated with hyperferritinaemia. We also address the challenge of interpreting inflammatory biomarkers' results for SARS-CoV-2 infection in neonates. Topics: Acyclovir; Antiviral Agents; COVID-19; Female; Ferritins; Fever; Herpes Simplex; Herpesvirus 1, Human; Humans; Infant, Newborn; Male; Pandemics; Polymerase Chain Reaction; Pregnancy; Pregnancy Complications, Infectious; SARS-CoV-2; Treatment Outcome | 2021 |
Ischemic Lesions in the Brain of a Neonate With SARS-CoV-2 Infection.
To describe a term newborn with acquired severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and multisystem involvement including seizures associated to ischemic lesions in the brain.. Coronavirus disease 2019 (COVID-19) is predominantly a respiratory infection, but it may affect many other systems. Most pediatric COVID-19 cases range from asymptomatic to mild-moderate disease. There are no specific clinical signs described for neonatal COVID-19 infections. In children, severe central nervous system compromise has been rarely reported.. We describe a 17-day-old newborn who acquired a SARS-CoV-2 infection in a family meeting that was admitted for fever, seizures and lethargy and in whom consumption coagulopathy, ischemic lesions in the brain and cardiac involvement were documented.. SARS-CoV-2 neonatal infection can be associated with multi-organic involvement. In our patient, significant central nervous system compromise associated to ischemic lesions and laboratory findings of consumption coagulopathy were found.. Although neonatal SARS-CoV-2 infections are infrequent, they can be associated with multi-organic involvement. Neonatologists and pediatricians should be aware of this unusual way of presentation of COVID-19 in newborn infants. Topics: Acyclovir; Anti-Bacterial Agents; Antiviral Agents; Brain; Brain Ischemia; Ceftriaxone; COVID-19; COVID-19 Drug Treatment; Fever; Frontal Lobe; Humans; Infant, Newborn; Infant, Newborn, Diseases; Lethargy; Magnetic Resonance Imaging; Male; Nasopharynx; SARS-CoV-2; Seizures | 2021 |
Intracranial Epstein-Barr virus infection appearing as an unusual case of meningitis in an immunocompetent woman: a case report.
Topics: Acyclovir; Adult; Dexamethasone; Diagnosis, Differential; Epstein-Barr Virus Infections; Female; Fever; Glucose; Herpesvirus 4, Human; Humans; Immunocompetence; Intracranial Hypertension; Meningitis; Monocytes; Skull | 2020 |
Fever, Rash, and Abdominal Pain.
Topics: Abdominal Pain; Acyclovir; Administration, Intravenous; Adult; Anti-HIV Agents; Antiretroviral Therapy, Highly Active; Exanthema; Female; Fever; Herpesvirus 3, Human; HIV Infections; Humans; Immunocompromised Host; Liver; Treatment Outcome; Varicella Zoster Virus Infection | 2020 |
Factors Associated With HSV PCR CSF Testing and Empiric Acyclovir Therapy in Young Febrile Infants.
Herpes simplex virus (HSV) infection in infants is a devastating disease with an often subtle presentation. We examined cerebrospinal fluid (CSF) HSV PCR (polymerase chain reaction) testing and empiric acyclovir therapy in young febrile infants. Chart review identified hospitalized infants aged ≤60 days with fever ≥38°C who had undergone lumbar puncture. Previously published criteria were used to define patients at high risk for HSV. Primary outcomes were CSF HSV PCR testing and empiric acyclovir therapy. Of 536 febrile infants, 23% had HSV testing; empiric acyclovir was started in 15%. HSV testing and therapy were associated with younger age, seizure, maternal vaginal lesions, postnatal HSV contact, vesicles, poor tone, CSF pleocytosis, and enteroviral testing. Sixty-two percent of high-risk infants did not undergo HSV testing, and 75% did not receive acyclovir. High-risk infants were untested and untreated at relatively high rates. Evidence-based criteria to guide HSV testing and treatment are needed. Topics: Acyclovir; Antiviral Agents; Female; Fever; Herpes Simplex; Humans; Infant; Infant, Newborn; Male; Polymerase Chain Reaction; Spinal Puncture; Treatment Outcome | 2019 |
Empiric Treatment for Acute Pharyngitis.
Topics: Acute Disease; Acyclovir; Administration, Intravenous; Female; Fever; Herpes Simplex; Herpesvirus 2, Human; Humans; Pharyngitis; Young Adult | 2019 |
A Case of Eastern Equine Encephalitis.
Topics: Acyclovir; Anti-Bacterial Agents; Antiviral Agents; Ceftriaxone; Diagnosis, Differential; Encephalomyelitis, Eastern Equine; Fever; Humans; Infant; Male; Nervous System Diseases; Seizures | 2019 |
Fever and Rash in an Adult: Varicella Re-infection in Conjunction with Newly Diagnosed Chronic Lymphocytic Leukemia.
Topics: Acyclovir; Adenine; Adult; Antiviral Agents; Chickenpox; Dermatitis; Fever; Humans; Leukemia, Lymphocytic, Chronic, B-Cell; Male; Piperidines; Pyrazoles; Pyrimidines | 2019 |
During the Emergency Department Evaluation of a Well-Appearing Neonate with Fever, Should Empiric Acyclovir Be Initiated?
Herpes simplex virus (HSV) infection represents significant morbidity and mortality in the neonatal period. Although clear guidelines exist on the evaluation and management of the otherwise well-appearing febrile neonate pertaining to occult serious bacterial infections, there is no standardized approach regarding when to initiate testing and treatment for HSV infection. It is vital we establish a unified guideline based on available clinical research to aid in our decision to evaluate and initiate therapy for this disease.. A PubMed search was performed using the keywords "neonate AND fever AND HSV" and "neonate AND fever AND acyclovir." The time period for the search was May 1982 to May 2016. Identified articles underwent further selection based on relevance to the clinical question. Selected articles then underwent detailed review and structured analysis.. Our search identified 93 articles, of which 18 were found to be relevant to our clinical question. Recommendations were then made based on thorough review and analysis of the selected articles.. Neonatal HSV infection carries significant morbidity and mortality if left untreated. High-quality clinical evidence on when to evaluate and treat for possible HSV infection is lacking. Based on available research, HSV infection in the febrile neonate should be strongly considered if age is < 21 days, or if presenting with concerning clinical features. If testing is performed, empiric treatment with high-dose acyclovir should be initiated. Additional research is needed to further clarify which cases mandate evaluation and treatment for HSV, and to better define treatment protocols. Topics: Acyclovir; Antiviral Agents; Decision Making; Female; Fever; Guidelines as Topic; Herpes Simplex; Humans; Infant, Newborn; Male; Pregnancy Complications, Infectious; Simplexvirus | 2018 |
An adult case with shigellosis-associated encephalopathy.
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 | 2018 |
Listeria monocytogenes Meningitis Complicating Rotavirus Gastroenteritis in an Immunocompetent Child.
Listeria monocytogenes only occasionally causes bacterial meningitis in immunocompetent children. We report a case of L. monocytogenes meningitis associated with rotavirus gastroenteritis. The patient was a previously healthy 20-month-old girl who was admitted because of sustained fever and lethargy after suffering from gastroenteritis for 6 days. The patient's peripheral white blood cell count was 18,600/µL and the C-reactive protein level was 2.44 mg/dL. A stool sample tested positive for rotavirus antigen. A cerebrospinal fluid (CSF) sample showed pleocytosis. Cultures of the CSF and stool samples revealed the presence of L. monocytogenes. The patient was successfully treated with ampicillin and gentamicin. We speculate that translocation of enteric flora across the intestinal epithelium that had been damaged by rotavirus gastroenteritis might have caused bacteremia that disseminated into the CSF. Both listeriosis and secondary systemic infection after rotavirus gastroenteritis are rare but not unknown. Initiation of appropriate treatment as soon as possible is important for all types of bacterial meningitis. This rare but serious complication should be taken into consideration even if the patient does not have any medical history of immune-related problems. Topics: Acyclovir; Anti-Bacterial Agents; Antiviral Agents; Ceftriaxone; Drug Therapy, Combination; Female; Fever; Humans; Immunocompetence; Infant; Meningitis, Listeria; Rotavirus Infections; Treatment Outcome; Vancomycin | 2017 |
Zoster vaccine-associated primary varicella infection in an immunocompetent host.
A 64-year-old immunocompetent man developed a widespread pruritic and vesicular rash 2 weeks after receiving the zoster vaccine (Zostavax). He had fever, bandaemia with normal total white blood cell count and mild transaminitis. PCR testing of serum and skin was positive for varicella zoster virus (VZV), while serum VZV IgG was negative. The analysis of single nucleotide polymorphism by PCR and sequencing from the skin swab was consistent with the vaccine strain. The patient received 1 week of intravenous acyclovir and was discharged after all lesions had crusted. He continues to do well on follow-up with no significant complications. Topics: Acyclovir; Antiviral Agents; Diagnosis, Differential; Fever; Herpes Zoster Vaccine; Humans; Immunocompetence; Infusions, Intravenous; Male; Middle Aged; Varicella Zoster Virus Infection | 2017 |
Painful loss of vision after an episode of herpes simplex encephalitis.
Topics: Acyclovir; Aged; Anti-Inflammatory Agents; Antiviral Agents; Confusion; Encephalitis, Herpes Simplex; Fever; Humans; Magnetic Resonance Imaging; Male; Nausea; Prednisolone; Retinal Detachment; Spinal Puncture; Treatment Outcome; Vitrectomy | 2017 |
Chickenpox: an ageless disease.
A 97-year-old woman presented with 4-day history of vesicular rash, initially at the feet but then spread up to the thighs bilaterally, abdomen and trunk. The initial differentials included bullous pemphigus and cellulitis by the emergency department. She was then managed as bullous pemphigus by the acute medical team and started on high-dose steroids, with no other differentials considered. When her care was taken over by the general medical team, varicella zoster virus (VZV) infection was suspected. After confirmation by the dermatology team regarding the clinical diagnosis and the positive VZV DNA swabs, she was started on acyclovir. Topics: Acyclovir; Administration, Intravenous; Aged, 80 and over; Antiviral Agents; Chickenpox; Diagnosis, Differential; Exanthema; Fatal Outcome; Female; Fever; Heart Failure; Herpesvirus 3, Human; Humans | 2017 |
Transmission of chromosomally integrated human herpesvirus 6 via cord blood transplantation.
Chromosomally integrated human herpesvirus 6 (ciHHV-6) can be transmitted via allogeneic hematopoietic cell transplantation. To date, only a few cases have been reported. Here, we report a case identified as transmission of ciHHV-6 via cord blood transplantation. Distinguishing transmission of ciHHV-6 from HHV-6 reactivation in cases with high titer of HHV-6 DNA load after transplantation is important to prevent unnecessary exposure to antiviral drugs that could be toxic. Topics: Acyclovir; Antibiotic Prophylaxis; Antiviral Agents; Busulfan; Child, Preschool; Chromosomes, Human, Pair 22; Cord Blood Stem Cell Transplantation; DNA, Viral; Exanthema; Fetal Blood; Fever; Herpesvirus 6, Human; Humans; Immunocompromised Host; Male; Melphalan; Myeloablative Agonists; Roseolovirus Infections; Transplantation Conditioning; Unrelated Donors; Valacyclovir; Valine; Viral Load; Virus Integration | 2017 |
Herpes Simplex Encephalitis Complicated by Cerebral Hemorrhage during Acyclovir Therapy.
Herpes simplex encephalitis (HSE) can be complicated by adverse events in the acute phase. We herein present the case of a 71-year-old woman with HSE complicated by cerebral hemorrhage. She presented with acute deterioration of consciousness and fever and was diagnosed with HSE based on the detection of herpes simplex virus-1 in the cerebrospinal fluid by a polymerase chain reaction. The cerebral hemorrhage developed during acyclovir therapy; however, its diagnosis was delayed for 2 days. After the conservative treatment of the cerebral hemorrhage, the patient made a near-complete recovery. Cerebral hemorrhage should be considered as an acute-phase complication of HSE. Topics: Acyclovir; Aged; Antiviral Agents; Cerebral Hemorrhage; Diagnosis, Differential; Encephalitis, Herpes Simplex; Female; Fever; Herpesvirus 1, Human; Humans; Magnetic Resonance Imaging; Tomography, X-Ray Computed | 2017 |
Thirteen-Year-Old Male Presenting With Fever, Cough, Weakness, and Somnolence.
Topics: Acyclovir; Adolescent; Anti-Bacterial Agents; Antiviral Agents; Ceftriaxone; Cough; Diagnosis, Differential; Disorders of Excessive Somnolence; Encephalomyelitis, Acute Disseminated; Fever; Humans; Male; Muscle Weakness | 2016 |
Seizure and Fever.
Topics: Acyclovir; Adrenal Cortex Hormones; Anti-Bacterial Agents; Antiviral Agents; Brain Neoplasms; Ceftriaxone; Dexamethasone; Diagnosis, Differential; Electroencephalography; Emergency Service, Hospital; Encephalitis, Herpes Simplex; Fever; Humans; Hypnotics and Sedatives; Infarction; Levetiracetam; Male; Massachusetts; Middle Aged; Phenytoin; Piracetam; Propofol; Status Epilepticus; Temporal Lobe; Tomography, X-Ray Computed; Unconsciousness; Vancomycin | 2016 |
Fever with seizure and confusion.
Topics: Acyclovir; Adult; Anticonvulsants; Antiviral Agents; Brain; Brain Edema; Confusion; Diuretics, Osmotic; DNA, Viral; Encephalitis, Herpes Simplex; Fever; Herpesvirus 1, Human; Humans; Male; Mannitol; Polymerase Chain Reaction; Seizures; Temporal Lobe; Tomography, X-Ray Computed | 2016 |
Case 3: Rash, Fever, Headache, and Neck Pain and Stiffness in a 15-year-old Boy.
Topics: Acyclovir; Adolescent; Diagnosis, Differential; Emergency Service, Hospital; Encephalitis, Varicella Zoster; Exanthema; Fever; Headache; Herpesvirus 3, Human; Humans; Infusions, Intravenous; Male; Neck Pain; Risk Assessment; Severity of Illness Index; Treatment Outcome | 2016 |
Quiz page April 2015: fever and encephalopathy in a kidney transplant recipient.
Topics: Acyclovir; Adult; Antiviral Agents; Brain Diseases; Central Nervous System Diseases; Cerebral Arterial Diseases; Chickenpox; Fatal Outcome; Fever; Glomerulonephritis; Herpesvirus 3, Human; Humans; Kidney Transplantation; Magnetic Resonance Imaging; Male | 2015 |
[Etiology, clinical presentation and outcome of severe viral acute childhood encephalitis (ECOVE study)].
Viral encephalitis are rare and potentially serious conditions with different etiologist, and not always identifiable. Our aim is to describe the etiological, clinical presentation and neurological outcome of viral encephalitis admitted in Paediatrics Intensive Care Units (PICUs) in Spain.. Observational prospective multicenter study. Children with viral encephalitis admitted to 14 PICUs, for a period of 3 years (2010-2013) were included. Polymerase chain reaction for the etiological diagnosis and neurotropic virus serology in blood and cerebrospinal fluid were used. Personal history, clinical presentation, evolution and neurological status at discharge were recorded.. 80 patients were included with a mean age of 5 years, 70% male. The most relevant clinical symptoms were decreased consciousness (86%), fever (82.4%), seizures (67%), vomiting (42%), headache (27%), agitation (25%) and dis-orientation (23%). The etiologic diagnosis was established in 35%, being more frequent herpes simplex virus and enterovirus. The outcome was discharge without sequelae in 55 patients (69%), mild to moderate sequelae in 19 (23.5%) and severe in 6 (7.5%). Two patients died.. In the Spanish PICU etiological diagnosis was established only in a third of cases of children with suspected acute viral encephalitis. Despite the clinical severity we observed a low mortality and morbidity rate. At discharge from the PICU, most children had no neurological sequelae or were mild.. Etiologia, presentacion clinica y evolucion neurologica de las encefalitis viricas graves en la edad pediatrica (estudio ECOVE).. Introduccion. Las encefalitis viricas son procesos raros y potencialmente graves, con etiologia diversa y no siempre identificable. El objetivo es describir las caracteristicas etiologicas, la presentacion clinica y la evolucion neurologica de las encefalitis viricas que ingresaron en las unidades de cuidados intensivos pediatricos (UCIP) en España. Pacientes y metodos. Estudio prospectivo multicentrico observacional. Se incluyeron los niños ingresados en 14 UCIP con diagnostico de encefalitis virica durante un periodo de tres años (2010-2013). Para el diagnostico etiologico se utilizo reaccion en cadena de la polimerasa y serologia a virus neurotropos en la sangre y el liquido cefalorraquideo. Se registraron los antecedentes personales, la presentacion clinica, la evolucion y la situacion neurologica en el momento del alta. Resultados. Se incluyeron 80 pacientes con edad media de 5 años; el 70%, varones. Los sintomas clinicos mas relevantes fueron disminucion de conciencia (86%), fiebre (82,4%), convulsiones (67%), vomitos (42%), cefalea (27%), agitacion (25%) y desorientacion (23%). Se llego al diagnostico etiologico en un 35%, y los mas frecuentes fueron virus herpes simple y enterovirus. La evolucion fue curacion sin secuelas en 55 pacientes (69%, sobre todo enterovirus, rotavirus y virus respiratorios), secuelas leves-moderadas en 19 (23,5%) y graves en seis (7,5%). Dos pacientes fallecieron. Conclusiones. En las UCIP españolas solo se realizo el diagnostico etiologico en un tercio de los niños con sospecha de encefalitis virica grave. A pesar de la gravedad clinica, hemos observado una tasa de mortalidad y morbilidad baja. La amplia mayoria son dados de alta de la UCIP con ninguna o escasa secuela neurologica. Topics: Acute Disease; Acyclovir; Adolescent; Antiviral Agents; Brain Damage, Chronic; Child; Child, Preschool; Clarithromycin; Consciousness Disorders; Encephalitis, Viral; Female; Fever; Headache; Humans; Infant; Male; Prospective Studies; Seasons; Seizures; Serologic Tests; Spain; Treatment Outcome; Vomiting | 2015 |
Pediatric Herpes Simplex Virus Encephalitis Complicated by N-Methyl-D-aspartate Receptor Antibody Encephalitis.
N-methyl-D-aspartate receptor antibodies (NMDAR-Abs) can contribute to neurological relapse after herpes simplex virus encephalitis (HSE). We describe a child with NMDAR-Ab encephalitis after HSE, which was recognized and treated early. We discuss the case in the context of existing reports, and we propose a modified immunotherapy strategy to minimize risk of viral reactivation. Topics: Acyclovir; Anti-N-Methyl-D-Aspartate Receptor Encephalitis; Antiviral Agents; Autoantibodies; Clonidine; Diazepam; Encephalitis, Herpes Simplex; Encephalomalacia; Female; Fever; Humans; Immunocompromised Host; Immunosuppression Therapy; Infant; Leukoencephalopathies; Movement Disorders; Neurological Rehabilitation; Pakistan; Paresis; Phenobarbital; Phenytoin; Plasmapheresis; Receptors, N-Methyl-D-Aspartate; Seizures; Trihexyphenidyl; United Kingdom; Valproic Acid | 2015 |
An unusual presentation of herpes simplex encephalitis with negative PCR.
A 74-year-old man presented with acute right-sided hemiparesis and epilepsia partialis continua in association with fever and confusion. Initial workup revealed possible cerebritis in the left medial frontal lobe without involvement of the temporal lobes. Cerebrospinal fluid (CSF) analysis revealed minimal lymphocytic pleocytosis but negative real-time herpes simplex virus (HSV) PCR. Acyclovir was discontinued on day 5 due to a negative infectious workup and clinical improvement. On day 9 his condition deteriorated and he was transferred to a higher level of acuity for advanced supportive care. Worsening encephalopathy and refractory status epilepticus ensued despite medical care. Repeat CSF analysis showed mild lymphocytic pleocytosis with negative real-time HSV PCR. Brain MRI revealed progression of cortical enhancement. Immunosuppressive therapy and plasma exchange were attempted without clinical response. On day 24, another lumbar puncture showed only mild lymphocytic pleocytosis. Brain MRI showed involvement of the right medial temporal lobe. Subsequently, acyclovir was resumed. The HSV-1 PCR result was positive on day 30. Unfortunately, the patient expired. Topics: Acyclovir; Aged; Antiviral Agents; Brain; Confusion; DNA, Viral; Encephalitis; Encephalitis, Herpes Simplex; Epilepsia Partialis Continua; False Negative Reactions; Fatal Outcome; Fever; Herpesvirus 1, Human; Humans; Leukocytosis; Magnetic Resonance Imaging; Male; Real-Time Polymerase Chain Reaction | 2015 |
Varicella Zoster Virus Meningoencephalitis Presenting with Elsberg Syndrome without a Rash in an Immunocompetent Patient.
Varicella zoster virus (VZV) infection usually manifests with a skin rash. To the best of our knowledge, this is the first report of a case of VZV meningoencephalitis presenting with Elsberg syndrome without a rash in an immunocompetent patient. Clinicians should consider the potential for VZV infection as well as herpes simplex virus infection in cases of aseptic meningitis accompanied by bladder and rectal disturbances, even in patients without any rash symptoms. Topics: Acyclovir; Antiviral Agents; DNA, Viral; Encephalitis, Varicella Zoster; Fever; Herpes Zoster; Herpesvirus 3, Human; Humans; Male; Meningoencephalitis; Middle Aged; Skin; Treatment Outcome | 2015 |
[Varicella-zoster virus infection of the central nervous system].
Topics: Acyclovir; Adolescent; Adult; Aged; Aged, 80 and over; Antiviral Agents; Encephalitis, Varicella Zoster; Female; Fever; Herpes Zoster; Humans; Male; Middle Aged; Spain; Valacyclovir; Valine; Young Adult | 2014 |
Clinical and laboratory characteristics of central nervous system herpes simplex virus infection in neonates and young infants.
We reviewed the characteristics of infants <3 months of age with central nervous system herpes simplex virus infection at our institution. Twenty-six cases were identified. The age range was 4-73 days. Most infants presented with fever, seizure activity and skin lesions. The blood herpes simplex virus polymerase chain reaction was positive in 91% of patients tested. Suppressive oral acyclovir therapy was likely helpful in preventing disease recurrence. Topics: Acyclovir; Antiviral Agents; Cerebrospinal Fluid; Fever; Herpes Simplex; Humans; Infant; Infant, Newborn; Magnetic Resonance Imaging; Meningoencephalitis; Retrospective Studies; Seizures; Skin Diseases, Viral | 2014 |
Clinical problem-solving. A creeping suspicion.
Topics: Acyclovir; Antiviral Agents; Aphasia; Cerebrospinal Fluid; Colonic Neoplasms; Diagnosis, Differential; Encephalitis, Herpes Simplex; Female; Fever; Humans; Magnetic Resonance Imaging; Middle Aged; Polymerase Chain Reaction; Simplexvirus; Spinal Puncture; Temporal Lobe | 2014 |
Fever and acute cytomegalovirus hepatitis in Crohn's disease.
Topics: Acyclovir; Adult; Antiviral Agents; Crohn Disease; Cytomegalovirus Infections; Fever; Humans; Ilium; Male; Valacyclovir; Valine | 2014 |
Relapse of immune thrombocytopenia associated with varicella 20 years after splenectomy.
A 45-year-old man who had undergone splenectomy 20 years earlier for immune thrombocytopenia (ITP) presented with a fever, arthralgia and vesicular skin rash. The skin rash was typical for varicella, as confirmed on serological studies. He exhibited isolated thrombocytopenia and was diagnosed with ITP. In addition, an accessory spleen was detected. The platelet count responded to treatment with prednisolone (PSL), and the varicella subsided uneventfully following therapy with acyclovir. Furthermore, the platelet count was maintained after PSL was discontinued. This case suggests an etiological link between varicella and very late relapse of ITP after initial splenectomy. Topics: Acyclovir; Antiviral Agents; Arthralgia; Chickenpox; Chronic Disease; Fever; Humans; Male; Middle Aged; Platelet Count; Prednisolone; Purpura, Thrombocytopenic, Idiopathic; Recurrence; Splenectomy; Time Factors; Treatment Outcome | 2014 |
Current practice patterns regarding diagnostic investigations and empiric use of acyclovir by Canadian pediatric emergency physicians in febrile neonates.
The aim of this study was to assess current attitudes and approaches to the febrile neonate in terms of diagnostic investigations and empiric treatment of suspected herpes simplex virus (HSV) infection.. Between March 2010 and November 2010, a survey describing a hypothetical case of a febrile neonate presenting to the ED without clear signs of an HSV infection was sent to tertiary care pediatric emergency physicians across Canada. Participants were asked multiple choice and open-ended questions to obtain information about their choice of investigations, empiric treatment, and impression of the likelihood of HSV in the case. Survey data were analyzed using univariate statistics.. Blood culture (98.6%), complete blood count (99.3%), lumbar puncture (81.2%), and nasopharyngeal swabs for respiratory viruses (61.6%) were most commonly performed by the 139 respondents, whereas 33% reported they would send cerebrospinal fluid for HSV polymerase chain reaction. Most (76%) would administer empiric antibiotics, whereas 5.8% included acyclovir to their treatment regimen. Greater than 50% included positive maternal history as an important factor in determining a febrile neonate's risk of HSV infection. Thirty-four percent reported that the wellness of the child, the presence of skin changes (37%), and the presence of any worrisome neurologic sign or symptom (37%) would influence their decision for investigations and empiric administration of acyclovir.. Canadian pediatric emergency physicians are aware of risk factors for neonatal HSV infection and tailor their history and diagnostic investigations toward the diagnosis of HSV infection, but very few empirically administer acyclovir. Examination of future Canadian HSV guidelines for this patient population is warranted. Topics: Acyclovir; Antiviral Agents; Canada; Diagnosis, Differential; Emergency Medicine; Female; Fever; Herpes Simplex; Humans; Infant, Newborn; Male; Practice Patterns, Physicians'; Pregnancy Complications, Infectious; Prospective Studies; Risk Factors; Surveys and Questionnaires | 2013 |
Febrile illness in pregnancy: disseminated herpes simplex virus.
Topics: Acyclovir; Antiviral Agents; Female; Fever; Herpes Simplex; Humans; Pregnancy; Pregnancy Complications, Infectious; Simplexvirus; Viremia | 2013 |
Herpes simplex encephalitis presenting with normal CSF analysis.
A 28 years old female presented with headache, fever, altered sensorium and right side weakness for one week. She was febrile and drowsy with right sided hemiplegia and papilledema. Tuberculous or bacterial meningitis, tuberculoma and abscess were at the top of the diagnosis list followed by Herpes simplex meningo-encephalitis (HSE). MRI showed abnormal signal intensity of left temporal lobe without significant post-contrast enhancement and midline shift. CSF examination was normal, gram stain and Ziehl-Neelsen stain showed no micro-organism, or acid fast bacilli. CSF for MTB PCR was negative. PCR DNA for Herpes simplex 1 on CSF was detected. Acyclovir was started and the patient was discharged after full recovery. A high index of suspicion is required for HSE diagnosis in Pakistan where other infections predominantly affect the brain and HSE may be overlooked as a potential diagnosis. Topics: Acyclovir; Adult; Antiviral Agents; Cerebrospinal Fluid; DNA, Viral; Encephalitis, Herpes Simplex; Female; Fever; Herpesvirus 1, Human; Humans; Magnetic Resonance Imaging; Paresis; Polymerase Chain Reaction; Treatment Outcome | 2013 |
41-year-old woman with fever, neutropenia, and elevated transaminase levels.
Topics: Acyclovir; Adult; Antiviral Agents; Biopsy; Diagnosis, Differential; Female; Fever; Hepatitis, Viral, Human; Herpes Simplex; Humans; Immunocompromised Host; Infusions, Intravenous; Neutropenia; Recurrence; Risk; Transaminases | 2013 |
Fever and psychosis as an early presentation of Brucella-associated meningoencephalitis: a case report.
To describe a case with Brucella-associated meningoencephalitis. In addition, we report drug-induced hepatotoxicity due to acyclovir.. A young woman was admitted with fever and psychosis and neuroimaging findings indicative of meningoencephalitis. Serology was positive for Brucella. She was treated with doxycycline, rifampin, and trimethoprim-sulfamethoxazole.. This case reminds physicians in endemic regions to consider neurobrucellosis as a differential diagnosis in patients with any unexplained neurologic symptoms or atypical psychosis. Early diagnosis and treatment of neurobrucellosis will be helpful in decreasing the sequelae of this complication. Topics: Acyclovir; Adult; Anti-Bacterial Agents; Brain; Brucella; Chemical and Drug Induced Liver Injury; Drug Therapy, Combination; Female; Fever; Humans; Meningoencephalitis; Organic Chemicals; Psychotic Disorders | 2013 |
Acyclovir reduces the duration of fever in patients with infectious mononucleosis-like illness.
Acyclovir is known for its antiviral activity against some pathogenic viruses such as the Epstein-Barr virus (EBV) that causes infectious mononucleosis (IM) and IM-like illness. Therefore, we empirically administered acyclovir to patients with suspected EBV-IM and IM like-illness, upon their admission to our hospital. We admitted 25 patients, who were hospitalized for fever and lymphadenopathy, to the Tohoku University Hospital Infectious Disease Ward. As part of treatment, 8 of these patients were given acyclovir (750 mg/day) with their consent and were assigned to the acyclovir group; the remaining 17 patients were assigned to the control group. The mean age of acyclovir patients (all men) was 42±5.2 years, and that of control patients (13 men and 4 women) was 31±3.0 years. The cause of illness was confirmed as EBV-IM in 6 patients (1, acyclovir; 5, control), and remained unknown for the other 19 IM-like illness patients (7, acyclovir; 12, control). A shorter duration of hospitalization and fever was observed in the acyclovir compared to that in the control patients (hospitalization duration: 16±3.7 vs. 27±7.7 days, P=0.36; fever duration: 4.5±1.8 vs. 18±6.5 days, P=0.04). Additionally, serum amyloid A (SAA) levels were lower in acyclovir than that in control patients (98±37 vs. 505±204 µg/mL, P=0.02). Therefore, we propose that acyclovir is a potential therapeutic agent for both EBV-IM and IM like-illnesses. Future studies should further examine its mechanism of action. Topics: Acyclovir; Adult; Antiviral Agents; Case-Control Studies; Cohort Studies; Female; Fever; Humans; Infectious Mononucleosis; Length of Stay; Male; Middle Aged; Retrospective Studies; Time Factors | 2013 |
Herpesviridae viral infections after chemotherapy without antiviral prophylaxis in patients with malignant lymphoma: incidence and risk factors.
The herpesviridae family includes, among others, herpes simplex virus, varicella zoster virus, Epstein-Barr virus, and cytomegalovirus. Herpesviridae viral infections (HVIs) can lead to serious complications in lymphoma patients undergoing chemotherapy. There is no consensus on the dose and duration of antiviral prophylaxis in these patients. We retrospectively analyzed the incidence and risk factors for HVI in lymphoma patients undergoing chemotherapy.. We reviewed the records of 266 patients who were newly diagnosed with lymphoma and received chemotherapy without acyclovir prophylaxis between June 1996 and August 2009.. The cumulative incidence rate of HVI was 20.16% for 5 years from the start of chemotherapy. Independent predictive factors for HVI in lymphoma patients were: female sex [hazard ratio (HR) 2.394; 95% confidence interval (CI): 1.245-4.607; P=0.009], cumulative dose of steroids per body surface area of at least 2500 mg/m(2) (HR 7.717; 95% CI: 3.814-18.703; P<0.001), and history of neutropenic fever (HR 0.297; 95% CI: 0.150-0.588; P<0.001).. Female sex, high dose of steroids per body surface area, and neutropenic fever were risk factors for HVI in patients with lymphoma undergoing chemotherapy without acyclovir prophylaxis. Topics: Acyclovir; Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Antiviral Agents; Female; Fever; Herpesviridae Infections; Humans; Incidence; Lymphoma; Male; Medical Records; Middle Aged; Neutropenia; Odds Ratio; Primary Prevention; Retrospective Studies; Risk Factors; Sex Factors | 2012 |
Herpetic gingivostomatitis with severe hepatitis in a previously healthy child.
A previously healthy boy aged 9 years and 11 months was admitted due to herpetic gingivostomatitis with poor intake. He also had fever, neutropenia, and elevated serum aminotransferase level (> 1000 IU/mL). Prolonged prothrombin time, mild gastrointestinal hemorrhage and transient decreased conscious level were noted during hospital days 2 and 3. Intravenous acyclovir therapy commenced on hospital day 2 and his serum aminotransferase level peaked (> 4000 IU/mL) on hospital day 3 and then improved gradually. A throat swab was positive for human herpes simplex virus (HSV)-1, serological test was positive for acute primary HSV-1 infection, and a blood specimen was also strongly positive for HSV-1 by polymerase chain reaction. He received a 14-day course of intravenous acyclovir and recovered uneventfully. Herpetic gingivostomatitis, although mostly benign and self-limited, may be complicated with severe hepatitis, even in immunocompetent hosts. Topics: Acyclovir; Administration, Intravenous; Antiviral Agents; Child; Fever; Hepatitis; Herpesvirus 1, Human; Humans; Male; Neutropenia; Serologic Tests; Specimen Handling; Stomatitis, Herpetic; Transaminases; Treatment Outcome | 2012 |
A 12-day-old male newborn with extensive vesicles and fever.
Neonatal varicella infection is a rare condition since vaccine introduction. The authors report the case of a 12-day-old male who presented with a fever and generalised vesicular eruption. The patient's mother had varicella infection 1 day before delivery without treatment. The neonate initially did not receive prophylaxis or treatment. He subsequently was started on intravenous acyclovir and recovered without further complications or sequelae. Prompt diagnosis and treatment for maternal prenatal varicella infection is necessary to prevent infection in the newborn, and healthcare provider awareness to avoid nosocomial transmission. Topics: Acyclovir; Adolescent; Antiviral Agents; Chickenpox; Female; Fever; Humans; Infant, Newborn; Infant, Newborn, Diseases; Infectious Disease Transmission, Vertical; Male; Pregnancy; Pregnancy Complications, Infectious | 2012 |
Postpartum herpes simplex virus endometritis and disseminated infection in both mother and neonate.
Herpes simplex virus (HSV) is an unusual cause of postpartum endometritis. We describe a rare case of primary disseminated maternal HSV in the postpartum period associated with endometritis.. A previously healthy patient developed fundal tenderness and postpartum fevers after an uncomplicated vaginal delivery. Despite traditional broad-spectrum antimicrobial therapy, she had persistent fevers and systemic symptoms. Concurrently, her neonate developed fevers and a nonvesicular rash, with viral cultures ultimately returning positive for HSV. The patient developed active pharyngeal and genital herpetic lesions and was diagnosed with HSV endometritis and disseminated HSV. Symptoms and fevers in both the mother and neonate responded to antiviral therapy.. Herpes simplex virus endometritis should be included in the differential diagnosis for postpartum fevers and fundal tenderness that are unresponsive to broad-spectrum antimicrobial treatment. Topics: Acyclovir; Adult; Antiviral Agents; Endometritis; Exanthema; Female; Fever; Herpes Simplex; Herpesvirus 2, Human; Humans; Infant, Newborn; Infectious Disease Transmission, Vertical; Male; Postpartum Period; Pregnancy; Pregnancy Complications, Infectious; Tomography, X-Ray Computed | 2012 |
Isolated reversible splenial lesion in tick-borne encephalitis: a case report and literature review.
Here, we demonstrate a first case of tick-borne encephalitis (TBE) associated with an isolated reversible splenial corpus callosum lesion (IRSL) and highlight the wide range of different clinical entities in which such alterations have been observed. A 42-year-old man showed fever, cephalgia and mild disturbance of coordination and gait. Diagnosis was ascertained by slight CSF-pleiocytosis and positive TBE-IgG as well as by positive intrathekal specific antibody index on follow-up. MRI demonstrated a single ovoid hyperintensity in T2 and DWI with reduction in ADC in the splenium of corpus callosum which was abrogated in follow-up after 6 weeks. Most entities of IRSL presented with excellent prognosis, including our novel case of TBE. We discuss different possible pathomechanisms and the so far unexplained propensity of the splenium for such alterations. Clinicians should be familiar with this phenomenon to avoid unnecessary diagnostic or therapeutic efforts. Topics: Acyclovir; Adult; Anti-Bacterial Agents; Antiviral Agents; Ataxia; Ceftriaxone; Corpus Callosum; Diffusion Magnetic Resonance Imaging; Encephalitis, Tick-Borne; Fever; Gait Disorders, Neurologic; Headache; Humans; Image Processing, Computer-Assisted; Immunoglobulin G; Magnetic Resonance Imaging; Male; Neck Pain | 2011 |
HSV-1 viremia as a potential cause of febrile neutropenia in an immunocompromised child.
Although the standard of care in febrile neutropenic patients includes the initiation of empirical antibacterial and antifungal therapy, many patients do not respond and need further diagnostic work up and treatment. Here, we report on an immunosuppressed neutropenic patient with a prolonged episode of fever unresponsive to empirical antibacterial therapy. Herpes polymerase chain reaction revealed systemic reactivation of herpes simplex virus type 1 (HSV-1) infection and treatment with acyclovir was associated with the prompt resolution of signs and symptoms of infection. Screening for HSV in persistently febrile neutropenic patients may discover HSV reactivation that can be treated successfully by acyclovir administration. Topics: Acyclovir; Child; Fever; Herpes Simplex; Herpesvirus 1, Human; Humans; Immunocompromised Host; Immunosuppressive Agents; Male; Neutropenia; Viremia; Virus Activation | 2010 |
Evaluation of orally administered valacyclovir in experimentally EHV1-infected ponies.
The purpose of the current study was to investigate the therapeutic efficacy of valacyclovir against EHV1 in a controlled study. Eight naïve Shetland ponies were inoculated with 10(6.5) TCID(50) of the neuropathogenic strain 03P37. Four ponies were treated with valacyclovir at a dosage of 40mg/kg bodyweight, 3 times daily, for 5 (n=2) or 7 (n=2) consecutive days, while the other four ponies served as untreated controls. The treatment regimen started 1h before inoculation. Ponies were monitored daily for clinical signs. At 0, 1, 2, 3, 4, 5, 7, 9, 11, 14, 17 and 21 days post inoculation (d pi), a nasopharyngeal mucus sample was taken to determine viral shedding. At the same time points, blood was collected and peripheral blood mononuclear cells (PBMC) were isolated to determine viremia. During the treatment, blood samples were collected 6 times daily, i.e. just before valacyclovir administration and 1h later, to determine the concentration of acyclovir in plasma. Also a nasopharyngeal swab was taken to measure the acyclovir concentration in nasal secretion. No differences could be noticed between valacyclovir-treated and untreated ponies. The clinical signs, the viral shedding and the viremia were similar in both the groups. Plasma acyclovir concentration could be maintained above the EC(50)-value of EHV1 during 50% of the entire treatment period in valacyclovir-treated ponies. Acyclovir could be detected in nasal swabs at concentrations varying from 50% to 100% of the corresponding plasma concentration. Although sufficiently high acyclovir levels could be reached in plasma and nasal mucus, no effect was seen of the treatment with valacyclovir on clinical signs, viral shedding and viremia of EHV1-infected ponies. Topics: Acyclovir; Animals; Antiviral Agents; Body Temperature; Dose-Response Relationship, Drug; Fever; Herpesviridae Infections; Herpesvirus 1, Equid; Horse Diseases; Horses; Valacyclovir; Valine; Virus Shedding | 2009 |
Fever, rash, and crusting ulcers.
Topics: Acyclovir; Adolescent; Anti-Inflammatory Agents; Antiviral Agents; Biopsy; Diagnosis, Differential; Exanthema; Fatal Outcome; Fever; Humans; India; Lymphadenitis; Lymphomatoid Papulosis; Male; Neck; Pityriasis Lichenoides; Skin Ulcer | 2009 |
Characteristics of hemophagocytic lymphohistiocytosis in neonates: a nationwide survey in Japan.
To assess the etiology, prognosis, and appropriate treatment of hemophagocytic lymphohistiocytosis (HLH) in neonates.. We collected information on neonates in whom HLH was diagnosed between 1997 and 2007 from participating members of the Japanese Society of Pediatric Hematology.. HLH was diagnosed in 20 patients within 4 weeks after birth. Of the diagnostic criteria for HLH-2004, the incidence of fever was quite low in preterm infants, and hypertriglyceridemia and neutropenia were uncommon. Familial HLH (n = 6) or severe combined immunodeficiency-associated HLH (n = 1) was diagnosed in 7 patients, and 2 of them have survived. Herpes simplex virus-associated HLH was diagnosed in 6 patients, and 2 of them have survived. The overall survival rate for the 20 patients was 40%.. HLH is rare in neonates and has a poor prognosis. Early diagnosis and immediate treatment are required when considering the possibility of herpes simplex virus-associated or familial HLH. Topics: Acyclovir; Adrenal Cortex Hormones; Antineoplastic Agents, Phytogenic; Antiviral Agents; beta 2-Microglobulin; Consciousness Disorders; Cyclosporine; Erythema; Etoposide; Exanthema; Female; Fetal Distress; Fever; gamma-Globulins; Hematopoietic Stem Cell Transplantation; Herpes Simplex; Humans; Immunologic Factors; Immunosuppressive Agents; Infant, Newborn; Infant, Premature; Japan; L-Lactate Dehydrogenase; Leukocytosis; Lymphohistiocytosis, Hemophagocytic; Male; Ocular Motility Disorders; Plasma Exchange; Prognosis; Respiratory Distress Syndrome, Newborn; Seizures; Severe Combined Immunodeficiency | 2009 |
Reactivation and centripetal spread of herpes simplex virus complicating acoustic neuroma resection.
Herpes simplex is a common human pathogen that has rare but severe manifestations including encephalitis.. A 44-year-old man underwent uneventful resection of an acoustic neuroma. Postoperatively, he developed swinging pyrexia, vomiting, and episodic confusion. Analysis of cerebrospinal fluid showed a lymphocytosis, and polymerase chain reaction revealed herpes simplex DNA. After treatment of herpes encephalitis with acyclovir, the patient made a good recovery.. Herpes encephalitis is a rare complication of neurosurgical procedures, and the most likely etiology is reactivation of latent infection from manipulation of cranial nerves. Topics: Acyclovir; Adult; Antiviral Agents; Consciousness Disorders; DNA, Viral; Encephalitis, Herpes Simplex; Facial Nerve; Facial Nerve Diseases; Fever; Humans; Magnetic Resonance Imaging; Male; Neuroma, Acoustic; Neurosurgical Procedures; Recurrence; Simplexvirus; Tomography, X-Ray Computed; Vestibulocochlear Nerve; Vomiting | 2009 |
Cost-effectiveness analysis of herpes simplex virus testing and treatment strategies in febrile neonates.
To determine the clinical effectiveness and cost-effectiveness of testing for and empirically treating herpes simplex virus (HSV) infection in neonates with fever aged from birth to 28 days.. Cost-effectiveness analysis.. Decision model.. Neonates with fever with no other symptoms and neonates with fever with cerebrospinal fluid (CSF) pleocytosis.. Four clinical strategies: (1) HSV testing and empirical treatment while awaiting test results; (2) HSV testing and treatment if test results were positive for HSV or the patient had symptoms of HSV; (3) treatment alone without testing; or (4) no HSV testing or treatment unless the patient exhibited symptoms. The 2 HSV testing methods used were CSF HSV polymerase chain reaction (PCR) and comprehensive evaluation with blood HSV PCR, CSF HSV PCR, and multiple viral cultures.. Twelve-month survival and quality-adjusted life expectancy with a cost-effectiveness threshold of $100,000 per quality-adjusted life year (QALY) gained.. Clinical strategy 1, when applied in febrile neonates with CSF pleocytosis, saved 17 lives per 10,000 neonates and was cost-effective using CSF HSV PCR testing ($55,652/QALY gained). The cost-effectiveness of applying clinical strategy 1 in all febrile neonates depended on the cost of the CSF HSV PCR, prevalence of disease, and parental preferences for neurodevelopmental outcomes. Clinical strategies using comprehensive HSV testing were not cost-effective in febrile neonates ($368,411/QALY gained) or febrile neonates with CSF pleocytosis ($110,190/QALY gained).. Testing with CSF HSV PCR and empirically treating with acyclovir sodium saves lives and is cost-effective in febrile neonates with CSF pleocytosis. It is not a cost-effective use of health care resources in all febrile neonates. Topics: Acyclovir; Antiviral Agents; Cost-Benefit Analysis; Decision Support Techniques; Disease Progression; Female; Fever; Herpes Simplex; Humans; Infant, Newborn; Leukocytosis; Male; Probability; Quality-Adjusted Life Years; Treatment Outcome | 2008 |
[Confusion and unexplained fever in an elderly man: a case report].
We report the story of a 81 year old man referred for confusion and unexplained hyperthermia. He had no meningeal sign. Routine emergency examinations (CT scanner and lumbar punction) were not contributory, but, later, PCR for herpes virus was highly positive and cerebral CT scan showed the temporal lobe necrosis typical of an herpes virus meningoencephalitis. This severe neurologic emergency is then shortly discussed. Topics: Acyclovir; Aged, 80 and over; Antiviral Agents; Confusion; DNA, Viral; Encephalitis, Herpes Simplex; Fever; Humans; Male; Polymerase Chain Reaction; Simplexvirus; Tomography, X-Ray Computed; Treatment Outcome | 2008 |
Salivary mediated autoinoculation of herpes simplex virus on the face in the absence of "cold sores," after trauma.
Topics: Accidents, Traffic; Acyclovir; Antiviral Agents; Facial Dermatoses; Facial Injuries; Female; Fever; Herpes Labialis; Humans; Middle Aged; Saliva; Simplexvirus | 2008 |
Outcome of herpes simplex encephalitis in children.
Herpes simplex encephalitis (HSE) can cause high mortality and morbidity in children. Since local data of HSE in children are rare, we performed a retrospective study to evaluate the prognostic factors and outcome of HSE in Taiwan.. Children were enrolled into this study if they were diagnosed as having encephalitis and also had positive polymerase chain reaction for herpes simplex virus (HSV) from cerebrospinal fluid, and/or positive immunoglobulin M or at least four-fold elevation of immunoglobulin G against HSV type 1 or type 2 from serum during the period from December 1, 1984 to January 31, 2003.. Forty patients were enrolled in this study. Twenty six patients (65%) had good outcome and 14 (35%) had poor outcome. No mortality or recurrence was found. Three-fifths of the patients were between 1 year and 6 years of age. Fever (75%) was the most common finding at admission, followed by seizures (63%), lethargy (60%), and altered consciousness (48%). Seizure and lethargy at the time of admission were more common in the poor outcome group (71% vs 58% and 64% vs 58%). Abnormal computed tomography/magnetic resonance imaging findings were found in 63% of patients in whom the examinations were performed. Abnormal electroencephalogram (EEG) findings were noted in 79% of tested patients. Acyclovir was used to treat 29 patients (73%). Abnormal neuroimaging or EEG findings were more prevalent in patients with poor outcome (75% vs 55% and 92% vs 71%), as well as delayed (>/=3 days) initiation of acyclovir therapy (92% vs 71%). There was no significant difference between the poor and good outcome groups in gender, age distribution, and clinical presentation.. As we cannot predict the outcome of patients with HSE in the early beginning of illness and delay of treatment may cause disaster, early diagnosis and prompt acyclovir initiation are important requirements for successful management. Topics: Acyclovir; Adolescent; Antiviral Agents; Child; Child, Preschool; Diagnosis, Differential; Encephalitis, Herpes Simplex; Female; Fever; Humans; Infant; Lethargy; Male; Retrospective Studies; Seizures; Taiwan; Treatment Outcome; Unconsciousness | 2007 |
[Infantile herpes zoster].
Herpes zoster occurs seldom in infants, especially in the absence of exposure to maternal varicella either intrauterine or postnatal. We report on a case in a 3-month-old infant admitted for herpes zoster in the sciatic nerve territory. No cutaneous eruption was found in the mother or in people who were in contact with the patient. This rare clinical situation is here reviewed, showing that the absence of antenatal or postnatal exposure to herpes viruses does not preclude the occurrence of herpes zoster infection in early infancy. Topics: Acyclovir; Antiviral Agents; C-Reactive Protein; Female; Fever; Herpes Zoster; Humans; Infant; Leukocytosis | 2007 |
Cytomegalovirus DNAemia and disease: incidence, natural history and management in settings other than allogeneic stem cell transplantation.
Despite increasing intensity and profound immunosuppression associated with newer therapies for hematologic malignancies, little information exists regarding cytomegalovirus (CMV) reactivation in settings other than allogeneic stem cell transplantation (SCT).. We reviewed the epidemiology of CMV disease in patients who were CMV polymerase chain reaction (PCR) positive during treatment for hematologic malignancies without allogeneic SCT from June 1999 to June 2004.. Thirty-six patients with CMV reactivation were identified. Of these, 92% were undergoing investigation for fever. Fifteen patients with CMV DNAemia were treated with ganciclovir without CMV disease developing. Notably, 20 patients with untreated CMV DNAemia did not develop CMV disease during a median follow-up of 3.5 (1-19) months. The highest rates of reactivation were observed with HyperCVAD (7.8%) and alemtuzumab (50%).. We recommend that screening for CMV DNAemia be instituted and pre-emptive therapy contemplated for asymptomatic CMV reactivation only in patients receiving alemtuzumab therapy, but not routinely for other patients outside the allogeneic SCT setting. Indeed for such patients, detection of isolated CMV DNAemia does not imply the need for immediate therapy and future studies are needed to validate PCR detection of CMV DNA and CMV DNA titers as predictors for CMV disease. Topics: Acyclovir; Adult; Aged; Alemtuzumab; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Antibodies, Monoclonal, Murine-Derived; Antibodies, Neoplasm; Antimetabolites, Antineoplastic; Antineoplastic Combined Chemotherapy Protocols; Antiviral Agents; Cohort Studies; Cyclophosphamide; Cytomegalovirus; Cytomegalovirus Infections; Dexamethasone; Diphtheria Toxin; DNA, Viral; Doxorubicin; Female; Fever; Follow-Up Studies; Ganciclovir; Hematologic Neoplasms; Humans; Interleukin-2; Male; Middle Aged; Peripheral Blood Stem Cell Transplantation; Polymerase Chain Reaction; Recombinant Fusion Proteins; Retrospective Studies; Rituximab; Transplantation, Autologous; Valacyclovir; Valine; Vidarabine; Vincristine; Viremia; Virus Activation | 2005 |
[Multiple actinomycosis brain abscesses].
Actinomycosis is a subacute or chronic bacterial infection, which can affect immunocompetent or immunodeficient subjects. It most often occurs in cervico-facial or thoracic-abdominal locations. Central nervous system infection is rare but of severe prognosis.. A 56 year-old woman with no history of immunodepression was admitted with unexplained fever, inappropriate behaviour, and spatial and temporal disorientation. The progressive worsening of the neurological signs let to coma and mechanical ventilation was required. Brain imaging showed multilocation cerebral abscesses. Stereotaxial biopsy permitted diagnosis of actinomycosis. Patient's outcome was favourable following appropriate dual antibiotherapy without surgical exeresis.. When lacking bacteriologic identification, diagnosis of cerebral actinomycosis is performed by pathologic findings. Dual antibiotherapy allows full recover, even in the case of multilocation cerebral abscesses. Topics: Actinomyces; Actinomycosis; Acyclovir; Amoxicillin; Biopsy; Brain Abscess; Chloramphenicol; Clindamycin; Coma; Diagnostic Errors; Drug Therapy, Combination; Encephalitis, Herpes Simplex; Female; Fever; Humans; Listeriosis; Magnetic Resonance Imaging; Meningoencephalitis; Middle Aged; Nocardia Infections; Remission Induction; Tuberculosis, Meningeal | 2004 |
Exacerbation of atopic dermatitis in the emergency department.
A 38-year-old man was admitted to the Emergency Department suffering from an exacerbation of atopic dermatitis, fever and a burning sensation in the eyes. He was first treated with systemic corticosteroids. A subsequent dermatological and ophthalmological examination established the diagnosis of Kaposi-Juliusberg disease or eczema herpeticum with bilateral herpetic keratitis. Eczema herpeticum is an uncommon herpes simplex virus infection that occurs in patients with atopic dermatitis. Because it is a possible life-threatening condition, this disease must be recognized by all emergency physicians. The association with herpetic keratitis is not frequent but is a major ophthalmological problem. Treatment consists of the administration of high-dose intravenous acyclovir and acyclovir ophthalmic ointment. Topics: Acyclovir; Adrenal Cortex Hormones; Adult; Antibodies, Viral; Dermatitis, Atopic; Emergencies; Emergency Medical Services; Fever; Humans; Kaposi Varicelliform Eruption; Keratitis, Herpetic; Male; Simplexvirus; Treatment Outcome | 2004 |
Photolocalized varicella.
Topics: Acyclovir; Antiviral Agents; Chickenpox; Child, Preschool; Female; Fever; Humans; Photosensitivity Disorders; Sunlight | 2004 |
[Hypertensive encephalopathy as revealing symptom of Takayasu's arteritis].
A 29-year-old patient presented with Takayasu's arteritis which was revealed by heart failure, epilepsy, right hemiparesis and fever. Transient abnormalities of MRI and CSF (raised protein and cell content) were initially observed. The hypothesis of a hypertensive encephalopathy is suggested. Topics: Acyclovir; Adult; Antimetabolites; Aortography; Cerebral Angiography; Electroencephalography; Female; Fever; Humans; Hypertensive Encephalopathy; Magnetic Resonance Imaging; Paresis; Reverse Transcriptase Polymerase Chain Reaction; Takayasu Arteritis | 2003 |
Pediatric lymphocytic interstitial pneumonitis in an HIV-negative child with pulmonary Epstein-Barr virus infection.
Lymphocytic interstitial pneumonitis (LIP) in children has been most commonly associated with human immunodeficiency virus (HIV) infection. Epstein-Barr virus (EBV) associated LIP without HIV infection has been reported only in adults. EBV associated LIP has been reported in children, but only with concurrent HIV infection. We report a case of EBV associated, HIV negative LIP in a child. Topics: Acyclovir; Antiviral Agents; Child; Epstein-Barr Virus Infections; Fever; Glucocorticoids; HIV Seronegativity; Humans; Lung; Lung Diseases, Interstitial; Lymphocyte Count; Male; Methylprednisolone; Reed-Sternberg Cells; Treatment Outcome | 2003 |
[Encephalitis as the first manifestation of herpes zoster].
Topics: Acyclovir; Adolescent; Antiviral Agents; Diagnosis, Differential; Electroencephalography; Encephalitis, Varicella Zoster; Fever; Headache; Herpes Zoster; Humans; Male; Migraine Disorders; Photophobia; Vomiting | 2002 |
Postpartum herpes simplex endometritis. A case report.
Herpes simplex virus (HSV) can cause postpartum endometritis. The clinical diagnosis of HSV endometritis has been reported previously. The disease is responsive to acyclovir intravenously.. A 22-year-old woman, gravida 2, para 1, status post primary cesarean section for a double footling breech presentation, developed a persistent postpartum fever. Simulating the febrile course of septic pelvic thrombophlebitis, the patient's condition was unresponsive to broad-spectrum antimicrobials and heparin therapy. Active herpetic lesions and a positive cervical culture for herpes simplex prompted the use of intravenous acyclovir. Rapid resolution of the fever and the similarity to previous case reports suggested the clinical diagnosis of herpes simplex endometritis.. The diagnosis of postpartum herpes simplex endometritis should be considered when managing a persistent postpartum fever unresponsive to aggressive antimicrobial and heparin therapy. Immediate resolution of the fever should occur with the use of acyclovir. Topics: Acyclovir; Adult; Antiviral Agents; Breech Presentation; Cesarean Section; Diagnosis, Differential; Endometritis; Female; Fever; Herpes Simplex; Humans; Infusions, Intravenous; Postoperative Complications; Postpartum Period; Pregnancy | 2001 |
[Infection in patients with neutropenia that undergo an autologous peripheral blood stem cell transplant due to breast cancer].
The extent and duration of neutropenia and the characteristics of the underlying disease are determinant factors for the prognosis of febrile syndromes. Despite the fact that traditionally the peripheral blood stem cell transplantation (PBSCT) were considered to cause high risk neutropenia, in all probability the neutropenia observed in the PBSCT in some solid tumours could be considered moderate risk. Febrile episodes in patients with these characteristics were evaluated.. We prospectively analysed 132 autologus PBSCT in patients with breast cancer (1994-1999). Conditioning regime: STAMP V. Antibacterial prophylaxis: ofloxacin (400 mg/12 hrs PO). Classification of the febrile syndrome: bacteremia, microbiologically documented infection withut bacteremia, clinical infection and a fever of unknown origin.. 122 patients had a fever (92%), mean age: 45 years (range: 27-61). There were 32 (26%) bacteremias, 13 (11%) microbiologically documented infections without bacteremia and 54 (44%) clinical infections. The mean number of days with a neutrophil count of <1x109/1 was 14 (range: 11-20). In the 74 patients (61%) that had a granulocyte colony stimulating factor (G-CSF), the mean number of days to reach a 0,5x109/I neutrophil count (7,6) and the average number of days in hospital (26) were significantly less. There was a main infectious point in 80 patients (65%): the most frequent being oropharynx in 33 cases (46%) and digestive in 29 cases (41%). 48 gram negative (GN) 29 gram positive (GP) bacteria were isolated (71% of the GN's were resistant to ofloxacin). Between 1997-1999 the GN/GP ratio was 2,3. There were no deaths related to the infection.. Given the excellent evolution of our patients we can consider their neutropenia to be moderate or low risk, and they are a long way from the death rates caused by infections published by other types of hemopoietic transplants. The predominance of GN over the last few years and their limited sensitivity to quinolones means that their prophylactic use in these patients should be reconsidered. Topics: Acyclovir; Adult; Anti-Infective Agents; Antifungal Agents; Antineoplastic Combined Chemotherapy Protocols; Antiviral Agents; Bacteremia; Bacterial Infections; Breast Neoplasms; Carboplatin; Combined Modality Therapy; Cyclophosphamide; Drug Resistance; Female; Fever; Granulocyte Colony-Stimulating Factor; Hematopoietic Stem Cell Transplantation; Humans; Immunocompromised Host; Incidence; Infection Control; Middle Aged; Neutropenia; Ofloxacin; Premedication; Prospective Studies; Transplantation Conditioning; Trimethoprim, Sulfamethoxazole Drug Combination | 2001 |
Detection of cytomegalovirus infection in a patient with febrile ulceronecrotic Mucha-Habermann's disease.
Febrile ulceronecrotic Mucha-Habermann's disease (FUMHD) is a severe and very rare variant of pityriasis lichenoides et varilioformis acuta, which is characterized by large coalescing, and ulceronecrotic maculopapules or plaques. Morphological changes of the skin accompanied by persistent high fever and several constitutional symptoms have suggested virus infection in patients with FUMHD. However, the available information of viral origin is limited. In this study we investigated the relationship of cytomegalovirus (CMV), Epstein-Barr virus (EBV), human herpesvirus 8 (HHV8), type I human T-cell lymphotropic virus (HTLV-I), and parvovirus B19 (PVB19) with FUMHD in a Taiwanese patient.. The existence of CMV, EBV, HHV8, HTLV-I, and PVB19 was determined by polymerase chain reaction (PCR). The presence of CMV in the endothelial cells was characterized by in situ hybridization (ISH) and immunohistochemistry (IHC).. Serologic immunoglobulin to CMV and IHC identification of CMV late gene in the biopsy specimen indicated that the patient was infected with CMV. Detection of CMV was confirmed by PCR and ISH.. These results indicate that FUMHD is associated with dermal CMV manifestation. Nonetheless, the induction mechanism of FUMHD with CMV infection has yet to be determined. Topics: Acyclovir; Anti-Bacterial Agents; Biopsy, Needle; Combined Modality Therapy; Cytomegalovirus; Cytomegalovirus Infections; Fever; Follow-Up Studies; Humans; Immunohistochemistry; In Situ Hybridization; Male; Middle Aged; Necrosis; Phototherapy; Pityriasis Lichenoides; Polymerase Chain Reaction; Severity of Illness Index | 2001 |
Clinical problem solving. The girl with the curl.
Topics: Acyclovir; Antitubercular Agents; Cyclosporine; Female; Fever; Herpesvirus 4, Human; Humans; Immunosuppression Therapy; Kidney Transplantation; Lupus Erythematosus, Systemic; Lupus Nephritis; Lymphoma; Middle Aged; Prednisone | 1995 |
Recurrent ocular herpes simplex infection.
Topics: Acyclovir; Administration, Oral; Cornea; Female; Fever; Humans; Keratitis, Herpetic; Recurrence | 1994 |
[Epstein-Barr virus infection and syndrome of inappropriate macrophage activation].
An 11-year-old girl presented with a typical serologically proven infectious mononucleosis with persistent fever, jaundice and hepatosplenomegaly in spite of steroid therapy. Laboratory tests showed pancytopenia, fibrinopenia and hypertriglyceridemia. The liver biopsy revealed an infiltration with hyperbasophilic cells. One month later, a slight improvement was noted and fever disappeared after 4 days on acyclovir therapy. The authors recall the spectrum of the macrophagic activation syndrome. Topics: Acyclovir; Child; Female; Fever; Histiocytosis, Non-Langerhans-Cell; Humans; Infectious Mononucleosis; Macrophage Activation; Pancytopenia; Phagocytosis; Syndrome | 1993 |
[Complicated febrile convulsion vs herpes-encephalitis].
Since Acyclovir is available a sufficient treatment of herpes simplex virus (HSV) encephalitis exists. Febrile convulsions may occur as the initial manifestation of an encephalitis, particularly of an HSV encephalitis. Within 25 months out of 151 children with febrile convulsions five children with complicated febrile convulsions were admitted at the pediatric department of Graz. In all children HSV antibodies in serum and cerebrospinal fluid (CSF) were negative and the diagnosis of an HSV encephalitis was made by positive CSF HSV polymerase chain reaction (PCR). Therefore, in any suspected case, i.e. in any case of a complicated febrile convulsion, CSF should be investigated including a HSV PCR to rapidly confirm or exclude HSV encephalitis. Topics: Acyclovir; Cerebrospinal Fluid; Child, Preschool; Diagnosis, Differential; Encephalitis; Female; Fever; Humans; Infant; Magnetic Resonance Imaging; Male; Polymerase Chain Reaction; Seizures; Simplexvirus | 1993 |
Fever, pulmonary infiltrates, and pleural effusion following acyclovir therapy for herpes zoster ophthalmicus.
A 71-year-old man presented with herpes zoster ophthalmicus and ocular involvement. Following the institution of intravenous therapy with acyclovir, the patient developed fever, hemoptysis, and a pleural friction rub. A ventilation-perfusion lung scan showed no defects; roentgenograms showed bilateral infiltrates and a left-sided pleural effusion. The fever abated promptly following discontinuation of acyclovir, and radiographic abnormalities resolved over ten days. No other anti-infective therapy was given. To our knowledge, the syndrome of fever, pulmonary infiltrates, and pleural effusion following use of acyclovir has not been previously reported. Topics: Acyclovir; Aged; Fever; Herpes Zoster Ophthalmicus; Humans; Lung; Lung Diseases; Male; Pleural Effusion; Radiography | 1990 |
Antibiotic resistant fever associated with herpes simplex virus infection in neutropenic patients with haematological malignancy.
The incidence of mucocutaneous herpes simplex virus infection confirmed by culture and occurring during febrile neutropenic episodes was determined in 43 patients with haematological malignancy. The outcome of 72 episodes of neutropenic fever was determined and correlated with the presence or absence of herpes simplex virus (HSV) infection. Twenty four patients had mucocutaneous HSV infection during at least one episode. In 24 episodes in which HSV was isolated only 12.5% of fevers responded to antibiotics and 75% of fevers were otherwise unexplained. Conversely, in 48 episodes of neutropenic fever in which HSV was not isolated 67% of fevers responded to antibiotics and only 8.3% were unexplained. The difference in incidence of antibiotic resistant fever in the two groups was significant. There was, therefore, a strong association between mucocutaneous HSV infection and antibiotic resistant fever in immunosuppressed neutropenic patients. As most HSV infections are the result of virus reactivation, establishing the HSV serological state of patients would identify those at risk of infection and hence those in whom the prophylactic use of acyclovir would be indicated. Topics: Acyclovir; Agranulocytosis; Drug Resistance, Microbial; Fever; Herpes Simplex; Humans; Leukemia; Neutropenia; Virus Activation | 1989 |
[Cytomegalovirus disease in immunosuppressed patients].
Cytomegalovirus (CMV) infection is relatively frequent and severe in immunosuppressed patients giving rise to diagnostic and therapeutic problems. We describe a series of 7 patients, six with acute lymphoblastic leukemia and one with aplastic anemia. All patients had CMV infection at the moment of maximum immunodepression. Two patients had undergone recent bone-marrow transplant. Six had been transfused in the two months prior to the onset of infection. Diagnosis was established through isolation of CMV from blood or serological methods. Symptoms ranged from prolonged fever to multi-organic involvement. Two cases had pulmonary involvement as well as fever, hepatitis and petechial rash. Two other cases presented with fever and hepatosplenomegaly and in the remaining, 3, fever was the only sign. Clinical course was favourable in all cases including the two with pneumonitis; of these two the first received acyclovir and anti-CMV Ig and the other received no specific therapy. One of the remaining cases was also given acyclovir and specific anti CMV Ig was administered to the 3 patients with isolated fever. In conclusion, CMV infection should be suspected in immunosuppressed patients with prolonged fever. Topics: Acyclovir; Anemia, Aplastic; Antineoplastic Agents; Bone Marrow Transplantation; Child; Child, Preschool; Combined Modality Therapy; Cytomegalovirus Infections; Female; Fever; Humans; Immunization, Passive; Immunologic Deficiency Syndromes; Infant; Leukemia, Lymphoid; Male; Postoperative Complications | 1988 |
Acyclovir-associated fever: a case report.
Drug-induced fever has been associated with many agents. We treated a patient who developed high, spiking fevers while receiving intravenous acyclovir. Rechallenge with the drug was not attempted. Clinicians should be aware of the possibility of drug-induced fever in patients who receive systemic acyclovir. Topics: Acyclovir; Adult; Body Temperature; Female; Fever; Herpes Simplex; Humans | 1987 |
Chronic Epstein-Barr virus infection associated with fever and interstitial pneumonitis. Clinical and serologic features and response to antiviral chemotherapy.
Two patients developed fever, interstitial pneumonitis, and pancytopenia associated with extremely high titers of antibody to replicative antigens of the Epstein-Barr virus. In contrast to most patients seropositive for Epstein-Barr virus, neither patient had an antibody response to the Epstein-Barr nuclear antigen K polypeptide. In addition, virus isolated from one patient had a deletion of the B95-8 type in the EcoRI C region of the genome. An etiologic relation between Epstein-Barr virus replication and the clinical manifestations of this syndrome is further shown by the response of each patient to acyclovir therapy. These patients have a new Epstein-Barr-virus-associated syndrome and provide additional evidence that acyclovir may play a role in therapy for selected patients with Epstein-Barr virus infection. Topics: Acyclovir; Adolescent; Antibodies, Viral; Chronic Disease; Female; Fever; Genes, Viral; Herpesviridae Infections; Herpesvirus 4, Human; Humans; Immunoglobulin A; Immunoglobulin G; Lung; Pulmonary Fibrosis; Virus Replication | 1986 |
[Antibiotic therapy of acute infection in patients with cancer].
Considerable progress has been made in the supportive care of patients undergoing cancer therapy. This progress has been associated with the improved survival of some patients. However, infection continues to be the major fatal complication in cancer. patients. The response of granulocytopenic patients with infections to some of the current available antibiotics is suboptimal. Since neutropenia is common during cancer treatment, there is a continual risk of infection in cancer patients; thus it is important for medical oncologists to become aware of these complications and their management. The most frequent types of acute infections, their clinical manifestations, and available antibiotic therapies were reviewed. Topics: Acyclovir; Anti-Bacterial Agents; Bacterial Infections; Fever; Humans; Leukemia, Lymphoid; Leukemia, Myeloid; Neoplasms; Neutropenia; Vidarabine; Virus Diseases | 1986 |
Intravenous acyclovir and neurologic effects.
Topics: Acyclovir; Cognition Disorders; Confusion; Female; Fever; Herpes Simplex; Humans; Middle Aged | 1983 |