acyclovir and Herpes-Zoster

Herpes simplex virus (HSV) and varicella zoster virus (VZV) are alpha herpesviruses that establish life-long latent infection in neuronal ganglia after primary infection. Periodic reactivation of these viruses results in recurrent infections that can have significant impact on patients' quality of life. HSV commonly causes oral and genital mucocutaneous infections whereas VZV is responsible for varicella/chickenpox and herpes zoster/shingles, but cancer patients are at particularly higher risk of complications including disseminated and visceral infections due to impaired cell-mediated immunity. While diagnosis of more common HSV and/or VZV infections is frequently clinically based, immunocompromised hosts may have atypical skin presentation or visceral involvement. Thus, diagnostic confirmation using virus-specific tests such as polymerase chain reaction or immunohistochemical staining is crucial in some cases. Oral acyclovir, valacyclovir and famciclovir are usually used for mild to moderate infections and intravenous acyclovir is the drug of choice for severe or disseminated infections. Foscarnet can be used when acyclovir-resistance is confirmed or suspected. Pharmaceutical prophylaxis against HSV and/or VZV should be considered in high-risk cancers patients. Currently, there is no commercially available vaccine against HSV, but VZV vaccines are available to prevent varicella and zoster.

Topics: Acyclovir; Chickenpox; Herpes Zoster; Herpesvirus 3, Human; Humans; Neoplasms; Quality of Life; Simplexvirus; Varicella Zoster Virus Infection

The most refractory symptom of herpes zoster (HZ) is pain. Approximately 90% of people who have HZ suffer from pain. Early use of antiviral medications has been found to reduce pain across all stages of the disease. Although many antiviral agents via oral or intravenous administration were recommended by clinical practice, the best approach to prevent HZ-associated pain remains uncertain.. The purpose of this study was to compare the efficacy and adverse events of various antiviral agents used for the treatment of HZ-associated pain through a network meta-analysis.. A systematic review and meta-analysis.. The Cochrane Register of Controlled Trials, Embase, and PubMed were searched from inception to Feb 2020.. Randomized clinical trials evaluating antiviral agents currently available for treating HZ-associated pain were included. We extracted data in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and conducted network meta-analyses with random-effects models. The primary outcome was the presence of acute pain at the end of anti-virus treatment, and the secondary outcomes included the presence of pain at 28-30 days after the onset of the acute herpetic rash, the presence of postherpetic neuralgia (PHN), and any other adverse events.. A total of 17 randomized control trials with 5,579 participants were included in this study. According to the results of the network meta-analysis, for the treatment of acute pain, there was no significant difference between oral acyclovir and intravenous acyclovir. Furthermore, oral famciclovir was the most effective treatment concerning both the odds ratio (OR) (superior to placebo OR = 0.25; 95% CI: 0.13~0.48) and the surface under the cumulative ranking curve (SUCRA) values of 0.84 for the treatment of acute pain among all the oral antiviral agents. For the presence of pain at 28-30 days, no significant difference was observed in efficacy between all antiviral treatments and placebo concerning the OR; however, oral valaciclovir ranked first (SUCRA values of 0.96). For the presence of NPH, oral famciclovir was determined to be the most effective (SUCRA values of 0.77) treatment with an efficacy of 0.42 (95% CI: 0.18~0.99) versus placebo. For adverse events, there was no significant difference between oral antivirals and placebo; however, intravenous acyclovir ranked last with a score of OR 4.31 (95% CI: 1.26~14.75) versus placebo.. The distribution of severity of pain was different in various studies; then, the lack of availability of individual data prevented us from analyzing the effects of the risk factors.. For the treatment of acute pain and PHN, oral famciclovir was the most effective treatment among all the oral antiviral agents. For alleviating pain after 28-30 days, oral valaciclovir appeared to be the most effective among all antiviral agents. Additionally, all oral antiviral agents were well tolerated.. PROSPERO under the identification CRD42020212834.

Topics: Acute Pain; Acyclovir; Antiviral Agents; Famciclovir; Herpes Zoster; Humans; Network Meta-Analysis; Neuralgia, Postherpetic; Randomized Controlled Trials as Topic; Valacyclovir

Herpes simplex virus types 1 and 2 HSV1 and 2, namely varicella-zoster VZV and cytomegalovirus CMV, are among the most common pathogens worldwide. They remain in the host body for life. The course of infection with these viruses is often asymptomatic or mild and self-limiting, but in immunocompromised patients, such as solid organ or bone marrow transplant recipients, the course can be very severe or even life-threatening. Unfortunately, in the latter group, the highest percentage of infections with strains resistant to routinely used drugs is observed. On the other hand, frequent recurrences of genital herpes can be a problem even in people with normal immunity. Genital herpes also increases the risk of acquiring sexually transmitted diseases, including HIV infection and, if present in pregnant women, poses a risk to the fetus and newborn. Even more frequently than herpes simplex, congenital infections can be caused by cytomegalovirus. We present the most important anti-herpesviral agents, the mechanisms of resistance to these drugs, and the associated mutations in the viral genome. Special emphasis was placed on newly introduced drugs such as maribavir and brincidofovir. We also briefly discuss the most promising substances in preclinical testing as well as immunotherapy options and vaccines currently in use and under investigation.

Topics: Acyclovir; Antiviral Agents; Cytomegalovirus; Female; Herpes Genitalis; Herpes Simplex; Herpes Zoster; Herpesviridae Infections; HIV Infections; Humans; Infant, Newborn; Pregnancy

Varicella zoster virus (VZV) ocular infection can manifest purely as a vasculopathy that leads to retinal arteriole occlusion, without any retinitis or vasculitis. This review summarizes our current knowledge of such VZV ocular infection phenotype, incorporating initial descriptions from 1988. We describe the pathogenesis and VZV's manifestations in the retina using fundus photography, fundus fluorescein angiography, optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA). Laboratory investigations, diagnostic procedures, prognoses, and treatment options are also being reviewed.. Ten case reports where VZV retinal vasculopathy was the primary feature observed after varicella or zoster rash are described. The retinal arteriole, cilioretinal artery, branches of retinal artery, central retinal artery and ophthalmic artery were found to be areas of more rarely affected, neither in the form of vasculitis nor retinitis. Diagnosis is typically made from positive polymerase chain reaction (PCR) for VZV from extracted intraocular fluid or positive serum or cerebrospinal fluid (CSF) anti-VZV immunoglobulin G antibody in the context of compatible ocular findings. In addition, retinal vasculopathy occurring in the setting of confirmed varicella or zoster rashes could be considered potentially pathognomonic. Pathological concepts, including direct VZV infection of affected tissue, persistent inflammation, and/or virus-induced hypercoagulability are also discussed.. VZV may produce a wide spectrum of ocular manifestations with isolated VZV retinal vasculopathy being a rarer presentation. A prompt diagnosis followed by an early treatment of systemic acyclovir with or without corticosteroids is the mainstay of treatment.

Topics: Acyclovir; Chickenpox; Eye Infections; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunoglobulin G; Retinitis; Vasculitis

Topics: Acyclovir; Antiviral Agents; Blister; Famciclovir; Herpes Zoster; Humans; Neuralgia, Postherpetic; Randomized Controlled Trials as Topic; Valacyclovir

Topics: Acyclovir; Antiviral Agents; DNA Primase; Herpes Zoster; Herpesvirus 3, Human; Humans

Varicella zoster virus (VZV) causes varicella, establishes latency, then reactivates to produce herpes zoster. VZV reactivation can also cause central nervous system (CNS) disease with or without rash. Herein, we review these CNS diseases, pathogenesis, diagnosis, and treatment.. The most common CNS manifestation of VZV infection is vasculopathy that presents as headache, cognitive decline, and/or focal neurological deficits. VZV vasculopathy has also been associated with cerebral amyloid angiopathy and moyamoya syndrome. Rarely, VZV will produce a meningitis, encephalitis, cerebellitis, and myelopathy. Pathogenic mechanisms include direct VZV infection of affected tissue, persistent inflammation, and/or virus-induced hypercoagulability. Diagnosis is confirmed by the temporal association of rash to disease onset, intrathecal synthesis of anti-VZV antibodies, and/or the presence of VZV DNA in CSF. Most cases respond to intravenous acyclovir with corticosteroids.. VZV produces a wide spectrum of CNS disorders that may be missed as some cases do not have an associated rash or a CSF pleocytosis. Clinicians must be vigilant in including VZV in their differential diagnosis of CNS infections as VZV is a ubiquitous pathogen; importantly, VZV CNS infections are treatable with intravenous acyclovir therapy and corticosteroids.

Topics: Acyclovir; Adrenal Cortex Hormones; Antibodies, Viral; Antiviral Agents; Central Nervous System Infections; Herpes Zoster; Herpesvirus 3, Human; Humans; Meningitis

Neurological complications due to reactivation of varicella-zoster virus (VZV) are very uncommon in immunocompetent patients. Generally a vesicular rash is present on one or more dermatomes, preceding or following the main manifestation. Few cases are reported in the international literature, but they concern mainly adult or elderly patients.. A 12-year-old girl was referred to our hospital for persisting headache, cough and rhinitis for six days. After first examination, diagnosis of anterior sinusitis was made by nasal endoscopy. The day after, the girl developed psychotic symptoms and altered mental status. Computed tomography (CT) scan was immediately performed but was unremarkable; lumbar puncture revealed leukocytosis with lymphocytic predominance and cerebrospinal fluid polymerase chain reaction (PCR) detected varicella-zoster virus DNA. The diagnosis of acute VZV encephalitis was made. The patient was promptly treated with acyclovir infused intravenously and her clinical conditions rapidly improved. Tests made did not show any condition of immunosuppression.. Although if rare, reactivation of VZV can occur in immunocompetent children and its complications can involve central nervous system. Among these complications, meningitis is more common, but cerebral parenchyma can also be involved leading to a severe medical condition that is defined meningoencephalitis. In rare cases vesicular rash may be absent; therefore high level of suspicion is required even in those patients in which suggestive clinical features are not present to guide the diagnosis. Intravenous acyclovir represents the treatment of choice to obtain a fast clinical response and to prevent the onset of late-term complications.

Topics: Acyclovir; Adult; Aged; Child; Exanthema; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Meningoencephalitis

Varicella zoster virus central nervous system infections can present as aseptic meningitis, encephalitis, myelitis, and vasculopathy. Diagnosis is based on identification of varicella zoster virus deoxyribonucleic acid (DNA) in the cerebrospinal fluid by polymerase chain reaction. Therapy for these infections is acyclovir or valacyclovir. However, acyclovir can have neurotoxic effects that can mimic the presentation of varicella zoster virus central nervous system disease. We present a rare presentation of a patient who had acyclovir-induced neurotoxicity who also had a false-positive cerebrospinal fluid varicella zoster virus polymerase chain reaction result, creating a management dilemma. We review the clinical characteristics of acyclovir-induced neurotoxicity. In addition, we present the diagnostic characteristics of the cerebrospinal fluid viral polymerase chain reaction and alternative methods to diagnose central nervous system varicella zoster virus disease.. A 68-year-old Hispanic man with end-stage renal disease was diagnosed with cutaneous zoster at an outside facility and was started on acyclovir 4 days prior to admission. His family noted worsening confusion, agitation, speech difficulty, and hallucinations, leading them to bring him to the emergency department. His cerebrospinal fluid varicella zoster virus polymerase chain reaction result was positive, indicating the presence of varicella zoster virus deoxyribonucleic acid in the cerebrospinal fluid; however, he did not have cerebrospinal fluid pleocytosis typical of varicella zoster virus meningoencephalitis. Pharmacy records from the outside hospital revealed supratherapeutic acyclovir dosing. This led to a diagnostic dilemma over whether this patient had varicella zoster virus encephalitis or acyclovir-induced neurotoxicity. Acyclovir was discontinued, and the patient underwent two sessions of hemodialysis to remove acyclovir, which led to a full neurologic recovery.. Varicella zoster virus encephalitis and acyclovir-induced neurotoxicity can have similar presentations. Varicella zoster virus deoxyribonucleic acid can be present in the cerebrospinal fluid during active cutaneous zoster in the absence of central nervous system disease. If concern for central nervous system varicella zoster virus disease remains high, additional testing with cerebrospinal fluid serology can be performed. Compared with central nervous system varicella zoster virus disease, acyclovir-induced neurotoxicity has a more predictable clinical resolution once drug therapy is discontinued or the patient undergoes hemodialysis, which can aid in making the diagnosis. Clinicians should be aware of this rare and dangerous complication of acyclovir. In addition, clinicians should have an understanding of the diagnostic limitations of cerebrospinal fluid viral polymerase chain reaction and have alternative approaches available to diagnose central nervous system varicella zoster virus disease when it is suspected.

Topics: Acyclovir; Aged; Antiviral Agents; Chickenpox; Herpes Zoster; Humans; Male; Polymerase Chain Reaction

Herpes zoster encephalitis (HZE) is a rare complication of varicella zoster virus (VZV) infection. We report two cases of HZE in solid organ transplant (SOT) recipients and review 10 other cases in the literature. In this review, rash was present in 67% of cases. Despite the absence of a rash, high clinical suspicion for HZE is necessary and empiric antiviral therapy should be considered. While with variable outcome, it was associated with high mortality rate of 42%. Prompt initiation of antiviral therapy remains crucial in decreasing morbidity and mortality from this fatal disease.

Topics: Acyclovir; Aged; Antiviral Agents; Encephalitis, Varicella Zoster; Herpes Zoster; Humans; Immunocompromised Host; Male; Organ Transplantation; Transplant Recipients

Varicella zoster virus (VZV) disease is a common complication after hematopoietic cell transplantation (HCT). The mortality rate for disseminated VZV infection is 34%. Acyclovir has been used for the prophylaxis of VZV disease after HCT, but the effectiveness of prophylaxis is controversial. We conducted a meta-analysis of the incidence of VZV disease within the first 1 year after acyclovir prophylaxis had been discontinued and assessed the risk of VZV disease during acyclovir prophylaxis.. Medline, EMBASE plus EMBASE classics, and the Cochrane Central Register of Controlled Trials were used for a systematic search. The inclusion criteria were both randomized controlled trials and cohort studies that described the effectiveness of acyclovir as prophylaxis against VZV disease after allogeneic HCT.. We included seven studies involving a total of 2265 patients. No mortality by VZV was identified. Acyclovir prophylaxis significantly reduced the rate of VZV infection within the first 1 year after discontinuation (risk ratio: 0.38, 95% confidence interval (CI): 0.29-0.51). The risk of VZV disease during acyclovir prophylaxis was also reduced (risk ratio: 0.17, 95% CI: 0.12-0.24). Both short-term and long-term prophylaxis reduced the incidence of VZV infection (RR: 0.51, 95% CI: 0.30-0.86 vs RR: 0.34, 95% CI: 0.22-0.54). Low-dose acyclovir (<400 mg/d) is sufficient to reduce the risk of VZV disease.. This study showed that acyclovir prophylaxis reduced VZV infection after HCT with no fatal cases and acyclovir prophylaxis is beneficial. No significant adverse effects occurred and no delayed VZV disease was identified.

Topics: Acyclovir; Allografts; Antiviral Agents; Hematopoietic Stem Cell Transplantation; Herpes Zoster; Herpesvirus 3, Human; Humans; Incidence; Randomized Controlled Trials as Topic; Risk Factors; Virus Activation

Herpes zoster can present many uncertainties for consulting dermatologists. We review the current guidelines and recent literature on important issues that arise in the care of hospitalized patients with herpes zoster, including infection control isolation practices, treatment courses for zoster and acute zoster-associated pain, and indications for long-term prophylaxis. We present the findings of an inpatient zoster management practices survey of the membership of the Society of Dermatology Hospitalists, an expert resource group of the American Academy of Dermatology, and discuss directions for future investigation and potential opportunities for management improvements in light of these collective data.

Topics: Acyclovir; Adult; Antiviral Agents; California; Communicable Disease Control; Cross-Sectional Studies; Evidence-Based Medicine; Female; Herpes Zoster; Herpesvirus 3, Human; Hospitalization; Humans; Incidence; Male; Middle Aged; Practice Guidelines as Topic; Prognosis; Risk Assessment; Severity of Illness Index; Treatment Outcome

An infection with the varicella-zoster virus (VZV) causes both varicella and herpes zoster (HZ). Although rare, the development of HZ does occur during pregnancy. Maternal HZ does not result in increased foetal mortality, and the passage of VZV to the foetus rarely occurs. However, HZ does increase maternal morbidity. Upon infection with HZ, patients typically present with a viral prodrome preceding the appearance of the characteristic zoster rash. HZ is usually diagnosed clinically by the zoster rash, but can also be confirmed by a polymerase chain reaction and an enzyme-linked immunosorbent assay. Pregnant women with an uncomplicated HZ should be treated with oral acyclovir. The major complications of HZ are subacute herpetic neuralgia and post-herpetic neuralgia. Other complications include zoster ophthalmicus, disseminated HZ and secondary bacterial infections. Regarding prophylaxis, the varicella and the zoster vaccines are not recommended for pregnant women, and it is important to advise non-immune pregnant women to avoid an exposure to VZV. Although HZ infection has a minimal effect on the foetus, maternal HZ and its complications cause a significant burden. It is important to focus care on the mother with appropriate treatment and management of complications as they develop.

Topics: Acyclovir; Antiviral Agents; Enzyme-Linked Immunosorbent Assay; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Polymerase Chain Reaction; Pregnancy; Pregnancy Complications, Infectious

The discovery of acyclovir and penciclovir has led to the development of a successful systemic therapy for treating herpes simplex virus infection and varicella-zoster virus infection, and the orally available prodrugs, valacyclovir and famciclovir, have improved antiviral treatment compliance. Acyclovir and penciclovir are phosphorylated by viral thymidine kinase and are incorporated into the DNA chain by viral DNA polymerase, resulting in chain termination. Helicase-primase plays an initial step in DNA synthesis to separate the double strand into two single strands (replication fork) and is a new target of antiviral therapy. The helicase-primase inhibitors (HPIs) pritelivir and amenamevir have novel mechanisms of action, drug resistance properties, pharmacokinetic characteristics, and clinical efficacy for treating genital herpes. The clinical study of amenamevir in herpes zoster has been completed, and amenamevir has been submitted for approval for treating herpes zoster in Japan. The clinical use of HPIs will be the beginning of a new era of anti-herpes therapy.

Topics: Acyclovir; Animals; Antiviral Agents; Clinical Trials as Topic; Guanine; Herpes Simplex; Herpes Zoster; Herpesvirus 3, Human; Humans; Oxadiazoles; Simplexvirus

Neurotoxicity is a side effect of acyclovir. We report the first case, to our knowledge, whereby Bayesian-informed clearance estimates supported a therapeutic intervention for acyclovir-associated neurotoxicity.. A 62-year-old male with the diagnosis of disseminated zoster was being treated with intravenous (IV) acyclovir when he developed symptoms of acute neurotoxicity. Acyclovir had been dose-adjusted for renal dysfunction according to traditional creatinine clearance estimates; however, as the patient was also on vancomycin, Bayesian estimates of vancomycin clearances were performed, which revealed a 2-fold lower creatinine clearance. In response to the Bayesian estimates, acyclovir was discontinued, and improvements in mentation were noted within 24 hours.. Alternate approaches to estimate renal function beyond Cockcroft-Gault, such as a Bayesian approach used in our patient, should be considered when population estimates are likely to be inaccurate and potentially dangerous to the patient.

Topics: Acyclovir; Antiviral Agents; Bayes Theorem; Creatinine; Dose-Response Relationship, Drug; Herpes Zoster; Humans; Male; Middle Aged; Neurotoxicity Syndromes; Vancomycin

We encountered two cases of Herpes zoster (HZ) meningitis, a rarely occurring complication of HZ, in previously healthy children. One patient treated with i.v. acyclovir (ACV, 31 mg/kg/day) did not recover. His symptoms were relieved somewhat by increased ACV dosage, but it caused transient renal dysfunction. Another patient treated with i.v. ACV (30 mg/kg/day) recovered. Treatment for HZ meningitis in immunocompetent children has not been established. In a literature review, 80% of 20 patients were treated with the usual dose of ACV 15-30 mg/kg/day. The present cases suggest that a high dosage of ACV up to 60 mg/kg/day should be considered (while monitoring for side-effects) unless symptoms improve. In the review, one of every three vaccine-strain Varicella zoster virus (VZV) cases was severe, whereas the present cases resulted from wild type. Further investigations must examine different clinical characteristics of HZ meningitis caused by wild-type and vaccine-strain VZV.

Topics: Acyclovir; Antiviral Agents; Child; Herpes Zoster; Humans; Immunocompetence; Male; Meningitis, Viral

The optimal duration of prophylaxis for the varicella-zoster virus following hematopoietic stem cell transplantation (HSCT) remains unclear. The purpose of this study was to systematically review the available literature to determine the optimal duration of antiviral prophylaxis for preventing herpes zoster (HZ) in allogeneic and autologous HSCT recipients. The MEDLINE and EMBASE databases were searched to identify relevant studies. The relative risk (RR) of HZ was calculated using fixed effects or random effects models depending on heterogeneity across the included studies. We analyzed six observational studies comprising a total of 3420 patients. In all HSCT recipients, the overall incidence of HZ in the prophylaxis group and the control group was 7.8% and 25.6%, respectively, with a pooled RR of 0.31 (95% CI, 0.26-0.37). The incidence of HZ in the subgroup wherein prophylaxis was given for at least 1 year and in the subgroup wherein prophylaxis was given for less than 1 year was 2.1% and 15.4%, respectively, with a pooled RR of 0.23 (95% CI, 0.04-1.39). Taken together, our results demonstrate that antiviral prophylaxis can significantly reduce HZ in HSCT recipients, and suggests that long-term prophylaxis given for at least 1 year may be recommended for better preventive effects.

Topics: Acyclovir; Antiviral Agents; Hematopoietic Stem Cell Transplantation; Herpes Zoster; Herpesvirus 3, Human; Humans; Observational Studies as Topic; Pre-Exposure Prophylaxis; Risk; Time Factors; Transplant Recipients; Valacyclovir; Valine; Virus Activation

To describe a case in which persistent plantar warts resolved after a ten-day treatment course of oral acyclovir prescribed for herpes zoster.. A 49 year-old Caucasian female with non-significant past medical history presented to the podiatry clinic for treatment of verrucae. Debridement was performed and monochloroacetic acid was applied to affected areas seven times over seven months. The patient was diagnosed and treated for herpes zoster with acyclovir for ten days. Following acyclovir completion, only one verruca remained with complete resolution at the next follow-up podiatry visit.. Few previous trials have supported the use of acyclovir cream in treatment-resistant plantar warts. However, no case reports to date describe the efficacy of oral acyclovir in the treatment of verruca. While a causal relationship has not been solidified between verrucous lesion resolution and treatment with acyclovir, it can be inferred and warrants additional attention.

Topics: Acyclovir; Administration, Oral; Antiviral Agents; Female; Herpes Zoster; Humans; Middle Aged; Treatment Outcome; Warts

A 75-year-old woman presented with edema of the left leg in December 2012. On examination, there was a palpable 5-cm tumor in the left lower abdomen, and PET/CT showed lymphadenopathy of the tracheal, para-aortic, left iliac and inguinal regions with increased FDG uptake. We performed histopathological examination of the iliac lymph node and diagnosed diffuse large B-cell lymphoma (DLBCL), stage IIIA. The patient received 8 courses of R-CHOP chemotherapy and achieved a complete response. In April 2014, she noticed seven new painful erythematous vesicles <1 cm in size on the skin of the left lower abdominal region. Herpes zoster was suspected and valacyclovir was administered. However, this medication had no effect, and the vesicles enlarged and became nodular. Histopathological examination of one of the skin lesions revealed the infiltration of DLBCL and the diagnosis of zosteriform cutaneous recurrence of DLBCL was thus made. Skin lesions mimicking herpes zoster have been reported in certain types of hematological malignancies, and histopathological diagnosis should be performed in such cases.

Topics: Acyclovir; Aged; Antibodies, Monoclonal, Murine-Derived; Antineoplastic Combined Chemotherapy Protocols; Antiviral Agents; Cyclophosphamide; Diagnosis, Differential; Doxorubicin; Female; Herpes Zoster; Humans; Lymphoma, Large B-Cell, Diffuse; Prednisone; Recurrence; Rituximab; Skin Neoplasms; Treatment Outcome; Valacyclovir; Valine; Vincristine

Aciclovir (ACV) is the first-line drug for the management of herpes simplex virus (HSV) and varicella-zoster virus (VZV) infections. Long-term administration of ACV for the treatment of severe infections in immunocompromised patients can lead to the development of drug resistance. Furthermore, the emergence of isolates resistant to ACV is increasingly recognized in immunocompetent individuals with herpetic keratitis. This review describes the mechanisms involved in drug resistance for HSV and VZV, the laboratory diagnosis and management of patients with infections refractory to ACV therapy.. Genotypic testing is more frequently performed for the diagnosis of infections caused by drug-resistant HSV or VZV isolates. Molecular biology-based systems for the generation of recombinant viruses have been developed to link unknown mutations with their drug phenotypes. Fast and sensitive methods based on next-generation sequencing will improve the detection of heterogeneous viral populations of drug-resistant viruses and their temporal changes during antiviral therapy, which could allow better patient management. Novel promising compounds acting on targets that differ from the viral DNA polymerase are under clinical development.. Antiviral drug resistance monitoring for HSV and VZV is required for a rational use of antiviral therapy in high-risk populations.

Topics: Acyclovir; Antiviral Agents; Drug Resistance, Viral; Herpes Simplex; Herpes Zoster; Herpesvirus 3, Human; Humans; Immune Tolerance; Simplexvirus; Varicella Zoster Virus Infection

Herpes zoster (HZ) infections rarely affect the mandibular branches of the trigeminal nerve. When the mandibular branches are involved, lesions may appear on the face, in the mouth, in the eye, or on the tongue. Additionally, this condition may be associated with devitalized teeth, internal resorption and spontaneous exfoliation of the teeth, and osteomyelitis of the alveolar bone. In this paper, the treatment of a case HZ of the mandibular branch of the trigeminal nerve is reported, and 22 articles on HZ cases with involvement of the mandibular branch are reviewed. This is the first literature review of HZ cases involving only the mandibular branch of the trigeminal nerve.

Topics: Acyclovir; Adolescent; Antiviral Agents; Diagnosis, Differential; Herpes Zoster; Humans; Male; Mandibular Diseases; Pain Management; Radiography, Panoramic; Trigeminal Nerve; Trigeminal Nerve Diseases; Valacyclovir; Valine

Topics: Acyclovir; Aged; Antiviral Agents; Arm; Autonomic Fibers, Preganglionic; Eyelids; Female; Ganglia, Sympathetic; Herpes Zoster; Herpesvirus 3, Human; Horner Syndrome; Humans; Neck; Spinal Cord; Thorax; Valacyclovir; Valine

Varicella zoster virus (VZV) reactivation results in zoster, which may be complicated by postherpetic neuralgia, myelitis, meningoencephalitis, and VZV vasculopathy. This review highlights the clinical features, laboratory abnormalities, imaging changes, and optimal treatment of each of those conditions. Because all of these neurological disorders produced by VZV reactivation can occur in the absence of rash, the virological tests proving that VZV caused disease are discussed.. After primary infection, VZV becomes latent in ganglionic neurons along the entire neuraxis. With a decline in VZV-specific cell-mediated immunity, VZV reactivates from ganglia and travels anterograde to the skin to cause zoster, which is often complicated by postherpetic neuralgia. VZV can also travel retrograde to produce meningoencephalitis, myelitis, and stroke. When these complications occur without rash, VZV-induced disease can be diagnosed by detection of VZV DNA or anti-VZV antibody in cerebrospinal fluid and treated with intravenous acyclovir.. Awareness of the expanding spectrum of neurological complications caused by VZV reactivation with and without rash will improve diagnosis and treatment.

Topics: Acyclovir; Antibodies, Viral; Antiviral Agents; DNA, Viral; Encephalitis, Varicella Zoster; Herpes Zoster; Herpesvirus 3, Human; Humans; Myelitis; Neuralgia, Postherpetic; Vascular Diseases; Virus Latency

The treatment of patients with various forms of herpes requires a complex approach with using chemo- and immunotropic drugs. The use of Cycloferon, an interferon inductor (12.5% injection solution, 150 mg tablets or 5% liniment) was shown efficient. It had antiviral and immunotropic action in the mono- and combination therapy of herpes simplex of the skin and mucosa, genital herpes, ophthalmoherpes, herpes zoster, infectious mononucleosis. Cycloferon lowered the level and period of the disease clinical signs, prolonged the remission, corrected the immunity shifts, prevented the complications. The results of the study presented a conclusive proof for recommending such a use of Cycloferon in wide medical practice.

Topics: Acridines; Acyclovir; Antiviral Agents; Female; Herpes Genitalis; Herpes Labialis; Herpes Zoster; Herpesviridae; Humans; Immunity, Innate; Infectious Mononucleosis; Interferon Inducers; Keratitis, Herpetic; Male

Herpes zoster infection occurs owing to reactivation of varicella zoster virus and classically manifests as a vesicular eruption involving a single dermatome. Disseminated herpes zoster - defined as having greater than twenty vesicles outside the primary or adjacent dermatome - is uncommon and typically occurs in immunocompromised individuals. Central nervous system complications during or following a zoster outbreak are exceedingly rare. Encephalitis is reported to affect only 0.1-0.2% of patients and occurs more often in disseminated cases and in outbreaks involving those dermatomes in close proximity to the central nervous system. We present an elderly woman with disseminated herpes zoster and altered mental status who was subsequently diagnosed with varicella zoster virus encephalitis and describe the characteristics of patients with disseminated zoster who developed varicella zoster virus encephalitis.

Topics: Acyclovir; Aged; Antiviral Agents; Encephalitis, Viral; Female; Glucocorticoids; Herpes Zoster; Herpesvirus 3, Human; Humans; Prednisone; Virus Activation

Opportunistic viral infections are a well-recognized complication of anti-tumor necrosis factor (TNF) therapy for inflammatory bowel disease (IBD). Cases of severe or atypical varicella zoster virus infection, both primary and latent reactivation, have been described in association with immunosuppression of Crohn's disease (CD) patients. However, central nervous system varicella zoster virus infections have been rarely described, and there are no previous reports of varicella zoster virus meningitis associated with anti-TNF therapy among the CD population. Here, we present the case of a 40-year-old male with severe ileocecal-CD who developed a reactivation of dermatomal herpes zoster after treatment with prednisone and adalimumab. The reactivation presented as debilitating varicella zoster virus meningitis, which was not completely resolved despite aggressive antiviral therapy with prolonged intravenous acyclovir and subsequent oral valacyclovir. This is the first reported case of opportunistic central nervous system varicella zoster infection complicating anti-TNF therapy in the CD population. This paper also reviews the literature on varicella zoster virus infections of immunosuppressed IBD patients and the importance of vaccination prior to initiation of anti-TNF therapy.

Topics: Acyclovir; Adalimumab; Adrenal Cortex Hormones; Adult; Antibodies, Monoclonal, Humanized; Antiviral Agents; Crohn Disease; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunocompromised Host; Immunosuppressive Agents; Male; Meningitis, Viral; Opportunistic Infections; Prednisone; Treatment Outcome; Tumor Necrosis Factor-alpha; Valacyclovir; Valine; Virus Activation

Osteonecrosis following herpes zoster infection is a rare but severe complication, and clinicians' awareness is important for early detection and management of this condition. A case of herpes zoster of the left maxillary division of the trigeminal nerve is reported in a young female having no concurrent predisposing factors, with accompanying rare complications of alveolar bone necrosis and rapid tooth exfoliation. Acyclovir was used to manage the case effectively. The previously reported similar cases in the literature have been reviewed and the pathophysiology of tooth exfoliation and osteonecrosis by varicella zoster viruses is discussed.

Topics: Acyclovir; Adult; Antiviral Agents; Cicatrix; Cranial Nerve Diseases; Facial Dermatoses; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Maxillary Diseases; Maxillary Nerve; Osteonecrosis; Tooth Loss; Virus Activation

Topics: Acyclovir; Aged; Anti-Inflammatory Agents, Non-Steroidal; Antiviral Agents; Brachial Plexus Neuritis; Electromyography; Herpes Zoster; Humans; Male; Physical Therapy Modalities; Shoulder Pain

Herpes zoster (Hz), which generally presents as a localized, painful cutaneous eruption, is a common clinical problem, particularly among adults ≥ 50 years of age and immunocompromised patients. The diagnosis of Hz is mainly made clinically, except in patients with atypical manifestations or certain complications, such as central nervous system involvement, in which laboratory virologic testing is required. In addition to having a higher mortality rate, immunocompromised individuals have atypical and severe clinical findings and are at greater risk for complications and recurrence of Hz. Treatment of Hz includes the use of antiviral agents, analgesics for control of acute zoster pain, good skin care for healing, and prevention of secondary bacterial infection. Antiviral agents, preferably valacyclovir or famciclovir, should be started within 72 hours of onset to reduce the severity of the infection, the duration of the eruptive phase, and the intensity of acute pain. Herpes zoster has been associated with several complications, of which post-herpetic neuralgia (PHN) is the most common and debilitating. Varicella-zoster virus vaccine and early treatment with either famciclovir or valacyclovir are the only measures proven to prevent PHN. The options for treating PHN include topical agents, such as lidocaine patches, and systemic agents, such as the anticonvulsants gabapentin and pregabalin. Measures for preventing Hz include infection control through routine hand hygiene and appropriate use of isolation precautions and personal protective equipment; immunoglobulins, such as the varicella-zoster virus immunoglobulin and vaccine; and antiviral agents. The zoster vaccine has been shown to be effective in reducing the incidence of Hz and PHN. The vaccine is recommended for all individuals aged ≥ 60 years who have no contraindications, including individuals who report a previous episode of Hz.

Topics: 2-Aminopurine; Acyclovir; Adult; Aged; Aged, 80 and over; Analgesics; Antiviral Agents; Cohort Studies; Famciclovir; Female; Herpes Zoster; Herpes Zoster Vaccine; Herpesvirus 3, Human; Humans; Incidence; Lidocaine; Male; Middle Aged; Neuralgia, Postherpetic; Practice Guidelines as Topic; Retrospective Studies; Risk Factors; United States; Valacyclovir; Valine

INTRODUCTION. Infection by the Epstein-Barr virus (EBV) -either as a primary infection, a reactivation or an active chronic infection- can give rise to several clinical forms of involvement of the central nervous system. We report a case of encephalitis due to EBV produced by viral reactivation in an immunocompetent patient which initially mimicked, from the clinical and electroencephalographic point of view, encephalitis due to type 1 herpes simplex virus (HSV-1). CASE REPORT. A 51-year-old male who had reported the presence of dorsal herpes zoster some days earlier. The patient visited the emergency department after suffering a holocranial oppressive headache and febricula for seven days; 24 hours before admission to hospital, he was suffering from drowsiness and language disorder. The neurological examination revealed stiffness in the back of the neck and dysphasia. An analysis of the cerebrospinal fluid revealed pleocytosis (422 cells/mm(3)) with 98% of mononuclear cells and normal protein and glucose concentration levels in cerebrospinal fluid. Magnetic resonance imaging of the brain and electroencephalogram readings were normal with periodic lateralised epileptiform discharges in the left temporal region. Intravenous acyclovir treatment was initiated, but renal failure meant it had to be changed to oral valaciclovir with clinical resolution and improvement of the liquoral parameters. Polymerase chain reaction in the cerebrospinal fluid was positive for EBV and negative for the other neurotropic viruses. In blood, the serology test for EBV with IgG was positive, while IgM and heterophile antibody tests were negative. CONCLUSIONS. EBV infection can give rise to acute disseminated encephalomyelitis or affect several locations in the central nervous system, especially the cerebellum. Clinical pictures mimicking HSV-1 are less frequent. When encephalitis is related to viral reactivation, precipitating factors can be detected, as in our case.. Encefalitis por el virus de Epstein-Barr: descripcion de un caso clinico y revision de la bibliografia.. Introduccion. La infeccion por el virus de Epstein-Barr (VEB) puede dar lugar –tanto como primoinfeccion, reactivacion o infeccion cronica activa– a varias formas clinicas de afectacion del sistema nervioso central. Presentamos un caso de encefalitis por VEB producido por reactivacion virica en un paciente inmunocompetente, que inicialmente simulaba, desde el punto de vista clinico y electroencefalografico, una encefalitis por virus herpes simple tipo 1 (VHS-1). Caso clinico. Varon de 51 años con antecedente de herpes zoster dorsal en los dias previos. Acudio a urgencias por un cuadro de siete dias de duracion de cefalea opresiva holocraneal y febricula; 24 horas antes de su ingreso, padecia somnolencia y alteracion del lenguaje. En la exploracion neurologica presentaba rigidez nucal y disfasia. En el liquido cefalorraquideo se evidencio pleocitosis (422 celulas/mm3) con un 98% de mononucleares, y proteinorraquia y glucorraquia normales. Resonancia magnetica cerebral normal y electroencefalograma con descargas epileptiformes lateralizadas periodicas en la region temporal izquierda. Se trato con aciclovir intravenoso; una insuficiencia renal motivo su cambio a valaciclovir oral con resolucion clinica y mejoria de los parametros licuorales. La reaccion en cadena de la polimerasa en el liquido cefalorraquideo fue positiva para VEB y negativa para el resto de virus neurotropos. En sangre, la serologia para VEB con IgG resulto positiva, y negativa con IgM y anticuerpos heterofilos. Conclusiones. La infeccion por VEB puede dar lugar a una encefalitis aguda diseminada o afectar a varias localizaciones del sistema nervioso central, principalmente el cerebelo. Menos frecuentes son los cuadros imitadores de VHS-1. Cuando la encefalitis se relaciona con reactivacion viral pueden detectarse, como en nuestro caso, factores precipitantes.

Topics: Acute Kidney Injury; Acyclovir; Antibodies, Viral; Antiviral Agents; Cerebrospinal Fluid; Drug Substitution; Electroencephalography; Encephalomyelitis, Acute Disseminated; Epilepsy; Epstein-Barr Virus Infections; Herpes Zoster; Herpesvirus 4, Human; Humans; Immunoglobulin G; Immunoglobulin M; Magnetic Resonance Imaging; Male; Middle Aged; Valacyclovir; Valine

Topics: Acyclovir; Aged; Antiviral Agents; Cross-Sectional Studies; Diagnosis, Differential; DNA, Viral; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Male; Middle Aged; Neuralgia, Postherpetic; Neurologic Examination; Opportunistic Infections; Pain Measurement; Polymerase Chain Reaction; Prognosis; Quality of Life; Risk Factors

Koebner phenomenon is defined as a nonspecific skin stimulus eliciting a disease skin reaction. The nature of the skin trauma varies greatly and includes areas of thermal injury, excoriations, surgical incisions, and scars. We report a patient with recent onset of systemic lupus erythematosus who developed Herpes zoster on immunosuppressant medication. Two weeks after resolution of the vesicles, the patient presented with new ulcerative reddish lesions over the herpes zoster scare and worsening of her malar rash without evidence of worsening of any other organ. Koebner phenomenon was suspected. We review the literature on Koebner phenomenon in SLE.

Topics: Acyclovir; Adolescent; Antiviral Agents; Female; Herpes Zoster; Humans; Immunosuppressive Agents; Lupus Erythematosus, Discoid; Lupus Erythematosus, Systemic; Skin

Necrotising fasciitis is a rare severe infection of the soft tissues and deep fascia, which is associated with a significant level of mortality. Involvement of the head and neck is uncommon, and necrotising fasciitis of the periorbital area even rarer. We present a case of bilateral periorbital necrotising fasciitis following shingles in an otherwise healthy immunocompetent patient.

Topics: Acyclovir; Debridement; Eye Infections, Viral; Eyelid Diseases; Fasciitis, Necrotizing; Female; Follow-Up Studies; Herpes Zoster; Herpesvirus 3, Human; Humans; Middle Aged; Rare Diseases; Severity of Illness Index; Treatment Outcome

Herpes zoster is due to the reactivation of the virus causing varicella, called varicella-zoster virus. It affects peripheral nerves and causes painful skin and nerve lesions. This pain may last for months, or years after the initial lesions have resolved: post-herpetic neuralgia is the most frequent complication. Antiviral drugs, acting directly on the infectious agent are prescribed to reduce or block viral replication, relieve pain, and shorten symptom duration, especially for people of 50 years of age or more. However, there is currently no systematic collection of data concerning the effectiveness of antiviral drugs administered outside of clinical trials. This review evaluates the effectiveness of antiviral drugs on: (a) the intensity of pain and progression of the rash during the acute phase of herpes zoster, and (b) the frequency, intensity, and duration of post-herpetic neuralgia. During the acute phase, antiviral drugs (acyclovir, valacyclovir and famcyclovir) significantly reduce the intensity of acute pain, accelerate the healing of the vesicular rash, and reduce the duration of viral excretion. According to some authors, these drugs taken at an early stage of the disease would help to prevent the development of post herpetic neuralgia. But for others, there is no convincing evidence that antiviral drugs reduce the risk of painful complications.

Topics: 2-Aminopurine; Acute Disease; Acyclovir; Age Factors; Aged; Antiviral Agents; Drug Administration Schedule; Drug Evaluation; Early Diagnosis; Famciclovir; Global Health; Herpes Zoster; Humans; Meta-Analysis as Topic; Middle Aged; Neuralgia, Postherpetic; Randomized Controlled Trials as Topic; Valacyclovir; Valine

There is lack of consensus from randomized controlled trials on the efficacy of antivirals in the management of herpes zoster. Therefore, a systematic review and meta-analysis was undertaken to provide better understanding of effectiveness of antivirals in management of herpes zoster.. A total of 12 randomized controlled trials with 7,277 patients were included in the review. Trials compared one antiviral to another (aciclovir, valaciclovir, famciclovir or brivudin) for a minimum of 7 days in immunocompetent patients presenting with herpes zoster diagnosed within 72 h of symptom onset. Primary outcome was reduction in pain.. Compared with aciclovir, valaciclovir showed significant reduction in herpes-zoster-associated pain up to 112 days. The largest risk reduction in pain (36%) was seen at 21-30 days (relative risk [RR] 0.64, 95% CI 0.59, 0.70) with number needed to treat to benefit (NNT) of 3 (95% CI 2.7, 3.8). Famciclovir was also superior to aciclovir with a 46% reduction in risk of pain at 28-30 days (RR 0.54, 95% CI 0.48, 0.68) with NNT of 3 (95% CI 2, 5). Time to lesion healing and adverse effect profile was comparable.. Evidence from quality trials have shown significant reduction in risk of pain with valaciclovir and famciclovir for management of herpes zoster including ophthalmicus. Valaciclovir or famciclovir should be preferred treatment options in patients with herpes zoster as they both provide significant reduction in risk of herpes-zoster-associated pain. Furthermore, the superior pharmacokinetics and more convenient dosing regimens with the use of valaciclovir and famciclovir clearly make them the preferred treatment option.

Topics: 2-Aminopurine; Acyclovir; Antiviral Agents; Bromodeoxyuridine; Famciclovir; Herpes Zoster; Herpesvirus 3, Human; Humans; Pain Management; Randomized Controlled Trials as Topic; Valacyclovir; Valine

Widespread use of varicella vaccine in the United States has drastically changed the epidemiology of the disease. Although chickenpox is no longer a ubiquitous childhood infection, varicella-zoster virus continues to circulate in the community and nonimmune pregnant women remain at risk. Varicella can cause severe infection in pregnant women, often complicated by viral pneumonia. Maternal varicella occurring in the first half of pregnancy can cause the rare but devastating congenital varicella syndrome, whereas infection in the late stages of pregnancy may cause neonatal varicella. The best approach to avoiding the morbidity and mortality associated with chickenpox in pregnancy is to screen and vaccinate susceptible reproductive-age women.

Topics: Acyclovir; Antiviral Agents; Chemoprevention; Chickenpox; Chickenpox Vaccine; Disease Susceptibility; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunization, Passive; Immunoglobulins; Immunologic Factors; Infant, Newborn; Pneumonia, Viral; Postnatal Care; Preconception Care; Pregnancy; Pregnancy Complications, Infectious; Prenatal Care

We describe an immunocompetent 45-year-old woman who had four episodes of neurological disease (meningoencephalitis, multifocal vasculopathy, myelitis and inflammatory brain stem disease) produced by varicella zoster virus (VZV) over an 11-month period, all in the absence of rash. The cerebrospinal fluid (CSF) contained anti-VZV IgG antibody, but not VZV DNA throughout her illness, reaffirming the superiority of detection of anti-VZV IgG in CSF compared to VZV DNA in diagnosing VZV infection of the nervous system. Moreover, 3 of 7 CSF samples examined during the 11 months showed a VZV-induced pleocytosis consisting predominantly of polymorphonuclear cells (PMNs), and 4 of 7 samples also contained increased numbers of red blood cells (RBCs). Because increased PMNs and RBCs in CSF can also occur in patients with central and peripheral nervous system disease produced by cytomegalovirus (CMV), the differential diagnosis of chronic nervous system infection with increased PMNs and RBCs in CSF should include analyses for both VZV and CMV.

Topics: Acyclovir; Antiviral Agents; Cell Count; Central Nervous System Infections; Erythrocytes; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Leukocytosis; Magnetic Resonance Imaging; Middle Aged; Neutrophils; Recurrence; Treatment Outcome

Varicella zoster virus infection, which causes chickenpox and herpes zoster (HZ), is not uncommon in the general population. Varicella zoster virus can be latent in cranial nerve or dorsal root ganglia, and reactivate several decades later to produce vesicles with post-herpetic neuralgia. HZ myelitis usually occurs in elderly or immunocompromised patients. We report here a case of HZ myelitis of the cervical spinal cord in a 35-year-old woman who was immunocompetent. Cervical myelitis developed 1 month after the eruption of vesicles. Pure sensation loss was limited initially from the C2 to T1 dermatomes, but later progressed to lower limb sensory loss and sphincter function impairment. The patient's motor function was also mildly affected. Despite the initial rapid neurological deterioration, the symptoms dramatically improved after 5 days of parenteral acyclovir and steroid administration with rehabilitation. We therefore propose that early medical intervention is necessary for better and earlier recovery.

Topics: Acyclovir; Adult; Antiviral Agents; Cervical Vertebrae; Female; Herpes Zoster; Humans; Myelitis

Valacyclovir (VACV) is used increasingly to treat herpes zoster, although neuropsychiatric symptoms [VACV neurotoxicity (VAN) or acyclovir neurotoxicity], may accompany use of this drug. To promote awareness of this rare condition, we describe here two clinical cases of VAN we previously reported and review 20 cases from the literature. In all cases, chronic or acute renal failure preceded VAN. The symptoms of VAN varied, but disturbances of consciousness and hallucination occurred most commonly. When acute renal failure was due to the drug, recovery from both the disturbance of consciousness and renal failure followed within several days after discontinuation of VACV. Early recognition and diagnosis will ensure effective treatment of VAN.

Topics: Acute Kidney Injury; Acyclovir; Adult; Aged; Antiviral Agents; Consciousness Disorders; Female; Hallucinations; Herpes Zoster; Humans; Kidney Failure, Chronic; Male; Middle Aged; Neurotoxicity Syndromes; Valacyclovir; Valine

Topics: Accessory Nerve Diseases; Acyclovir; Antiviral Agents; Cranial Fossa, Posterior; Electromyography; Glossopharyngeal Nerve Diseases; Herpes Zoster; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Neck; Rare Diseases; Syndrome; Thymoma; Thymus Neoplasms; Tomography, X-Ray Computed; Vagus Nerve Diseases

Zona zoster infection is often associated with painful erythematous vesicular eruptions of the skin or mucous membranes. Varicella zoster virus which stays latent in the sensorial root ganglia causes zona zoster infection. The most recognized feature of zona zoster is the dermatomal distribution of vesicular rashes. In the present case report, we state an unusual presentation of sacral zona zoster with urinary retention, erectile dysfunction and meningitis.

Topics: Acyclovir; Adult; Antiviral Agents; Erectile Dysfunction; Ganglia, Spinal; Herpes Zoster; Humans; Male; Meningitis, Viral; Sacrum; Treatment Outcome; Urinary Catheterization; Urinary Retention

Topics: Acetaminophen; Acyclovir; Administration, Oral; Adult; Aged; Analgesics, Non-Narcotic; Antiviral Agents; Chickenpox; Child, Preschool; Female; Herpes Simplex; Herpes Zoster; Herpes Zoster Ophthalmicus; Humans; Immunocompetence; Infant, Newborn; Pregnancy; Pregnancy Complications, Infectious; Prognosis; Recurrence; Seroepidemiologic Studies; Valacyclovir; Valine

As reflections by the recipient for the Japanese society for vaccinology Takahashi award, clinicopathologic understanding and control of varicella-zoster virus (VZV) infection was briefly reviewed. In 1974, a live varicella vaccine was developed by attenuating the Oka strain of VZV after the passages in non-human cells at a low temperature. The vaccine was immunogenic, well tolerated, and effective, and distributed worldwide so far. For post-exposure prophylaxis of varicella, the vaccine and acyclovir is effectively used in the incubation period of varicella. The delayed type hypersensitivity to VZV skin test antigen was applied for evaluation of cell-mediated immunity to VZV which is commercially available in Japan. The biphasic viremia during incubation period of varicella and airborne spread of VZV from varicella patients and from herpes zoster patients with localized lesions were shown by the virus isolation or by detection of the virus DNA.

Topics: Acyclovir; Antiviral Agents; Chickenpox; Chickenpox Vaccine; Herpes Zoster; Herpesvirus 3, Human; Humans; Skin Tests

Varicella myelitis is very rarely observed in healthy adult. We report the case of 25-year-old nursing care worker who suffered from chickenpox for the first time. Approximately 2 weeks prior to the development of the symptoms, she cared for an old man who suffered from herpes zoster. She was admitted to our hospital, and she complained of weakness and paresthesia in the lower limbs. Subsequently, she experienced vesicorectal disorders: this was followed 5 days later by the appearance of a rash. Spinal T2-weighted MR images showed a high-intensity lesion in the spinal cord at the level of Th9/10, and both IgM-type anti-VZV antibodies and VZV-DNA were present in her cerebrospinal fluid. Treatment comprising a combination of acyclovir at 1,500 mg/day for 14 days and gamma-globulin with high titer of IgG-type anti-VZV antibodies at 5 g/day for 5 days result in remarkable improvement. She was able to walk again. The high-intensity lesion in the spinal T2-weighted MR images disappeared. Urinary dysfunction disappeared completely after 5 months. Care persons without anti-IgG antibodies against VZV are at a high risk of contracting varicella infection. Guidelines for infection control in home care, as well as hospitals, are necessary for caregivers.

Topics: Acyclovir; Adult; Caregivers; Female; gamma-Globulins; Health Personnel; Herpes Zoster; Humans; Infection Control; Infectious Disease Transmission, Patient-to-Professional; Male; Myelitis; Nursing Care; Occupational Diseases; Occupational Exposure; Risk

To review the evidence regarding treatment of herpes zoster (HZ) in the short-term, focusing on the prevention of postherpetic neuralgia (PHN).. The evidence relating to treatment of HZ is derived mainly from randomized controlled trials (level I evidence).. Antiviral drugs might have some effect on the severity of acute pain and on the duration of skin lesions. Corticosteroids also alleviate acute pain. Oral antiviral medication reduces the risk of eye complications in patients with ophthalmic HZ. There is no convincing evidence that antiviral medication reduces the risk of PHN. Some studies, however, have shown that famciclovir and valacyclovir shorten the duration of PHN. The effectiveness of amitriptyline or cutaneous and percutaneous interventions in preventing PHN has not been proven.. Oral antiviral drugs should be prescribed to elderly HZ patients with high risk of PHN. Moreover, these drugs should be prescribed to all patients at the first signs of ophthalmic HZ, irrespective of age or severity of symptoms.

Topics: 2-Aminopurine; Acyclovir; Antiviral Agents; Famciclovir; Glucocorticoids; Herpes Zoster; Herpes Zoster Ophthalmicus; Humans; Neuralgia, Postherpetic; Prednisolone; Time Factors; Valacyclovir; Valine

We report a case of varicella-zoster vasculopathy that occurred in a 42-year-old renal transplant recipient with concurrent vertebral artery aneurysm and dissection. The patient was successfully treated with embolization and acyclovir therapy. Here, we review the English literature regarding the association of varicella-zoster virus infection with cerebral aneurysm.

Topics: Acyclovir; Adult; Anticoagulants; Antiviral Agents; Embolism; Herpes Zoster; Herpesvirus 3, Human; Humans; Intracranial Aneurysm; Male; Vertebral Artery

The objective of this article is to provide evidence-based recommendations for the management of patients with herpes zoster (HZ) that take into account clinical efficacy, adverse effects, impact on quality of life, and costs of treatment. Systematic literature reviews, published randomized clinical trials, existing guidelines, and the authors' clinical and research experience relevant to the management of patients with HZ were reviewed at a consensus meeting. The results of controlled trials and the clinical experience of the authors support the use of acyclovir, brivudin (where available), famciclovir, and valacyclovir as first-line antiviral therapy for the treatment of patients with HZ. Specific recommendations for the use of these medications are provided. In addition, suggestions are made for treatments that, when used in combination with antiviral therapy, may further reduce pain and other complications of HZ.

Topics: 2-Aminopurine; Acyclovir; Analgesics; Anti-Inflammatory Agents; Antiviral Agents; Bromodeoxyuridine; Famciclovir; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunocompetence; Immunocompromised Host; Valacyclovir; Valine

We have analysed zoster-associated pain treated with valaciclovir (VCV) in immunocompetent patients with acute herpes zoster over 6 months, and evaluated the safety of VCV. We know of no reports that evaluate postherpetic neuralgia (PHN) treated with VCV for 6 months. Predisposing factors that influence PHN were age (over 60 years), clustered vesicles, severity of eruption, sleep disturbance, and hypesthesia. Timing of the administration of VCV before or after the onset of rash did not influence the incidence of PHN. No serious adverse reactions were observed during the administration of VCV.

Topics: Acyclovir; Administration, Oral; Adolescent; Adult; Aged; Aged, 80 and over; Antiviral Agents; Female; Follow-Up Studies; Herpes Zoster; Humans; Immunocompetence; Kaplan-Meier Estimate; Male; Middle Aged; Neuralgia, Postherpetic; Pain Measurement; Surveys and Questionnaires; Treatment Outcome; Valacyclovir; Valine

Topics: Acyclovir; Animals; Antiviral Agents; DNA, Viral; Drug Resistance, Viral; Herpes Simplex; Herpes Zoster; Herpesvirus 3, Human; Humans; RNA, Viral; Simplexvirus; Thymidine Kinase

Topics: 2-Aminopurine; Acyclovir; Antiviral Agents; Famciclovir; Herpes Zoster; Herpes Zoster Vaccine; Humans; United States; Valacyclovir; Valine

Ophthalmological and cervical involvement of herpes zoster virus ranks second and third, respectively, in terms of localization frequency. Involvement of the cranial nerves is a particular sign of complications, notably ocular complications, possibly compromising the visual or facial prognosis through involvement of the VIIth nerve, which is responsible for facial paralysis. These types of involvement should be rapidly diagnosed and treated so as to limit these complications. The pain associated with herpes zoster remains frequent and difficult to treat, even if today the criteria for defining postzoster pain is increasingly refined. Antalgic and antiviral treatment should be initiated early, from the very first signs, to attempt to reduce the incidence of this postzoster pain. The risk factors, associated with the development of postzoster pain are age over 50 years, the severity of the skin rash and the intensity of the acute pain, and the existence of a prodromic pain phase before onset. The European Federation of Neurological Societies has recently published guidelines on the pharmacological treatments for postzoster pain. Nerve block treatments remain at a limited evidence level. Patients with postzoster pain should be managed by teams specializing in pain management as soon as conventional treatments fail.

Topics: Acyclovir; Administration, Cutaneous; Analgesics; Antiviral Agents; Cranial Nerves; Facial Pain; Herpes Zoster; Herpes Zoster Vaccine; Humans; Neck Pain

Topics: Acyclovir; Amantadine; Anti-HIV Agents; Antiviral Agents; Cytomegalovirus Infections; Herpes Simplex; Herpes Zoster; HIV Infections; Humans; Influenza, Human; Oseltamivir; Protease Inhibitors; Reverse Transcriptase Inhibitors

Viral skin infections are common findings in organ transplant recipients. The most important etiological agents are the group of human herpesviruses (HHV), human papillomaviruses (HPV), and molluscum contagiosum virus. HHV that are important in this group of patients are herpes simplex virus (HSV) types 1 and 2, varicella-zoster virus (VZV), cytomegalovirus (CMV), Epstein-Barr virus (EBV), HHV-6 and -7, and HHV-8, which causes Kaposi sarcoma (KS). HSV infections are characterized by their ability to establish latency and then reactivate at a later date. The most common manifestations of HSV infection in organ transplant recipients are mucocutaneous lesions of the oropharynx or genital regions. Treatment is usually with acyclovir, valaciclovir, or famciclovir. Acyclovir resistance may arise although the majority of acyclovir-resistant strains have been isolated from AIDS patients and not organ transplant recipients. In such cases, alternatives such as foscarnet, cidofovir, or trifluridine may have to be considered. VZV causes chickenpox as well as herpes zoster. In organ transplant recipients, recurrent herpes zoster can occur. Acute chickenpox in organ transplant patients should be treated with intravenous acyclovir. CMV infection occurs in 20-60% of all transplant recipients. Cutaneous manifestations, which include nonspecific macular rashes, ulcers, purpuric eruptions, and vesiculobullous lesions, are seen in 10-20% of patients with systemic infection and signify a poor prognosis. The present gold standard for treatment is ganciclovir, but newer drugs such as valganciclovir appear promising. EBV is responsible for some cases of post-transplant lymphoproliferative disorder, which represents the greatest risk of serious EBV disease in transplant recipients. HHV-6 and HHV-7 are two relatively newly discovered viruses and, at present, the body of information concerning these two agents is still fairly limited. KS is caused by HHV-8, which is the most recently discovered lymphotrophic HHV. Iatrogenic KS is seen in solid-organ transplant recipients, with a prevalence of 0.5-5% depending on the patient's country of origin. HPV is ubiquitous, and organ transplant recipients may never totally clear HPV infections, which are the most frequently recurring infections in renal transplant recipients. HPV infection in transplant recipients is important because of its link to the development of certain skin cancers, in particular, squamous cell carcinoma. Regular surve

Topics: 2-Aminopurine; Acyclovir; Antiviral Agents; Cidofovir; Cytomegalovirus Infections; Cytosine; Drug Administration Schedule; Epstein-Barr Virus Infections; Famciclovir; Foscarnet; Herpes Zoster; Herpesviridae Infections; Humans; Immunocompromised Host; Molluscum Contagiosum; Organ Transplantation; Organophosphonates; Papillomavirus Infections; Skin Diseases, Viral; Trifluridine; Valacyclovir; Valine

Topics: Acyclovir; Antiviral Agents; Herpes Simplex; Herpes Zoster; Herpesvirus 1, Human; Herpesvirus 2, Human; Humans; Meningitis, Aseptic; Meningitis, Viral; Polymerase Chain Reaction

Topics: Acyclovir; Antiviral Agents; Herpes Simplex; Herpes Zoster; Humans; Immunocompromised Host; Secondary Prevention; Severity of Illness Index; Valacyclovir; Valine

Topics: Acyclovir; Adrenal Cortex Hormones; Antiviral Agents; Drug Therapy, Combination; Eye Infections, Viral; Herpes Simplex; Herpes Zoster; Humans; Valacyclovir; Valine; Vitrectomy

Genital herpes is the most prevalent sexually transmitted infection in the USA. While sometimes mild in severity, it can be a distressing and painful chronic condition. Likewise, herpes labialis and herpes zoster can be both physically and psychologically painful. While there is no cure for these conditions, treatment to alleviate symptoms, suppress recurrences and reduce transmission has been drastically improved over the past 20 years with the use of guanine nucleoside antivirals, such as valacyclovir hydrochloride (Valtrex), GlaxoSmithKline) the highly bioavailable prodrug of acyclovir (Zovirax((R)), GlaxoSmithKline), and famciclovir (Famvir, Novartis), a highly bioavailable prodrug of penciclovir (Denavir, Novartis). Clinical trials involving approximately 10,000 patients (including patients from nongenital herpes studies, such as herpes zoster) have assessed the safety and efficacy of valacyclovir in the treatment of initial genital herpes outbreaks, episodic treatment of recurrent episodes and daily suppressive therapy. It was shown that valacyclovir has similar efficacy to acyclovir in the episodic and suppressive treatment of genital herpes. Valacyclovir is the only antiviral drug approved for a once-daily dose of suppressive therapy for genital herpes, as well as the only antiviral drug US FDA approved for a 3-day regimen of episodic treatment of recurrent genital herpes. In addition, valacyclovir is also indicated in the reduction of the sexual transmission of herpes simplex virus infection and for the treatment of herpes labialis. In herpes zoster, valacyclovir is more effective than acyclovir or placebo (and as equally effective as famciclovir) in shortening the length and severity of herpes zoster-associated pain and postherpetic neuralgia. Valacyclovir has an acceptable safety profile in patients with herpes simplex and herpes zoster. The less frequent dosing regimen makes it an attractive option in the treatment of genital herpes and other viral infections, and may contribute to increased patient adherence to therapy.

Topics: Acyclovir; Antiviral Agents; Drug Resistance, Viral; Herpes Genitalis; Herpes Zoster; Humans; Recurrence; Valacyclovir; Valine

Topics: Acyclovir; Adolescent; Adult; Age Factors; Antiviral Agents; Chickenpox; Chickenpox Vaccine; Child; Diagnosis, Differential; Female; Herpes Zoster; Herpes Zoster Ophthalmicus; Herpes Zoster Oticus; Herpesvirus 3, Human; Herpesvirus Vaccines; Humans; Infant; Infant, Newborn; Male; Middle Aged; Pregnancy; Pregnancy Complications, Infectious; Time Factors; Vaccination

Topics: 2-Aminopurine; Acute Disease; Acyclovir; Administration, Oral; Adult; Age Factors; Analgesics, Non-Narcotic; Analgesics, Opioid; Anticonvulsants; Antidepressive Agents, Tricyclic; Antiviral Agents; Bromodeoxyuridine; Child; Drug Therapy, Combination; Famciclovir; Female; Herpes Zoster; Herpesvirus 3, Human; Herpesvirus Vaccines; Humans; Male; Middle Aged; Neuralgia, Postherpetic; Pain; Prodrugs; Risk Factors; Sex Factors; Time Factors; Vaccination; Valacyclovir; Valine

Antiviral agents play a key role in the prevention and treatment of varicella zoster virus (VZV) disease in immunosuppressed patients. Randomized trials show that aciclovir is effective in preventing VZV reactivation disease; however, no consensus exists on dose, duration and patient population for its use. The recent shortage of VZV-specific immunoglobulin has generated renewed interest in the use of antiviral agents as post-exposure prophylaxis. The use of antiviral agents for post-exposure prophylaxis is not supported by randomized trials, but uncontrolled experience suggests that it might be a reasonable alternative if varicella-specific immunoglobulin is not available. Current evidence on the use of antiviral agents in the prevention of reactivation disease and management of exposure to VZV is discussed.

Topics: Acyclovir; Antiviral Agents; Chemoprevention; Chickenpox; Hematopoietic Stem Cell Transplantation; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunocompromised Host; Valacyclovir; Valine; Virus Activation

Herpes zoster (HZ) presents as a cutaneous vesicular eruption in the area innervated by the affected sensory nerve, usually associated with severe pain. Oral manifestations of HZ appear when the mandibular or maxillary divisions of the trigeminal nerve are affected.. This is a case report of a 63-year-old woman with HZ infection with trigeminal nerve involvement that led to a rapid loss of alveolar bone and exfoliation of two teeth.. The initial intraoral examination showed redness of the alveolar mucosa and gingiva of the lower right quadrant with multiple well-delimited and painful erosive lesions affecting the attached gingiva around the teeth. Two weeks later, teeth number 27 (lower right canine) and 28 (lower right first premolar) had class III mobility, flow of purulent exudate from the gingival sulcus, and deep pockets (>11 mm). The radiological examination showed advanced alveolar bone loss around both teeth. The prognosis for teeth number 27 and 28 was considered hopeless, and they were extracted. Due to extensive necrosis there was no interdental alveolar bone. The case is presented with a review of clinical data from patients with trigeminal HZ infection associated with osteonecrosis or exfoliation of teeth previously reported in the literature. The mechanisms by which the HZ infection leads to the alveolar bone necrosis are discussed.. Extensive osteonecrosis and exfoliation of teeth in the area innervated by the nerve affected by HZ has been reported after HZ infection. Clinicians should be aware of this possible outcome after a trigeminal HZ infection.

Topics: Acyclovir; Alveolar Bone Loss; Antiviral Agents; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Mandibular Diseases; Middle Aged; Osteonecrosis; Tooth Exfoliation; Trigeminal Nerve

The amount of antiviral drugs have increased recently. Many viruses treated as a mild pathogens has turned out to cause different complications and severe diseaseses in elderly people and immunocomprised patients. The authors have made an attempt of presenting on the basis of scientific reports the principles of antiviral prophylaxis and treatment. The first part is focused on infections caused by DNA viruses.

Topics: Acyclovir; Aged; Antiviral Agents; Chickenpox; DNA Viruses; Female; Herpes Zoster; Humans; Male; Vaccination; Virus Diseases

Topics: Acyclovir; Age Distribution; Antiviral Agents; Child; Diagnosis, Differential; Drug Therapy, Combination; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunocompetence; Morpholines; Primary Health Care; Prognosis; Risk Factors; Silver Sulfadiazine; Valacyclovir; Valine; Virus Activation; Virus Latency

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

Varicella zoster virus (VZV) causes chicken pox (varicella) after which it establishes latency and can subsequently reactivate to cause herpes zoster. Central nervous system (CNS) complications can follow both primary infection and reactivation of VZV. The more serious manifestations arise when VZV invades the spinal cord or cerebral arteries after reactivation of the virus, causing diseases such as myelitis and focal vasculopathies. The International Herpes Management Forum (IHMF) has developed guidelines to aid in the diagnosis and management of CNS syndromes associated with VZV and these have focused on VZV vasculopathy. The new guidelines recommend that where VZV vasculopathy is suspected, cerebrospinal fluid (CSF) should be analysed by polymerase chain reaction (PCR) for VZV DNA. As VZV antibodies may be present in the CSF in the presence or absence of detectable VZV DNA, CSF should also be analysed for VZV-specific antibody if there is a high likelihood of CNS disease. Early diagnosis of these serious complications is important, as aggressive antiviral treatment can be effective. Patients with VZV focal vasculopathy should be treated with intravenous aciclovir (10 mg/kg every 8 h for adults, 500 mg/m2 body surface area for children) for 7 days. The immunocompromised patient may require longer treatment. However, treatment should be discontinued if negative results are obtained for both VZV DNA and anti-VZV antibody in CSF. Steroid therapy (prednisone 60-80 mg/day for 3-5 days) should be considered in VZV vasculopathy to reduce inflammation.

Topics: Acyclovir; Antiviral Agents; Central Nervous System Viral Diseases; Herpes Zoster; Herpesvirus 3, Human; Humans; Infusions, Intravenous; Practice Guidelines as Topic

Blistering disorders in childhood are usually difficult to diagnose and pose complicated management dilemmas. The incidence of herpes zoster in children with malignancy and immunodeficiency is greatly increased compared to normal children of comparable age. Although herpes zoster is known to occur in children with malignancy, the bullous form of herpes zoster is rare; to the authors' knowledge, there was no previous report of this phenomenon in children in general and in children with cancer in particular. The authors describe a 3.5-year-old girl who was diagnosed with acute lymphoblastic leukemia; 7 months after presentation, during chemotherapy treatment, she developed the bullous form of herpes zoster on her right hand. The authors describe the method of diagnosis and provide a review of the literature concerning this rare phenomenon. Recognizing this entity and differentiating it from other bullomatous conditions enable the application of appropriate treatment, without unnecessary delay.

Topics: Acyclovir; Antineoplastic Combined Chemotherapy Protocols; Antiviral Agents; Child, Preschool; DNA, Viral; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Polymerase Chain Reaction; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Skin Diseases, Vesiculobullous

The herpesviruses continue to produce considerable morbidity in man. Once infected with herpes simplex (HSV), the virus remains dormant within the nervous system and may reactivate if provoked by stress, trauma and/or other factors. To date, there is no cure, but antiviral medication can reduce duration and severity of symptoms and prophylaxis can suppress recurrent episodes of disease. The second-generation guanosine nucleosides, acyclovir and penciclovir, are effective inhibitors with low toxicity; both, however, have relatively low oral bioavailability. Subsequently, the orally bioavailable prodrugs valaciclovir and famciclovir have been introduced. These compounds offer high oral bioavailabilty and deliver acyclovir and penciclovir, respectively, to the target cells by means of more convenient dosing schedules. This short review points to recent experience with famciclovir in the management of HSV and varicella-zoster virus.

Topics: 2-Aminopurine; Acyclovir; Antiviral Agents; Biological Availability; Clinical Trials as Topic; Famciclovir; Guanine; Herpes Genitalis; Herpes Zoster; Humans; Male; Nervous System; Prodrugs

There are eight members of the herpesviridae family: herpes simplex virus-1 (HSV-1), HSV-2, varicella-zoster virus, Epstein-Barr virus, cytomegalovirus, human herpes virus-6, human herpes virus-7 and human herpes virus-8. The diseases caused by viruses of the herpesviridae family are treated with and managed by systemic and topical antiviral therapies and immunomodulating drugs. Because these viruses establish a latent state in hosts, antiherpetic agents, such as nucleoside analogues, only control symptoms of disease or prevent outbreaks, and cannot cure the infections. There is a need for treatments that require less frequent dosing, can be taken even when lesions are more advanced than the first signs or symptoms, and can treat resistant strains of the viruses without the toxicities of existing therapies. Immunomodulating agents, such as resiquimod, can act on the viruses indirectly by inducing host production of cytokines, and can thereby reduce recurrences of herpes. The new helicase primase inhibitors, which are the first non-nucleoside antiviral compounds, are being investigated for treatment of HSV disease, including infections resistant to existing therapy.

Topics: Acyclovir; Antiviral Agents; Cytomegalovirus; Drug Therapy; Herpes Simplex; Herpes Zoster; Herpesviridae; Herpesviridae Infections; Herpesvirus 3, Human; Herpesvirus 4, Human; Humans

Progressive outer retinal necrosis is a necrotizing herpetic retinopathy usually seen in immunocompromised patients. The authors describe two patients with this disease who initially had findings suggestive of an optic neuropathy. Vision declined after treatment with methylprednisolone, after which fundus examination became consistent with progressive outer retinal necrosis. These cases underscore the importance of careful examination of the retinal periphery before management of any presumed optic neuropathy with steroids.

Topics: Acyclovir; Adult; AIDS-Related Opportunistic Infections; Antiviral Agents; Cytomegalovirus Infections; Cytomegalovirus Retinitis; Diagnostic Errors; Diplopia; Disease Progression; Encephalitis, Viral; Female; Foscarnet; Herpes Zoster; Humans; Magnetic Resonance Imaging; Methylprednisolone; Middle Aged; Necrosis; Optic Neuritis; Paresis; Prednisone; Retina

Topics: 2-Aminopurine; Acyclovir; Amines; Antidepressive Agents, Tricyclic; Antiviral Agents; Arabinofuranosyluracil; Cyclohexanecarboxylic Acids; Famciclovir; Gabapentin; gamma-Aminobutyric Acid; Herpes Zoster; Humans; Neuralgia; Valacyclovir; Valine

Topics: Acyclovir; Follow-Up Studies; Herpes Zoster; Humans; Infant; Lower Extremity; Male; Rare Diseases; Risk Assessment; Skin Diseases, Viral; Treatment Outcome

Topics: Acyclovir; Antiviral Agents; Chickenpox; Diagnosis, Differential; Herpes Zoster; Herpesvirus 3, Human; Humans

Herpes zoster has been known since ancient times. It is a ubiquitous disease, occurring sporadically without any seasonal preference and is caused by the varicella-zoster virus. It may be defined as an endogenous relapse of the primary infection varicella. Herpes zoster is characterised by typical efflorescences in the innervation region of a cranial or spinal nerve and starts and ends with pain of varying intensity. Currently, several antiviral drugs are approved and many studies have shown that antiviral therapy, started early in the course of disease, can significantly reduce the risk and the duration of postherpetic neuralgia in elderly patients. The effects of all antivirals discussed in this article, given either orally or intravenously, are comparable with regards to the resolution of virus replication, prevention of dissemination of skin lesions and reduction of acute herpes zoster pain. Valaciclovir (valacyclovir), famciclovir and brivudine (brivudin) are comparably effective in the reduction of the incidence and/or prevention of zoster-associated pain and postherpetic neuralgia. Brivudine 125mg once daily is as effective as famciclovir 250mg three times daily in reducing the prevalence and the duration of zoster-associated pain and postherpetic neuralgia, especially if therapy is combined with a structured-pain therapy. The intensity of the therapy for pain should depend on the intensity of the pain that it is treating. Famciclovir and brivudine offer an advantage over other antivirals because they are administered less frequently; this is particularly relevant for elderly patients who may already be taking a number of medications for other diseases. Therefore, antiviral therapy in combination with adequate pain management should be given to all elderly patients as soon as herpes zoster is diagnosed.

Topics: 2-Aminopurine; Acyclovir; Age Factors; Aged; Analgesics; Antiviral Agents; Bromodeoxyuridine; Drug Therapy, Combination; Famciclovir; Herpes Zoster; Humans; Neuralgia; Pain Measurement; Valacyclovir; Valine

Over the past several years there have been many advances in the diagnosis and treatment of cutaneous infectious diseases. This review focuses on the three major topics of interest in the geriatric population: herpes zoster and postherpetic neuralgia (PHN), onychomycosis, and recent advances in antibacterial therapy. Herpes zoster in adults is caused by reactivation of the varicella-zoster virus (VZV) that causes chickenpox in children. For many years acyclovir was the gold standard of antiviral therapy for the treatment of patients with herpes zoster. Famciclovir and valacyclovir, newer antivirals for herpes zoster, offer less frequent dosing. PHN refers to pain lasting > or = 2 months after an acute attack of herpes zoster. The pain may be constant or intermittent and may occur spontaneously or be caused by seemingly innocuous stimuli such as a light touch. Treatment of established PHN through pharmacologic and nonpharmacologic therapy will be discussed. In addition, therapeutic strategies to prevent PHN will be reviewed. These include the use of oral corticosteroids, nerve blocks, and treatment with standard antiviral therapy. Onychomycosis, or tinea unguium, is caused by dermatophytes in the majority of cases, but can also be caused by Candida and nondermatophyte molds. Onychomycosis is found more frequently in the elderly and in more males than females. There are four types of onychomycosis: distal subungual onychomycosis, proximal subungual onychomycosis, white superficial onychomycosis, and candidal onychomycosis. Over the past several years, new treatments for this disorder have emerged which offer shorter courses of therapy and greater efficacy than previous therapies. The treatment of bacterial skin and skin structure infections in the elderly is an important issue. There has been an alarming increase in the incidence of gram-positive infections, including resistant bacteria such as methicillin-resistant Staphylococcus aureus (MRSA) and drug-resistant pneumococci. While vancomycin has been considered the drug of last defense against gram-positive multidrug-resistant bacteria, the late 1980s saw an increase in vancomycin-resistant bacteria, including vancomycin-resistant enterococci (VRE). More recently, strains of vancomycin-intermediate resistant S. aureus (VISA) have been isolated. Gram-positive bacteria, such as S. aureus and Streptococcus pyogenes are often the cause of skin and skin structure infections, ranging from mild pyodermas to compl

Topics: 2-Aminopurine; Acetamides; Acyclovir; Aged; Anti-Bacterial Agents; Antidepressive Agents, Tricyclic; Antiviral Agents; Famciclovir; Herpes Zoster; Humans; Itraconazole; Linezolid; Onychomycosis; Oxazolidinones; Skin Diseases, Infectious; Virginiamycin

Topics: Acyclovir; Administration, Oral; Adolescent; Adult; Chickenpox; Chickenpox Vaccine; Child; Child, Preschool; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Infant; Infant, Newborn; Injections, Intravenous; Male; Pregnancy; Pregnancy Complications, Infectious; Recurrence; Streptococcal Infections

Topics: Acyclovir; Adrenal Cortex Hormones; Amitriptyline; Antidepressive Agents, Tricyclic; Antiviral Agents; Herpes Zoster; Humans; Idoxuridine; Neuralgia

Topics: 2-Aminopurine; Acyclovir; AIDS-Related Opportunistic Infections; Anti-Infective Agents; Antifungal Agents; Antiprotozoal Agents; Antiretroviral Therapy, Highly Active; Antitubercular Agents; Antiviral Agents; Atovaquone; Azithromycin; Clarithromycin; Cytomegalovirus Infections; Drug Therapy, Combination; Famciclovir; Herpes Simplex; Herpes Zoster; Humans; Mycobacterium avium-intracellulare Infection; Mycoses; Naphthoquinones; Pneumonia, Pneumocystis; Toxoplasmosis; Trimethoprim, Sulfamethoxazole Drug Combination; Tuberculosis, Pulmonary; Valacyclovir; Valine

Topics: 2-Aminopurine; Acyclovir; Adrenal Cortex Hormones; Adult; Amines; Amitriptyline; Analgesics, Non-Narcotic; Antidepressive Agents, Tricyclic; Antiviral Agents; Cyclohexanecarboxylic Acids; Famciclovir; Gabapentin; gamma-Aminobutyric Acid; Herpes Zoster; Humans; Idoxuridine; Neuralgia

Varicella-zoster virus (VZV) causes 2 clinical illnesses, varicella (chickenpox) and herpes zoster (shingles). The purpose of this review is to describe the role of antiviral therapy in the treatment of VZV infections in healthy and immunocompromised children. Acyclovir is the drug of choice for varicella and herpes zoster. The route of administration may be intravenous or oral, depending on the immunocompetence of the host. The clinical impact of acyclovir therapy is related directly to its use early in the clinical course and to the likely susceptibility of the patient to severe or life-threatening VZV infection. Patients who have the most clinical benefit are otherwise healthy adolescents with varicella infection and high-risk populations of immunocompromised children who have varicella or herpes zoster. The morbidity and mortality of VZV infections are reduced substantially by initiating acyclovir treatment early in the course of the disease.

Topics: Acyclovir; Administration, Oral; Adolescent; Adult; Algorithms; Antiviral Agents; Chickenpox; Child; Child, Preschool; Clinical Trials as Topic; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunocompromised Host; Infant; Infant, Newborn; Injections, Intravenous; Time Factors

Any new patient with suspected genital herpes should have diagnostic testing with virus identification. Type-specific serological tests that distinguish between antibodies for type 1 and type 2 herpes simplex virus (HSV) may be useful to determine previous exposure but cannot be used to diagnose recurrences of genital herpes. Initial episodes of genital herpes usually require antiviral therapy, while recurrences may be treated with continuous antiviral suppression (if frequent) or episodic therapy; patient counselling and education (including how to recognise lesions) are essential. Topical or systemic therapy is available for initial and recurrent non-genital herpes simplex. Primary varicella infection (chickenpox) and herpes zoster (shingles) are usually diagnosed clinically, but can be confirmed by detection of varicella-zoster virus antigens or nucleic acid from swabs of lesions or by antibody tests. Antiviral therapy should be considered in chickenpox if disease is complicated or the patient is immunocompromised. In herpes zoster, antiviral therapy should be given within 72 hours of onset to patients aged over 50 years or with severe pain or neurological abnormalities to reduce the likelihood and duration of postherpetic neuralgia. The availability of effective antiviral therapy makes early diagnosis vital

Topics: Acyclovir; Adult; Antiviral Agents; Australia; Female; Herpes Simplex; Herpes Zoster; Herpesvirus 1, Human; Herpesvirus 2, Human; Herpesvirus 3, Human; Humans; Male; Pregnancy; Pregnancy Complications, Infectious

After herpes zoster, immunocompetent persons frequently experience chronic pain and considerable suffering. Zoster-associated pain has a complex pathophysiology that begins with viral damage and increased sensitization of peripheral sensory neurons. The enhanced afferent barrage from these neurons sensitizes spinal neurons and leads to loss of synapses from descending inhibitory fibers, resulting in central neuropathic pain and allodynia. Antiviral therapy of acute zoster limits this sequence of pathophysiologic mechanisms. There is no clear consensus regarding the optimal means of determining the benefits of antiviral therapy in the management of pain of herpes zoster. A novel statistical approach utilizing rates of disappearance of pain of differing pathophysiologic mechanisms is proposed.

Topics: 2-Aminopurine; Acyclovir; Analgesics; Antiviral Agents; Chronic Disease; Clinical Trials as Topic; Famciclovir; Herpes Zoster; Herpesvirus 3, Human; Humans; Meta-Analysis as Topic; Pain; Pain Measurement; Proportional Hazards Models; Treatment Outcome; Valacyclovir; Valine

(1) To describe the demographic features of patients with voiding dysfunction associated with herpes zoster; (2) to discuss the pathophysiology of voiding dysfunction associated with herpes zoster; and (3) to suggest the best management policy.. A retrospective study.. A university-affiliated medical center in Taiwan.. Four hundred twenty-three patients (mean age, 55.5y) admitted with the diagnosis of herpes zoster from 1988 to 2000.. Not applicable.. Dermatomal distribution of skin eruptions, urologic symptoms, treatment (catheterization, urecholine), clinical course of voiding dysfunction, and outcome.. Seventeen (mean age, 61.2+/-14.1y) of 423 patients (4.02%) with voiding dysfunction related to this virus infection were identified. Ten (58.8%) were men, and 7 (41.2%) were women. The incidence of dysfunction was as high as 28.6% if only lumbosacral dermatome-involved patients were considered. We classified urologic manifestations caused by herpes zoster into 3 groups: cystitis-associated (n=12), neuritis-associated (n=4), and myelitis-associated (n=1). Urinalysis revealed pyuria in all patients with cystitis-associated voiding dysfunction and microscopic hematuria in all patients with neuritis-associated voiding dysfunction. All patients, although receiving different treatment regimens for voiding dysfunction, regained a normal or balanced bladder within 8 weeks. No major urologic sequelae were noted.. Voiding dysfunction, although a transient course, is not uncommon in patients with herpes zoster involving lumbosacral dermatomes. Treatment with intermittent catheterization (our preferred choice) or indwelling catheter placement is recommended if the patients have prolonged difficulty in urination. This disease entity usually has a benign clinical course, and almost every patient will either regain normal voiding or, at least, balanced bladder function.

Topics: Academic Medical Centers; Acyclovir; Adult; Aged; Antiviral Agents; Bethanechol; Cystitis; Diagnosis, Differential; Electrodiagnosis; Female; Herpes Zoster; Humans; Lumbosacral Region; Male; Middle Aged; Parasympathomimetics; Remission, Spontaneous; Retrospective Studies; Risk Factors; Taiwan; Urinalysis; Urinary Bladder, Neurogenic; Urinary Catheterization; Urodynamics

Ramsay Hunt's hypothesis that herpes zoster oticus results from reactivation of the varicella zoster virus (VZV) in the geniculate ganglion is supported by the detection of viral genome in archival temporal bones of normals and Ramsay Hunt patients by the polymerase chain reaction. Ramsay Hunt syndrome is characterized by the presence of cochleovestibular symptoms in association with facial paralysis. VZV has also been demonstrated in the spiral and/or vestibular ganglion. Two cases are reported in which cochleovestibular symptoms outweighed the facial nerve symptoms, presumably representing VZV reactivation in the spiral and/or vestibular ganglion. From these observations and the known dormancy of VZV in non-neuronal satellite cells, it is argued that the cochleovestibular symptoms in Ramsay Hunt syndrome may result from VZV transmission across the nerves inside the internal auditory canal and that prompt treatment with an antiviral-corticosteroid combination might be justified in the management of any acute non-hydropic cochleovestibular syndrome.

Topics: Acyclovir; Antiviral Agents; Facial Paralysis; Female; Glucocorticoids; Hearing Loss, Sensorineural; Herpes Zoster; Herpes Zoster Oticus; Humans; Male; Middle Aged; Nystagmus, Pathologic; Prednisolone; Vertigo; Virus Activation

Herpetic laryngitis is a rare inflammatory disease caused by herpes simplex or herpes zoster virus. The propensity for spreading along peripheral nerves and within the central nervous system, with frank herpetic meningoencephalitis, is a rare complication. We present one case of herpetic laryngitis by reactivation of varicella zoster, with central nervous system spreading, and discuss the relevant literature on the pathophysiology, diagnosis, evaluation, and management of this disease.

Topics: Acyclovir; Aged; Antiviral Agents; Female; Herpes Zoster; Humans; Laryngitis; Laryngoscopy; Magnetic Resonance Imaging

Genital herpes is prevalent and sometimes debilitating. Likewise, herpes zoster ('shingles') can be painful and often disabling. The treatment of these conditions has been advanced over the past two decades by the introduction of guanosine nucleoside antivirals such as valacyclovir (Valtrex), Glaxo Wellcome), the highly bioavailable prodrug of acyclovir (Zovirax), Glaxo Wellcome). This review describes the pharmacology, pharmacokinetics, clinical efficacy and tolerability of valacyclovir and considers its clinical attributes in the context of those of the antivirals, acyclovir and famciclovir (Famvir), SmithKline Beecham). The data demonstrate that valacyclovir is more effective than placebo and as effective as other antivirals in the episodic and suppressive treatment of recurrent genital herpes. Valacyclovir is the only antiviral shown to be effective with a short (3-day) course in the episodic treatment of recurrent genital herpes, as well as with once-daily dosing for daily suppressive therapy. In herpes zoster, valacyclovir is as effective as famciclovir and more effective than either placebo or acyclovir at facilitating cutaneous healing and healing of zoster-associated pain and post-herpetic neuralgia. Valacyclovir is well tolerated, with convenient dosing frequencies for the treatment of genital herpes or herpes zoster, it also has the option for use as a short course therapy in the episodic treatment of recurrent genital herpes, all of which are important benefits in the management of these conditions.

Topics: Acyclovir; Antiviral Agents; Clinical Trials as Topic; Headache; Herpes Genitalis; Herpes Zoster; Humans; Nausea; Secondary Prevention; Tissue Distribution; Treatment Outcome; Valacyclovir; Valine

Varicella zoster virus (VZV) encephalitis is associated with large or small vessel vasculopathy. We report the case of a 67-year-old woman with a history of non-Hodgkin's lymphoma and cancers of the breast and colon, who presented with a zosteriform rash and Brown-Sequard syndrome. Despite 10 days therapy with intravenous acyclovir, meningoencephalitis developed and the patient died 15 days after onset of neurological symptoms. Autopsy showed meningoencephalomyelitis with necrotising vasculitis of leptomeningeal vessels, which is a rare complication of VZV, and we review the literature of the nine similar published cases. Polymerase chain reaction of cerebrospinal fluid for VZV was negative 6 days after onset of neurological symptoms, but became positive by day 10. Only one multinucleated giant cell with intranuclear Cowdry type A inclusions was seen within an endothelial cell in a leptomeningeal vessel involved by vasculitis.

Topics: Acyclovir; Aged; Antiviral Agents; Brain; Demyelinating Diseases; DNA, Viral; Encephalitis, Viral; Fatal Outcome; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Magnetic Resonance Imaging; Meningoencephalitis; Polymerase Chain Reaction; Spinal Cord; Vasculitis, Central Nervous System

Our goal was to determine if any treatment of acute herpes zoster alters the incidence or duration of postherpetic neuralgia (PHN), a common sequela in elderly patients.. We systematically searched MEDLINE and The Cochrane Library. We also examined the reference lists of identified trials and reviews.. We included all randomized controlled trials of treatments of zoster published in English that included assessment of pain at any time after rash healing.. Forty-two trials met inclusion criteria, and 2 reviewers independently evaluated them for methodologic quality and the statistical and clinical significance of results.. Four placebo-controlled trials of oral acyclovir with 692 patients provided marginal evidence for reduction in pain incidence at 1 to 3 months following zoster onset. Famciclovir significantly reduced duration but not incidence of PHN in one placebo-controlled trial of 419 patients. Valacyclovir significantly reduced duration but not incidence of PHN in one acyclovir-controlled trial of 1141 patients. Steroids had no effect on PHN. Amitriptyline for 90 days reduced pain incidence at 6 months in one placebo-controlled trial of 80 patients. A single trial of percutaneous electrical nerve stimulation (PENS) in 50 patients suggested a decrease in pain incidence at 3 and 6 months compared with famciclovir.. There is limited evidence that current interventions prevent or shorten PHN. Famciclovir and valacyclovir have been shown to reduce the duration of PHN in single published trials. Well-designed and larger trials of amitriptyline and PENS should be conducted.

Topics: Acute Disease; Acyclovir; Aged; Amitriptyline; Analgesics, Non-Narcotic; Antiviral Agents; Drug Therapy, Combination; Evidence-Based Medicine; Herpes Zoster; Humans; Middle Aged; Neuralgia; Randomized Controlled Trials as Topic; Steroids

Herpes zoster (commonly referred to as "shingles") and postherpetic neuralgia result from reactivation of the varicella-zoster virus acquired during the primary varicella infection, or chickenpox. Whereas varicella is generally a disease of childhood, herpes zoster and post-herpetic neuralgia become more common with increasing age. Factors that decrease immune function, such as human immunodeficiency virus infection, chemotherapy, malignancies and chronic corticosteroid use, may also increase the risk of developing herpes zoster. Reactivation of latent varicella-zoster virus from dorsal root ganglia is responsible for the classic dermatomal rash and pain that occur with herpes zoster. Burning pain typically precedes the rash by several days and can persist for several months after the rash resolves. With postherpetic neuralgia, a complication of herpes zoster, pain may persist well after resolution of the rash and can be highly debilitating. Herpes zoster is usually treated with orally administered acyclovir. Other antiviral medications include famciclovir and valacyclovir. The antiviral medications are most effective when started within 72 hours after the onset of the rash. The addition of an orally administered corticosteroid can provide modest benefits in reducing the pain of herpes zoster and the incidence of postherpetic neuralgia. Ocular involvement in herpes zoster can lead to rare but serious complications and generally merits referral to an ophthalmologist. Patients with postherpetic neuralgia may require narcotics for adequate pain control. Tricyclic antidepressants or anticonvulsants, often given in low dosages, may help to control neuropathic pain. Capsaicin, lidocaine patches and nerve blocks can also be used in selected patients.

Topics: Acyclovir; Analgesics; Anti-Inflammatory Agents; Anticonvulsants; Antidepressive Agents, Tricyclic; Antiviral Agents; Drug Therapy, Combination; Herpes Zoster; Humans; Neuralgia; Risk Factors; Steroids; Time Factors

Varicella zoster virus (VZV), the pathogen responsible for herpes zoster, belongs to the herpesvirus family and is sensitive to the antiviral drug aciclovir. However, the low oral bioavailability of aciclovir has to some extent limited its efficacy in the treatment of herpes zoster and has prompted the development of the more readily absorbed oral prodrug valaciclovir. In a large comparative study valaciclovir, (1000 mg 3 times daily for 7 days) was at least as effective as aciclovir (800 mg 5 times daily for 7 days) in controlling the symptoms of acute herpes zoster. Importantly, valaciclovir alleviated zoster-associated pain and postherpetic neuralgia significantly faster than aciclovir. A 14-day regimen of valaciclovir showed no significant advantage over the 7-day regimen. A smaller trial in Japanese patients focusing primarily on the cutaneous (rash) signs of herpes zoster confirmed the similar efficacy of valaciclovir and aciclovir in the 7-day regimen. This study did not follow all patients for a formal analysis of postherpetic neuralgia. Valaciclovir and aciclovir demonstrated similar efficacy for the control of cutaneous lesions and ocular complications in patients with zoster ophthalmicus. Preliminary results of a large controlled trial indicate that valaciclovir 1000 mg 3 times daily and famciclovir (the prodrug of penciclovir) 500 mg 3 times daily are of similar efficacy in speeding resolution of acute herpes zoster rash and shortening the duration of postherpetic neuralgia. Starting treatment later than 72 hours after rash onset did not significantly reduce the beneficial effect of valaciclovir on duration of zoster-associated pain (a continuum of pain that encompasses both acute pain and postherpetic neuralgia) in a large observational study, suggesting that valaciclovir might be effective when given later than previously thought. However, valaciclovir should ideally be given as soon as possible after symptoms appear. With the recommended regimen for the treatment of herpes zoster (1000 mg 3 times daily for 7 days) valaciclovir was well tolerated, with nausea and headache being the most commonly reported adverse events. The adverse events profile of the agent was similar to that seen with aciclovir or famciclovir.. The efficacy of valaciclovir for the treatment of herpes zoster has been confirmed and extended by follow-up studies in herpes zoster ophthalmicus, in Japanese patients, and in the wider primary care setting. Valaciclovir is at least equivalent to, and better in certain parameters than, aciclovir and appears to have similar efficacy to famciclovir 500 mg 3 times daily. Valaciclovir is a well tolerated first-line therapy with an established place in the treatment of immunocompetent patients with herpes zoster.

Topics: Acyclovir; Antiviral Agents; Herpes Zoster; Humans; Valacyclovir; Valine

With the US population aging steadily, herpes zoster represents a growing contributor to diminished quality of life. Dermatologic manifestations appear as immunity declines with age but rarely pose a significant threat, except in instances when ocular structures are involved. Pain is of more concern, because it usually accompanies and may even precede and persist after acute eruptions. In most young patients, pain is transient and bearable. Unfortunately, in the elderly--who are at highest risk for herpes zoster--pain is often more prolonged and more intense. In spite of a wide spectrum of interventions, palliative efforts remain rather ineffectual. At present, intervening as early as possible, ideally within 48 to 72 hours of disease onset, offers the greatest chance of minimizing neurologic sequelae. Inoculation with varicella vaccine in patients between ages 55 and 65 may prove to boost cell-mediated immunity sufficiently so that recrudescence of the varicella virus can be relegated to the annals of history.

Topics: 2-Aminopurine; Acute Disease; Acyclovir; Aged; Antiviral Agents; Chronic Disease; Famciclovir; Herpes Zoster; Humans; Neuralgia; Risk Factors; Valacyclovir; Valine

Topics: Acyclovir; Antiviral Agents; Diagnosis, Differential; Encephalitis, Viral; Herpes Zoster; Herpesvirus 3, Human; Humans; Prognosis; Vidarabine

Topics: Acyclovir; Antiviral Agents; Diagnosis, Differential; Herpes Zoster; Herpesvirus 3, Human; Humans; Infusions, Intravenous; Pneumonia, Viral; Prognosis; Vidarabine

Topics: Acyclovir; Antiviral Agents; Diagnosis, Differential; Herpes Zoster; Herpesvirus 3, Human; Humans; Prognosis

Herpes zoster (HZ) is a cutaneous viral infection of the skin that presents in a dermatomal distribution. It represents reactivation of herpes varicella zoster virus that has continued to exist in a latent form in the neurons of the posterior root ganglia. Although it is rare to see HZ in children, cases have been reported after exposure to varicella zoster in utero or during the first months of life. We present a case of HZ in a healthy 7-month-old girl who had had chickenpox at age 4 months.

Topics: Acyclovir; Antiviral Agents; Back; Female; Herpes Zoster; Humans; Infant; Skin Diseases, Viral

Noncontiguous multidermatomal herpes zoster is very rare in both immunocompetent and immunocompromised persons. Most of the reported cases have been limited to 2 noncontiguous dermatomes. This unique presentation has been referred to as zoster duplex unilateralis or bilateralis, depending on whether one or both halves of the body are involved. Granulomatous dermatitis at sites of herpes zoster scars, a rare isotopic response, has only been reported in persons with contiguous dermatomes of zoster. We describe an immunocompromised patient who developed herpes zoster in 7 disparate dermatomes. Three months after resolution of the zoster, the patient developed a granulomatous dermatitis in a zosteriform distribution at the sites of previous infection.

Topics: 2-Aminopurine; Acyclovir; Aged; Antiviral Agents; Dermatitis; Famciclovir; Granuloma; Herpes Zoster; Humans; Immunocompromised Host; Kidney Transplantation; Male; Prodrugs; Skin Diseases, Viral

LITERATURE REVIEW AND CASE REPORT: A literature review of Herpes zoster of the trigeminal nerve is presented. Included are differential diagnosis and treatment modalities that will enable the dental practitioner to identify and manage this disease. A case report is provided to amplify this timely information.

Topics: Acyclovir; Cranial Nerve Diseases; Dental Pulp Diseases; Diagnosis, Differential; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Middle Aged; Toothache; Trigeminal Nerve

The majority of peripheral seventh cranial nerve palsy cases remain without an identified etiology and will eventually be diagnosed as idiopathic or Bell's palsy. Some features of this condition may be characteristic of a viral infection. Indeed, several herpes viruses have been implicated as potential causative pathogens. Besides varicella-zoster virus, shown to cause Bell's palsy under the Ramsay-Hunt syndrome, recent years have seen an increased interest and focus on the possible herpes simplex virus type 1 (HSV-1) etiology in idiopathic facial paralysis. We review the clinical, biological and virological basis for the potential herpetic cause of Bell's palsy and the rational for antiviral therapy in this condition.

Topics: Acyclovir; Antiviral Agents; Bell Palsy; Herpes Simplex; Herpes Zoster; Herpesviridae Infections; Herpesvirus 1, Human; Herpesvirus 2, Human; Humans

Topics: 2-Aminopurine; Acyclovir; Antiviral Agents; Famciclovir; Guanine; Herpes Genitalis; Herpes Labialis; Herpes Simplex; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunocompromised Host; Prodrugs; Simplexvirus; Virus Replication

Topics: Acyclovir; Antiviral Agents; Cytomegalovirus Infections; Herpes Genitalis; Herpes Zoster; Humans; Prodrugs; Valacyclovir; Valine

The past several years have provided exciting advances in the management of herpes zoster in the normal host. In spite of these advances, a significant portion of zoster patients still have persistent complications from this disease. Persistent pain is the most debilitating sequela and it occurs in at least 15% of individuals over 50 years of age. Future research efforts must embrace alternative approaches for pain control.

Topics: 2-Aminopurine; Acyclovir; Antiviral Agents; Famciclovir; Herpes Zoster; Humans; Pain; Prednisone; Prodrugs; Valacyclovir; Valine

The introduction of varicella vaccine for immunization of healthy children is expected to have a gradual impact on the incidence of VZV infections in the population but antiviral therapy remains an important intervention in clinical practice. The efficacy of aciclovir for treatment of primary and recurrent VZV infections in children has reduced the morbidity and mortality of these illnesses in immunocompromised children dramatically. Oral aciclovir is an effective and useful for the management of varicella in healthy children and adolescents.

Topics: Acyclovir; Antiviral Agents; Chickenpox; Chickenpox Vaccine; Child; Herpes Zoster; Humans; Immunocompromised Host

Topics: 2-Aminopurine; Acyclovir; Adrenal Cortex Hormones; Antiviral Agents; Chickenpox; Famciclovir; Guanine; Herpes Zoster; Humans; Immunocompromised Host; Prodrugs; Valacyclovir; Valine

Topics: 2-Aminopurine; Acyclovir; Adult; Aged; Antiviral Agents; Chickenpox; Child; Child, Preschool; Diagnosis, Differential; Famciclovir; Female; Herpes Zoster; Herpes Zoster Ophthalmicus; Herpes Zoster Oticus; Humans; Immunocompromised Host; Infant; Infant, Newborn; Male; Middle Aged; Pregnancy; Pregnancy Complications, Infectious; Prodrugs; Valacyclovir; Valine

With increasing use of acyclovir and ganciclovir, primarily due to the increased number of AIDS and transplant patients, further cases of neurologic toxicity will undoubtedly be encountered. Discontinuation or dosage reduction of acyclovir and ganciclovir is necessary to manage neurologic toxicity that is directly attributed to either agent. Renal dysfunction is a known risk factor for acyclovir neurotoxicity, and case reports indicate that renal dysfunction may also be a risk factor for ganciclovir neurotoxicity. Since ganciclovir is structurally related to acyclovir, clinicians should monitor for signs and symptoms of neurotoxicity as they would with acyclovir until the risk factors are more clearly defined. Dosage reduction for both agents and increased monitoring should occur when renal dysfunction is present, to minimize the risk of neurotoxicity and other serious adverse effects. Tables 1 and 2 summarize the recommended dosages of acyclovir and ganciclovir, respectively, in the presence of renal dysfunction. However, as a few case reports describe, neurotoxicity from these agents has also occurred in patients with normal renal function. Therefore, clinicians should always remain vigilant in monitoring for signs of neurotoxicity when acyclovir or ganciclovir is administered, and have a high index of suspicion for these agents if neurotoxicity is encountered during therapy.

Topics: Acyclovir; AIDS-Related Opportunistic Infections; Antiviral Agents; Central Nervous System Diseases; Cytomegalovirus Infections; Ganciclovir; Herpes Simplex; Herpes Zoster; Humans; Renal Insufficiency; Risk Factors

Herpes zoster leukoencephalitis is a rare complication of varicella-zoster virus infection. Associated with high mortality, the majority of cases have been discovered postmortem; today, however, magnetic resonance imaging is being used successfully as an aid in the diagnosis of this disease. The first two reported cases of HIV-infected patients with herpes zoster leukoencephalitis who recovered clinically and showed complete resolution of the magnetic resonance demyelination images after acyclovir treatment are described. In addition, the cases of herpes zoster leukoencephalitis reported in the literature to date are reviewed.

Topics: Acyclovir; Adult; AIDS-Related Opportunistic Infections; Antiviral Agents; Encephalitis, Viral; Herpes Zoster; Humans; Male

Topics: 2-Aminopurine; Acyclovir; Antiviral Agents; Famciclovir; Herpes Genitalis; Herpes Zoster; Humans; Prodrugs; Valacyclovir; Valine

Herpes zoster is a common affliction in older patients, with up to 15% experiencing some residual pain in the distribution of the rash several months after healing. Despite numerous randomized clinical trials, the effect of treating herpes zoster with oral acyclovir in preventing postherpetic neuralgia remains uncertain because of conflicting results.. Meta-analysis of published randomized clinical trials on the use of acyclovir to prevent postherpetic neuralgia using the fixed-effects model of Peto.. Thirty clinical trials of treatment with oral acyclovir in immunocompetent adults were identified. After excluding studies with duplicate data, suboptimal and topical dosing, non-placebo-controlled or nonrandomized designs, and those using intravenous acyclovir, 5 trials were found to be homogeneous and were combined for analysis. From these trials, the summary odds ratio for the incidence of "any pain" in the distribution of rash at 6 months in adults treated with acyclovir was 0.54 (95% confidence interval, 0.36-0.81).. Treatment of herpes zoster with 800 mg/d of oral acyclovir within 72 hours of rash onset may reduce the incidence of residual pain at 6 months by 46% in immunocompetent adults.

Topics: Acyclovir; Antiviral Agents; Herpes Zoster; Humans; Incidence; Neuralgia; Odds Ratio; Randomized Controlled Trials as Topic; Severity of Illness Index; Treatment Outcome

Herpes simplex virus and varicella-zoster virus are common infections and are seen frequently in clinical practice. Infection with these viruses results in cutaneous lesions that may be diagnosed clinically, but widely available laboratory testing is useful for confirmation. Asymptomatic herpes simplex virus shedding, or "subclinical reactivation," likely occurs in all persons infected with herpes simplex virus and results in the transmission of virus despite the absence of signs or symptoms that suggest active infection. Oral and intravenous acyclovir are effective in treating initial and recurrent herpes simplex and varicella-zoster virus infections. The daily administration of oral acyclovir as suppressive therapy is effective in patients with frequently recurring genital infection with herpes simplex virus by reducing the number of symptomatic recurrences and the frequency of asymptomatic virus shedding. Two new antiviral agents, famciclovir and valacyclovir hydrochloride, have been approved for the short-term treatment of recurrent genital herpes simplex virus and recurrent zoster in nonimmunocompromised hosts. Famciclovir and valacyclovir demonstrate superior pharmacokinetics compared with acyclovir and allow for less frequent daily dosing with higher achievable serum drug concentrations. The attenuated live varicella virus vaccine is now available in the United States and prevents primary varicella-zoster virus infection in susceptible children and adults.

Topics: 2-Aminopurine; Acyclovir; Adult; Antiviral Agents; Chickenpox; Child; Famciclovir; Female; Herpes Simplex; Herpes Zoster; Humans; Male; United States; Valacyclovir; Valine

To alert practitioners to the danger of acyclovir neurotoxicity occurring in the presence of renal failure.. Two case reports of acyclovir neurotoxicity in the patients on continuous ambulatory peritoneal dialysis.. In one case neurotoxicity resulted from the use of a dosage regimen that would be appropriate in patients with normal renal function. In the other case, neurotoxicity occurred even though a reduced dose of acyclovir was given. Supportive management resulted in a complete recovery.. In patients with end stage renal failure with varicella zoster infections, when acyclovir is prescribed the loading dose should be 400 mg and the maintenance dose should be 200 mg twice daily.

Topics: Acyclovir; Aged; Antiviral Agents; Dose-Response Relationship, Drug; Female; Herpes Zoster; Humans; Kidney Failure, Chronic; Middle Aged; Nervous System; Peritoneal Dialysis, Continuous Ambulatory

Topics: Acyclovir; Antiviral Agents; Biological Availability; Herpes Zoster; Humans; Prodrugs; Valacyclovir; Valine

Topics: 2-Aminopurine; Acyclovir; Antiviral Agents; Famciclovir; Herpes Zoster; Humans; Valacyclovir; Valine

Postherpetic neuralgia is defined as pain persisting, or recurring, at the site of shingles at least three months after the onset of the acute rash. Thus defined, at least half of shingles sufferers over the age of 65 years develop postherpetic neuralgia. In addition to increasing age, less important risk factors for postherpetic neuralgia are pain severity of acute shingles and trigeminal distribution. Postherpetic neuralgia accounts for 11-15% of all referrals to pain clinics and would, in fact, be far more effectively dealt with in primary care. Effective treatment of acute shingles by systemic antivirals at the appropriate time may have some effect in reducing the incidence of postherpetic neuralgia, making it easier to treat with tricyclics and greatly reducing scarring (25% of all cases affect the face). Pre-emptive treatment with low-dose tricyclics (ami- or nor-triptyline 10-25 mg nocte) from the time of diagnosis of acute shingles reduces the incidence of postherpetic neuralgia by about 50%. Established postherpetic neuralgia should be vigorously treated with adrenergically active tricyclics in a dose rising over two or three weeks from 10-25 mg to 50-75 mg. Positive relaxation should also be used. Carbamazepine, like conventional analgesics, is of little or no value. Failure of tricyclics to effect relief within eight weeks calls for specialist treatment. North American practitioners in particular believe that some opioids (e.g., oxycodone) may be helpful in otherwise intractable cases.

Topics: Acyclovir; Amitriptyline; Analgesics; Antidepressive Agents; Antiviral Agents; Herpes Zoster; Humans; Incidence; Neuralgia; Prevalence; Risk Factors

Antiviral treatment of herpesvirus infections is rapidly changing since the advent of new drugs with improved oral availability. The efficacy of valaciclovir, the prodrug of aciclovir, and famciclovir, the prodrug of penciclovir, in the treatment of herpes genitalis and acute herpes zoster has been well documented in large clinical trials. Both drugs are effective on zoster-associated pain. Brivudin and sorivudine which are the most active compounds against varicella-zoster virus (VZV) in cell culture have also been successful in the treatment of herpes zoster. Aciclovir is still the standard therapy of severe herpes simplex virus (HSV) and varicella virus infections. In patients treated with aciclovir, the mortality of herpes encephalitis has been reduced to about 25%. The development of resistance against aciclovir and the other nucleoside analogues has not been a problem to date in the treatment of immunocompetent individuals. However, in immunocompromised patients, aciclovir-resistant HSV strains often emerge. In such cases, intravenous foscarnet is the current treatment of choice.

Topics: 2-Aminopurine; Acyclovir; Administration, Oral; Antiviral Agents; Arabinofuranosyluracil; Bromodeoxyuridine; Chickenpox; Drug Resistance, Microbial; Encephalitis, Viral; Famciclovir; Herpes Genitalis; Herpes Labialis; Herpes Simplex; Herpes Zoster; Humans; Immunocompromised Host; Prodrugs; Simplexvirus; Valacyclovir; Valine

A 43-year-old woman was admitted with a 14-day history of general malaise, subfebrile temperature, radicular dysaesthesias in the "riding breeches" area, severe pain in the lumbar region and progressive disorders of bladder and rectal emptying. Physical examination showed a conus-cauda syndrome. Differential diagnosis was between myelitis (inflammatory or infectious), space-occupying intraspinal mass or vascular lesion.. Cerebrospinal fluid contained 1700/3 cells and there was intrathecal antibody synthesis against varicella zoster virus (VZV) and positive VZV-DNA analysis in the polymerase chain reaction. Magnetic resonance imaging of the lumbar spine revealed an inflamed enlarged conal and epiconal area with small haemorrhagic spots. There was no evidence of an underlying immune-modulated disease.. With the diagnosis of varicella zoster myelitis with cutaneous changes having been established the clinical signs and symptoms regressed almost completely with aciclovir administration (10mg/kg intravenously for 14 days).. VZV without cutaneous involvement should be considered in the differential diagnosis of the radicular pain syndrome. When clinical signs of beginning myelitis or encephalitis are present, immediate investigations and therapy are necessary.

Topics: Acyclovir; Adult; Antiviral Agents; Diagnosis, Differential; Female; Hemorrhoids; Herpes Zoster; Humans; Myelitis; Pain; Remission Induction; Sacrococcygeal Region; Spinal Nerve Roots; Syndrome

Topics: Acyclovir; Antiviral Agents; Herpes Genitalis; Herpes Zoster; Humans; Valacyclovir; Valine

This paper is a case presentation and discussion of a 12-year-old boy previously in excellent health who presents with dematomal herpes zoster. Although not unheard of, the occurrence of herpes zoster in the pediatric population is infrequent. This case provides the opportunity to address many of the aspects of herpes zoster that are unique to the pediatric population including epidemiology, pathophysiology, management and course, and the potential impact of the live attenuated varicella vaccine, recently approved for the prevention of the primary varicella infection, chickenpox.

Topics: Acyclovir; Administration, Oral; Adolescent; Antiviral Agents; Diagnosis, Differential; Herpes Zoster; Humans; Male

Varicella-zoster virus (VZV) is a ubiquitous human alphaherpesvirus that causes varicella (chicken pox) and herpes zoster (shingles). Varicella is a common childhood illness, characterized by fever, viremia, and scattered vesicular lesions of the skin. As is characteristic of the alphaherpesviruses, VZV establishes latency in cells of the dorsal root ganglia. Herpes zoster, caused by VZV reactivation, is a localized, painful, vesicular rash involving one or adjacent dermatomes. The incidence of herpes zoster increases with age or immunosuppression. The VZV virion consists of a nucleocapsid surrounding a core that contains the linear, double-stranded DNA genome; a protein tegument separates the capsid from the lipid envelope, which incorporates the major viral glycoproteins. VZV is found in a worldwide geographic distribution but is more prevalent in temperate climates. Primary VZV infection elicits immunoglobulin G (IgG), IgM, and IgA antibodies, which bind to many classes of viral proteins. Virus-specific cellular immunity is critical for controlling viral replication in healthy and immunocompromised patients with primary or recurrent VZV infections. Rapid laboratory confirmation of the diagnosis of varicella or herpes zoster, which can be accomplished by detecting viral proteins or DNA, is important to determine the need for antiviral therapy. Acyclovir is licensed for treatment of varicella and herpes zoster, and acyclovir, valacyclovir, and famciclovir are approved for herpes zoster. Passive antibody prophylaxis with varicella-zoster immune globulin is indicated for susceptible high-risk patients exposed to varicella. A live attenuated varicella vaccine (Oka/Merck strain) is now recommended for routine childhood immunization.

Topics: Acyclovir; Antibody Formation; Antiviral Agents; Chickenpox; Contraindications; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunity, Cellular; Immunization, Passive; Serology; Vaccination; Vaccines, Attenuated

Topics: Acyclovir; Animals; Antiviral Agents; Herpes Zoster; Herpesviridae Infections; Humans; Prodrugs; Valacyclovir; Valine

Meta-analysis of four double-blind, randomized, placebo-controlled trials of oral acyclovir (800 mg five times daily) for the treatment of herpes zoster was conducted to provide definitive assessments of the effect of acyclovir on the resolution of zoster-associated pain. The studies involved a total of 691 patients, and the analysis was performed on an intent-to-treat basis. A range of milestones of pain cessation were evaluated by means of Cox regression models with adjustment for relevant prognostic factors. The proportion of patients with postherpetic neuralgia at 3 and 6 months was also determined. Advancing age and more severe pain at presentation were associated with more prolonged pain. Acyclovir was clearly shown to accelerate pain resolution by all of the measures employed. Benefit was especially evident in patients 50 years of age or older. Fewer acyclovir recipients had postherpetic neuralgia at 3 or 6 months. Overall, the reductions of pain duration and prevalence were approximately twofold.

Topics: Acyclovir; Antiviral Agents; Double-Blind Method; Herpes Zoster; Humans; Middle Aged; Neuralgia; Randomized Controlled Trials as Topic; Regression Analysis; Time Factors

Topics: 2-Aminopurine; Acyclovir; Antiviral Agents; Famciclovir; Guanine; Herpes Zoster; Herpesviridae Infections; Humans

Famciclovir is the well-absorbed oral form of penciclovir, a potent and selective antiviral agent, with activity against members of the herpesvirus family, including varicella-zoster virus (VZV), and herpes simplex virus-1 (HSV-1) and HSV-2. Famciclovir is rapidly absorbed and converted to penciclovir. Penciclovir has excellent bioavailability (77%) after oral administration of 500 mg of famciclovir. Similar to acyclovir, famciclovir is converted by phosphorylation to its active metabolite, penciclovir-triphosphate. Penciclovir-triphosphate has a prolonged in vitro intracellular half-life of 10 to 20 hours in HSV-1-and HSV-2-infected cells, respectively, and 9 to 14 hours in VZV-infected cells. In contrast, the in vitro intracellular half-life of acyclovir is substantially shorter at 0.7 and 1 hours in HSV-1- and HSV-2-infected cells, respectively, and 0.8 hours in VZV-infected cells. Famciclovir is eliminated primarily via the kidneys. Dosage adjustment is not required for famciclovir in elderly patients with normal or mildly impaired renal function, and the extent of penciclovir availability is not affected by food. The excellent bioavailability ensures that adequate drug reaches virus-infected cells, and the prolonged intracellular half-life of the active form of famciclovir results in persistent antiviral activity.

Topics: 2-Aminopurine; Acyclovir; Aged; Antiviral Agents; Drug Interactions; Famciclovir; Guanine; Herpes Zoster; Humans

A 58-year-old Japanese woman who had herpes zoster in association with colitis was successfully treated with intravenously administrated acyclovir. Vesicular lesions with red haloes ranged from the left side of her buttock to the left extremity, corresponding to the L4 to S2 dermatomes. Her colitis was considered to have been induced by varicella-zoster virus, based on the facts that the clinical courses were correlated and that the innervation of the affected site of the colon corresponded to an infected dermatome (S2).

Topics: Acyclovir; Antiviral Agents; Biopsy, Needle; Colitis; Female; Herpes Zoster; Humans; Middle Aged; Radiography

Valaciclovir, the L-valyl ester of aciclovir (acyclovir), is an oral prodrug that undergoes rapid and extensive first-pass metabolism to yield aciclovir and the essential amino acid L-valine. Aciclovir, the active antiviral component of valaciclovir, shows good in vitro activity against the herpesviruses herpes simplex virus (HSV)-1, HSV-2 and varicella zoster virus. The bioavailability of aciclovir from oral valaciclovir is considerably greater than that achieved after oral aciclovir administration. Thus, valaciclovir delivers therapeutic aciclovir concentrations when administered in a less frequent oral dosage regimen than is required for aciclovir. Valaciclovir is an effective treatment for herpes zoster in immunocompetent adults. In a large comparative study that included patients > or = 50 years of age, valaciclovir (1000mg 3 times daily for 7 or 14 days) and oral aciclovir (800mg 5 times daily) were equally effective in achieving resolution of cutaneous zoster lesions. Importantly, valaciclovir was significantly more effective than aciclovir in reducing the duration of zoster-associated pain. Preliminary results of several studies indicate that valaciclovir (500 to 1000mg twice daily for 5 to 10 days) is as effective as aciclovir (200mg 5 times a day for 5 to 10 days) in the treatment of genital herpes. In patients with first or recurrent episodes of genital herpes, valaciclovir reduced the duration of viral shedding, hastened lesion healing and decreased lesion-associated pain. Valaciclovir was also effective in suppressing recurrent episodes of genital herpes and significantly prolonged the time to a recurrent episode of infection compared with placebo. Valaciclovir is a well tolerated drug; in herpes zoster and HSV studies its tolerability profile was similar to that of aciclovir or placebo. Valaciclovir represents and advance in antiherpes drug therapy and is a useful treatment option for patients with herpes zoster or genital herpes. It is at least as effective as aciclovir and is administered in a more convenient oral dosage regimen. Thus, valaciclovir may ultimately succeed aciclovir as a first-line treatment for genital herpes or herpes zoster.

Topics: Acyclovir; Adult; Animals; Antiviral Agents; Drug Resistance, Microbial; Drug Tolerance; Herpes Genitalis; Herpes Zoster; Herpesviridae; Herpesviridae Infections; Humans; Middle Aged; Recurrence; Valacyclovir; Valine

Until recently aciclovir has been the only licensed drug for the treatment of herpes zoster. A number of new drugs have emerged over the past few years which offered the potential for improved efficacy or ease of administration. With the completion of the first efficacy trials for each of these agents it has become apparent that, whilst less frequent dosing can he accomplished, it is not easy to significantly improve on the efficacy of aciclovir. Increasing age, the presence of prodromal pain and more severe pain at presentation have, however, been found to predispose to a longer duration of pain. Taking cessation of pain as the single most important parameter, at least for the older immunocompetent population as a whole, only valaciclovir has, to date, been shown to be superior to standard therapy with aciclovir. This review utilises primarily intent-to-treat data to illustrate the relative efficacy of the different therapies.

Topics: 2-Aminopurine; Acyclovir; Antiviral Agents; Arabinofuranosyluracil; Controlled Clinical Trials as Topic; Drug Approval; Famciclovir; Herpes Zoster; Humans; Prodrugs; Treatment Outcome; United States; Valacyclovir; Valine

Oral administration of the prodrug valacyclovir results in enhanced bioavailability and significantly greater plasma concentrations of acyclovir than can be achieved with oral doses of acyclovir itself. The results of clinical trials with valacyclovir have demonstrated significant benefits in the resolution of pain associated with herpes zoster infection. Efficacy parameters were similar for valacyclovir and acyclovir in the treatment of herpes simplex; however the results were achieved with lower and less-frequent doses of valacyclovir. The cost of a course of therapy with valacyclovir is expected to be similar to that of other antivirals. The potential clinical benefits of valacyclovir will likely be apparent in the case of acyclovir-resistant herpesvirus infections, where high-dose intravenous treatment with acyclovir has been necessary. Most of these resistant viruses have been encountered in immunocompromised patients, and the resistance has been attributed to inadequate exposure to the drug. Because optimal levels of acyclovir are achieved with a simpler dosing regimen of valacyclovir, compliance may be improved in many patients, thus reducing the incidence of resistant virus.

Topics: Acyclovir; Adolescent; Adult; Antiviral Agents; Clinical Trials as Topic; Herpes Genitalis; Herpes Zoster; Humans; Male; Prodrugs; Valacyclovir; Valine

Inhibition of varicella-zoster virus replication during acute herpes zoster would, theoretically, accelerate cutaneous healing and reduce the pain, both acute and chronic, associated with shingles. Early antiviral drugs were of limited efficacy, excessively toxic, or needed to be given parenterally, and were unsuitable for use in immunocompetent individuals. Acyclovir was a significant advance and remains the antiviral drug of choice for herpes zoster. There is ample evidence for its efficacy in acute illness, but its ability to influence post-herpetic neuralgia is controversial. This review also discusses the role of adjunctive therapy with steroids in acute shingles.

Topics: Acute Disease; Acyclovir; Adult; Antiviral Agents; Cytarabine; Herpes Zoster; Humans; Idoxuridine; Interferons; Middle Aged; Steroids; Vidarabine

Varicella zoster virus (VZV) is responsible for a primary infection (varicella) followed by a latency, eventually resulting in herpes zoster (shingles). The replication cycle of VZV is normally interrupted after varicella. Consequently, VZV remains dormant in the organism. Reactivation occurs after viraemia, and the development of tissue alterations (skin and viscera) depends on the immunological status of the patient. Diagnosis of herpes zoster relies on clinical recognition and cytological and histological evaluations combined with immunohistochemistry and molecular biology techniques. Treatment of herpes zoster primarily relies upon antiviral drugs and incidentally on immunomodulating agents, specific immunoglobulins, antimicrobial agents, antiviral enzymes and corticosteroids. Drugs with a clinically relevant activity against varicella zoster virus infections include aciclovir, adenosine monophosphate, bromodeoxyuridine, desciclovir, fiacitabine, idoxuridine, interferon-alpha and vidarabine. Among them, aciclovir appears to be a first-line agent. Its efficacy has been well established by many clinical studies. Promising drugs for the future include famciclovir, penciclovir, valaciclovir and other molecules currently under investigation. Recent and promising improvements in antiviral drug development may increase patient compliance, cost-benefit ratios and therapeutic efficacy.

Topics: Acyclovir; Adjuvants, Immunologic; Adrenal Cortex Hormones; Antiviral Agents; Arabinofuranosyluracil; Chickenpox; Herpes Zoster; Humans; Immunoglobulins; Virus Replication

Topics: 2-Aminopurine; Acyclovir; Antiviral Agents; Arabinofuranosyluracil; Chickenpox; Drug Resistance, Microbial; Famciclovir; Herpes Simplex; Herpes Zoster; Humans; Valacyclovir; Valine

Herpes zoster is an infection caused by reactivation of dormant varicella-zoster virus. The acute course of herpes zoster is generally benign; however, some patients will experience postherpetic neuralgia characterized by severe, relentless, and at times disabling pain that is often refractory to treatment. While herpes zoster responds to acyclovir, cost-benefit considerations limit the drug's usefulness to only a select group. Postherpetic neuralgia requires a holistic approach, including pharmacologic therapy using several different classes of drugs.

Topics: Acyclovir; Adrenal Cortex Hormones; Algorithms; Analgesics; Anticonvulsants; Antidepressive Agents, Tricyclic; Antipsychotic Agents; Cimetidine; Clinical Protocols; Drug Costs; Drug Therapy, Combination; Herpes Zoster; Humans; Neuralgia

Acyclovir produces neurologic symptoms that resemble extension of viral infection into the central nervous system. We discuss our observations in the cases of two patients with acyclovir neurotoxicity and review the findings of all previous reports in the English language literature. Systemic disease, most commonly renal dysfunction, preceded all 30 reported cases of acyclovir neurotoxicity. The most common symptoms were mental status disorder and involuntary movements. Measurement of serum acyclovir levels substantiated the diagnosis in only a subset of patients. Although all patients recovered, hemodialysis hastened the rate of recovery.

Topics: Acyclovir; Adult; Aged; Aged, 80 and over; Central Nervous System Diseases; Cytomegalovirus Infections; Female; Herpes Simplex; Herpes Zoster; Humans; Kidney Failure, Chronic; Male; Middle Aged; Renal Dialysis

Chickenpox in immunocompromised individuals is potentially fatal and should be treated with intravenous acyclovir as soon as it is recognized. Data from four double-blind, placebo-controlled trials in the USA provide a sound scientific basis for using acyclovir to treat chickenpox in immunocompetent individuals. Three studies in children and a fourth study in US naval recruits showed statistically significant reductions in the duration of fever, constitutional illness, and time to cutaneous healing, when treatment was initiated within 24 h of rash onset. Although chickenpox is generally mild in children the severity of the disease increases with age and secondary cases in the family tend to be more ill than the primary case. It is recommended that secondary and tertiary cases in a family, and adolescents and adults with chickenpox be treated with acyclovir. In immunocompromised hosts, intravenous acyclovir halts the progression of herpes zoster and is recommended as therapy during new lesion formation. Herpes zoster in otherwise normal hosts is rarely accompanied by visceral dissemination, but carries an increasing risk of post-herpetic neuralgia with increasing age. Published clinical trials have shown a reduction in the duration and severity of acute pain during herpes zoster for patients treated with acyclovir, but results for chronic pain are conflicting with some, but not all, studies showing a beneficial effect.

Topics: Acyclovir; Adolescent; Adult; Chickenpox; Child; Female; Herpes Zoster; Humans; Immunocompromised Host; Male; Pregnancy

Topics: Acyclovir; Child; Herpes Simplex; Herpes Zoster; Herpesviridae Infections; Humans; Infant

Persons with AIDS who have CD4+ counts < or = 100 and transplant patients, especially bone marrow allograft recipients, may experience clinically significant infections with acyclovir-resistant herpes simplex virus (HSV) or varicella-zoster virus (VZV). Patients who have received prior repeated acyclovir treatment appear to be at the highest risk of harboring acyclovir-resistant strains. Algorithms for the management of these infections were developed at a recent roundtable symposium. The consensus of the panelists was that treatment with foscarnet should be initiated within 7-10 days in patients suspected to have acyclovir-resistant HSV or VZV infections. Foscarnet therapy should be continued for at least 10 days or until lesions are completely healed.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; Algorithms; Drug Resistance, Microbial; Female; Foscarnet; Herpes Simplex; Herpes Zoster; Herpesviridae Infections; Herpesvirus 3, Human; Humans; Immunocompromised Host; Male; Recurrence; Simplexvirus; Trifluridine; Vidarabine

Topics: Acyclovir; Administration, Oral; Adolescent; Adult; Chickenpox; Child; Child, Preschool; Double-Blind Method; Herpes Zoster; Humans; Immunocompetence; Randomized Controlled Trials as Topic

Two otherwise healthy immunocompetent men, ages 62 and 66 years, experienced years of radicular pain without zoster rash. An extensive search for systemic disease and malignancy was negative. Varicella-zoster virus DNA, but not herpes simplex virus DNA, was found in the cerebrospinal fluid of the first patient 5 months after the onset of pain, and in the second patient 8 months after the onset of pain. Prolonged radicular pain without zoster rash combined with the presence of varicella-zoster virus in the cerebrospinal fluid indicates that both men had zoster sine herpete, and strongly supports this syndrome as a clinical variant.

Topics: Acyclovir; Aged; Cerebrospinal Fluid; DNA, Viral; Herpes Zoster; Herpesvirus 3, Human; Humans; Male; Middle Aged

Herpes zoster is a serious medical problem, not only because of the discomfort associated with the acute rash, but also because of the potential for post-herpetic neuralgia. Acyclovir is currently the antiviral drug of choice for the treatment of herpes zoster. Efforts are underway to develop new drugs that have improved activity against varicella-zoster virus as well as more favorable pharmacokinetic properties. The goal of these efforts is to develop an orally administered antiviral drug that will accelerate the events of cutaneous healing as well as reduce the frequency and severity of post-herpetic neuralgia. Investigational drugs currently under evaluation include valaciclovir and famciclovir, the prodrugs of acyclovir and penciclovir, respectively. Two new uracil derivatives, sorivudine and BW882C87, with increased anti-varicella-zoster virus activity in vitro are also being studied.

Topics: 2-Aminopurine; Acyclovir; Antiviral Agents; Arabinofuranosyluracil; Drugs, Investigational; Famciclovir; Herpes Zoster; Humans; Prodrugs; Valacyclovir; Valine

A series of randomized, placebo-controlled, double-blind clinical trials conducted from 1980 to the present provide the basis for appropriate management of varicella-zoster virus (VZV) infections. Placebo recipients in these studies have also provided valuable natural history data on the clinical course of VZV infections. The protocols in toto have shown acyclovir (ACV) to be safe and effective for treatment of nearly all forms of acute VZV infection. A number of issues still need to be addressed, including appropriate dosage, importance of early initiation of therapy, cost-benefit ratio, and viral resistance. Considering the data in aggregate, the author recommends ACV treatment for all acute VZV infections in immunocompromised hosts; for acute herpes zoster infections in all adults; and for varicella in otherwise healthy adults and adolescents, and children who contract it from a sibling.

Topics: Acyclovir; Chickenpox; Herpes Zoster; Humans; Immunocompromised Host

Topics: Acyclovir; Bone Marrow Transplantation; Chickenpox; Herpes Zoster; Humans; Vidarabine

Oral and intravenous acyclovir formulations provide effective virostasis against many herpes viruses infections, especially severe herpes simplex or varicella-zoster infections in ambulatory and immunocompromised patients. The therapeutic virostatic efficacy of topical acyclovir formulations requires further development, however, especially for orolabial herpetic infections.

Topics: Acyclovir; Administration, Topical; Herpes Labialis; Herpes Zoster; Humans; Immunocompromised Host; Stomatitis, Herpetic

The Varicella zoster virus may affect the central nervous system (CNS) as a complication of herpes zoster (HZ). A series of neurological syndromes are described and, on the basis of a review of the literature and two illustrative case histories, the symptomatology, pathogenesis, therapeutic possibilities and the diagnostic difficulties in HZ-associated cerebral vasculitis and HZ-associated encephalitis are reviewed. Progressive multifocal encephalopathy in immune-insufficient individuals is briefly mentioned. The diagnosis is most frequently established on the basis of the clinical picture when the characteristic symptoms develop in connection with cutaneous HZ. A long latent period may result in defective recognition of the connection. Immuno-suppression and dissemination are critical determinants for the course of the condition but, in immune-competent individuals, the morbidity and mortality are low. Treatment with acyclovir is employed to an increasing extent with good results but the conditions are rare and clinically controlled investigations are not available. It is important that the possibility of HZ-associated CNS-disease is borne in mind, in view of the therapeutic possibilities. The pathogeneses of these complications is little understood but there is increasing evidence that a direct viral invasion is the mechanism responsible. A post-infectious immune-mediate mechanism is also another popular opinion.

Topics: Acyclovir; Adult; Diagnosis, Differential; Encephalitis; Encephalomyelitis; Female; Herpes Zoster; Humans; Male; Middle Aged; Prognosis; Vasculitis

A 5 day old girl was transferred to the pediatric ward of Kyushu University Hospital because of papules noted since birth. The papules were distributed on her skin corresponding to the dermatomes innervated by the left Th1-Th3 and the left L1-L3. Varicella-zoster virus antigens were detected in scrapings of incised papules. The diagnosis of herpes zoster was made and acyclovir (ACV) was administered. She responded to ACV well, but she experienced a recurrence twice after discontinuation of ACV. This is the first report of 'congenital herpes zoster', which supports the hypothesis that varicella embryopathy is the sequelae of herpes zoster in utero.

Topics: Acyclovir; Female; Fluorescent Antibody Technique; Gestational Age; Herpes Zoster; Humans; Infant, Newborn; Recurrence

Topics: Acyclovir; Chickenpox; Herpes Simplex; Herpes Zoster; Humans

Varicella-zoster virus (VZV) infections, the cause of chickenpox and shingles, are usually benign but are associated with morbidity and mortality, especially in immunocompromised hosts. Significant advances have been achieved in the treatment of VZV infections. In immunocompromised patients, both vidarabine and acyclovir have proved useful for the therapy of chickenpox and herpes zoster. Acyclovir, administered intravenously, is the treatment of choice for these infections. Both chickenpox and herpes zoster in the normal host are amenable to therapy with orally administered acyclovir. For older individuals with herpes zoster, acceleration of cutaneous healing can be accomplished at dosages of 800 mg five times a day for 10 days. Acyclovir therapy of chickenpox is recommended for adolescents and young adults with infection. In the future, improved therapies for VZV infections may include such newer antiviral drugs as bromovinyl arabinosyl uracil and acyclovir prodrugs.

Topics: Acyclovir; Antiviral Agents; Chickenpox; Herpes Zoster; Humans; Immunocompromised Host; Interferons; Vidarabine

Topics: Acyclovir; Antiviral Agents; Chickenpox; Drug Resistance, Microbial; Herpes Simplex; Herpes Zoster; Humans; Interferons

Herpes simplex virus type 1 and 2 may cause painful mucocutaneous lesions in both immunosuppressed and immunocompetent patients. Indications for the use of acyclovir (ACV) are reviewed. In the second part the management of infections caused by varicella-zoster virus are discussed. Primary varicella (chickenpox) in immunosuppressed children should be treated with i.v. ACV without delay. In healthy patients varicella pneumonia needs to be treated with ACV. Healthy patients with herpes zoster are not usually candidates for antiviral therapy. The only exception is herpes zoster ophthalmicus. In patients with severe immunosuppression, such as transplant recipients, ACV therapy is recommended in order to reduce the rate of dissemination. First reports and our own observations on the development of ACV-resistant HSV and VZV isolates stress the importance of discriminating use of ACV and other antiviral compounds in immunosuppressed patients.

Topics: Acyclovir; Antiviral Agents; Chickenpox; Child; Herpes Simplex; Herpes Zoster; Herpes Zoster Ophthalmicus; Humans; Immunocompetence; Immunocompromised Host

As many as 9000 pregnancies annually may be complicated by varicella, which creates management problems for the woman and her fetus or newborn. Estimates on risk to the fetus and to neonates vary widely, making counseling difficult. Likewise, the efficacy of passive immunization of pregnant women or their exposed newborns is not precisely known. In addition to these problems in clinical management, questions remain about the developmental immunology of varicella-zoster virus infection. For example, why do infants exposed in utero to the virus get zoster at an early age and why does passive immunization of newborns appear to be less effective than immunization of older individuals?

Topics: Acyclovir; Chickenpox; Congenital Abnormalities; Female; Fetal Diseases; Herpes Zoster; Humans; Immunization, Passive; Infant, Newborn; Pregnancy; Pregnancy Complications, Infectious

Chronic zoster represents an infrequent presentation of varicella zoster virus infection. It is observed with increased frequency in patients infected with human immunodeficiency virus, especially when their lymphocyte counts are depressed. We report a child infected with human immunodeficiency virus who showed a long-standing cutaneous zoster lesion and was treated for a prolonged period of time with acyclovir. The occurrence of resistance to acyclovir by varicella zoster virus was suspected based on the clinical picture. The clinical and laboratory features of this case and a review of the literature are presented.

Topics: Acyclovir; Child; Chronic Disease; Herpes Zoster; HIV Infections; Humans; Male; Skin; Skin Diseases, Infectious

Topics: Acyclovir; Antiviral Agents; Cytomegalovirus Infections; Drug Resistance, Microbial; Foscarnet; Ganciclovir; Herpes Simplex; Herpes Zoster; Herpesviridae Infections; Humans; Phosphonoacetic Acid

Varicella-zoster virus (VZV) causes significant morbidity and even mortality in immunocompromised patients. Varicella has more serious consequences than herpes zoster, although zoster is more common. This paper reviews the natural history of varicella-zoster infections, as well as strategies for prevention and treatment. Although initial studies supported the use of either vidarabine or acyclovir for treatment of varicella in immunocompromised children, subsequent data have shown acyclovir to be superior for this purpose. Recent data in bone marrow transplant patients indicated that acyclovir was also more effective in preventing progression of herpes zoster in the immunocompromised host. The question of using steroids to prevent postherpetic neuralgia remains controversial. With the advent of effective antiviral chemotherapy, treatment of VZV infections in the immunocompromised host has become a reality. The potential problem of acyclovir-resistant VZV strains justifies continued development of other anti-VZV agents. Several new compounds are presently in or slated for clinical trials.

Topics: Acyclovir; Chickenpox; Chickenpox Vaccine; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunization, Passive; Immunocompromised Host; Vidarabine; Viral Vaccines

Topics: Acyclovir; Herpes Labialis; Herpes Zoster; Herpesviridae Infections; HIV Infections; Humans; Mouth Diseases; Stomatitis, Herpetic; Virus Diseases

Herpes zoster results from reactivation of latent varicella-zoster virus. It is most common in elderly patients and immunosuppressed patients, especially those with human immunodeficiency virus (HIV) infection. Zoster is often the earliest indicator of HIV infection. The acute course of herpes zoster is generally benign, but systemic complications may be fatal. Postherpetic neuralgia is the major chronic complication and is a difficult management problem. High-dose acyclovir (800 mg orally five times daily) has recently been approved for treatment of herpes zoster and, if started early, decreases the duration and severity of symptoms. In the prevention of postherpetic neuralgia, acyclovir does not appear to be effective, and the efficacy of steroids is questionable. The best therapy currently available for postherpetic neuralgia is amitriptyline, topical capsaicin and transcutaneous electrical stimulation.

Topics: Acupuncture Therapy; Acyclovir; Amitriptyline; Anesthetics, Local; Anticonvulsants; Antipsychotic Agents; Capsaicin; Herpes Zoster; Humans; Neuralgia; Transcutaneous Electric Nerve Stimulation; Ultrasonic Therapy

Rigorous clinical trials have established that both acyclovir and vidarabine favourably alter the clinical course of herpes zoster and chicken-pox in immunocompromised patients. In one comparative study, acyclovir was shown to be superior to vidarabine for zoster in bone marrow transplant recipients. These data, plus the fact that acyclovir is easier to administer than vidarabine, and perhaps less toxic, have made intravenous acyclovir the recognized drug of choice for treatment of herpes zoster in immunocompromised patients. Acyclovir sodium sterile powder received Federal Drug Administration (FDA) approval for this indication in 1990 in the United States. Since complications of zoster occur in only a minority of immunocompromised patients, most physicians would prefer to initiate therapy with an orally-administered drug and avoid the cost and inconvenience of hospitalization. Future studies will compare the efficacy and safety of orally administered bromovinyl arabinosyl uracil and acyclovir in treatment of varicella-zoster virus infections.

Topics: Acyclovir; Administration, Oral; Adult; Aged; Chickenpox; Child; Clinical Trials as Topic; Herpes Zoster; Humans; Immunologic Deficiency Syndromes; Infusions, Intravenous; Vidarabine

Oral acyclovir recently was approved for the treatment of herpes zoster and has been shown to be effective in the treatment of varicella. Studies of the use of high-dose oral acyclovir in the management of varicella-zoster infections in immunocompetent pediatric patients are reviewed. Guidelines are provided for the drug's use in immunocompetent children and adolescents, pregnant patients, and pediatric atopic patients receiving systemic steroids.

Topics: Acyclovir; Administration, Oral; Adolescent; Adrenal Cortex Hormones; Adult; Chickenpox; Child; Child, Preschool; Drug Administration Schedule; Female; Herpes Zoster; Humans; Male; Middle Aged; Pregnancy; Pregnancy Complications, Infectious

An overview of all the available placebo-controlled trial data for oral acyclovir in acute herpes zoster infection has confirmed that a dose of 800 mg five times daily for seven to ten days is effective in reducing the incidence of post-herpetic neuralgia and the duration of pain. Although one study failed to demonstrate such an effect, three other studies and a combined analysis, using the log rank test, did so. The duration of pain was shortened from an average of 86 to 49 days (p less than 0.001). Future studies will need to take account of these findings since oral acyclovir is most likely to be used as the standard reference therapy.

Topics: Acute Disease; Acyclovir; Herpes Zoster; Herpes Zoster Oticus; Humans; Pain; Randomized Controlled Trials as Topic

Topics: Acyclovir; Adult; Aged; Aged, 80 and over; Female; Herpes Zoster; Humans; Influenza, Human; Japan; Male; Pneumonia, Viral; Sexually Transmitted Diseases; Virus Diseases

Topics: Acyclovir; Administration, Oral; Herpes Zoster; Humans; Risk Factors; Waiting Lists

Specific antivirals like acyclovir have ameliorated the outcome of severe herpesvirus infections, especially in immunocompromised patients. Varicella can be prevented in high-risk patients after exposure by therapy with varicella-zoster immunoglobulin. Despite this favorable development, there are many unresolved problems in the management of herpesvirus infections, such as the use of acyclovir during pregnancy, the treatment of both motoric neuropathy and postherpetic neuralgia. Chemotherapy-resistant herpesvirus may cause severe syndromes in patients suffering from HIV infection or from iatrogenic immunosuppression. Isolation of resistant viruses provides the stimulus to establish tests of viral resistance and to use antiviral drugs more carefully.

Topics: Acyclovir; Antiviral Agents; Chickenpox; Drug Resistance; Herpes Simplex; Herpes Zoster; Herpesviridae Infections; Humans; Idoxuridine; Immunologic Deficiency Syndromes; Interferons; Vidarabine

Topics: Acyclovir; Chickenpox; Clinical Trials as Topic; Cytomegalovirus Infections; Drug Resistance, Microbial; Herpes Simplex; Herpes Zoster; Herpesviridae Infections; Humans

Studies have demonstrated the benefit of acyclovir, given intravenously or orally, on the acute illness in herpes zoster (HZ). Whether or not such treatment influences the subsequent development of postherpetic neuralgia (PHN) has been the subject of recent controversy. Intravenous acyclovir has not been shown to influence PHN significantly in prospective studies. Oral acyclovir in large doses may reduce PHN during the 3 months after acute HZ, but this effect has not been observed consistently in well-designed studies. From 3 months onwards, no trial has demonstrated a significant effect of oral acyclovir in reducing PHN. The way forward is discussed.

Topics: Acyclovir; Administration, Oral; Herpes Zoster; Humans; Injections, Intravenous; Neuralgia

The incidence of paresis due to herpes zoster (HZ) infections are reported very differently in the literature with rates varying from 0.5 to 31%. Many of the paresis are presumed to be undiagnosed on account of topographic dissociation, variable periods from the cutaneous affection to the muscular involvement, masking of the paresis by pain, paresis of the intercostal and abdominal muscles which are not obvious and difficulties in correlating the visceral symptoms with a herpes zoster eruption. Paresis of the cranial nerves are easily diagnosed and 50% of all HZ paresis are diagnosed from this region. Early acyclovir treatment has improved the prognosis. Four cases of hypotonic herpes zoster paresis in immunocompetent persons are described and the diagnostic difficulties are discussed.

Topics: Acyclovir; Aged; Antibodies, Viral; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Paralysis

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Herpes Zoster; Humans; Immune Tolerance; Immunocompetence; Immunologic Deficiency Syndromes; Virus Replication

Topics: Acyclovir; Chickenpox; Female; Fetal Diseases; Herpes Zoster; Humans; Immunity, Maternally-Acquired; Immunization, Passive; Infant, Newborn; Pregnancy; Pregnancy Complications, Infectious

We discuss the latest findings regarding the therapy of acute herpes zoster and postherpetic neuralgia. Aside from the conventional modes of treatment. We especially refer to the therapy with aciclovir. In addition, we present the techniques of transcutaneous electrostimulation and neurosurgery.

Topics: Acyclovir; Analgesics; Herpes Zoster; Humans; Neuralgia; Spinal Nerve Roots; Spinothalamic Tracts; Stereotaxic Techniques; Transcutaneous Electric Nerve Stimulation

Topics: Acyclovir; Adolescent; Adult; Age Factors; Chickenpox; Child; Child, Preschool; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Immune Sera; Immunization, Passive; Infant; Pregnancy; Pregnancy Complications, Infectious; Recurrence; Time Factors; Vaccines, Attenuated

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Antiviral Agents; Chickenpox; Child; Chronic Disease; Herpes Zoster; Herpesvirus 3, Human; Humans; Immune Tolerance; Neoplasms; Pneumonia, Viral

The Ramsay-Hunt syndrome affects mostly adults. The recovery of facial nerve function, according to recent literature, seems better than has been generally accepted. A small number of children with herpes zoster oticus have been reported. We describe a case of Ramsay-Hunt syndrome in a healthy 3 1/2-year-old girl. She still had an obvious facial palsy after 12 months. Three out of 6 reported children with herpes zoster oticus have had a slow recovery of the facial nerve function. This suggests a less favorable prognosis in children than in adults. Although not successful in this case, acyclovir should be tried early in the course of the disease.

Topics: Acyclovir; Child, Preschool; Facial Paralysis; Female; Herpes Zoster; Humans; Prognosis

Herpes simplex and varicella-zoster infections of the skin are commonly seen in primary care practice. For the patient to be managed most effectively, clinical diagnoses must be accurately made and supported by laboratory confirmation using the Tzanck smear and/or viral culture. Topical therapy and systemic acyclovir can be of help to most patients with these infections.

Topics: Acyclovir; Herpes Simplex; Herpes Zoster; Humans; Recurrence; Skin Diseases, Infectious

Acyclovir (ACV), an antiviral nucleoside analog, is active against Herpes simplex viruses (HSV1, HSV2) and varicella virus (VZV). These viruses seems to be prejudicial to the pregnant woman and to the fetus. Yet, ACV is not recommended for use in pregnancy. However in certain cases, this drug has been used. We review in this paper, the pharmacokinetics and transplacental passage of ACV, indications, and whether the benefits of the administration of ACV in pregnancy outweigh the theoretical risks. Peak and trough plasma concentrations of ACV in pregnant women seem to be lower as compared to those of non-pregnant adults but effective. This drug crosses the placenta. Levels of ACV in cord blood ranged from 0.5 to 3 mumol/l. In as much as in vitro inhibitory doses 50 (ID 50) for HSV1, HSV2 and VZV ranged from 0.1 to 3 mumol/l, it is quite likely that levels noted above may be effective for in utero inhibition of viral replication. No adverse effects were noted in newborn exposed in utero to ACV. But one must be careful about the direct effects of this drug on nucleic acid metabolism despite encouraging results on animal fetuses. Based on these findings and from our experience, ACV can be administered in pregnancy in two particular situations: in cases of maternal severe viral infections and in order to inhibit in utero VZV replication. Doses required for pregnant women range from 5 to 15 mg/kg/8 hours given intravenously, and 200 mg of oral Acyclovir 5 times daily.

Topics: Acyclovir; Female; Herpes Simplex; Herpes Zoster; Humans; Pregnancy; Pregnancy Complications, Infectious

Regarding the treatment of herpes zoster, aciclovir (ACV) is as the most effective and safe drug available. ACV reduces the viral shedding time and promotes the cutaneous healing and pain resolution. Oral ACV in high doses (5 x 800 mg daily), as well, has proved effective in the treatment of acute herpes zoster. If there is no convincing effect on the pain, additional application of corticoids in high doses may be of benefit.

Topics: Acyclovir; Antiviral Agents; Herpes Zoster; Humans; Opportunistic Infections

We now have a basis for a more rational approach to rapid evaluation and development of antiviral drugs by screening for activity in vitro, testing for toxicity and efficacy in animals, and clinical testing in humans. Acyclovir is a prototype of this improved process. Interferon has a beneficial effect against CMV infection in renal transplant patients and has promising results in the treatment of papillomas and rhinovirus infections. It does not seem to be as effective against genital herpes or varicella zoster as acyclovir. Ribavirin is effective against respiratory syncytial virus infections and Lassa fever. Varicella-zoster virus is highly sensitive to bromovinyl deoxyuridine in vitro. Phosphonoformate is effective in herpes simplex in animals but of little clinical benefit topically in human recurrent A2 herpes. Zidovudine may decrease mortality rates and infectious complications in patients with acquired immunodeficiency syndrome. DHPG (9-(1,3-dihydroxy-2-propoxymethyl]guanine is useful in treatment of cytomegalovirus and infection in immunocompromised patients. The prodrug of acyclovir results in high blood levels of acyclovir and shows promise in the treatment of varicella-zoster infections. Many halogenated pyrimidine nucleoside analogs are being developed. Buciclovir is another acyclic guanosine analog effective against herpes simplex virus in vitro. 2'-nor-cyclic guanosine monophosphate has a broad antiviral spectrum of action. Interleukin-2 is being investigated. Combined therapies of two or more antiviral drugs or antiviral drugs and other treatments are being studied.

Topics: Acyclovir; Animals; Antiviral Agents; Bromodeoxyuridine; Cytomegalovirus Infections; Foscarnet; Ganciclovir; Herpes Simplex; Herpes Zoster; Humans; Interferons; Phosphonoacetic Acid; Ribavirin; Thymidine; Zidovudine

Cytomegalovirus, herpes simplex, and herpes zoster are responsible for the majority of cases of viral retinitis. Herpes zoster also has been strongly incriminated as a causal agent in acute retinal necrosis. Effective chemotherapy exists for retinitis caused by herpes simplex and herpes zoster, along with acute retinal necrosis. Conventional antiviral therapy and immunomodulators are ineffective in the treatment of cytomegalovirus retinitis in patients with acquired immune deficiency disorder. Ganciclovir, a new antiviral agent, has significantly reduced visual morbidity in these patients. Recurrence of the infection is not uncommon while patients are on the drug or when the agent is discontinued, because ganciclovir is virostatic and does not stop viral replication in the retina. The inability to control this viral retinitis using presently available chemotherapy indicates a need to examine other therapeutic modalities.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Cytomegalovirus Infections; Ganciclovir; Herpes Simplex; Herpes Zoster; Herpesviridae Infections; Humans; Retinitis

Varicella is relatively mild in otherwise normal children, in whom new lesions form for a mean of four days after onset and heal 50 percent of their lesions in eight days. New lesions form in most immunocompromised children for longer than five days and those not treated with antiviral drugs have a 28 percent incidence of pneumonitis and a 7 percent mortality rate. Untreated immunocompromised adults with herpes zoster shed virus for longer (7.0 days) than otherwise normal adults (5.3 days). Herpes zoster is much more likely to disseminate cutaneously in immunocompromised than in immunocompetent hosts. Visceral dissemination, which is a rare event in immunocompetent patients, occurred in 8 percent of prospectively followed untreated immunocompromised hosts with herpes zoster. Acyclovir has been found to be superior to vidarabine for treatment of both chickenpox and herpes zoster. Whether or not steroids should be used to treat herpes zoster remains controversial. Concerns about the use of intravenous acyclovir include the side effects of renal and central nervous system dysfunction and the possibility of emergence of resistant viral strains. None of these concerns has proved to be an impediment to successful treatment of immunocompromised patients. The major future challenge is to find an optimal way to treat varicella zoster virus infections with oral formulations of acyclovir or its congeners.

Topics: Acyclovir; Chickenpox; England; Herpes Zoster; History, 17th Century; History, 18th Century; History, 19th Century; History, 20th Century; Humans; Immune Tolerance; Vidarabine

Varicella in otherwise healthy children usually requires no antiviral treatment. In severe cases, however, such as are seen in neonates and adults, treatment must be given. Anecdotal evidence suggests the efficacy of intravenous acyclovir in such patients. Herpes zoster in immunocompetent patients may be severe enough to warrant antiviral therapy, particularly in elderly patients. Both idoxuridine and acyclovir have been investigated in placebo-controlled double-blind studies. Due to its low toxicity, ease of administration, and the possibility of systemic administration, acyclovir has largely replaced older antivirals in the management of herpes zoster in the normal host. Recent studies have shown the efficacy of oral acyclovir. In addition, oral acyclovir may prevent the ocular complications of ophthalmic zoster. When acyclovir is given, it should be administered as early as possible, preferably no later than four days after the onset of the rash. The combination of acyclovir and prednisolone for the prevention of post-herpetic neuralgia has not proved effective.

Topics: Acyclovir; Chickenpox; Clinical Trials as Topic; Herpes Zoster; Humans; Idoxuridine; Immunity; Neuralgia; Prednisolone

Topics: Acyclovir; Administration, Oral; Herpes Zoster; Humans

Herpes zoster is a cutaneous vesicular eruption resulting from recrudescence of the chickenpox virus. It is mainly a disease of adults, with a predisposition for the elderly or immunocompromised. Although usually localized, the disease can disseminate to visceral organs. Diagnosis is often made based on the characteristic pattern of the lesion and clinical features. Tzanck smear, viral isolation, seroconversion, antibody titers, and monoclonal antibodies may further aid or confirm the diagnosis. Clinical features of herpes zoster may follow a progression through 3 stages, prodromal, acute, and chronic. The prodromal and acute phases seldom require more than symptomatic management. The chronic pain syndrome, postherpetic neuralgia (PHN), demands a more aggressive approach. Pharmacologic intervention, neuroaugmentation, and/or surgery may prevent or alleviate PHN, but universal response to any of these therapeutic approaches is unlikely. Tricyclic antidepressants remain the first choice in treating this pain syndrome. A trial of antiviral therapy may be warranted in patients with disseminated disease or in immunocompromised patients with localized disease. Of the antiviral agents, acyclovir is considered the drug of choice by most clinicians.

Topics: Acyclovir; Analgesics; Antiviral Agents; Electric Stimulation Therapy; Herpes Zoster; Humans; Patient Isolation; Vidarabine

Topics: Acyclovir; Administration, Oral; Chickenpox; Child; Child, Preschool; Drug Resistance, Microbial; Herpes Simplex; Herpes Zoster; Herpesvirus 3, Human; Humans; Infant; Injections, Intravenous; Simplexvirus

In the 5 years since its release for clinical use, acyclovir (9-[2-hydroxyethoxymethyl]guanine) has proved to be a safe and effective agent for therapy of herpes simplex and varicella-zoster infections. The drug's availability in topical, oral, and intravenous preparations has allowed its use in a range of clinical situations. Acyclovir must be phosphorylated by viral thymidine kinase in infected cells, where it then acts to inhibit viral DNA replication specifically. Epstein-Barr virus and human cytomegalovirus infections do not seem to respond to acyclovir therapy, although in-vitro effects on these viruses may be seen. Acyclovir is well absorbed and distributed, with cerebrospinal fluid levels 50% that of plasma. Clearance is almost entirely by the renal route, with a half-life of 20 hours in the anuric patient. Acyclovir has an excellent safety profile, its major adverse effect being transient serum creatinine elevations during high-dose intravenous use. Major uses include treatment of primary and recurrent genital herpes and herpes encephalitis and prophyllaxis and therapy of mucocutaneous herpes and varicella-zoster infections in immunocompromised patients. Resistance to acyclovir in herpes simplex virus is rarely encountered and does not seem to be due to long-term chronic suppressive therapy.

Topics: Acyclovir; Chickenpox; Drug Interactions; Drug Resistance, Microbial; Ganciclovir; Herpes Simplex; Herpes Zoster; Herpesviridae; Humans; Postoperative Complications; Transplantation

Effective antiviral therapy is now available for many forms of infection due to varicella-zoster virus. Acyclovir is the most widely prescribed treatment, but the virus is not exquisitely sensitive to this drug, and others are under study. The goals of therapy differ among different kinds of patients and must be considered when designing a treatment program.

Topics: Acyclovir; Antiviral Agents; Chickenpox; Herpes Zoster; Humans; Immunocompetence; Neuralgia

Topics: Acyclovir; Herpes Zoster; Humans; Immune Tolerance; Vidarabine

Topics: Acyclovir; Adenosine Monophosphate; Adolescent; Adrenal Cortex Hormones; Adult; Aged; Anesthetics, Local; Antidepressive Agents; Antipsychotic Agents; Child; Cytarabine; Dimethyl Sulfoxide; Female; Herpes Zoster; Humans; Male; Middle Aged; Nerve Block; Neuralgia; Phenothiazines

Topics: Acyclovir; Chickenpox; Herpes Genitalis; Herpes Labialis; Herpes Simplex; Herpes Zoster; Humans; Infant, Newborn; Interferons; Papillomaviridae; Skin Diseases, Infectious; Tumor Virus Infections

The group of the human-pathogenic herpesviruses comprises five subgroups: Herpes simplex virus type 1 (HSV-1), Herpes simplex virus type 2 (HSV-2), varicella zoster virus (VZV), cytomegalovirus (CMV), and Epstein-Barr virus (EBV). Primary infection with these ubiquitous herpesviruses usually occurs in childhood or during adolescence and frequently remains inapparent. However, it can also give rise to a variety of clinical pictures. Important clinical manifestations of herpesvirus infections are mucocutaneous lesions (HSV-1, HSV-2, VZV) self-limited, lymphoproliferative diseases (CMV, EBV) and congenital malformations (CMV). Primary infection with herpesviruses leads to a persistent infection of the host. This clinically silent condition of latency can be interrupted and may cause pathological symptoms to recur by reactivation of latent herpesviruses. A classical example of the clinical manifestation of herpesvirus reactivation is herpes zoster following an overcome varicella disease. The mechanism of herpesvirus reactivation has not yet been fully clarified. Reactivation of herpesviruses might be attributable to a weakening of the cellular immunodefence. For the control of viral infections mainly two cellular effector systems are responsible: unspecific, cytotoxic, natural killer (NK) cells and specific cytotoxic thymus-dependent (T) lymphocytes. The functional impairment of these cytotoxic active cells my cause herpesvirus reactivation in immunodeficient or immunosuppressed persons. Interference with the immunological control function may also contribute to the genesis of herpesvirus-associated tumours. Such an association between herpesviruses and human tumours is assumed to exist especially in the case of EBV. The frequently life-endangering severity of local or disseminated herpesvirus infections calls for suitable measures ensuring efficient prophylaxis and therapy. However, the possibilities of a specific immunoprophylaxis (vaccine, special immunoglobulins) against herpesvirus infections are still rather limited. The development of antiviral substances has greatly benefited from the introduction of new agents (Acyclovir) and the production of sufficient quantities of interferon (IFN) preparations during the last few years. Impressive results were obtained with the nucleoside-related substance Acyclovir in the prevention and therapy of primary or reactivated HSV-1 or HSV-2 infections. The use of Acyclovir as prophylactic agent produced the effect tha

Topics: Acyclovir; Antiviral Agents; Burkitt Lymphoma; Chickenpox; Cytomegalovirus; Cytomegalovirus Infections; Female; Herpes Genitalis; Herpes Simplex; Herpes Zoster; Herpesviridae; Herpesviridae Infections; Herpesvirus 3, Human; Herpesvirus 4, Human; Humans; Immunity, Cellular; Immunization, Passive; Infectious Mononucleosis; Male; Nasopharyngeal Neoplasms; Simplexvirus; Smallpox Vaccine; T-Lymphocytes; Vidarabine

Topics: Acyclovir; Adult; Antiviral Agents; Chickenpox; Clinical Trials as Topic; Encephalitis; Herpes Simplex; Herpes Zoster; Herpesviridae Infections; Humans; Idoxuridine; Infant, Newborn; Infant, Newborn, Diseases; Keratitis, Dendritic; Trifluridine; Vidarabine

New therapies and diseases causing immunosuppression have provoked new and devastating ocular diseases. The possible reasons for the vulnerability of the retina to opportunistic infections are discussed. The clinical patterns of disease caused by common opportunistic agents are described, and current treatment available is reviewed.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; Candidiasis; Chorioretinitis; Cytomegalovirus Infections; Eye Diseases; Herpes Simplex; Herpes Zoster; Humans; Immunity, Cellular; Immunosuppression Therapy; Infant, Newborn; Retina; Retinal Diseases; Retinal Vessels

Topics: Acyclovir; Chickenpox; Clinical Trials as Topic; Cytomegalovirus Infections; Double-Blind Method; Herpes Simplex; Herpes Zoster; Herpesviridae Infections; Herpesvirus 4, Human; Humans; Immune Tolerance; Interferon Type I; Recurrence; Vidarabine

Acyclovir is now established as an effective and well tolerated therapeutic agent for the management of at least the more common infections of the herpes virus group. Evaluation of the drug nevertheless continues, primarily to verify its value in those infections caused by cytomegalovirus (CMV) and Epstein-Barr virus (EBV). Furthermore with the development of analogues of acyclovir with better absorption profiles or enhanced anti-viral activity the future for this area of anti-viral therapy looks optimistic.

Topics: Acyclovir; Cytomegalovirus Infections; Encephalitis; Forecasting; Hepatitis B; Herpes Genitalis; Herpes Labialis; Herpes Simplex; Herpes Zoster; Humans; Immune Tolerance; Infectious Mononucleosis; Keratitis, Dendritic; Recurrence

Topics: Acyclovir; Allopurinol; Animals; Drug Therapy; Folic Acid Antagonists; Herpes Simplex; Herpes Zoster; Humans; Leishmania; Mercaptopurine; Neoplasms; Nucleic Acid Synthesis Inhibitors; Recurrence; Species Specificity

Topics: Acyclovir; Antiviral Agents; Carbamazepine; Herpes Zoster; Humans; Pain

Topics: Acute Disease; Acyclovir; Anti-Bacterial Agents; Bacterial Infections; Catheterization; Chickenpox; Gram-Negative Bacteria; Herpes Zoster; Humans; Immunization; Immunization, Passive; Infection Control; Leukemia, Lymphoid; Mycoses; Protozoan Infections; Sulfamethoxazole; Trimethoprim

This paper reviews the clinical evaluation of acyclovir in the treatment of herpes-virus infections, predominantly those due to herpes simplex and varicella-zoster viruses. Intravenous, oral and topical acyclovir have been reported to be effective in the therapy of a wide variety of established herpes simplex virus infections and the systemic drug has been shown to be capable of suppressing reactivation of that virus. Although acyclovir has less activity against varicella-zoster virus, infections caused by this agent are also susceptible to intravenous and possibly oral therapy. Clinical efficacy against Epstein-Barr virus and cytomegalovirus infections has not been demonstrated but several studies are currently in progress. Limited evidence of in vivo activity against hepatitis B virus also requires further evaluation. Continued studies on tolerance of the drug in clinical use has confirmed the early promise of this selective antiviral, whilst initial concern about the development of widespread resistance has not been borne out in practice.

Topics: Acyclovir; Clinical Trials as Topic; Cytomegalovirus Infections; Drug Resistance, Microbial; Female; Herpes Genitalis; Herpes Labialis; Herpes Zoster; Humans; Immunosuppression Therapy; Keratitis, Dendritic; Male; Recurrence

Topics: Acyclovir; Antiviral Agents; Chickenpox; Clinical Trials as Topic; Encephalitis; Female; Herpes Genitalis; Herpes Labialis; Herpes Simplex; Herpes Zoster; Herpesviridae Infections; Humans; Idoxuridine; Infant, Newborn; Keratitis, Dendritic; Keratoconjunctivitis; Male; Vidarabine

Acyclovir [9-(2-hydroxyethoxymethyl)guanine] is a newly licensed acyclic nucleoside analog that is active in vitro and in vivo against herpes simplex virus (HSV) and varicella zoster virus (VZV). This agent is available in the United States in topical and intravenous forms, and the oral preparation is currently being evaluated in clinical trials. The precise therapeutic role for acyclovir in patients with herpesvirus infections is still evolving. This article reviews the current status of this exciting new antiviral agent.

Topics: Acyclovir; Aged; Chickenpox; Cytomegalovirus Infections; Female; Herpes Genitalis; Herpes Simplex; Herpes Zoster; Humans; Infant, Newborn; Infectious Mononucleosis; Injections, Intravenous; Keratitis, Dendritic; Male; Pregnancy; Risk; Virus Diseases

Topics: Acyclovir; Administration, Oral; Administration, Topical; Antiviral Agents; Chickenpox; Cytomegalovirus Infections; Herpes Labialis; Herpes Simplex; Herpes Zoster; Humans; Immune Tolerance; Immunization; Injections, Intramuscular; Interferon Type I; Vidarabine

Herpes viruses are among the most common and troublesome opportunistic pathogens infecting patients with neoplastic diseases. The recent development of partially effective and relatively nontoxic antiviral agents offers promise for the prophylaxis or therapy of these infections in high-risk groups. Vidarabine and acyclovir have shown efficacy in several herpes virus infections and are now licensed in the United States. Alpha interferon may also be useful in the prophylaxis or early therapy of certain herpes virus infections. Newer antiviral agents and combination therapies are under study. Early and rapid diagnosis of such infections is critical to the development of effective therapy.

Topics: Acyclovir; Antineoplastic Agents; Antiviral Agents; Bone Marrow Transplantation; Bromodeoxyuridine; Cloning, Molecular; Cytomegalovirus Infections; Herpes Simplex; Herpes Zoster; Herpesviridae Infections; Humans; Infectious Mononucleosis; Interferons; Kidney Transplantation; Leukemia; Lymphopenia; Neoplasms; Pulmonary Fibrosis; Vidarabine

Progress in antiviral chemotherapy has taken place as a logical strategy for the design of antiviral agents has emerged. The second-generation nucleoside analogues, led by acyclovir, have proved their worth against herpesviruses and should now become a standard part of medical practice. Meanwhile, recombinant DNA technology has lowered the cost of interferons to the point at which the several human subtypes of these naturally occurring hormones can be subjected individually to controlled clinical trials against the viral diseases in the treatment of which they show promise. Yet, optimism about the future of antiviral chemotherapy must be tempered by the observation that most of the agents discussed in this review are described more accurately as promising rather than proven, and several of these have not yet been released in Australia at the time of writing.

Topics: Acyclovir; Amantadine; Animals; Antiviral Agents; Bromodeoxyuridine; Female; Hepatitis B; Herpes Genitalis; Herpes Simplex; Herpes Zoster; Humans; Idoxuridine; In Vitro Techniques; Interferons; Male; Neoplasms; Papillomaviridae; Respiratory Tract Infections; Ribavirin; Rimantadine; Tumor Virus Infections; Vidarabine

Recent developments have increased the options for treatment of viral infections. Vidarabine, an agent originally released for herpes simplex encephalitis, has more recently been shown to be of benefit in neonatal herpes simplex infection and in varicella-zoster infections in immunocompromised hosts. The introduction of acyclovir represents a major advance in antiviral therapy because of its low host toxicity and marked selectivity for herpes simplex and varicella-zoster viruses. Extensive controlled clinical trials demonstrate efficacy in the treatment of infections caused by these viruses in the immunocompromised host and in genital herpes simplex infections in normal hosts. The use of recombinant DNA technology has increased the purity, variety, and availability of interferons for clinical trial. Earlier experience with natural buffy coat-derived alpha interferon showed efficacy in the treatment of varicella-zoster infections in the immunocompromised host, as well as prophylaxis of herpes virus infections in high-risk populations. These results have to be confirmed using the newer interferon preparations. Under development are a variety of new drugs with broadened viral spectrum and improved pharmacokinetic properties. These include nucleoside analogues and novel interferons with modified amino acid sequences. One or more of these agents, used singly or in combination, may prove useful in the more difficult therapeutic problems, such as cytomegalovirus and hepatitis B infections.

Topics: Acyclovir; Antiviral Agents; Chickenpox; Female; Herpes Genitalis; Herpes Simplex; Herpes Zoster; Herpesviridae Infections; Humans; Infant, Newborn; Interferons; Male; Respiratory Tract Infections; Vidarabine

Herpes zoster is a commonly encountered infectious disease primarily affecting the elderly and immunosuppressed. The natural history and complications of the disease and the principles of management are often not appreciated by clinicians in a variety of disciplines who may see the patient during the acute phase. Recent literature has furthered our understanding of the virology of herpes zoster and the roles of corticosteroid and antiviral therapy. We review the clinical features, diagnostic principles, and management controversies of herpes zoster.

Topics: Acyclovir; Adrenal Cortex Hormones; Adult; Aged; Antiviral Agents; Child; Diagnosis, Differential; Facial Paralysis; Herpes Simplex; Herpes Zoster; Herpes Zoster Ophthalmicus; Herpesviridae; Herpesvirus 3, Human; Humans; Immunity, Cellular; Interferons; Keratitis; Middle Aged; Neuralgia; Uveitis; Vidarabine

The recent profusion of antiviral research has resulted in significant advances toward prevention and treatment of herpes group virus infections. The most promising new agent is acyclovir, which is available in topical, intravenous, and oral formulations. Results of clinical trials of acyclovir for prevention and treatment of herpes simplex, varicella-zoster virus, cytomegalovirus, and Epstein-Barr virus infections are discussed, and the potential problem of antiviral resistance considered. Vidarabine therapy is reviewed briefly, and future new drugs with activity against herpesviruses are mentioned.

Topics: Acyclovir; Chickenpox; Cytomegalovirus Infections; Drug Resistance, Microbial; Encephalitis; Female; Herpes Genitalis; Herpes Labialis; Herpes Simplex; Herpes Zoster; Herpesviridae Infections; Herpesvirus 4, Human; Humans; Keratitis, Dendritic; Male; Vidarabine

Topics: Acyclovir; Administration, Topical; Adolescent; Amantadine; Antiviral Agents; Chickenpox; Child; Clinical Trials as Topic; Encephalitis; Female; Herpes Genitalis; Herpes Simplex; Herpes Zoster; Humans; Idoxuridine; Influenza, Human; Keratitis, Dendritic; Male; Rimantadine; Vidarabine

Topics: Acyclovir; Antiviral Agents; Bromodeoxyuridine; Chickenpox; Herpes Zoster; Herpesviridae Infections; Herpesvirus 4, Human; Humans; Immune Tolerance; Interferon Type I; Interferons; Vidarabine

New knowledge of the relationship between the varicella-zoster virus and its host suggests a heretofore unappreciated dynamic pattern. Molecular finger-printing has demonstrated a degree of heterogeneity between different strains of virus. It is probable that exogenous reinfection with different strains and endogenous reactivation are commonplace events, although usually asymptomatic. The lability of the endogenous interaction inversely parallels the responsiveness of the cell-mediated immune system--a major factor in viral containment by the human host. Thus, the therapeutic use of immunosuppressive or cytotoxic substances increases the morbidity and mortality associated with varicella-zoster. Promising new approaches to the prevention and treatment of the virus should alter the balance in favor of the host.

Topics: Acyclovir; Chickenpox; Cross Infection; Disease Outbreaks; Female; Herpes Zoster; Humans; Immune Tolerance; Immunization, Passive; Infant, Newborn; Interferons; Pregnancy; Reye Syndrome; Transfer Factor; Vaccination; Vaccines, Attenuated; Viral Vaccines

Acyclovir (acycloguanosine) is a new antiviral compound with activity against certain herpes viruses. Acyclovir is phosphorylated preferentially in virus-infected cells into its active form, acyclovir triphosphate, an inhibitor of viral-induced DNA polymerase. Acyclovir, which possesses an acyclic carbohydrate moiety, also causes premature DNA chain termination. Acyclovir has shown clinical activity against herpes simplex virus (HSV) types 1 and 2 and varicella zoster virus (VZV), but its usefulness in cytomegalovirus, Epstein-Barr virus, and chronic hepatitis B infections requires further study. In randomized clinical trials of infections caused by HSV and VZV, intravenous acyclovir has been shown to shorten the duration of viral shedding and lesion pain and hasten the resolution of skin lesions, with minimal toxicity.

Topics: Acyclovir; Clinical Trials as Topic; Cytomegalovirus Infections; Drug Resistance, Microbial; Herpes Simplex; Herpes Zoster; Humans; Injections, Intravenous; Kinetics; Virus Diseases

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

In a randomized, placebo-controlled, double-blind trial of intravenous acyclovir in the treatment of varicella zoster virus (VZV) infections, 8 of 20 immunocompromised children with varicella received acyclovir (500 mg/m2/dose three times daily for 7 days). There was no significant difference in skin healing between the acyclovir and placebo groups although there was a significant reduction in the incidence of development of pulmonary involvement during acyclovir treatment. Nineteen out of 34 patients received vidarabine (10 mg/kg/day for 5 days). Vidarabine significantly shortened the duration of new vesicle formation. Both drugs significantly reduced the incidence of visceral varicella, the most serious complication of VZV infection. An open trial also concluded that early treatment of varicella in these patients is essential. Of the 94 patients with zoster infection, 52 received acyclovir (500 mg/m2/dose infused over one hour three times daily for 7 days). Acyclovir recipients healed more rapidly, had fewer days of pain and shorter duration of viral shedding compared with placebo patients. The most important finding was that acyclovir significantly protected against progression of zoster as defined by development or progression of cutaneous dissemination and development of visceral zoster. Vidarabine seemed to be equally effective in this respect. The likelihood of cutaneous dissemination is related to the nature of the underlying condition. The in vitro sensitivity of VZV isolates from patients with second episode VZV infection during the trial did not change appreciably which suggests that VZV does not become resistant to acyclovir during therapy.

Topics: Acyclovir; Adolescent; Adult; Aged; Bone Marrow Transplantation; Chickenpox; Child; Clinical Trials as Topic; Double-Blind Method; Drug Resistance, Microbial; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunosuppression Therapy; Injections, Intravenous; Kidney Transplantation; Lymphoproliferative Disorders; Male; Middle Aged; Neoplasms; Random Allocation; Vidarabine

Topics: Acyclovir; Chickenpox; Cytomegalovirus Infections; Drug Resistance, Microbial; Female; Hepatitis B; Herpes Simplex; Herpes Zoster; Herpesviridae Infections; Humans; Infectious Mononucleosis; Male; Recurrence

Acyclovir (aciclovir) is a nucleoside analogue antiviral drug related to cytarabine, idoxuridine, trifluridine and vidarabine. In common with these earlier antivirals, acyclovir is active against some members of the herpesvirus group of DNA viruses. The efficacy of topical acyclovir has been convincingly demonstrated in ocular herpetic keratitis, and in initial and primary initial genital herpes infection, but little or no clinical benefit was seen when non-primary initial genital infections were assessed separately. Acyclovir ointment demonstrated little benefit in recurrent genital herpes but topical acyclovir cream decreased the course of the infection by 1 to 2 days. Orally and intravenously administered acyclovir were beneficial in initial genital herpes infections, and oral therapy shortened the duration of recurrent infections by 1 to 2 days but did not ameliorate pain. In non-immunocompromised patients with recurrent herpes simplex labialis, generally little clinical benefit was seen with the use of topical acyclovir ointment even when therapy was initiated during the prodromal phase, while topical acyclovir cream effected small but significant improvements in the clinical but not the symptomological course of the disease. However, in immunocompromised patients, both intravenous and topical acyclovir shortened the clinical course of herpes simplex virus infections occurring mainly on the lips, oral mucosa and face, and prophylaxis with either oral or intravenous acyclovir suppressed the appearance of recurrent lesions from latent virus for the period of drug administration, but acyclovir did not eradicate latent herpesviruses. In non-immunocompromised patients, intravenous acyclovir was shown to decrease the acute pain of zoster, especially in the elderly, but postherpetic neuralgia was not ameliorated. When immunocompromised patients were studied, intravenous acyclovir inhibited the progression of zoster infections and shortened the healing time and duration of viral shedding in patients with cutaneous disseminated zoster. However, acute and post-herpetic pain were not significantly affected. Well designed controlled studies are underway to establish the efficacy of acyclovir in herpes simplex encephalitis and cytomegalovirus infections in immunocompromised patients, infections due to Epstein-Barr virus, and neonatal herpesvirus infections. Despite some aspects of the drug's use which require further clarification, acyclovir will make a major imp

Topics: Acyclovir; Animals; Clinical Trials as Topic; Cytomegalovirus; Drug Resistance, Microbial; Encephalitis; Female; Herpes Genitalis; Herpes Simplex; Herpes Zoster; Herpesvirus 4, Human; Humans; Immunity; Keratitis, Dendritic; Kinetics; Male; Mutagens; Recurrence

Only a few agents with antiviral activity are available for routine clinical use. Amantadine hydrochloride is effective in the prophylaxis of influenza A. In addition, accumulated evidence shows that amantadine has some therapeutic effect when used early in the course of an influenza A infection. Idoxuridine and adenine arabinoside have found application as topical agents in the treatment of herpes simplex keratitis. Adenine arabinoside has also been approved for the treatment of disseminated infections due to herpes zoster and herpes simplex. Acyclovir sodium has been approved as a topical agent in the treatment of limited mucocutaneous herpes simplex viral infections in immunosuppressed patients and of initial episodes of genital herpes simplex infections in patients with normal immunity. Ribavirin, an experimental agent with a wide spectrum of activity in vitro, has not fulfilled expectations in clinical trials. Because of the eradication of smallpox, methisazone has become obsolete as a prophylactic agent in smallpox.

Topics: Acyclovir; Amantadine; Animals; Antiviral Agents; Herpes Simplex; Herpes Zoster; Humans; Idoxuridine; Influenza A virus; Keratitis, Dendritic; Methisazone; Ribavirin; Smallpox; Vidarabine; Virus Diseases

Acyclovir given intravenously in either low dose (5 mg/kg every 8 h) or high dose (500 mg/m2 every 8 h) significantly reduced pain and accelerated skin healing in acute herpes zoster occurring in otherwise healthy adults. The higher dose also significantly reduced the duration of viral shedding. No significant effect on post-herpetic neuralgia could be demonstrated, although the higher dose showed a promising trend. No adverse effects were associated with the lower dose, but acyclovir at 500 mg/m2 resulted in nausea, vomiting and transiently elevated serum creatinine in a substantial number of patients.

Topics: Acyclovir; Adult; Creatinine; Follow-Up Studies; Herpes Zoster; Humans; Injections, Intravenous; Nausea; Pain; Random Allocation; Time Factors; Vomiting

Intravenous acyclovir had a significant effect on the resolution of the skin rash in patients with acute zoster, but the 5-day course of therapy was not, in itself, sufficient to treat coexisting ocular involvement. In an open study, topical acyclovir was found to control herpes zoster kerato-uveitis, without recurrences and in a shorter time than if steroids alone were used. The use of steroids in combination with acyclovir led to prolonged treatment and high recurrence rates. A comparative trial of topical acyclovir versus steroids in the treatment of acute herpes zoster kerato-uveitis showed significant differences in favour of acyclovir in terms of the time to resolution of corneal epithelial disease, total treatment duration and the numbers of patients having a recurrence of infection. The reductions in treatment duration and recurrence rate would be expected to result in a reduced incidence of ocular damage and visual loss in acyclovir treated patients.

Topics: Acyclovir; Administration, Topical; Herpes Zoster; Herpes Zoster Ophthalmicus; Humans; Injections, Intravenous; Recurrence; Skin Diseases, Infectious; Steroids

As reflected in the preclinical and early clinical data, acyclovir seems destined to have a very useful role in the treatment and/or prophylaxis of herpes virus (HSV) infections in immunosuppressed humans. If the preclinical predictions can be extrapolated to varicella-zoster (V-Z) infections, acyclovir could well also play a meaningful role in therapy of V-Z infections in the immunosuppressed host; however, this conjecture awaits proof of controlled studies in humans. Clearly the usefulness of acyclovir for treatment of V-Z infections should be compared with that of adenine arabinoside (ara-A) to put into proper perspective the relative efficacies of the two drugs for future therapeutic regimens. The need for comparative studies is most important at this early stage of antiviral drug development, to avoid ethical problems that will cloud the knowledge needed to move forward in a positive way. In any event, the development of acyclovir, with its targeted approach, represents a real fundamental advance in antiviral drug development. Together with the development and deployment of ara-A, it should provide the needed impetus for a surge in the creation of new antiviral compounds for tomorrow.

Topics: Acyclovir; Administration, Topical; Antiviral Agents; Chickenpox; Cytomegalovirus Infections; Guanine; Hepatitis B; Herpes Simplex; Herpes Zoster; Herpesviridae Infections; Humans; Immune Tolerance; Infectious Mononucleosis; Infusions, Parenteral

Allogeneic hematopoietic cell transplantation (HCT) recipients are at increased risk for varicella zoster virus (VZV) reactivation and associated complications. The incidence, timing, and risk factors for severe herpes zoster (HZ) are not well described in the era of acyclovir (ACV) prophylaxis. We performed a retrospective cohort study of all patients who underwent first allogeneic HCT between October 2006 and December 2015 at our institution. Patients were followed until December 2017 for the development of severe HZ, defined as necessitating administration of i.v. antiviral medication. Out of 2163 patients who underwent allogeneic HCT, 22 (1.0%) developed severe HZ at a rate of 1 per 228 person-years, including dermatomal/multidermatomal disease (n = 5), disseminated skin disease (n = 5), HZ ophthalmicus (n = 4), meningitis/encephalitis (n = 4), pneumonia (n = 2), viremia (n = 1), and erythema multiforme (n = 1). Severe HZ infection occurred in a bimodal distribution during the early peri-HCT period and at 12 to 24 months post-HCT (median, 12.7 months). Twelve patients (54.5%) were compliant with ACV prophylaxis at the time of HZ diagnosis. Eleven patients (50%) died during the study period, only 2 of whom (9.1%) with active VZV infection. Mortality was higher in patients on immunosuppressive therapy (62.5% versus 16.7%; P = .045) and with concurrent graft-versus-host disease (75.0% versus 35.7%; P= .044). These data suggest that severe HZ remains an important consideration despite ACV prophylaxis.

Topics: Acyclovir; Adolescent; Adult; Aged; Allografts; Antiviral Agents; Disease-Free Survival; Female; Hematopoietic Stem Cell Transplantation; Herpes Zoster; Herpesvirus 3, Human; Humans; Male; Middle Aged; Severity of Illness Index; Survival Rate

This study investigated the safety and efficacy of famciclovir compared to acyclovir in patients with herpes zoster, to determine whether the two regimens are equally effective for the treatment of patients with uncomplicated herpes zoster over a period of 7days.. Patients were randomly assigned to receive either famciclovir 500mg (one tablet) three times daily or acyclovir 800mg (two capsules) five times daily for 7 days. The primary endpoint was defined as the time to full crusting of herpes zoster lesions. Secondary endpoints were the proportion of patients who achieved complete cure and the change in score of signs/symptoms (pain, vesicular lesions, loss of sensitivity, burning pain, and pruritus) according to the patient diary. This study has been registered at ClinicalTrials.gov (NCT01327144).. One hundred and seventy-four patients were enrolled and randomized; 151 of these patients completed treatment (n=75 famciclovir, n=76 acyclovir). A similar proportion of patients who received acyclovir (94.74%) and famciclovir (94.67%) achieved complete cure. The mean time to full crusting of herpes zoster lesions was 15.033days in the acyclovir group and 14.840days in the famciclovir group (log-rank p-value=0.820). The most common adverse events in the pooled groups were headache, diarrhea, nausea, back pain, cold, and drowsiness, but none of these was deemed to be clinically important.. Both interventions obtained high rates of cure and had a similar time to full crusting of lesions. Analysis of the primary efficacy endpoint proved that famciclovir is non-inferior to acyclovir, as the confidence interval for the difference in efficacy did not violate the non-inferior margin. Therefore, the results are not different enough to be clinically relevant.

Topics: 2-Aminopurine; Acyclovir; Adult; Aged; Antiviral Agents; Famciclovir; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Male; Middle Aged; Pain; Pruritus; Treatment Outcome

Amenamevir is a potent helicase-primase inhibitor and a novel class of antiviral agent other than nucleoside compounds, such as aciclovir, valaciclovir and famciclovir. This study is the first randomized, double-blind, valaciclovir-controlled phase 3 study to evaluate the efficacy and safety of amenamevir in Japanese patients with herpes zoster when treated within 72 h after onset of rash. A total of 751 patients were randomly assigned to receive either amenamevir 400 mg or 200 mg p.o. once daily or valaciclovir 1000 mg three times daily (daily dose, 3000 mg) for 7 days. The primary efficacy end-point was the proportion of cessation of new lesion formation by day 4 ("day 4 cessation proportion"). The day 4 cessation proportions for amenamevir 400 and 200 mg and valaciclovir were 81.1% (197/243), 69.6% (172/247) and 75.1% (184/245), respectively. Non-inferiority of amenamevir 400 mg to valaciclovir was confirmed by a closed testing procedure. Days to cessation of new lesion formation, complete crusting, healing, pain resolution and virus disappearance were evaluated as secondary end-points. No significant differences were observed in any of the treatment groups. Amenamevir 400 and 200 mg were well tolerated as well as valaciclovir. The proportions of patients who experienced drug-related adverse events were 10.0% (25/249), 10.7% (27/252) and 12.0% (30/249) with amenamevir 400 and 200 mg and valaciclovir, respectively. In conclusion, amenamevir 400 mg appears to be effective and well tolerated for treatment of herpes zoster in immunocompetent Japanese patients.

Topics: Acyclovir; Aged; Antiviral Agents; Double-Blind Method; Female; Herpes Zoster; Humans; Male; Middle Aged; Oxadiazoles; Treatment Outcome; Valacyclovir; Valine

Treatment of established postherpetic neuralgia (PHN) is difficult and often disappointing. In this study, we assessed the efficacy of repetitive intracutaneous injections with local anesthetics and steroids in acute thoracic herpes zoster (HZ) pain, herpetic eruption, and incidence of PHN.. Ninety-three patients with acute thoracic HZ were randomly assigned to receive a standard treatment of antiviral medication with p.o. analgesics or the standard treatment with the addition of repetitive intracutaneous injections of a local anesthetic and steroid mixture. Patients were permitted to take tramadol when the visual analog scale (VAS) ≥ 4. Pain assessment using VAS was conducted at the initial visit, as well as 1, 2, 4, 12, and 24 weeks after the end of the treatments.. In comparison with the standard treatment group, the VAS scores of the intracutaneous injection group were significantly lower during the study. The intracutaneous injection group also reported shorter duration of pain and skin eruption than the control group ( P  = 0.005 vs P  < 0.001, respectively). At 1 month post-therapy, 12.8% patients in the intracutaneous injection group reported zoster-associated pain, compared with 47.8% in the standard treatment group ( P  < 0.001). At 3 and 6 months post-therapy, the incidence of PHN was still significantly lower in the intracutaneous injection group than the standard treatment group. EuroQol VAS scores were significantly higher in the intracutaneous injection group vs standard treatment group (P < 0.001).. Repetitive intracutaneous injections with local anesthetics and steroids along with standard treatment significantly reduce the duration of pain and herpetic eruption and incidence of PHN.

Topics: Acyclovir; Aged; Aged, 80 and over; Amides; Analgesics, Opioid; Anesthetics, Local; Antiviral Agents; Female; Herpes Zoster; Humans; Incidence; Injections, Intradermal; Male; Methylprednisolone; Middle Aged; Neuralgia, Postherpetic; Neuroprotective Agents; Pain Measurement; Ropivacaine; Tramadol

This prospective, parallel-group, randomized, double-blind, multicenter study compared the efficacy and safety of FV-100 with valacyclovir for reducing pain associated with acute herpes zoster (HZ). Patients, ≥50 years of age, diagnosed with HZ within 72 h of lesion appearance who had HZ-associated pain, were randomized 1:1:1 to a 7-day course of either FV-100 200 mg QD (n = 117), FV-100 400 mg QD (n = 116), or valacyclovir 1000 mg TID (n =117). Efficacy was evaluated on the basis of the burden of illness (BOI; Zoster Brief Pain Inventory scores); incidence and duration of clinically significant pain (CSP); pain scores; incidence and severity of post-herpetic neuralgia (PHN); and times to full lesion crusting and to lesion healing. Safety was evaluated on the basis of adverse event (AE)/SAE profiles, changes in laboratory and vital signs values, and results of electrocardiograms. The burden of illness scores for pain through 30 days were 114.5, 110.3, and 118.0 for FV-100 200 mg, FV-100 400 mg, and valacyclovir 3000 mg, respectively. The incidences of PHN at 90 days for FV-100 200 mg, FV-100 400 mg, and valacyclovir 3000 mg were 17.8%, 12.4%, and 20.2%, respectively. Adverse event and SAE profiles of the two FV-100 and the valacyclovir groups were similar and no untoward signals or trends were evident. These results demonstrate a potential for FV-100 as an antiviral for the treatment of shingles that could both reduce the pain burden of the acute episode and reduce the incidence of PHN compared with available treatments.

Topics: Acyclovir; Aged; Aged, 80 and over; Antiviral Agents; Cost of Illness; Double-Blind Method; Female; Herpes Zoster; Humans; Male; Middle Aged; Neuralgia, Postherpetic; Pain; Pain Management; Prospective Studies; Pyrimidine Nucleosides; Valacyclovir; Valine

Postherpetic neuralgia (PHN) is a chronic neuropathic pain that results from alterations of the peripheral nervous system in areas affected by the herpes zoster virus. The symptoms include pain, paresthesia, dysesthesia, hyperalgesia, and allodynia. Despite the availability of pharmacological treatments to control these symptoms, no treatments are available to control the underlying pathophysiology responsible for this disabling condition.. Patients with herpes zoster who are at least 50 years old and have a pain score of 4 or higher on a visual analogue scale (VAS) will be recruited. The aim is to recruit 134 patients from the practices of general physicians. Participants will be randomized to receive gabapentin to a maximum of 1800 mg/day for 5 weeks or placebo. Both arms will receive 1000-mg caplets of valacyclovir three times daily for 7 days (initiated within 72 h of the onset of symptoms) and analgesics as needed. The primary outcome measure is the percentage of patients with a VAS pain score of 0 at 12 weeks from rash onset. The secondary outcomes measures are changes in quality of life (measured by the SF-12 questionnaire), sleep disturbance (measured by the Medical Outcomes Study Sleep Scale), and percentage of patients with neuropathic pain (measured by the Douleur Neuropathique in 4 Questions).. Gabapentin is an anticonvulsant type of analgesic that could prevent the onset of PHN by its antihypersensitivity action in dorsal horn neurons.. ISRCTN Registry identifier: ISRCTN79871784 . Registered on 2 May 2013.

Topics: Acyclovir; Amines; Analgesics; Antiviral Agents; Clinical Protocols; Cyclohexanecarboxylic Acids; Double-Blind Method; Female; Gabapentin; gamma-Aminobutyric Acid; Herpes Zoster; Humans; Male; Middle Aged; Neuralgia, Postherpetic; Pain Measurement; Quality of Life; Research Design; Sleep; Spain; Surveys and Questionnaires; Time Factors; Treatment Outcome; Valacyclovir; Valine

Human immunodeficiency virus (HIV)-infected persons have higher rates of herpes zoster than HIV-uninfected individuals. We assessed whether twice daily treatment with 400 mg of oral acyclovir reduces the incidence of herpes zoster in a randomized, double-blind, placebo-controlled trial among 3408 persons coinfected with HIV and herpes simplex virus type 2. During 5175 person-years of follow-up, 26 cases of herpes zoster occurred among those assigned acyclovir, compared with 69 cases among those assigned placebo (rates, 1.00 and 2.68/100 person-years, respectively), a relative decrease of 62% (hazard ratio, 0.38; 95% confidence interval, .24-.67; P < .001). Daily acyclovir prophylaxis significantly reduced herpes zoster incidence among HIV-infected persons.

Topics: Acyclovir; Adult; Antiviral Agents; Chemoprevention; Double-Blind Method; Female; Herpes Zoster; Herpesvirus 2, Human; HIV; HIV Infections; Humans; Incidence; Male; Placebos; Treatment Outcome; Young Adult

Postherpetic neuralgia (PHN) is a sequela of herpes zoster that adversely affects quality of life seriously. The risk factors for PHN are well known but the effective interventions that reduce the incidence of PHN are less studied. The objective of this study is to evaluate the efficacy of treatment with gabapentin in patients with acute herpes zoster for preventing PHN. We performed a prospective randomized controlled study of 120 participants diagnosed with acute herpes zoster, aged 50 and over and complaining moderate to severe pain. All patients were treated with valacyclovir and acetaminophen. Half of the participants were assigned to the gabapentin group and received gabapentin 300 mg three times a day additionally. The intensity of pain at every visit and the incidence of PHN in both groups were measured. Total 52 and 49 patients in the gabapentin group and the control group, respectively, had completed 12 weeks of follow-up period. Although the incidence of PHN was higher in the control group, the difference was not statistically significant (6.1% vs. 3.8%, p = 0.67). Our results indicate that the use of low-dose gabapentin in acute herpes zoster seems not effective in the prevention of PHN.

Topics: Acetaminophen; Acyclovir; Aged; Aged, 80 and over; Amines; Analgesics; Analgesics, Non-Narcotic; Antiviral Agents; Cyclohexanecarboxylic Acids; Drug Therapy, Combination; Female; Gabapentin; gamma-Aminobutyric Acid; Herpes Zoster; Humans; Male; Middle Aged; Neuralgia, Postherpetic; Pain Measurement; Prospective Studies; Quality of Life; Republic of Korea; Time Factors; Treatment Outcome; Valacyclovir; Valine

To evaluate the clinical efficacy of intradermal injection of methylene blue for treatment of moderate to severe acute thoracic herpes zoster and prevention of postherpetica neuralgia in elderly patients.. Sixty-four elderly patients with herpes zoster were randomized to receive a 10-day course of intradermal injection of methylene blue and lidocaine plus oral valaciclovir (group A, 32 cases) and intradermal injection of lidocaine plus oral valaciclovir (group B).Herpes evaluation index, pain rating index, incidence of postherpetic neuralgia, and comprehensive therapeutic effect were compared between the two groups at 11, 30 and 60 days after the treatment.. The baseline characteristics were comparable between the two groups (all P>0.05). Compared with that in group B, the time for no new blister formation, blister incrustation and decrustation, and pain relief was significantly shortened in group A (P<0.05) with also obviously lower pain intensity after the treatment. The incidence of postherpetic neuralgia was significantly lower in group A than in group B at 30 days (P<0.05), but not at 60 and 90 days after the treatment. The total clinical response rate was 93.8% in group A, much higher than that in group B (62.5%, P<0.05).. Intradermal injection of methylene blue can effectively shorten the disease course, reduce the pain intensity and prevent the development of postherpetic neuralgia in elderly patients with herpes zoster.

Topics: Acyclovir; Aged; Herpes Zoster; Humans; Incidence; Injections, Intradermal; Lidocaine; Methylene Blue; Neuralgia, Postherpetic; Pain Measurement; Valacyclovir; Valine

To observe the effect of electroacupuncture (EA) combined with ultraviolet therapy on herpes zoster at the acute stage and the impacts on serum interleukin 2 (IL-2), interleukin 6 (IL-6) and interleukin 10 (IL-10) in the patients.. Thirty-four patients of herpes zoster were randomized into a medicine group and a combined therapy group, 17 cases in each one. In the medicine group, the intravenous drops with acyclovir injection, muscular injection with cobamamide and the topical with acyclovir ointment were applied. Additionally, TDP was radiated locally. In the combined therapy group, on the basis of the treatment as the medicine group, EA and ultraviolet therapy were supplemented. The duration of treatment was 10 days in the two groups. Before and after treatment, blister relief, incrustation time and the visible analogue scale (VAS) were recorded in the two groups. The clinical efficacy was assessed in the two groups and the levels of serum IL-2, IL-6 and IL-10 were determined in the two groups.. In the combined therapy group, the time of blister relief and incrustation was earlier apparently than that in the medicine group (both P<0.05). VAS score after treatment were reduced as compared with that before treatment in the two groups (both P<0.01), and the reducing amplitude in the combined therapy group was larger than that in the medicine group (P<0.01). The total effective rate was 94. 1% (16/17) in the combined therapy group, higher than 76.4% (13/17) in the medicine group (P<0.05). After treatment, IL-2 levels were increased as compared with those before treatment in the two groups (both P<0.05), the levels of IL-6 and IL-10 were reduced obviously as compared with those before treatment in the two groups (all P<0.01). After treatment, the levels of IL-6, IL-10 were reduced much more apparently in the combined therapy group as compared with those in the medicine group (both P<0.05).. EA combined with ultraviolet irradiation more rapidly and effectively relief the symptoms of herpes zoster, significantly relief pain, shorten the duration of sickness, improve the body immunity and reduce nerve injury.

Topics: Acyclovir; Adult; Combined Modality Therapy; Electroacupuncture; Female; Herpes Zoster; Humans; Interleukin-10; Interleukin-2; Interleukin-6; Male; Middle Aged; Treatment Outcome; Ultraviolet Therapy

Herpes zoster neural injury was assessed by determining cutaneous nerve density in skin biopsies from the affected dermatomes of 35 adult patients with herpes zoster in the acute phase and 3 months post-treatment, using protein gene product 9.5 immunohistochemistry. In contrast to the significant increase in subepidermal nerve fibre density (11.77 ± 4.88/mm vs. 13.29 ± 5.74/mm, p = 0.045) after 3 months, no differences were found in epidermal free nerve endings (2.43 ± 2.35/mm and 2.8 ± 2.86/mm, p = 0.168). Patients with post-herpetic neuralgia had significantly lower subepidermal nerve fibre densities (9.7 ± 2.05/mm vs. 14.72 ± 6.13/mm, p = 0.011) compared with non-post-herpetic neuralgia patients. No differences in cutaneous nerve density were found in relation to antiviral therapy. In conclusion, 3 months after acute infection, no sign of epidermal innervation recovery is observed, while the increased subepidermal nerve fibre density in the affected dermatomes probably reflects nerve regeneration that is not affected by antiviral agent type. Subepidermal nerve fibre density is decreased in patients with post-herpetic neuralgia 3-months post-acute herpes zoster infection.

Topics: 2-Aminopurine; Acyclovir; Antiviral Agents; Biomarkers; Biopsy; Bromodeoxyuridine; Famciclovir; Female; Herpes Zoster; Humans; Immunohistochemistry; Male; Middle Aged; Nerve Fibers; Neuralgia, Postherpetic; Skin; Ubiquitin Thiolesterase; Valacyclovir; Valine

Intravenous acyclovir-induced acute kidney injury (AKI) from drug crystallization in the renal tubules is described in case reports, review articles, and drug prescribing manuals. Similarly, AKI from oral acyclovir is described in case reports, but the risk in routine practice is unknown.. Retrospective population-based cohort study.. We studied a large cohort of older patients in Ontario, Canada, receiving new outpatient prescriptions from 1997 to 2011 for oral acyclovir or valacyclovir (which is metabolized to acyclovir). The comparison drug was famciclovir, an antiviral used for indications similar to acyclovir, but with no known renal toxicity.. Outpatient prescription for oral acyclovir, valacyclovir, or famciclovir.. The primary outcome was hospital admission with AKI in the 30 days after the initial prescription.. We assessed the primary outcome with health care diagnostic codes. In a subpopulation, we assessed AKI using available laboratory serum creatinine measurements.. 76,269 patients received acyclovir or valacyclovir and 84,646 received famciclovir. On average, patients were aged 76 [IQR, 71-81] years and prescription duration was 7 days. Acyclovir or valacyclovir use was not associated with a higher risk of hospital admission with AKI (209 [0.27%] events with acyclovir or valacyclovir vs 238 [0.28%] events with famciclovir [relative risk, 0.97; 95% CI, 0.81-1.17]). Results were consistent in adjusted analyses, in all subgroups, and in the subpopulation with laboratory measurements.. Diagnostic codes had high specificity but low sensitivity and underestimated the incidence of AKI. Only a limited number of patients (n = 2,729) had serum creatinine values available.. In this population-based study of older adults, oral acyclovir use was not associated with a higher risk of AKI compared to famciclovir.

Topics: Acute Kidney Injury; Acyclovir; Administration, Oral; Aged; Aged, 80 and over; Antiviral Agents; Creatinine; Female; Herpes Simplex; Herpes Zoster; Humans; Male; Ontario; Outpatients; Population Surveillance; Retrospective Studies; Risk Factors

Host defense and latency determinants in viral recurrent dermatologic infections are not entirely understood, as conventional protocols are inadequate to achieve fast healing and relapse prevention. Endogenously produced oxygen/nitrogen reactive species (ROS/RNS) are essential for antiviral immune defense, while their excess may aggravate skin inflammation. Here, we sought a nutritional approach capable of controlling ROS/RNS balance to accelerate recovery and inhibit recurrences of two mucocutaneous chronic DNA-virus infections.. Two controlled clinical trials evaluated the feasibility of ROS/RNS-modulating nutriceutical dosages of coenzyme Q(10), RRR-α-tocopherol, selenium aspartate, and L-methionine associated with established therapies. Clinical trial 1 evaluated 68 patients with relapsing human papillomavirus skin warts treated with cryotherapy followed by 180 d of nutriceutical/placebo administration. Clinical trial 2 compared the combination of acyclovir followed by 90 d of nutriceutical administration versus acyclovir alone in patients with recurrences of herpes simplex genitalis (n = 60) or herpes zoster (n = 29). Viral DNA levels were assessed by polymer chain reaction, biomarkers of antiviral defense (peroxynitrite and IFNα/γ) and antioxidant capacity (lipophilic antioxidants and glutathione) were assayed by biochemical/enzyme-linked immunosorbent assay techniques in blood fractions.. In both trials, the nutriceutical induced significantly faster healing (P < 0.01-0.05) with reduced incidence of relapses (P < 0.05) as compared to control groups, which was confirmed by decreased viral load and increased antiviral cytokine and peroxynitrite plasma levels. Plasma antioxidant capacity was higher (P < 0.01) in the experimental versus control groups.. Results document positive clinical outcomes of the selected nutriceutical associated with conventional protocols in the management of relapsing mucocutaneous human papillomavirus and herpes infections.

Topics: Acyclovir; Administration, Oral; Adult; alpha-Tocopherol; Alphapapillomavirus; Antioxidants; Antiviral Agents; Chronic Disease; Cryotherapy; Dietary Supplements; DNA Virus Infections; DNA, Viral; Double-Blind Method; Enzyme-Linked Immunosorbent Assay; Female; Herpes Genitalis; Herpes Zoster; Host-Pathogen Interactions; Humans; Male; Methionine; Middle Aged; Reactive Nitrogen Species; Reactive Oxygen Species; Recurrence; Selenium; Skin Diseases, Infectious; Ubiquinone; Viral Load; Vitamin E; Young Adult

Famciclovir is a guanine analog antiviral drug used commonly for herpes zoster. Efficacy of famciclovir treatment has been reported to be comparable to valacyclovir treatment. Both of these medications reduce the time to complete cessation of zoster-associated pain including post-herpetic neuralgia, as compared to acyclovir. We conducted a multicenter, randomized, open clinical trial in order to evaluate the extent of pain relief afforded by these two antiviral drugs during the acute disease phase of herpes zoster. The study group comprised 86 immunocompetent adult patients suffering from herpes zoster, who were treated with either famciclovir or valacyclovir for 7 days. Of these, 55 patients enrolled in this study within 72 h of the onset of the rash and 31 patients after 72 h of the onset. There was a significant reduction in acute herpes zoster pain with famciclovir on day 7 and at 2-3 weeks in both of these patient groups, while with valacyclovir, there was not significant reduction in pain on day 7. Of patients aged 50 years or older, there was a significantly earlier reduction in pain with famciclovir than with valacyclovir. In addition, a significant reduction in the number of patients with pain was observed as early as days 3-4 with famciclovir treatment as compared with valacyclovir treatment. We conclude that famciclovir was superior to valacyclovir in the relief of acute pain of herpes zoster. Accordingly, famciclovir is recommended for herpes zoster patients with moderate symptoms and a visual analog scale score of under 50 mm.

Topics: 2-Aminopurine; Acute Pain; Acyclovir; Adult; Aged; Anti-Inflammatory Agents, Non-Steroidal; Antiviral Agents; Asian People; Famciclovir; Female; Herpes Zoster; Humans; Immunocompetence; Japan; Male; Middle Aged; Pain Measurement; Valacyclovir; Valine

Herpes zoster is a common infectious disease that can result in significant acute and chronic morbidity. The safety and efficacy of once-daily oral valomaciclovir (EPB-348) was evaluated for non-inferiority to 3-times daily valacyclovir, an approved therapy. In this study, 373 immunocompetent adults with onset of a herpes zoster rash within the preceding 72 hr were randomly assigned to receive one of four treatments for 7 days: (1) EPB-348 1,000 mg once-daily; (2) EPB-348 2,000 mg once-daily; (3) EPB-348 3,000 mg once-daily; or (4) valacyclovir 1,000 mg 3-times daily. A 20% margin was the reference for non-inferiority assessment. For the primary efficacy measure of time to complete crusting of the zoster rash by Day 28, non-inferiority criteria were met for once-daily EPB-348 2,000 mg and once-daily EPB-348 3,000 mg compared to 3-times daily valacyclovir. Additionally, EPB-348 3,000 mg significantly shortened the time to complete rash crusting by Day 28 compared to valacyclovir. For secondary efficacy measures, non-inferiority was achieved for the EPB-348 1,000 and 2,000 mg groups compared to the valacyclovir group for time to rash resolution by Day 28. No EPB-348 group was non-inferior to valacyclovir for time to cessation of new lesion formation or time to cessation of pain by Day 120, though no significant differences occurred between treatment groups. Nausea, headache, and vomiting were the most common adverse events. Based on these results, additional studies are warranted to define further EPB-348's potential as an effective and safe therapy for acute herpes zoster.

Topics: Acute Disease; Acyclovir; Antiviral Agents; Double-Blind Method; Female; Guanine; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunocompetence; Male; Middle Aged; Treatment Outcome; Valacyclovir; Valine

Reactivation of latent VZV remains a significant cause of morbidity after SCT. Twenty-five percent or more of patients undergoing SCT will experience zoster within the first year after transplant. Short-course (<1 year) prophylaxis with acyclovir has been shown to be effective, but compliance with five times daily dosing may be problematic. We conducted a randomized, double-blind, placebo-controlled trial of valacyclovir (VACV) 1000 mg twice daily from 4 through 24 months after SCT for the prevention of VZV. Fifty-three VZV-seropositive transplant recipients (17 auto-SCT, 36 allo-SCT) were randomized at a median of 163 days after SCT. In a modified intent-to-treat analysis of 49 patients who took study drug, 0 of 22 in the VACV arm experienced zoster reactivation, compared with 6 of 26 (23%) in the placebo arm (P=0.025). Thirty-two subjects completed therapy through the second year post transplant or first episode of zoster. Adverse events resulting in discontinuation were more frequent in the placebo group (5 of 26 vs 3 of 27 for placebo and study drug, respectively). VACV at a dose of 1000 mg twice daily through 24 months after transplant is well tolerated and effective in suppressing shingles after SCT.

Topics: Acyclovir; Adult; Aged; Antiviral Agents; Double-Blind Method; Female; Hematopoietic Stem Cell Transplantation; Herpes Zoster; Humans; Male; Middle Aged; Recurrence; Time Factors; Valacyclovir; Valine

Varicella zoster virus (VZV) disease is a frequent complication after allogeneic hematopoietic stem cell transplantation (HSCT).  We carried out a trial of 1-year low-dose valacyclovir (VCV) prophylaxis against VZV disease to evaluate its efficacy and safety. Patients received oral acyclovir (ACV) 1000mg/day until day 35 after HSCT. Oral VCV 500mg/day, 3 times a week, was started on day 36 and continued until 1 year after HSCT. The development of VZV disease was monitored until 2 years after HSCT. A total of 40 patients with a median age of 43 years were enrolled. VCV was well tolerated in all but 1 patient who discontinued it on day 224 because of thrombocytopenia of unknown cause. Seven patients developed VZV disease at a median of 479 days (range 145-651) after HSCT, with a cumulative incidence of 18.5%. Two patients developed breakthrough disease during VCV prophylaxis. The other 5 patients developed VZV disease after the discontinuation of VCV, and 3 of these had developed extensive chronic graft-versus-host disease. Visceral involvement and serious complications were completely eliminated. All patients responded to the therapeutic dose of VCV or ACV. One-year low-dose VCV can be safely and effectively administered for the prevention of VZV disease after allogeneic HSCT.

Topics: Acyclovir; Adolescent; Adult; Antiviral Agents; Female; Hematopoietic Stem Cell Transplantation; Herpes Zoster; Humans; Incidence; Male; Middle Aged; Prospective Studies; Risk Factors; Transplantation, Homologous; Treatment Outcome; Valacyclovir; Valine

Various treatments have been used to manage post-herpetic neuralgia (PHN). Safe and effective therapies to prevent PHN are needed.. A clinical trial involving 152 patients diagnosed with acute herpes Zoster (HZ) was conducted to determine whether short-course acyclovir therapy (800 mg five times a day for four days) can alleviate HZ-associated pain and prevent post-herpetic neuralgia (PHN).  The patients were divided into two groups: Group 1 had a rash with a duration of less than 72 hours and Group 2 had a rash with a duration of more than 72 hours. To assess PHN, the patients categorized and assessed the severity of their symptoms using a four-point verbal rating scale (VRS).. By the fourth week, 134 out of 152 patients (88.2%) had complete pain response (CPR). Of these, 68 patients (89.5%) were from Group 1 and 66 from Group 2 (86.8%). After four weeks, the mean VRS scores had changed significantly in both groups compared to the scores at the beginning of study (p = 0.001), but there was no difference between the two groups (0.88 ± 0.66 Vs. 0.94 ± 0.72; p = 0.66) After three months no differences were observed in the treatment results between the two groups (0.51 ± 0.13 Vs.0.54 ± 0.19; p = 0.77).. Short-course acyclovir therapy is an effective treatment for zoster and its efficacy in patients with a rash duration of more than 72 hours is similar to that in patients with rash duration of less than 72 hours.

Topics: Acyclovir; Aged; Aged, 80 and over; Antiviral Agents; Drug Administration Schedule; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Male; Middle Aged; Neuralgia, Postherpetic; Pain; Time Factors; Treatment Outcome

A phase 2 trial was conducted to evaluate the efficacy of a topical antiviral, sorivudine, as an adjuvant to valacyclovir for the treatment of acute herpes zoster.. In this randomized, placebo-controlled, double-blind trial, 25 patients were treated with either sorivudine or placebo cream. All patients began 7 days of valacyclovir treatment on day 3. Zoster lesion swab samples and samples of peripheral blood mononuclear cells were collected periodically throughout the study and were analyzed for varicella-zoster virus (VZV) DNA by use of both qualitative and real-time polymerase chain reaction. Serum samples collected periodically throughout the study were analyzed for VZV DNA by use of real-time polymerase chain reaction.. VZV DNA was detected in all 3 sample types, and the number of viral copies correlated with the progression of herpes zoster. No statistically significant differences were seen between the placebo- and sorivudine-treated groups with respect to clinical characteristics or laboratory test results.. The detection of VZV DNA in the serum and peripheral blood mononuclear cells of all 25 zoster patients documents that viremia is a common manifestation of herpes zoster. Sorivudine cream appears to be a safe and well-tolerated adjuvant therapy; however, further phase 2 studies are needed to determine its clinical efficacy for the treatment of herpes zoster. Trials registration. ClinicalTrials.gov identifier: NCT00652184.

Topics: Acyclovir; Adult; Aged; Antiviral Agents; DNA, Viral; Double-Blind Method; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Male; Middle Aged; Patient Selection; Placebos; Valacyclovir; Valine; Viremia

To evaluate clinical therapeutic effect and the safety of pricking blood therapy combined with ultraviolet irradiation for treatment of acute herpes zoster.. One hundred and thirty cases were randomly divided into an observation group and a control group, 65 cases in each group. The observation group was treated with pricking blood therapy combined with ultraviolet irradiation. Firstly, the affected parts were heavily taped with a plum-blossom needle and then cupping. After the cup was removed, with the body surface-dividing field method, ultraviolet irradiation was given at the skin injury area and the nerve root area corresponding to paraspinal vertebra, and the control group was treated with Aciclovir and other western medicine. Seven days constituted one course. Their therapeutic effects and adverse reactions were observed.. After treatment of 7 days, the cured rate of 76.9% and the total effective rate of 90.8% in the observation group were significantly higher than 38.5% and 66.2% in the control group, respectively (both P < 0.01); the incidence rate of post herpetic neuralgia of 3.1% in the observation group was significantly lower than 12.3% in the control group (P < 0.05); after treatment, the scores for pain, rash and sleep decreased significantly in the two groups (all P < 0.01), more significantly decreased in the observation group than in the control group (P < 0.01 or P < 0.05); the pain-relieving time, herpes-stopping time, scab-forming time and the cured time in the cured patients of the observation group were significantly shorter than those in the control group (P < 0.01 or P < 0.05).. The pricking blood therapy combined with ultraviolet irradiation has rapid therapeutic effect, effectively shortens duration of illness, decreases the incidence rate of post herpetic neuralgia and it is a safe remedy for treatment of herpes zoster.

Topics: Acupuncture Points; Acyclovir; Adult; Aged; Antiviral Agents; Combined Modality Therapy; Dizziness; Erythema; Female; Herpes Zoster; Humans; Male; Medicine, Chinese Traditional; Middle Aged; Treatment Outcome; Ultraviolet Therapy; Young Adult

Relative hazard is a central measure of association in randomized clinical trials. Relative time (RT) is a competing measure that is rarely used.. We describe a simple area-based nonparametric estimator of RT and illustrate its use in the Acyclovir Prevention Trial.. Let Q( x)(p) be the quantile function for the xth treatment group, defined as the time by which p% of the treatment group experience the event, and p( x) be the maximum event proportion observed. Our consistent estimator is defined as the ratio of the integrals of Q(1)(p) and Q(0) (p) with integration over 0 to p, where p =min(p(1), p( 0)). Confidence limits (CL) are provided by bootstrap.. A total of 703 immunocompetent adult men and women (54% male, 79% Caucasian, median age 49 years) with a history of ocular herpes simplex virus (HSV) were enrolled in 1992-1996, randomized to acyclovir or placebo, followed for up to 1 year for the 1st episode of ocular HSV, and 170 events were confirmed by a study-certified ophthalmologist using slit-lamp biomicroscopy. The nonparametric RT comparing acyclovir use with nonuse was 2.6 (bootstrap 95% CL: 1.6, 4.2). For comparison, the best-fitting parametric model was the lognormal (RT = 2.5; 95% CL: 1.5, 3.9). In limited simulations, the average proposed estimate of RT was similar to the true RT with a relative root mean squared error of 1.13 compared to a correctly specified parametric (lognormal) model.. An analytical variance estimator for the proposed RT is lacking. Also, more examples and more extensive simulations are warranted.. Similar to Cox's relative hazard estimator, the proposed RT does not assume the data are generated from a particular distribution. RTs should be more widely used as a measure of association in clinical trials.

Topics: Acyclovir; Adult; Aged; Antiviral Agents; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Male; Middle Aged; Monte Carlo Method; Proportional Hazards Models; Randomized Controlled Trials as Topic; Risk; Time Factors

To observe the clinical therapeutic effect of electroacupuncture (EA) of Jiaji (EX-B 2) plus focus-encircled needling for promoting the crust formation of herpes zoster and analgesia.. Eighty cases of herpes zoster patients were equally randomized into EA group [treated with EA of Ashi-point, Jiaji (EX-B 2), Zhigou (SJ 6) and Houxi (SI 3), once daily for 10 times] and medication group (treated with valaciclovir hydrochloride 300 mg/time, b. i. d. and vitamin B1 10 mg/time, t.i.d., 10 days). The pain severity was evaluated by using visual analogous scale (VAS) method. The time when the cutaneous scabbing area was equal or over 50% was recorded.. After the treatment, of the two 40 cases in EA and medication groups, 30 (75.0%) and 15 (37.5%) were cured, 7 (17.5%) and 12 (30.0%) improved, 3 (7.5%) and 13 (32.5%) failed, with the total effective rates being 92.5% and 67.5%, respectively. The therapeutic effect of EA was significantly superior to that of medication (P < 0.01). VAS scores of both groups reduced significantly (P < 0.01). Both the VAS score and the crust formation time of EA group were significantly lower than those of medication group (P < 0.01).. EA of Jiaji (EX-B 2) in combination with focus-encircled needling is effective in facilitating the crust formation and pain relief in the treatment of herpes zoster, and the effect of acupuncture is superior to that of medication.

Topics: Acupuncture Points; Acupuncture Therapy; Acyclovir; Adolescent; Adult; Aged; Electroacupuncture; Female; Herpes Zoster; Humans; Male; Middle Aged; Valacyclovir; Valine

The treatment of postherpetic neuralgia (PHN) continues to be a challenge in clinical pain management. In this randomized, controlled study, we assessed the effectiveness of repetitive paravertebral injections with local anesthetics and steroids for the prevention of PHN in patients with acute herpes zoster.. One hundred thirty-two patients with acute herpes zoster diagnosed 1-7 days after the onset of the rash were randomly assigned to receive either standard therapy (oral antivirals and analgesics) or standard therapy with additional repetitive paravertebral injections of a mixture of 10 mL 0.25% bupivacaine and 40 mg methylprednisolone acetate every 48 h for a week. Efficacy was evaluated at 1, 3, 6, and 12 mo after the end of the treatments. The primary end point was the proportion of patients with zoster-associated pain and/or allodynia 1 mo after inclusion. Statistical analysis was performed based on the intent-to-treat population.. One hundred thirteen patients completed the 1-yr follow-up. At 1 mo posttherapy, 13% of patients in the paravertebral group reported zoster-related pain, compared with 45% in the standard group (P < 0.001). At 3, 6, and 12 mo posttherapy, the incidence of PHN was still significantly lower in the paravertebral group than in the standard group. The quality of life improved in both groups at each follow-up time point with no significant difference between groups.. Repetitive paravertebral anesthetic block in combination with steroids plus standard treatment with acyclovir and analgesics significantly reduced the incidence of PHN than the standard treatment alone.

Topics: Acute Disease; Acyclovir; Administration, Oral; Aged; Analgesics; Anesthetics, Local; Antiviral Agents; Bupivacaine; Drug Administration Schedule; Drug Combinations; Drug Therapy, Combination; Female; Herpes Zoster; Humans; Injections; Male; Methylprednisolone; Methylprednisolone Acetate; Middle Aged; Nerve Block; Neuralgia, Postherpetic; Pain Measurement; Prospective Studies; Quality of Life; Steroids; Time Factors; Treatment Outcome

To study the therapeutic effect of integrative medicinal therapy with Qinzhu Liangxue Mixture (QLM) in combined with valaciclovir on herpes zoster (HZ) in middle and old aged patients.. Ninety-seven HZ patients were randomly assigned to three groups and treated respectively with QLM alone (A), valaciclovir alone (B) and QLM plus valaciclovir (C). Times for stopping newly appeared blisters, scabbing relieving pain, and curing, as well as incidence rate of postherpetic neuralgia (PHN) after treatment were evaluated. Patients' symptoms and signs were scored before and after treatment.. Time for appeaed newly blister and scabbing was shorter in Group B than in Group A; time for relieving pain and curing was shorter in Group C than in Group A; and the PHN incidence rate in Group C was the lowest.. Valaciclovir can control the skin rash of HZ with quicker initiating time, and QLM can effectively relieve pain, the combined use with the two drugs can decrease the incidence rate of PHN availably.

Topics: Acyclovir; Aged; Analgesics; Antiviral Agents; Drug Therapy, Combination; Drugs, Chinese Herbal; Herpes Zoster; Humans; Integrative Medicine; Middle Aged; Valacyclovir; Valine

A dosage of 1 g of valacyclovir 3 times per day (TID) for 7 days has already been shown to be superior to an oral dosage of 800 mg acyclovir 5 times per day for 7 days in immunocompetent individuals. The objective of this study was to assess the safety and efficacy of an oral dosage of valacyclovir, 1 g TID versus 2 g TID, for the treatment of herpes zoster in immunocompromised patients > or =18 years of age. The oral dosage schedule of 2 g of valacyclovir TID reaches acyclovir plasma levels similar to those achieved with intravenous acyclovir therapy given to immunocompromised patients (10 mg/kg every 8 h for 7 days). In this double-blind study, 87 immunocompromised patients with clinical evidence of localized herpes zoster were randomized to receive oral valacyclovir therapy for 7 days, either 1 g TID or 2 g TID, within 72 h after onset of zoster rash. Patients were seen and assessed for cutaneous healing, zoster-associated pain (ZAP), and/or zoster-associated abnormal sensations (ZAAS), up to 24 weeks. Participants in both arms of the study demonstrated similar median times to full crusting of the rash (8 days), and both dosages were safe and effective therapies for reduction of ZAP and ZAAS in the immunocompromised patient population.

Topics: Acyclovir; Administration, Oral; Adult; Aged; Antiviral Agents; Double-Blind Method; Drug Administration Schedule; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunocompromised Host; Male; Middle Aged; Safety; Valacyclovir; Valine

No consensus exists on whether acyclovir prophylaxis should be given for varicella-zoster virus (VZV) prophylaxis after hematopoietic cell transplantation because of the concern of "rebound" VZV disease after discontinuation of prophylaxis. To determine whether rebound VZV disease is an important clinical problem and whether prolonging prophylaxis beyond 1 year is beneficial, we examined 3 sequential cohorts receiving acyclovir from day of transplantation until engraftment for prevention of herpes simplex virus reactivation (n = 932); acyclovir or valacyclovir 1 year (n = 1117); or acyclovir/valacyclovir for at least 1 year or longer if patients remained on immunosuppressive drugs (n = 586). In multivariable statistical models, prophylaxis given for 1 year significantly reduced VZV disease (P < .001) without evidence of rebound VZV disease. Continuation of prophylaxis beyond 1 year in allogeneic recipients who remained on immunosuppressive drugs led to a further reduction in VZV disease (P = .01) but VZV disease developed in 6.1% during the second year while receiving this strategy. In conclusion, acyclovir/valacyclovir prophylaxis given for 1 year led to a persistent benefit after drug discontinuation and no evidence of a rebound effect. To effectively prevent VZV disease in long-term hematopoietic cell transplantation survivors, additional approaches such as vaccination will probably be required.

Topics: Acyclovir; Adolescent; Adult; Aged; Antiviral Agents; Child; Child, Preschool; Female; Hematopoietic Stem Cell Transplantation; Herpes Zoster; Humans; Immunocompromised Host; Infant; Male; Middle Aged; Simplexvirus; Time Factors; Virus Activation

Varicella-zoster virus (VZV) disease occurs in 30% of allogeneic hematopoietic cell transplant recipients who had a history of VZV infection. A safe and effective prevention strategy has not been established. In a double-blind controlled trial, 77 hematopoietic cell transplant recipients at risk for VZV reactivation were randomized to acyclovir 800 mg twice daily or placebo given from 1 to 2 months until 1 year after transplantation. VZV disease at 1 year was the primary end point; VZV disease after discontinuation of prophylaxis, VZV-specific T-cell immunity, herpes simplex virus (HSV) infection, cytomegalovirus (CMV) disease, survival, and safety were secondary end points. Acyclovir significantly reduced VZV infections at 1 year after transplantation (HR, 0.16; 95% CI, 0.035-0.74; P = .006). In the post-intervention observation period, this difference was not statistically significant (2 years: HR, 0.52; 95% CI, 0.21-1.3; 5 years: HR, 0.76; 95% CI, 0.36-1.6). There was no statistically significant difference in reconstitution of VZV-specific T-helper cell responses, HSV infections, CMV disease, chronic graft-versus-host disease, and overall survival between the groups. Acyclovir was well tolerated. Post-study VZV disease predominantly occurred in patients with continued need for systemic immunosuppression. In conclusion, acyclovir effectively and safely prevents VZV disease during the first year after hematopoietic cell transplantation. Periods of prophylaxis longer than 12 months may be beneficial for those hematopoietic cell transplant recipients on continued immune suppression.

Topics: Acyclovir; Adolescent; Adult; Aged; Child; Chronic Disease; Cytomegalovirus; Cytomegalovirus Infections; Double-Blind Method; Female; Follow-Up Studies; Graft vs Host Disease; Hematologic Neoplasms; Hematopoietic Stem Cell Transplantation; Herpes Simplex; Herpes Zoster; Humans; Male; Middle Aged; Simplexvirus; T-Lymphocytes, Helper-Inducer; Transplantation, Homologous; Virus Activation

Postherpetic neuralgia (PHN) is one of the common complications of herpes zoster infection, particularly in the elderly. Current therapeutic measures are only partially effective in the affected patients. As inflammatory mediators released by different cells play an important role in the pathogenesis of this neuropathic pain and with regard to the immunomodulatory effects of ultraviolet B (UVB) spectrum, we presumed that UVB phototherapy might be effective in the prevention of PHN.. This study was performed in two phases. Phase I was a prospective open controlled trial. Twenty-five patients with severe pain in the first 7 days of zoster rash were divided into two groups: the prevention group (n=12) received oral acyclovir (800 mg five times a day for 10 days) plus broad-band UVB to the affected dermatomes, starting with 20 mJ/cm(2) and gradually increasing the dose by 10 mJ/cm(2) each session to a maximum dose of 100 mJ/cm(2). Treatment sessions were repeated three times a week until pain relief or to a maximum of 15 sessions. The control group (n=13), who had disease characteristics similar to the prevention group, received only oral acyclovir with the same dose. All patients reported their severity of pain on a verbal rating scale (VRS, score 0-4) before treatment and at 1 and 3 months' follow-up. In phase II of the study, five patients with established PHN (more than 3 months after rash onset) received UVB with the above-mentioned protocol.. A total of 17 patients older than 40 (10 females, seven males; mean age, 65.5 years; range: 47-82 years) who had intractable pain due to zoster infection received UVB in two phases of the study. In patients who received phototherapy in the first 7 days of rash, 58.33% and 83.33% were completely pain free at 1-and 3-month follow-up, respectively. The corresponding figure in the control group was significantly lower (38.46% at 1 month and 53.85% at 3 months). The severity of pain was also lower in the phototherapy group than the control group (mean VRS 2.50 vs. 3.28 at 3 months). None of the patients who were treated more than 3 months after rash onset (established PHN) experienced significant (more than 50%) pain relief.. UVB phototherapy in the acute stage of zoster rash might reduce the incidence and severity of PHN. Treatment after 3 months does not seem to have a significant beneficial effect.

Topics: Acyclovir; Administration, Oral; Aged; Aged, 80 and over; Antiviral Agents; Combined Modality Therapy; Female; Herpes Zoster; Humans; Male; Middle Aged; Neuralgia, Postherpetic; Pain Measurement; Prospective Studies; Severity of Illness Index; Treatment Outcome; Ultraviolet Therapy

Famciclovir, the well absorbed oral pro-drug of penciclovir, is effective in the treatment of herpes zoster when given three times daily. Because the intracellular half-life of penciclovir triphosphate in varicella-zoster virus (VZV)-infected cells (7h) is considerably longer than that of aciclovir triphosphate (1h), it may be possible to administer famciclovir less frequently than three times daily for herpes zoster: aciclovir is administered five times daily.. 559 immunocompetent adults presenting with herpes zoster whose skin lesions were present for less than 72 h were randomized to receive famciclovir 750 mg once daily (od), 500 mg twice daily (bid), or 250 mg three times daily (tid), or aciclovir 800 mg five times daily. All treatments were given for 7 days. Participants were evaluated until complete healing or for 4 weeks, whichever occurred first.. There were no significant differences between the four treatment groups with respect to times to full crusting; loss of vesicles, ulcers and crusts; cessation of new lesion formation; a 50% reduction in the area of affected skin; and the loss of acute pain.. Famciclovir 750 mg once daily, 500 mg twice daily and 250 mg daily, and aciclovir 800 mg five times daily are three times comparable in efficacy with respect to the cutaneous healing of herpes zoster. The current study was not designed to assess the effects of the treatments on postherpetic neuralgia (PHN).

Topics: 2-Aminopurine; Acyclovir; Administration, Oral; Adolescent; Adult; Aged; Antiviral Agents; Double-Blind Method; Famciclovir; Female; Herpes Zoster; Humans; Male; Middle Aged; Neuralgia; Pain; Skin

This randomized, double-blind, parallel-group study compared the efficacy and safety of famciclovir administered at 250 mg thrice daily with acyclovir 800 mg 5 times daily for the treatment of acute uncomplicated herpes zoster in immunocompetent adults. A total of 55 patients participated in this trial. Twenty seven patients (49.1%) were randomized into the famciclovir plus placebo treatment group and 28 (50.9%) into the acyclovir plus placebo group. Six of the 55 patients did not complete the study. Two of these patients were in the famciclovir plus placebo group and dropped out due to deviation from the study protocol. Four patients in the acyclovir plus placebo group did not complete the study protocol due to adverse events (n = 2), deviation from the protocol (n = 1), or loss to follow-up (n = 1). Treatment was initiated within 72 h of onset of the zoster rash and was continued for 7 days. When treatment was initiated within 72 h, famciclovir was as effective as acyclovir for healing the cutaneous lesion, as indicated by the time to full crusting, loss of acute phase pain, loss of vesicles, and loss of crusts. Famciclovir was well tolerated and had a more favorable adverse event profile compared to acyclovir. Constipation, hematuria, and glycosuria were the most commonly reported adverse events, but only constipation was considered to have a possible relationship to the treatment. In conclusion, famciclovir, administered less frequently and at lower unit doses than acyclovir, is an effective treatment for uncomplicated herpes zoster.

Topics: 2-Aminopurine; Acyclovir; Adult; Aged; Antiviral Agents; Constipation; Double-Blind Method; Famciclovir; Female; Glycosuria; Hematuria; Herpes Zoster; Humans; Male; Middle Aged; Placebos

Brivudin [(E)-5-(2-bromovinyl)-2'-deoxyuridine] is a nucleoside analogue with a high and selective antiviral activity against varicella-zoster virus (VZV) and herpes simplex virus type 1 (HSV-1). The double-blind, randomized study presented here compared efficacy and safety of oral brivudin 1 x 125 mg and acyclovir 5 x 800 mg, both for 7 days, in 1227 immunocompetent patients with herpes zoster. Main results were as follows: brivudin was superior to acyclovir in accelerating the "time to last formation of new vesicles" (primary parameter; risk ratio(ITT): 1.13, P=0.014). Equivalent effects of brivudin and acyclovir were observed for the secondary parameters "time to first crust" (RR(ITT): 0.93, P=0.004), "time to full crusting" (risk ratio(ITT): 1.03, P<0.001), and "time to loss of crusts" (RR(ITT): 0.95, P=0.002). The incidence of potentially treatment-related adverse events was similar under brivudin (7.7%) and acyclovir (10.0%). In conclusion, brivudin proved to be more effective than acyclovir in terminating vesicle formation, the parameter which reflects the end of viral replication, thus confirming, in the clinical setting, the greater in vitro antiviral activity of brivudin. Compared with acyclovir, brivudin provides a similar safety profile and a significant improvement in efficacy.

Topics: Acyclovir; Adult; Aged; Antiviral Agents; Bromodeoxyuridine; Double-Blind Method; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunocompetence; Male; Middle Aged; Pain; Skin; Virus Replication

This concerns a double-blind survey study on 608 herpes zoster patients treated with 1x 125 mg oral brivudin (n=309) or 5x 800 mg acyclovir (n=299), both for 7 days, during two prospective, randomised clinical herpes zoster trials. The survey aimed at evaluating the outcome of the two treatment regimens on postherpetic neuralgia (PHN). During a follow-up ranging from 8 to 17 months after start of treatment, former study participants aged >/=50 years were interviewed for the occurrence of PHN. Neither the investigators nor the patients were aware of which treatment the patients received during acute herpes zoster. The incidence of PHN, defined as zoster-associated pain occurring or persisting after rash healing was significantly lower in brivudin recipients (32.7%) than in acyclovir recipients (43.5%, P=0.006). Mean duration of PHN was similar with brivudin (173 days) and acyclovir (164 days, P=0.270). Despite some methodological disadvantages common to this type of study, the present survey provides for the first evidence that brivudin treatment during acute herpes zoster favourably affects the incidence of PHN in immunocompetent elderly herpes zoster patients.

Topics: Acyclovir; Adult; Aged; Antiviral Agents; Bromodeoxyuridine; Double-Blind Method; Female; Follow-Up Studies; Herpes Zoster; Humans; Male; Middle Aged; Neuralgia; Prospective Studies

Ramsay Hunt syndrome is an herpetic disease with ominous prognosis regarding the facial nerve. Treatment with acyclovir, a well-known virostatic agent, has been given in a small number of patients in recent years with excellent results. We report on the administration of acyclovir intravenously for 7 days in 31 patients with Ramsay Hunt syndrome, with overall recovery rate of 82.6%. There were no side effects regarding this treatment.

Topics: Acyclovir; Adolescent; Adult; Aged; Anti-Inflammatory Agents; Antiviral Agents; Child; Drug Therapy, Combination; Facial Nerve; Female; Herpes Zoster; Humans; Hydrocortisone; Male; Middle Aged; Parkinsonian Disorders; Retrospective Studies; Severity of Illness Index

Valacyclovir was administered to 28 immunocompromised children (ages 5-12 years) to obtain preliminary pharmacokinetic and safety information. Patients were randomized to valacyclovir regimens of 250 mg (9.4-13.3 mg/kg) or 500 mg (13.9-27.0 mg/kg) twice daily or 500 mg (13.2-21.7 mg/kg) 3 times a day. Acyclovir pharmacokinetics were evaluated at steady state. Valacyclovir was rapidly absorbed and converted to acyclovir. Mean (+/-SD) acyclovir peak concentrations from 250 mg and 500 mg valacyclovir were 4.11+/-1.41 and 5.19+/-1.96 microg/mL, respectively. Corresponding single dose area-under-curve values were 12.14+/-6.60 and 14.49+/-4.69h microg/mL. By using historical data for intravenous acyclovir as reference, the overall estimate of acyclovir bioavailability from valacyclovir was 48%, 2- to 4-fold greater than for oral acyclovir. In general, adverse events were not attributable to valacyclovir and were consistent with disease-related expectations and concomitant therapies. Dosage options for using valacyclovir in children are discussed.

Topics: Acyclovir; Administration, Oral; Analysis of Variance; Area Under Curve; Belgium; Biological Availability; Child; Child, Preschool; Female; France; Herpes Simplex; Herpes Zoster; Humans; Immunocompromised Host; Male; Pilot Projects; Prodrugs; Switzerland; Valacyclovir; Valine

Topics: 2-Aminopurine; Acyclovir; Aged; Antiviral Agents; Double-Blind Method; Famciclovir; Gastrointestinal Diseases; Headache; Herpes Zoster; Humans; Middle Aged; Nausea; Neuralgia; Pain; Prospective Studies; Time Factors; Treatment Outcome; Valacyclovir; Valine

In this randomized, double-blind, multicenter, acyclovir-controlled study, the efficacy and safety of famciclovir were evaluated for the treatment of herpes zoster in patients who were immunocompromised following bone marrow or solid organ transplantation or oncology treatment. A total of 148 patients, 12 years or older with clinical evidence of localized herpes zoster, received either oral famciclovir, 500 mg three times daily, or acyclovir, 800 mg five times daily, for 10 days. Famciclovir was equivalent to acyclovir with respect to the numbers of patients reporting new lesion formation while on therapy (77% vs. 73%, respectively). There were no significant differences between the groups in the time to cessation of new lesion formation, full crusting, complete healing of lesions, or loss of acute phase pain. Treatment with famciclovir was well tolerated, with a safety profile comparable to that of acyclovir. Thus oral famciclovir is a convenient, effective, and well-tolerated regimen for immunocompromised patients with herpes zoster.

Topics: 2-Aminopurine; Acyclovir; Adolescent; Adult; Aged; Antiviral Agents; Double-Blind Method; Famciclovir; Herpes Zoster; Humans; Immunocompromised Host; Male; Middle Aged; Pain; Skin Diseases

Acyclovir, a specific and selective inhibitor of the replication of Herpesviridae family, has well-documented efficacy and tolerability in the treatment of herpes zoster. Its limited oral bioavailability and short half-life, however, necessitates frequent dosing. Valaciclovir, the l-valyl ester of acyclovir, could be rapidly converted to acyclovir after oral administration, resulting in a three- to five-fold increase in acyclovir bioavailability compared with oral acyclovir in humans. Valaciclovir allows less frequent dosing and maintains the safety profiles of the parent drug. During the period from October 1996 through May 1998, a randomized, prospective study was performed in the Kaohsiung Veterans General Hospital to compare the safety and efficacy of valaciclovir with acyclovir in the treatment of herpes zoster in Taiwanese patients. Patients presenting with herpes zoster within 72 h after the onset of rash were enrolled and randomized to receive one of the following treatments: 1000 mg valaciclovir three times daily for 7 days or acyclovir 800 mg five times daily for 7 days. Patients were followed up for 29 days beginning with the start of therapy. A total of 57 patients were enrolled and randomized to receive valaciclovir (n = 32) or acyclovir (n = 25). Five patients in the valaciclovir group and three in the acyclovir group did not complete the study. The intent-to-treat analysis (57 patients) showed that valaciclovir significantly accelerated the resolution of herpes zoster-associated pain compared with acyclovir; on day 29, the valaciclovir group was 23% superior to the acyclovir group. There was no clinically significant difference in the nature, frequency or severity of adverse events between these two groups, although one and three adverse events were reported in the acyclovir and valaciclovir group, respectively. Thus, we conclude that in the management of herpes zoster, valaciclovir accelerates the resolution of pain and offers a simpler dosing, and maintains the favorable safety profile of acyclovir.

Topics: Acyclovir; Adult; Aged; Antiviral Agents; Female; Herpes Zoster; Humans; Male; Middle Aged; Prospective Studies; Valacyclovir; Valine

Postherpetic neuralgia is the most common complication of herpes zoster (shingles) in the immunocompetent host. Its mechanism is incompletely understood, but one postulate is that continuous replication of varicella-zoster virus (VZV) in nerve tissues may be responsible for the pain. If this is so, antiviral treatment could be advantageous. To test this hypothesis, we performed a randomized, double-blind, placebo-controlled trial of intravenous acyclovir (10 mg/kg every 8 h [q8h]) for 14 days, followed by oral acyclovir (800 mg q6h) for 42 days in 10 subjects (median age, 71 years) who had experienced at least 6 months of severe pain (median duration of postherpetic neuralgia before enrollment, 3.2 years). Intensive and sparse pharmacokinetic sampling occurred during both dosing phases of the study. One- and two-compartment models were fitted to the oral and intravenous concentration-time data, respectively. The four men and four women assigned to acyclovir during either or both dosing phases tolerated it well. Pharmacokinetic results were similar to those previously reported in younger individuals. The mean oral clearance and elimination half-life following oral dosing were 1.47 liters/h/kg and 2.78 h, respectively. Total clearance and terminal half-life following intravenous administration were 0.16 liters/h/kg and 3.67 h, respectively. Only 1 of 10 participants reported definite improvement in the severity of postherpetic pain, and treatment had no effect on titers of humoral antibody to VZV. We concluded that 56 days of intravenous and oral acyclovir therapy were well tolerated but had little or no effect on the clinical course of postherpetic neuralgia.

Topics: Acyclovir; Adult; Aged; Aged, 80 and over; Antiviral Agents; Female; Herpes Zoster; Humans; Infusions, Intravenous; Male; Middle Aged; Neuralgia; Treatment Outcome

Ninety-two patients suffering from herpes zoster were enrolled in a double-blind controlled study aimed at evaluating the efficacy and tolerance of the drug neuramide. Neuramide (N) and placebo (P) were administered to patients intramuscularly twice daily for 28 days as follows: group N + N (patients always treated with neuramide); group N + P (patients treated with neuramide for 1 week, then with placebo); group P + N (patients treated with placebo for 1 week, then with neuramide); group P + P (patients always treated with placebo). During the first week, all patients were also treated with standardized doses of acyclovir. The presence and extent of clinical symptoms were evaluated during the first 4 weeks, while the appearance, degree and duration of postherpetic neuralgia were evaluated both during treatment and over a 6-month follow-up period. There were no significant differences between the four groups of patients when subjective parameters (such as pain and paresis at the lesion site) were examined. However, clinical examination at the end of treatment showed that treatment with neuramide was therapeutic. Indeed, the times for recovery and for regeneration of epithelium were significantly shorter when neuramide was administered for 3 weeks of the treatment period. Furthermore, the change from vesicles to crusts was significantly faster in the neuramide group than in the placebo group. Postherpetic neuritis occurred in the first months of follow-up. However, in groups N + P and P + P, the symptoms lasted throughout the 6-month observation period, while in the other groups this period was shorter. Indeed, there were significant differences (p < 0.05) in terms of the above complications between the following groups: N + N and N + P; N + N and P + P; N + P and P + N; P + N and P + P. No significant differences were observed between the N + N and P + N, or N + P and P + P groups. Taken together, these data demonstrate that neuramide treatment for at least 3 weeks significantly reduces the risk of postherpetic neuritis development.

Topics: Acyclovir; Adult; Aged; Aged, 80 and over; Antimicrobial Cationic Peptides; Antiviral Agents; Double-Blind Method; Female; Follow-Up Studies; Herpes Zoster; Humans; Male; Middle Aged; Neuritis

Reactivation of varicella zoster virus (VZV) is a common event in patients undergoing allogeneic bone marrow transplantation (BMT) and may lead to life-threatening complications. We retrospectively analyzed the incidence, clinical outcome, and risk factors for VZV infections occurring within the first 5 years of transplantation in 100 consecutive adults undergoing allogeneic BMT between 1992 and 1997. Forty-one patients (41%) developed VZV reactivation a median of 227 days (range 45-346 days) post-transplantation. Twelve percent of VZV reactivation occurred in the first 100 days and 88% within the first 24 months. Among those who survived for 2 or more years after transplantation (n = 47), 59% developed VZV infection. Forty percent of patients with VZV reactivation required admission with a mean hospital stay of 7.2 days. Two patients developed encephalitis, and 1 died despite antiviral therapy. The most frequent complications were post-herpetic neuralgia and peripheral neuropathy (68%). Thoracic dermatomal zoster represented 41% of the infections; disseminated cutaneous involvement was observed in 17% of patients. No clinical or epidemiologic risk factors were associated with recurrence. Administration of ganciclovir for prevention of cytomegalovirus infection delayed the onset of VZV infection beyond 4 months (P = .06). In a further subset analysis, patients with a limited chronic graft-versus-host disease (GVHD) had a lower estimated incidence of VZV reactivation compared with those with extensive chronic GVHD (P = .11). We conclude that complications from reactivation of VZV infection are common and associated with considerable morbidity and mortality in patients undergoing allogeneic BMT.

Topics: 2-Aminopurine; Acyclovir; Adolescent; Adult; Antiviral Agents; Bone Marrow Transplantation; Chickenpox; Cytomegalovirus Infections; Famciclovir; Female; Graft vs Host Disease; Herpes Zoster; Herpesvirus 3, Human; Humans; Incidence; Male; Middle Aged; Pain; Retrospective Studies; Risk Factors; Skin Diseases; Transplantation, Homologous; Treatment Outcome; Virus Activation

We examined the incidence of herpes varicella-zoster virus (VZV) infection in 151 patients undergoing allogeneic BMT between August 1990 and September 1997 and who survived at least 3 months. Median follow-up was 17 (range 3.3-80.7) months. Herpes simplex virus antibody positive (HSV+) patients received aciclovir 1200 mg p.o. daily or 750 mg i.v. daily, in divided doses from day 0 to engraftment. Ganciclovir (5 mg/kg i.v. three times per week) was given in CMV+ patients (or if the donor was CMV+) from engraftment to day 84. Ganciclovir was continued or recommenced if a dose of greater than 20 mg of prednisone was used for the treatment of GVHD otherwise aciclovir was recommenced. In HSV+ patients not receiving ganciclovir, aciclovir 600 mg p.o. daily in divided doses was given until at least 6 months after BMT. Thirty-two patients developed VZV infection from 4.1 to 28 months after transplant. The estimated cumulative incidence of VZV was 13% (95% confidence interval 6-19%) at 12 months, 32% (22-42%) at 24 months and 38% (27-50%) at 28 months, with no further cases beyond that time. No patient developed VZV whilst receiving aciclovir or ganciclovir (P < 0.0001). However, there was a rapid onset of VZV following cessation of antiviral therapy (33% (20-46%) at 1 year post cessation). The presence of GVHD and the prior duration of antiviral prophylaxis were significant and independent risk factors for the development of VZV. Age, underlying disease, conditioning therapy or donor type were not. We conclude that 3-6 months of low-dose aciclovir and ganciclovir are effective at delaying the onset of VZV after allogeneic BMT, but may not affect the overall incidence of infection. Prolonged prophylaxis may be warranted in patients at high risk of infection, for example those patients with GVHD.

Topics: 2-Aminopurine; Acyclovir; Adolescent; Adult; Age of Onset; Aged; Analysis of Variance; Antiviral Agents; Bone Marrow Transplantation; Chickenpox; Dose-Response Relationship, Drug; Enzyme Activation; Famciclovir; Female; Ganciclovir; Graft vs Host Disease; Herpes Zoster; Herpesvirus 3, Human; Humans; Incidence; Male; Middle Aged; Prodrugs; Retrospective Studies; Risk Factors; Skin Diseases; Transplantation, Homologous; Valacyclovir; Valine

An observational study with valaciclovir was conducted to assess clinical outcome in herpes zoster, especially pain and associated neurological signs and symptoms in relation to a series of demographic and disease characteristics discernible at presentation. The safety and acceptability of valaciclovir for treatment of zoster was assessed in a wide variety of primary care and clinic referral settings.. In total, 1897 immunocompetent adults with clinically diagnosed, localized acute herpes zoster were enrolled in this international, open-label study of valaciclovir. All subjects received treatment with oral valaciclovir (1000 mg three times daily) for 7 days from entry to the study and were asked to record the presence of zoster-associated pain and abnormal sensations throughout treatment and 6 months' follow-up. They were seen frequently in clinic to verify subjective assessments and for evaluation of rash healing. Safety and tolerability were assessed by adverse event monitoring.. Overall, 1191 subjects (63%) were aged > or = 50 years, and 203 (11%) had ophthalmic zoster. Cessation of zoster-associated pain was significantly faster in the younger age group; median times to loss of zoster-associated pain were 23 days and 9 days in the > or = 50 and < 50 years age groups, respectively. Similarly, abnormal sensations resolved significantly more rapidly in the younger subjects; the median duration of abnormal sensations was 31 days in the > or = 50 year olds and 16 days in those aged < 50 years. In cases of ophthalmic zoster, the rate of pain resolution was not different from those with zoster in other dermatomes (median duration of pain 18 vs. 16 days). However, abnormal sensations persisted significantly longer in subjects with ophthalmic zoster than in those with zoster at other sites (47 vs. 22 days). In addition to advancing age, subjects suffering moderate to severe prodromal pain or acute pain during the rash phase were at significantly greater risk of zoster-associated pain and abnormal sensations persisting for longer. Subjects with concomitant neurological disorders were also more likely to develop prolonged abnormal sensations. Valaciclovir treatment was well tolerated, and adverse events were rare and generally mild.. This study confirmed the prognostic importance of advancing age and the intensity of prodromal or acute pain as risk factors for prolonged zoster-associated pain and persisting abnormal sensations in the affected dermatome. Ophthalmic zoster and pre-existing neurological disorders are also identified as highly significant risk factors for prolonged abnormal sensations in herpes zoster.

Topics: Acyclovir; Adolescent; Adult; Antiviral Agents; Female; Herpes Zoster; Humans; Male; Middle Aged; Pain; Prognosis; Treatment Outcome; Valacyclovir; Valine

Treatment of herpes zoster (HZ) includes the use of acyclovir with or without steroids. An alternative therapy is the epidural administration of local anesthetics with or without steroids. This trial compared the efficacy of these two treatment regimens in the prevention of post-herpetic neuralgia (PHN).. Six hundred adults over 55 years of age with a rash of less than 7 days duration, and severe pain due to HZ, were enrolled and randomized to receive either intravenous acyclovir (10 mg/kg three times daily) for 9 days+prednisolone (60 mg per day with progressive reduction) for 21 days, or 6-12 ml bupivacaine (0.25%) every 6-8 or 12 h+methylprednisolone 40 mg every 3-4 days by epidural catheter during a period ranging from 7 to 21 days. Efficacy was evaluated at 1, 3, 6 and 12 months. PHN was assessed as pain and/or allodynia, and "abnormal sensations" (hypoesthesia, burning, itching, etc.). Statistical analysis was performed based on the intent-to-treat population.. In the 485 patients who completed the study, the incidence of pain after 1 year was 22.2% (51 patients of 230) after acyclovir+steroids, and 1.6% (4 patients of 255) after epidural analgesia+steroids. The incidence of abnormal sensations was 12.2% (28 patients) after acyclovir+steroids, and 4.3% (11 patients) in group B.. Epidural administration of local anesthetic and methylprednisolone is significantly more effective in preventing PHN at 12 months compared to intravenous acyclovir and prednisolone.

Topics: Acyclovir; Aged; Aged, 80 and over; Analgesia, Epidural; Anesthetics, Local; Anti-Inflammatory Agents; Antiviral Agents; Female; Follow-Up Studies; Herpes Zoster; Humans; Male; Methylprednisolone; Middle Aged; Neuralgia; Pain Measurement; Prednisolone; Prospective Studies

Acute neuritis and persistent pain are the most significant clinical manifestations of herpes zoster and are end points for clinical trials therapy. In an acyclovir and prednisone study, patients were categorized according to pain severity and number of lesions at presentation. Risk categories were defined according to the magnitude of risk ratios (RRs) and a comparison of Kaplan-Meier survival estimates. For acute neuritis and zoster-associated pain, RRs defined rate of resolution. Patients who presented with severe or incapacitating pain and a large number of lesions were less likely to achieve resolution of both acute neuritis and zoster-associated pain (RR, 18.0; 95% confidence interval [CI], 6. 6-48.6, and RR, 5.3; 95% CI, 4.2-17.2, respectively). These analyses identify the subgroups of patients for whom aggressive interventions are most strongly indicated.

Topics: Activities of Daily Living; Acyclovir; Aged; Anti-Inflammatory Agents; Antiviral Agents; Female; Herpes Zoster; Humans; Male; Middle Aged; Neuritis; Pain; Prednisone; Quality of Life; Risk Factors; Time Factors

We studied 39 AIDS patients from 1989 to 1996, with previous history of herpes zoster. Twelve of them received acyclovir (ACV) secondary prophylaxis. There were 31 males and 8 females, mean age 33.9 years (19-60) during first herpes zoster. Transmission was sexual in 71.8%. Among these 39 patients, 78 herpes zoster episodes occurred. Median CD4 lymphocytes was 18/mm3 (0-232) among the 12 patients with ACV prophylaxis. Mean posology of ACV was 2,400 mg (1,600-4,000) per day, during mean 10 months (median 4 months). ACV prophylaxis was used because of high frequence of herpes zoster (more than 4) (4 cases), neurologic complications in 4 cases (1 myelitis, 1 myeloradiculitis, 1 vascularitis and 1 meningo-encephalitis), disseminated herpes zoster in 4 cases and one hyperalgic zoster. Ten from these 12 patients occurred no zoster recurrence. Among patients without prophylaxis, zoster recurrences were more frequent at 12 months (68% versus 22% among patients with prophylaxis). This prophylaxis seems to be interesting, particularly in deep immunocompromised patients (CD4 < 50/mm3) with serious herpes zoster or frequent recurrences (more than 4). However, since protease inhibitors treatments, zoster incidence is decreasing in HIV+ patients. This prophylaxis will probably be less usefull than before.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Administration, Oral; Adult; AIDS-Related Opportunistic Infections; Antiviral Agents; Female; Follow-Up Studies; Herpes Zoster; Humans; Male; Middle Aged; Treatment Outcome

Topics: Acute Disease; Acyclovir; Adolescent; Adult; Aged; Aged, 80 and over; Antiviral Agents; Female; Herpes Zoster; Humans; Male; Middle Aged; Neuralgia; Single-Blind Method

To evaluate the relief of acute pain and possible preventive effects on postherpetic neuralgia through the use of an epidural blockade in the acute stage of herpes zoster.. Prospective, nonrandomized, comparative clinical trial.. A dermatologic clinic in a university hospital.. Sixty-five consecutive patients with pain due to acute herpes zoster were treated for a 7-day hospitalization period from July 1, 1996, through June 30, 1997.. The consecutive patients were divided into 2 groups. Group A consisted of 30 patients who were seen from July 1, 1996, through December 31, 1996, and who were treated with intravenous acyclovir (5 mg/kg) for 7 days. Group B consisted of 35 patients who were seen from January 1, 1997, through June 30, 1997, and who were treated with intravenous acyclovir (5 mg/kg) and an epidural blockade for 7 days. The changes in the intensity of pain and the total duration of pain in both groups were assessed for 12 to 18 months.. The number of days required for relief of pain and the total duration of pain.. The mean +/- SD number of days required for relief of pain, which was rated on a scale of 100 (worst pain) to 0 (no pain), was significantly fewer in group B than in group A: it took 2.6 +/- 1.1 days to go from 100 to 50 on the relief-of-pain scale in group B, but 3.8 +/- 1.1 days in group A (P = .03), and 12.5 +/- 6.4 days to go from 100 to 10 in group B, but 20.1 +/- 14.6 days in group A (P = .04). The duration of late residual pain was significantly shorter in group B (5.9 +/- 5.8 days) than in group A (11.9 +/- 7.5 days) (P = .03). The total duration of pain was also significantly shorter in group B (18.5 +/- 9.3 days) than in group A (31.6 +/- 17.6 days) (P = .04).. We believe that an epidural blockade combined with an antiviral agent is a very effective treatment modality for the pain of acute herpes zoster, and we recommend its use for the prevention of postherpetic neuralgia, with a view to shortening the total duration of pain, especially late residual pain.

Topics: Acute Disease; Acyclovir; Adult; Aged; Aged, 80 and over; Analgesia, Epidural; Analysis of Variance; Anesthetics, Local; Antiviral Agents; Bupivacaine; Female; Follow-Up Studies; Glucocorticoids; Herpes Zoster; Humans; Injections, Intravenous; Male; Methylprednisolone; Middle Aged; Nerve Block; Neuralgia; Pain Measurement; Prospective Studies; Time Factors

Topics: Acyclovir; Adolescent; Adult; Aged; Antiviral Agents; Female; Herpes Zoster; Humans; Male; Middle Aged; Valacyclovir; Valine

Immunocompromised patients with varicella-zoster virus (VZV) infection are at greater risk for dissemination and the development of complications than immunocompetent individuals. Consequently, they are generally hospitalized in strict isolation rooms and treated with parenterally administered acyclovir. Although effective, this approach is expensive and creates logistic difficulties in the hospital. We treated 38 immunosuppressed cancer patients presenting to our ambulatory treatment center with VZV infections with intravenous acyclovir (500 mg/m2 8-hourly) in an ambulatory/home setting. Patients were monitored for success or failure of therapy, progression of infection, development of complications or drug toxicity, and satisfaction/compliance with therapy. Most patients (33, or 87%) responded to therapy. Among the failures, 2 patients had progressive VZV infection, 2 were hospitalized due to renal toxicity, and 1 developed a superinfection. All patients eventually responded and there were no deaths on this study. Two patients relapsed within 1 month of initial response. Both responded to retreatment with acyclovir, without hospitalization. The median duration of parenteral therapy with acyclovir was 7.5 days. Seven patients (18%) had to be switched to oral acyclovir (800 mg, 5 times a day) before complete response, owing to problems with venous access. All 7 completed therapy successfully. Overall, patients expressed a high level of satisfaction with outpatient therapy, and there were no instances of noncompliance or patient requests for withdrawal from study. The results of this study indicate that VZV infections in clinically stable immunosuppressed cancer patients are relatively benign and do not require hospitalization. Parenterally administered acyclovir in an ambulatory setting is effective therapy for such infections.

Topics: Acyclovir; Adolescent; Adult; Aged; Ambulatory Care; Antiviral Agents; Costs and Cost Analysis; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunocompromised Host; Injections, Intravenous; Male; Middle Aged; Neoplasms; Prognosis; Treatment Outcome

The present randomized, double-blind, placebo-controlled, multicenter clinical trial was designed to compare the efficacy and tolerability of sorivudine [1-beta-D-arabinofuranosyl-E-(2-bromovinyl)uracil] and acyclovir for the treatment of dermatomal herpes zoster in human immunodeficiency virus (HIV)-seropositive patients. A total of 170 HIV-seropositive adults presenting with herpes zoster (confirmed by direct fluorescent-antigen testing and/or viral culture) were enrolled and randomized to receive a 10-day course of orally administered sorivudine (40 mg once daily plus acyclovir placebos) or acyclovir (800 mg five times daily plus sorivudine placebo). Patients were monitored daily to document the events of cutaneous healing, pain, zoster-related complications, and drug-related adverse events. Patients were reassessed on days 21 and 28 and then once monthly for 1 year. The primary efficacy endpoint was time to the cessation of new vesicle formation. Secondary efficacy endpoints included times to other events of cutaneous healing, resolution of pain, and frequency of dissemination and zoster recurrence. In a multivariate analysis, sorivudine was superior to acyclovir for reducing the times to the cessation of new vesicle formation (relative risk [RR] = 1.54, 95% confidence interval [CI] = 1.00 to 2.36; P = 0.049) and total lesion crusting (RR = 1.48, 95% CI = 1.07 to 2.04; P = 0.017). In a univariate analysis, there was a trend favoring sorivudine for the cessation of new vesicle formation (median of 3 versus 4 days; P = 0.07) and a significant advantage for time to total lesion crusting (median of 7 versus 8 days; P = 0.02). The time to the resolution of zoster-associated pain, the frequency of dissemination, and the frequency of zoster recurrence were not different between the two treatment groups. Both drugs were well tolerated. Sorivudine is an effective drug for the treatment of herpes zoster in HIV-infected patients and results in accelerated cutaneous healing when compared with acyclovir therapy.

Topics: Acyclovir; Adolescent; Adult; Aged; AIDS-Related Opportunistic Infections; Antiviral Agents; Arabinofuranosyluracil; Double-Blind Method; Female; Herpes Zoster; Humans; Male; Middle Aged; Quality of Life; Recurrence; Treatment Outcome

Oral acyclovir has become the standard of care for treatment of acute herpes zoster. Netivudine is a novel antiviral with greater in-vitro activity against varicella zoster virus. It was compared with acyclovir in a randomized, double-blind, controlled trial in immunocompetent adults with herpes zoster. Patients with rash for less than 72 h were assigned to receive either acyclovir or netivudine, then assessed regularly for 6 months. No evidence for a dose response with netivudine was found, so intent-to-treat analyses of all 511 enrolled patients compared acyclovir with netivudine. The time to complete cessation of pain (P = 0.007) and to cessation of moderate to excruciating pain (P = 0.005) was accelerated in acyclovir recipients. Rash outcomes and adverse event profiles were similar for both treatments. This study has confirmed the efficacy of acyclovir in decreasing the duration and severity of pain following herpes zoster. Greater in-vitro activity of newer agents may not necessarily provide greater benefit in humans.

Topics: Acyclovir; Aged; Antiviral Agents; Arabinofuranosyluracil; Double-Blind Method; Drug Administration Schedule; Exanthema; Female; Herpes Zoster; Humans; Male; Middle Aged; Pain; Prognosis

Topics: Acyclovir; Administration, Oral; Adult; Aged; Antiviral Agents; Drug Administration Schedule; Female; Herpes Zoster; Humans; Male; Middle Aged; Prodrugs; Retrospective Studies; Valacyclovir; Valine

Reactivation of varicella herpes virus (VHV), latent in individuals who have previously suffered varicella, gives rise to herpes zoster and in some cases leads to a sequela of post herpetic neuritis with severe pain which is refractory to analgesics. Many different antiviral agents have been tried without achieving satisfactory results. Of all the antiviral agents employed, acyclovir has been the most successful in reducing post herpetic pain. However acyclovir has not been as reliable as interferon alpha (IFN-alpha). We have previously looked into the use of transfer factor (TF) as a modulator of the immune system, specifically with respect to its effectiveness in the treatment of herpes zoster. In this work findings from a comparative clinical evaluation are presented. A double blind clinical trial of TF vs acyclovir was carried out in which 28 patients, presenting acute stage herpes zoster, were randomly assigned to either treatment group. Treatment was administered for seven days and the patients were subsequently submitted to daily clinical observation for an additional 14 days. An analogue visual scale was implemented in order to record pain and thereby served as the clinical parameter for scoring results. The group treated with TF was found to have a more favorable clinical course, P < or = 0.015. Laboratory tests to assess the immune profile of the patients were performed two days prior and 14 days after initial treatment. The results of these tests showed an increase in IFN-gamma levels, augmentation in the CD4+ cell population but not the percentage of T rosettes in the TF treated group. These parameters were however insignificantly modified in patients receiving acyclovir. Although TF treated patients showed an increase in CD4+ counts these cells remained below the levels for healthy individuals. The fact that IFN-gamma levels as well as the counts for CD4+ cells rose in the TF treated group and not in the acyclovir one is very significant and confirms the immunomodulating properties of TF.

Topics: Acyclovir; Antiviral Agents; CD4-CD8 Ratio; Double-Blind Method; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Interferon-gamma; Male; T-Lymphocytes; Transfer Factor

To estimate the occurrence of postherpetic neuralgia (PHN) arising after acute period of herpes zoster (HZ) and determination of zovirax efficiency in PHN prevention.. Of a total of 102 patients with HZ aged 17-89 years, 20 patients aged 26-83 years were given zovirax.. Acute pain syndrome in PHN was observed in more that one-third of HZ patients. Patients over 60 years of age were more predisposed to PHN. Zovirax reduced the duration of acute rash and its healing, decreased the number of patients with zoster-associated pain and PHN patients.. Zovirax is effective and safe in preventing PHN in HZ patients.

Topics: Acyclovir; Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Antiviral Agents; Female; Herpes Zoster; Humans; Male; Middle Aged; Neuralgia

The clinical efficacy and safety of sorivudine as treatment for acute cutaneous zoster in human immunodeficiency virus-infected adults was compared with that of acyclovir in a double-blinded randomized study. A total of 125 patients with laboratory-confirmed zoster rash present for < or =72 h were assigned treatment with either 40 mg of sorivudine once daily or 800 mg of acyclovir five times daily, both taken orally for 7 days. Patients were assessed daily until all lesions crusted and then monthly for 6 months for postherpetic neuralgia (PHN) and for 12 months for recurrent or new episodes of zoster. Sorivudine significantly shortened the median period of new vesicle formation from 3.0 to 4.0 days (log rank P = .0001). Sorivudine was effective regardless of duration of rash before treatment. Zoster recurrences and new episodes were experienced by fewer patients assigned sorivudine (11%) than acyclovir (26%, P = .037). No differences were seen in incidence, severity, or duration of either acute neuritis or PHN. Both treatments were well tolerated.

Topics: Acute Disease; Acyclovir; Adolescent; Adult; Antiviral Agents; Arabinofuranosyluracil; Double-Blind Method; Herpes Zoster; HIV Infections; Humans; Middle Aged; Patient Compliance

Shingles (herpes zoster) affects 20% of the population at some stage during their lives. The economic consequences can be significant. For example, in the UK, the costs of post-herpetic neuralgia, a complication that affects between 10 and 14% of patients with shingles, have been estimated between 4.8 million and 17.9 million pounds sterling (Pounds). This study is the first formal assessment of the cost-effectiveness of the 2 most commonly used oral antiviral treatments that have proven efficacy in patients with shingles: famciclovir and aciclovir (acyclovir). It shows that the clinical advantages of famciclovir over aciclovir are accompanied by potential economic advantages in the form of savings in direct costs to the UK National Health Service of between 2.04 pounds and 16.85 pounds per patient treated. Future economic research to validate the benefits of antiviral treatment should focus on prospective assessments alongside controlled trials incorporating resource use analysis, quality-of-life appraisal, assessments of pain severity, and long term follow-up with continuation protocols.

Topics: 2-Aminopurine; Acyclovir; Adult; Antiviral Agents; Cost-Benefit Analysis; Double-Blind Method; Drug Costs; Famciclovir; Herpes Zoster; Humans; Immunocompetence

Topics: Acyclovir; Administration, Oral; Antiviral Agents; Herpes Zoster; Humans; Prodrugs; Valacyclovir; Valine

To determine the effect of acyclovir and prednisone treatment of herpes zoster on chronic pain and quality-of-life outcomes.. Randomized, double-blind, placebo-controlled study with a 2 x 2 factorial design.. 15 university hospitals or affilliated clinics.. 208 immunocompetent patients older than 50 years of age who had localized herpes zoster that developed less than 72 hours before study enrollment.. Acyclovir or a matched placebo was administered orally, 800 mg five times daily, for 21 days. Prednisone or a matched placebo was administered orally at 60 mg/d for the first 7 days, 30 mg/d for days 8 to 14, and 15 mg/d for days 15 to 21. The four treatments regimens given were acyclovir plus prednisone; acyclovir plus prednisone placebo; prednisone plus acyclovir placebo; and placebos for both acyclovir and prednisone.. Patients were monitored daily for the first 28 days for lesion healing, resolution of pain, return to usual activity, and return to uninterrupted sleep. Monitoring was then done monthly for 6 months. Patients documented analgesic requirements each day, and adverse events and laboratory abnormalities were recorded at each clinical visit. An intention-to-treat analysis was used.. Patients were randomly allocated to receive one of the four regimens. Demographic characteristics were similar for each group. Time to total crusting and healing was accelerated for patients receiving acyclovir plus prednisone compared with patients receiving two placebos; the risk ratios were 2.27 (95% Cl, 1.46 to 3.55) for total crusting and 2.07 (Cl, 1.26 to 3.38) for healing. Similarly, compared with the placebo group, patients receiving acyclovir plus prednisone had accelerated time to cessation of acute neuritis (risk ratio, 3.02 [Cl, 1.42 to 6.41]), time to return to uninterrupted sleep (risk ratio, 2.12 [Cl, 1.25 to 3.58]); time to return to usual daily activity (risk ratio, 3.22 [Cl, 1.92 to 5.40]); and time to cessation of analgesic therapy (risk ratio, 3.15 [Cl, 1.69 to 5.89]). In the acyclovir plus prednisone group, resolution of pain during the 6 months after disease onset did not statistically differ from that in the other groups. No important clinical or laboratory adverse events occurred in any group.. In relatively healthy persons older than 50 years of age who have localized herpes zoster, combined acyclovir and prednisone therapy can improve quality of life.

Topics: Acyclovir; Aged; Antiviral Agents; Chronic Disease; Drug Therapy, Combination; Female; Glucocorticoids; Herpes Zoster; Humans; Male; Middle Aged; Pain; Placebos; Prednisone; Quality of Life; Regression Analysis

The effect of oral treatment with acyclovir (ACV) on sensory axonal neuropathy, segmental motor paresis and postherpetic neuralgia (PHN) was studied in 105 patients with herpes zoster. Forty-seven patients were treated with ACV at a dose of 4 g/day in 5 doses for at least a week; the others did not undergo any kind of treatment. Electrodiagnostic examination of the nerves and muscles corresponding to the dermatomeric lesions was performed, including sensory and motor nerve conduction studies, blink reflex and electromyography (EMG). The patients treated with ACV showed a significant reduction in the number of cases in which there was electrophysiological evidence of axonal damage in afferent fibres of nerves arising from roots corresponding to affected dermatomes. The treated group also showed a smaller incidence of segmental motor neuritis, clinically evident or only detectable by EMG as denervation. However, there was no significant difference between groups as far as the incidence of PHN was concerned. Oral treatment with ACV therefore reduces peripheral sensory axonopathy due to ganglion damage and prevents the possibility of spread to anterior roots and spinal motoneurones. In this way it reduces the incidence of segmental motor neuritis, but does not reduce the incidence of PHN.

Topics: Acyclovir; Adult; Aged; Aged, 80 and over; Axons; Blinking; Electromyography; Electrophysiology; Female; H-Reflex; Herpes Zoster; Humans; Incidence; Male; Middle Aged; Neural Conduction; Neuralgia; Paresis; Prospective Studies; Sensation Disorders

Clinical course of herpes zoster was assessed in 119 immuno-competent and in 28 immuno-compromised hosts. Complications of herpes zoster were observed in one third cases. However, the frequency of post-herpetic neuralgia was lower than that seen by other authors. Despite severe underlying diseases in compromised hosts, good outcome of herpes zoster was obtained. It may be related to the use of aciclovir in all these cases. Early and rational treatment with aciclovir is important for decreasing of the frequency of severe complications of herpes zoster.

Topics: Acyclovir; Adult; Aged; Aged, 80 and over; Antiviral Agents; Bacterial Infections; Female; Herpes Zoster; Humans; Immune Tolerance; Male; Middle Aged; Neuralgia; Opportunistic Infections; Polyradiculoneuropathy; Treatment Outcome

Acyclovir treatment of acute herpes zoster speeds rash healing and decreases pain and ocular complications. The limited oral bioavailability of acyclovir necessitates frequent dosing. Valaciclovir, the l-valyl ester of acyclovir, is rapidly and almost completely converted to acyclovir in vivo and gives three- to fivefold increases in acyclovir bioavailability. In a randomized, double-blind, multicenter study, the safety and efficacy of oral valaciclovir given at a dosage of 1,000 mg three times daily for 7 or 14 days and oral acyclovir given at a dosage of 800 mg five times daily for 7 days were compared in immunocompetent adults aged > or = 50 years with herpes zoster. Patients were evaluated for 6 months. The intent-to-treat analysis (1,141 patients) showed that valaciclovir for 7 or 14 days significantly accelerated the resolution of herpes zoster-associated pain (P = 0.001 and P = 0.03, respectively) compared with acyclovir; median pain durations were 38 and 44 days, respectively, versus 51 days for acyclovir. Treatment with valaciclovir also significantly reduced the duration of postherpetic neuralgia and decreased the proportion of patients with pain persisting for 6 months (19.3 versus 25.7%). However, there were no differences between treatments in pain intensity or quality-of-life measures. Cutaneous manifestations resolved at similar rates in all groups. Adverse events were similar in nature and prevalence among groups, and no clinically important changes occurred in hematology or clinical chemistry parameters. Thus, in the management of immunocompetent patients > or = 50 years of age with localized herpes zoster, valaciclovir given at 1,000 mg three times daily for 7 days accelerates the resolution of pain and offers simpler dosing, while it maintains the favorable safety profile of acyclovir.

Topics: Acyclovir; Administration, Oral; Aged; Aged, 80 and over; Analgesics; Antiviral Agents; Double-Blind Method; Drug Administration Schedule; Female; Herpes Zoster; Herpes Zoster Ophthalmicus; Humans; Immunocompetence; Male; Middle Aged; Neuralgia; Pain; Quality of Life; Valacyclovir; Valine

The efficacy of oral brivudin vs. intravenous acyclovir was compared in a randomized multicentered study under double-blind conditions using the double-dummy technique. Forty-eight patients with a herpes zoster rash less than 72 hours in duration were entered in the study. Brivudin was given as one 125-mg tablet every 6 hours. Acyclovir was infused over 1 hour at a dose of 10 mg/kg every 8 hours. Treatment was continued for 5 days. There was no significant difference between the treatment groups when analyzed in terms of new lesion formation, increase in the area of rash within the primary dermatome, cutaneous dissemination, and affection of mucous membranes or visceral organs. Both treatment regimes were also equally effective in the time to full crusting of lesions. Oral brivudin and intravenous acyclovir were well tolerated by most patients. There was no need to interrupt the treatment in any case. As effective as intravenous acyclovir in the treatment of herpes zoster, oral brivudin offers the potential for outpatient treatment of herpes zoster in immunocompromised patients.

Topics: Acyclovir; Administration, Oral; Adolescent; Adult; Antibodies, Viral; Antiviral Agents; Bromodeoxyuridine; Double-Blind Method; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunocompromised Host; Injections, Intravenous; Male; Treatment Outcome

Herpes Zoster requires an effective, inexpensive form of treatment not only because it impairs quality of life, but also on account of its relatively high incidence and the resulting costs incurred. Given the present situation in the health care sector, the high costs of treatment with the standard drug, acyclovir, often mean that herpes zoster patients do not receive medicinal therapy.. The aim of the present study was to establish whether the positive results of a prior investigation involving treatment with an enzyme combination preparation could be confirmed.. Over a period of 14 days, two groups of 96 patients each were given acyclovir or an enzyme combination preparation. During the course of the study, the intensity (score) of segmental pain and various skin lesions were investigated.. In terms of the first end point, "segmental pain", the test groups showed no significant difference either on day 7 or on day 14. Although the second end point "segmental reddening" did reveal a significant difference (p = 0.015) in favor of the acyclovir group on day 14, no significant difference was found for any of the other examination endpoints. Nor did any of the other skin lesions evaluated differ significantly by the end of the study.. Overall, the enzyme combination preparation showed identical efficacy with acyclovir. The results of the prior study were thus confirmed. Further investigations on the immunomodulatory potency, dosage and effects on postherpetic herpes neuralgia are, however, still required.

Topics: Acyclovir; Adolescent; Adult; Aged; Aged, 80 and over; Chymotrypsin; Complementary Therapies; Double-Blind Method; Drug Combinations; Female; Herpes Zoster; Humans; Male; Middle Aged; Neuralgia; Pain Measurement; Pancreatic Extracts; Papain; Thymus Extracts; Trypsin

In this paper, data from a clinical trial of a new antiviral agent for treating patients with zoster are used to answer the following question: Does the Nottingham Health Profile (NHP) add to the information obtained from the clinical measures? Three ways in which the NHP could add information are measured. First, Cox's regression analysis is used to determine whether health-related quality-of-life scores obtained at diagnosis give information about disease prognosis. Second, changes in mean NHP scores in different dimensions are computed after pain resolution to determine whether NHP scores provide more sensitive indicators of disease resolution. Third, linear regression is used to determine whether the impacts of disease on quality of life are measured adequately by the clinical parameters. These analyses show that use of the physical mobility and energy dimensions of the NHP increases understanding of disease prognosis; demonstrates the continuing impact of zoster on patients' sleep patterns and energy levels, disease symptoms not included as clinical measures, that persist after the cessation of zoster-associated pain; and gives a measure of the impact of zoster on the patient, which includes unmeasured and measured levels of severity.

Topics: Acyclovir; Antiviral Agents; Double-Blind Method; Female; Herpes Zoster; Humans; Male; Middle Aged; Outcome Assessment, Health Care; Pain; Prognosis; Quality of Life; Regression Analysis; Sleep; Valacyclovir; Valine

Topics: Acyclovir; Aged; Follow-Up Studies; Herpes Zoster; Humans; Neuralgia

Topics: Acyclovir; Aged; Aged, 80 and over; Antiviral Agents; Female; Herpes Zoster; Humans; Male; Middle Aged

Topics: Acyclovir; Administration, Oral; Aged; Aging; Double-Blind Method; Drug Administration Schedule; Female; Herpes Zoster; Humans; Kidney; Male; Middle Aged

Acyclovir given for 7 to 10 days is of proved benefit in acute herpes zoster, but studies of its effectiveness in preventing postherpetic neuralgia have had conflicting results. The role of corticosteroids in the treatment of herpes zoster is also controversial.. We conducted a double-blind, controlled trial in patients with acute herpes zoster to determine whether either 21 days of acyclovir therapy or the addition of prednisolone offered any improvement over 7 days of acyclovir therapy. Patients with a rash of less than 72 hours' duration were assigned to receive acyclovir (800 mg orally, five times daily) for 7 days with either prednisolone or placebo, or acyclovir for 21 days with either prednisolone or placebo. Prednisolone therapy was initiated at a dose of 40 mg per day and tapered over a three-week period. Patients were assessed frequently through day 28 and then monthly through month 6 to assess postherpetic neuralgia.. Of 400 patients recruited, 349 completed the study. No significant differences were detected between the four groups in the progression of the rash (P > 0.1). With steroid therapy, a significantly higher proportion of the rash area had healed on days 7 and 14 (P = 0.02). Pain reduction was greater during the acute phase of disease in patients treated with steroids or 21 days of acyclovir (P < 0.01 and P = 0.02, respectively, on day 7; P < 0.01 for steroid therapy on day 14). However, on follow-up there were no significant differences between any of the groups in the time to a first or a complete cessation of pain. The steroid recipients reported more adverse events.. In acute herpes zoster, treatment with acyclovir for 21 days or the addition of prednisolone to acyclovir therapy confers only slight benefits over standard 7-day treatment with acyclovir. Neither additional treatment reduces the frequency of postherpetic neuralgia.

Topics: Acute Disease; Acyclovir; Adolescent; Adult; Double-Blind Method; Drug Administration Schedule; Drug Therapy, Combination; Female; Herpes Zoster; Humans; Male; Middle Aged; Neuralgia; Pain Measurement; Prednisolone; Statistics as Topic

Retrospective analysis: This open controlled non-randomized study was carried out to investigate the influence of intravenous acyclovir (ACV) on the incidence of post-herpetic neuralgia (PHN). Twelve women and 11 men (mean age 52 years, range 19-89) received ACV 5 mg/kg every 8 hours) for 10 days (I). Twenty-seven untreated patients (mean age 62 years, range 20-89) were taken as a control group (II). Six to 24 months after the onset of herpes zoster (shingles) the patients were reexamined. The analysis revealed a significantly lower incidence of both general pain and severe pain (P < 0.05, chi 2 = 5.55 and 4.39) for (I) compared to (II). For 21 patients who were treated for a period of 10 days, the significance level was 1% (chi 2 = 7.82 and 8.62). Observational study: Fifteen thousand eight hundred and thirty-one non-hospitalized patients with shingles (mean age 55.2 years) received oral ACV (800 mg five times daily) for 7 days. At the onset of therapy, 15,420 patients (97.6%) reported pain (severe 42.6%, moderate 43.1%, mild 14.3%). The pain during treatment was documented by the patients (n = 5,728) in a diary and transferred to a scoring system (0 = none, 1 = mild, 2 = moderate, 3 = severe). From day 1 to day 7 there was a decrease in the pain score level from 2.3 to 0.9. Three months after the onset of herpes zoster, 2,519 of 14,858 patients (16.95%) reported pain; 311 patients (2.1%) complained of continuous pain, typical for PHN.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Acyclovir; Adult; Aged; Aged, 80 and over; Female; Herpes Zoster; Humans; Injections, Intravenous; Male; Middle Aged; Neuralgia; Retrospective Studies

The most frequent complication of herpes zoster is postherpetic neuralgia, usually defined as chronic pain in the area of the exanthem that persists for at least a month after the skin lesions have healed. Several clinical studies of acyclovir showed a reduction in severity and duration of acute pain, but provided no definitive data for chronic pain. In order to determine if acyclovir therapy could reduce chronic pain, we reanalyzed data from the largest U.S. placebo-controlled treatment trial of 187 immunocompetent persons with herpes zoster. By considering pain as a continuum, we found that the median duration of pain in acyclovir recipients was 20 days vs. 62 days for their placebo counterparts (P = 0.02). Thus, acyclovir has been shown to reduce chronic zoster-associated pain. We also noted that the absence of pain at the onset of cutaneous herpes zoster did not preclude its later development.

Topics: Acyclovir; Administration, Oral; Adult; Double-Blind Method; Herpes Zoster; Humans; Middle Aged; Neuralgia

The efficacy of r-interferon alpha 2a (IFM) versus acyclovir (ACV) and vitamin therapy in the treatment of herpes zoster is reported. A total of 305 patients were randomly divided into 3 groups. One million units of IFN were administered i.n. once a day for 6 days in 223 cases, oral ACV 200 mg five times daily for 7 days in 34 cases, and vitamin B12, B1 and B2 therapy at conventional doses for 7-14 days in 48 cases. The results showed that both IFN and ACV could reduce pain in patients with herpes zoster and cut the total duration of symptoms, in comparison with vitamin therapy (P < 0.01). In the IFN group, 45 patients (20.2%) experienced side effects, including mild fever in 35 cases (15.7%) and a slightly depressed leukocyte count or increased serum ALT level (3 cases each). In the ACV group, one complained of discomfort in the gastroenteric tract, and another patient reported lumbodynia.

Topics: Acyclovir; Adolescent; Adult; Aged; Aged, 80 and over; Female; Herpes Zoster; Humans; Interferon alpha-2; Interferon-alpha; Male; Middle Aged; Recombinant Proteins; Vitamin B 12

Seventy-three immunocompromised patients with disseminated herpes zoster were evaluated in a double-blind controlled trial of acyclovir (n = 37) versus vidarabine (n = 36) therapy. Acyclovir was administered at 30 mg/kg/day at 8-h intervals and vidarabine was given as a continuous 12-h infusion at 10 mg/kg/day for 7 days (longer if resolution of cutaneous or visceral disease was incomplete). No demographic differences existed between treatment groups. No deaths attributable to varicella-zoster virus infection occurred within 1 month of treatment. Neither rates of cutaneous healing, resolution of acute neuritis, and frequency of postherpetic neuralgia nor adverse clinical and laboratory events differed between treatment groups. Acyclovir recipients were discharged from the hospital more promptly than vidarabine recipients (P = .04, log rank test). These data indicate that disseminated herpes zoster is amenable to therapy with either acyclovir or vidarabine; resultant mortality is low.

Topics: Acyclovir; Adolescent; Adult; Aged; Aged, 80 and over; Child; Cost-Benefit Analysis; Double-Blind Method; Female; Hepatitis, Viral, Human; Herpes Zoster; Humans; Immunocompromised Host; Infusions, Intravenous; Male; Meningoencephalitis; Middle Aged; Neuritis; Pneumonia, Viral; Skin Diseases, Infectious; Vidarabine

Both topical 40% idoxuridine in dimethylsulfoxide (IDU) and oral acyclovir (ACV) are useful in herpes zoster (HZ). This is the first clinical trial which compares the efficacy of both drugs in the course of the disease and in the prevention of post-herpetic neuralgia (PHN).. Patients of both sexes older than 18 years, with a HZ of less than 4 days were selected. Patients with otic or ophthalmic zoster, serious concomitant illness or pregnant or breast-feeding women were excluded. Following a double dummy design, the patients received at random topical IDU and oral placebo, or oral ACV and topical placebo. Topical treatment was applied during 4 days and oral treatment during 7 days. The evolution of the disease (number of individual lesions, evolution of symptoms, use of analgesic drugs and eventual appearance of complications) was controlled on days 0, 2, 4, 6, 8, and weekly until its resolution.. The group of patients treated with IDU (85) showed a better evolution of the disease than those treated with ACV (86) in some of the parameters controlled: day of first and all vesicles drying (p less than 0.05), last day of moderate-intense pain (p less than 0.05), hyperaesthesia (p less than 0.05) and itching (p less than 0.05) and last day of analgesic use (p less than 0.01). The appearance of new vesicles during treatment was lower in the IDU treated group (p less than 0.01). A tendency favouring IDU can be observed in the appearance of PHN.. In our study topical 40% idoxuridine in DMSO was better than oral acyclovir in 7 of the 14 clinical parameters studied.

Topics: Acyclovir; Administration, Oral; Administration, Topical; Adult; Dimethyl Sulfoxide; Double-Blind Method; Female; Herpes Zoster; Humans; Idoxuridine; Male; Middle Aged; Solutions; Spain; Time Factors

Topics: Acyclovir; Adult; Chickenpox; Chickenpox Vaccine; Child; Herpes Zoster; Herpesvirus 3, Human; Humans; Leukemia; Vaccination; Viral Vaccines

The therapeutic effect of isoprinosine and acyclovir have been studied in 352 and 284 patients with chicken-pox and herpes zoster respectively. The patients were divided into 4 groups: the first one was given palliative treatment only, the second--both palliative and isoprinosine ones, the third--palliative and acyclovir treatment, and the fourth group was given all these. The best therapeutic effect was achieved when acyclovir and isoprinosine was applied jointly, the one of acyclovir alone was less pronounced and that of isoprinosine only was the smallest. According to the authors acyclovir should be the treatment of choice in the very severe and severe cases of chicken-pox and herpes zoster; in the early stage of disease it should be supplemented with isoprinosine and passive immunotherapy.

Topics: Acyclovir; Administration, Oral; Adolescent; Adult; Aged; Chickenpox; Child; Drug Administration Schedule; Drug Therapy, Combination; Female; Herpes Zoster; Humans; Injections, Intravenous; Inosine Pranobex; Male; Middle Aged; Remission Induction; Time Factors

Aciclovir administration in 8 herpes zoster patients aged 14-74 to manage resistant generalized herpetic eruption, serous meningitis, meningoencephalitis resulted in a pronounced response in 5 of them. Aciclovir has the advantage of its effectiveness in spite of late treatment (on herpes zoster day 6-22). This is particularly important for those forms of the disease which manifest severe symptoms during the second phase, i.e. disseminated eruption, involvement of brain matter, etc. Two lethal outcomes due to pulmonary artery embolism were unrelated to the drug administration.

Topics: Acyclovir; Adolescent; Adult; Aged; Drug Evaluation; Female; Herpes Zoster; Humans; Male; Meningitis, Viral; Meningoencephalitis; Middle Aged; Placebos

The effects of prednisone, oral acyclovir, and radiotherapy were compared with placebo in the prevention of post-herpetic neuralgia. No treatment used was able to prevent, with statistical significance, post-herpetic neuralgia, although prednisone and acyclovir showed some pain reduction in the acute phase. Radiotherapy was of no value in either the acute or post-herpetic phase.

Topics: Acute Disease; Acyclovir; Administration, Oral; Aged; Combined Modality Therapy; Female; Herpes Zoster; Humans; Male; Middle Aged; Neuralgia; Prednisone

Topics: Acyclovir; Administration, Oral; Clinical Trials as Topic; Drug Evaluation; Herpes Zoster; Humans; Neuralgia; Time Factors

Twenty-one patients with postherpetic neuralgia of two- to 84-months duration participated in a double-blind, placebo-controlled study of oral acyclovir. Pain perception was assessed with the Melzack Pain Questionnaire at baseline and at two-to six-week intervals during the ensuing six months. Clinically significant pain reduction occurred in eight patients: four received acyclovir, and four received a placebo. Several treatment strategies have been advocated for relief of postherpetic neuralgia. Results of the present study demonstrate the need for a double-blind, placebo-controlled paradigm to substantiate the efficacy of new clinical approaches. The same caveat applies to the more common syndromes encountered in psychiatric practice.

Topics: Acyclovir; Administration, Oral; Aged; Aged, 80 and over; Clinical Trials as Topic; Double-Blind Method; Female; Herpes Zoster; Humans; Male; Middle Aged; Neuralgia; Pain Measurement

Topics: Acyclovir; Aged; Clinical Trials as Topic; Double-Blind Method; Herpes Zoster; Humans; Middle Aged; Neuralgia; Random Allocation

Eighty-two patients were randomly allocated to receive intravenous acyclovir 5 mg kg-1 t.d.s. for 23 days followed by oral acyclovir 800 mg 6-hourly for 6 months or matching placebos after allogeneic bone marrow transplantation. Herpes simplex and varicella zoster virus infections were significantly reduced during the period of administration of acyclovir. No reduction in cytomegalovirus infection was demonstrated. The drug was not toxic.

Topics: Acyclovir; Administration, Oral; Adolescent; Adult; Bone Marrow Transplantation; Child; Clinical Trials as Topic; Cytomegalovirus Infections; Double-Blind Method; Drug Administration Schedule; Female; Herpes Simplex; Herpes Zoster; Humans; Infusions, Intravenous; Male

A double-blind, randomised trial evaluated the efficacy of oral acyclovir, 800 mg 5 times daily for 7 days, in acute herpes zoster and postherpetic neuralgia. Forty patients aged 16 years or over, presenting to their general practitioners within 3 days of rash onset, received acyclovir, while 43 patients received placebo. Acyclovir reduced the extent and duration of the rash, the spread of the rash to adjacent dermatomes and the incidence of disseminated lesions. It shortened the period of new lesion formation and reduced the incidence of ulceration. The weekly prevalence of pain was reduced on acyclovir by the fourth week, with a reduction in the monthly prevalence of chronic pain in the second and third months and a reduction in associated local neurological symptoms between months 3-6. Total analgesic use in the first 4 weeks was reduced by acyclovir, but during follow up there was no difference in the prevalence of analgesic use between groups. There were slightly fewer medical events on acyclovir in the second week, but the frequency was the same in each group for the rest of the 6 months. Biochemical and haematological tests showed no adverse effects of treatment.

Topics: Acute Disease; Acyclovir; Administration, Oral; Adolescent; Adult; Aged; Aged, 80 and over; Analgesics; Clinical Trials as Topic; Double-Blind Method; Drug Administration Schedule; Family Practice; Female; Follow-Up Studies; Herpes Zoster; Humans; Male; Middle Aged; Neuralgia; Random Allocation; Tablets

Topics: Acyclovir; Adult; Aged; Antineoplastic Agents; Bone Marrow Transplantation; Clinical Trials as Topic; Double-Blind Method; Female; Herpes Simplex; Herpes Zoster; Humans; Immune Tolerance; Leukemia; Male; Middle Aged; Risk

Twenty-seven bone marrow transplant patients who developed localized herpes zoster were treated with acyclovir in a randomized study comparing oral and intravenous drug administration. Fourteen patients received oral and 13 patients received intravenous treatment. None of the patients developed disseminated disease. No differences were found between the treatment groups in the number of days that new lesions continued to develop, in number of days with pain, or in the number of days from start of treatment until all lesions were crusted over. We suggest that oral acyclovir may be as effective as intravenous acyclovir in the treatment of localized herpes zoster after bone marrow transplantation.

Topics: Acyclovir; Administration, Oral; Bone Marrow Transplantation; Herpes Zoster; Humans; Injections, Intravenous; Randomized Controlled Trials as Topic

In 21 children with weakened immune response++ (18 patients after immunosuppression and/or after radiotherapy because of neoplastic disease, 1 patients with diagnosed hepatitis chronica persistens, 1 patient with streptococcal septicemia and one infant with protein deficiency and severe anemia) Zovirax was applied in treatment of Varicella virus infection. Clinical observation showed a positive effect of Zovirax in treatment of VZV infection which was manifested by a milder course of the infection and disappearance symptoms. Better effects were obtained when the treatment was started in the first 72 hours of infection.

Topics: Acyclovir; Adjuvants, Immunologic; Adolescent; Child; Child, Preschool; Clinical Trials as Topic; Female; Herpes Zoster; Humans; Immune Tolerance; Infant; Male; Opportunistic Infections

Varicella in otherwise healthy children usually requires no antiviral treatment. In severe cases, however, such as are seen in neonates and adults, treatment must be given. Anecdotal evidence suggests the efficacy of intravenous acyclovir in such patients. Herpes zoster in immunocompetent patients may be severe enough to warrant antiviral therapy, particularly in elderly patients. Both idoxuridine and acyclovir have been investigated in placebo-controlled double-blind studies. Due to its low toxicity, ease of administration, and the possibility of systemic administration, acyclovir has largely replaced older antivirals in the management of herpes zoster in the normal host. Recent studies have shown the efficacy of oral acyclovir. In addition, oral acyclovir may prevent the ocular complications of ophthalmic zoster. When acyclovir is given, it should be administered as early as possible, preferably no later than four days after the onset of the rash. The combination of acyclovir and prednisolone for the prevention of post-herpetic neuralgia has not proved effective.

Topics: Acyclovir; Chickenpox; Clinical Trials as Topic; Herpes Zoster; Humans; Idoxuridine; Immunity; Neuralgia; Prednisolone

Oral acyclovir, 800 mg five times per day for seven days, was compared with placebo in a randomized, double-blind trial conducted at three centers in the United Kingdom. The study group consisted of 364 elderly immunocompetent patients with herpes zoster who were entered within 72 hours of the onset of rash. Acyclovir significantly reduced the times to last new lesion formation (p less than 0.01), loss of vesicles (p less than 0.01), and full crusting (p = 0.03). No significant hastening of rash healing was seen in those who started therapy later than 48 hours after the onset of rash. There was also a significant reduction pain during treatment with acyclovir (p = 0.02). Acyclovir produced no effects on the frequency or severity of post-herpetic neuralgia. No clinically important adverse effects of acyclovir were reported.

Topics: Acute Disease; Acyclovir; Clinical Trials as Topic; Double-Blind Method; Drug Administration Schedule; Female; Herpes Zoster; Humans; Male; Middle Aged; Placebos; Random Allocation; Time Factors

Oral acyclovir therapy for herpes zoster has been studied in double-blind, placebo-controlled trials of two dosages, 400 mg and 800 mg five times per day for 10 days. Compared with placebo recipients, recipients of the high-dosage acyclovir experienced a significantly shortened period of viral shedding, significantly accelerated time to 50 percent scabbing, significantly accelerated time to 50 percent healing, and after two days of therapy, significantly less frequent formation of new lesions. The duration and severity of acute pain were less in acyclovir recipients, with differences in pain severity achieving statistical significance (p = 0.03) between Days 3 and 10 and correlating with the treatment differences in new lesion formation. In studies of the 400 mg five times per day dose schedule, differences between acyclovir and placebo recipients were not significant. In a six-month follow-up of recipients in the higher dosage study, the acyclovir recipients experienced less post-zoster pain than placebo recipients; differences in the prevalence of pain were most significant for the presence of a persistent pain in the first three months of follow-up. Oral acyclovir at these dosages appears to be free of adverse reactions. In summary, oral acyclovir at a dosage of 800 mg five times per day for 10 days for treatment of acute herpes zoster is superior to 400 mg five times per day and favorably alters the course of the disease.

Topics: Acyclovir; Adult; Clinical Trials as Topic; Double-Blind Method; Drug Administration Schedule; Female; Follow-Up Studies; Herpes Zoster; Humans; Male; Neuralgia; Placebos; Random Allocation

Both acyclovir and vidarabine are effective treatment for varicella zoster virus (VZV) infection in immunosuppressed patients. To determine which is preferable, therapy with these two agents was compared in a prospective, randomized trial. A total of 22 immunocompromised patients undergoing treatment for hematologic malignancies and presenting with VZV infection within 72 hours of the onset of rash were randomly assigned to receive intravenous acyclovir or vidarabine; 11 patients were randomly assigned to each treatment group. Acyclovir was significantly more effective than vidarabine in preventing complications of VZV infection, and treatment failures requiring a change to the alternate therapy occurred only among those treated with vidarabine. As compared with vidarabine, acyclovir shortened the median period during which results of viral culture specimens were positive and new lesions formed. Acyclovir also shortened the median interval until the first decrease in pain, the crusting of all lesions, and the complete healing of lesions. Acyclovir is more effective than vidarabine in the treatment of VZV infection in severely immunocompromised patients and should be considered the treatment of choice in such cases.

Topics: Acyclovir; Adult; Chickenpox; Clinical Trials as Topic; Female; Herpes Zoster; Humans; Immune Tolerance; Male; Prospective Studies; Random Allocation; Risk Factors; Vidarabine

Following allogeneic bone marrow transplantation for leukemia, herpes zoster infections that are potentially severe with a high risk of dissemination develop in 30 to 50 percent of patients. Intravenous acyclovir is an effective treatment for established zoster in immunocompromised persons. Oral acyclovir has relatively low bioavailability, which has made the value of this route of administration for the treatment or prophylaxis of herpes zoster infections uncertain. In this trial, 82 patients undergoing allogeneic bone marrow transplantation for leukemia were randomly assigned to receive either intravenous acyclovir for 23 days followed by oral acyclovir for six months, or matched placebos; the random groups were well-matched in all clinical characteristics. During the six-month period of acyclovir/placebo administration, no patient receiving acyclovir developed herpes zoster, whereas six patients receiving placebo did so (p = 0.006). During the six-month follow-up, there were six cases of zoster in the treatment arm of the study and two cases in the placebo arm. Herpes zoster was not restricted to those patients who had positive evidence of antibody before transplant. This study shows that oral acyclovir is capable of preventing zoster infection during its period of administration; once the drug treatment is stopped, infections occur. In selected patients, the use of long-term oral acyclovir may be of value in preventing zoster infections during the time of greatest immunosuppression.

Topics: Acyclovir; Adult; Bone Marrow Transplantation; Child; Clinical Trials as Topic; Double-Blind Method; Female; Follow-Up Studies; Herpes Zoster; Humans; Immune Tolerance; Leukemia; Male; Placebos; Random Allocation; Risk Factors; Time Factors

Sixty-four patients with herpes zoster were entered into a randomised double-masked, placebo-controlled trial of 5% acyclovir cream applied five times daily for 5 days. Of these patients, 56 were included in the final analysis (26 acyclovir, 30 placebo). Significant and objective differences in either progression of the rash, severity of acute pain or incidence of post-herpetic neuralgia were not observed. Although significantly more rashes involuted in the acyclovir group, this isolated finding cannot be explained. Twenty-two patients (12 acyclovir, 10 placebo) experienced erythema or desquamation or both during treatment with the cream. The similar incidence of skin reactions in both groups suggests that they were related to the cream base rather than the acyclovir.

Topics: Acyclovir; Aged; Aged, 80 and over; Clinical Trials as Topic; Double-Blind Method; Female; Herpes Zoster; Humans; Male; Middle Aged; Ointments; Random Allocation

Topics: Acyclovir; Adolescent; Antiviral Agents; Chickenpox; Child; Child, Preschool; Clinical Trials as Topic; Herpes Zoster; Humans; Immune Tolerance; Infant; Neoplasms; Opportunistic Infections

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

During 1 year of continuous suppressive therapy for frequent recurrent genital herpes, about 44% of patients taking 400 mg acyclovir twice a day had no recurrences and 4% of patients taking placebo had no recurrences (i.e., fewer patients taking acyclovir had recurrences, and when they did there were fewer recurrences). Toxicity of continuous suppressive acyclovir treatment appears to be minimal, and viral resistance developing to the drug during use of suppressive therapy has not been a problem, although it does occur. Patients with acquired immunodeficiency syndrome with recurrent herpes may be given 400 mg acyclovir five times a day for 5 days or until the eruption clears and then 400 mg three times a day for 1 or 2 months followed by 400 mg twice a day thereafter. Herpes zoster of immunocompromised patients, including patients with acquired immunodeficiency syndrome, may be treated with 800 mg oral acyclovir five or six times a day for 5 to 10 days depending on the response, and they may derive additional benefit from concomitant topical acyclovir.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Drug Administration Schedule; Female; Herpes Genitalis; Herpes Zoster; Humans; Male; Recurrence

In-vitro and in-vivo evaluation of cellular immune reactions (T-cell subset, E-rosette formation, 2,4-dinitrochlorobenzene, were made in patients with varicella-zoster infection (VZ) and with other intracellular infections. The data demonstrated depressed cellular immunity including a decrease in the number of T-helper cells and a fall in the T-helper/T-suppressor lymphocyte subset ratio to less than 0.7. Three groups of patients with VZ infections were randomly assigned to three regimens: nine patients were given acyclovir alone for five days; ten patients received acyclovir for five days and isoprinosine for ten days; and twelve patients acyclovir for five days and levamisole twice weekly for three weeks. In patients with VZ infections treated with acyclovir and either levamisole or isoprinosine cellular immunity improved faster, while VZ infections in those treated with levamisole healed more rapidly. One patient treated with acyclovir alone had recurrent VZ infection and required a further course of therapy.

Topics: Acyclovir; Adjuvants, Immunologic; Adolescent; Adult; Aged; Dinitrochlorobenzene; Drug Therapy, Combination; Female; Herpes Zoster; Humans; Immunity, Cellular; Inosine; Inosine Pranobex; Levamisole; Male; Middle Aged; Random Allocation; Rosette Formation; T-Lymphocytes; T-Lymphocytes, Helper-Inducer; T-Lymphocytes, Regulatory

In a randomised, double-blind, controlled study of the effect of prednisolone on the development of post-herpetic neuralgia 78 patients with herpes zoster whose pain and exanthema had been present for less than 96 h were given 800 mg acyclovir five times daily for 7 days and prednisolone in a total dose of 575 mg, starting with 40 mg daily in the first week and tapering off over the next 2 weeks. 18 (23%) of the patients had post-herpetic neuralgia at 6 months after the acute zoster, 9 (24.3%) having received prednisolone and 9 (22.5%) placebo. The 95% CI for the difference between the placebo and prednisolone groups in the proportion of patients having pain at 6 months was minus 17% to plus 20%. Prednisolone, however, relieved pain for the first 3 days. The 1-2 week interval between admission and reappearance of pain and development of triggered pain seems to be the time needed to establish neuralgia. Once established, the type and intensity of pain remained largely unaltered.

Topics: Acyclovir; Aged; Clinical Trials as Topic; Double-Blind Method; Drug Therapy, Combination; Female; Follow-Up Studies; Herpes Zoster; Humans; Male; Middle Aged; Prednisolone; Random Allocation; Trigeminal Neuralgia

Previous studies have shown that intravenous acyclovir does modify rash development, reduce viral shedding and alleviate acute pain in herpes zoster. To assess the clinical efficacy of an oral dosage regimen with 800 mg acyclovir five times daily, double-blind, placebo-controlled studies were carried out at three centres within the U.K., using a common protocol. According to inclusion criteria (immune competent patients over 60 years of age with a clinical diagnosis of herpes zoster with rash of no more than 72 h duration, no previous systemic antiviral treatment, no history of renal insufficiency) 205 patients were recruited after they had given their informed consent. Patients were randomly assigned to receive either two 400 mg tablets acyclovir (41 men, 59 women) or matching placebo (46 men, 59 women) five times daily for seven days. Treatment was predominantly domiciliary based. According to clinical assessment and pain score acyclovir recipients showed a significant benefit in terms of reduction in rash progression if treatment was started within 48 h of the onset of rash, and alleviation of pain during the acute phase of herpes zoster. Overall, the number of patients developing extradermal lesions was significantly lower in the acyclovir group than in the placebo group (p = 0.02). However, there were no significant differences in rash progression and pain response in patients with herpes zoster affecting the ophthalmic division of the trigeminal nerve in patients who received acyclovir (n = 21) compared to those who received placebo (n = 32). 12 acyclovir and 13 placebo recipients reported symptoms, predominantly gastrointestinal in nature, possibly or probably related to therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Acute Disease; Acyclovir; Administration, Oral; Aged; Aged, 80 and over; Clinical Trials as Topic; Double-Blind Method; Female; Herpes Zoster; Humans; Immunocompetence; Male; Middle Aged; Random Allocation

Sixty immunocompetent patients with herpes zoster of various dermatomes were treated 5 times a day for 5 days with either acyclovir at a dose of 400 mg or placebo. Acyclovir was shown to reduce significantly the time to full crusting (P = 0.02). There were also trends in favour of acyclovir for time to first dry vesicle and time to first day without macules or papules, but these were not statistically significant. There were no differences between the groups in the occurrence of adverse events or postherpetic neuralgia.

Topics: Acyclovir; Administration, Oral; Adult; Clinical Trials as Topic; Double-Blind Method; Female; Herpes Zoster; Humans; Male; Neuralgia

Topics: Acyclovir; Administration, Oral; Aged; Clinical Trials as Topic; Double-Blind Method; Female; Herpes Zoster; Humans; Male; Middle Aged; Pain; Pain Measurement; Random Allocation

Topics: Acyclovir; Adult; Clinical Trials as Topic; Cyclosporins; Double-Blind Method; Drug Interactions; Female; Herpes Simplex; Herpes Zoster; Humans; Immunosuppression Therapy; Kidney Transplantation; Male; Middle Aged; Prospective Studies; Random Allocation

In a prospective, randomized trial, we compared intravenous acyclovir and vidarabine in the treatment of varicella-zoster virus infection in severely immunocompromised patients who presented within 72 hours of onset of the infection. Eleven patients were treated in each group. Cutaneous dissemination of infection occurred in none of the 10 acyclovir recipients and in 5 of the 10 vidarabine recipients who had presented with localized dermatomal disease (P = 0.016). As compared with vidarabine, acyclovir treatment shortened the median periods during which cultures were positive for the virus (four vs. seven days, P = 0.004) and new lesions formed (three vs. six days, P = 0.03). Acyclovir also shortened the median interval until the first decrease in pain (4 vs. 7 days, P = 0.005), the pustulation of all lesions (4 vs. 7 days, P = 0.0004), the crusting of all lesions (7 vs. 17 days, P = 0.0003), and the complete healing of lesions (17 vs. 28 days, P = 0.003). In addition, acyclovir reduced the incidence of fever (two vs. eight patients, P = 0.015). We conclude that acyclovir is better than vidarabine for the treatment of varicella-zoster infection in immunocompromised patients.

Topics: Acyclovir; Adolescent; Adult; Child; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Immune Tolerance; Leukemia; Lymphoma; Male; Prospective Studies; Random Allocation; Vidarabine

Topics: Acyclovir; Administration, Oral; Drug Resistance, Microbial; Herpes Zoster; Herpesvirus 3, Human; Humans; In Vitro Techniques; Injections, Intravenous; Time Factors

The frequencies of reactivated disease due to varicella-zoster virus (VZV) in immunocompromised patients were determined by enzyme-linked immunosorbent assay for antibody and also by the lymphocyte proliferation response to VZV antigen. Subclinical reactivations were as common as classical herpes zoster in all patient groups. Among bone marrow transplant (BMT) recipients, 36% developed herpes zoster and 26%, a subclinical reactivation. The corresponding frequencies for patients with leukemia during induction therapy were 5% and 10%; in renal transplant recipients, 0% and 26%; and in patients with seminoma, 0% and 6%, respectively. Subclinical reactivation of VZV thus appears to be a common finding in severely immunocompromised patients. A regained lymphocyte proliferation response to VZV antigen is a sensitive indicator of subclinical reactivation of VZV in BMT recipients. None of 19 BMT recipients with subclinical disease due to VZV later developed clinical reactivation of VZV. Acyclovir given as prophylaxis against infection with herpes simplex virus reduced the number of clinical and subclinical reactivations of VZV during treatment in BMT recipients, but not thereafter.

Topics: Acyclovir; Antibodies, Viral; Antigens, Viral; Bone Marrow Transplantation; Chickenpox; Dysgerminoma; Graft vs Host Disease; Herpes Zoster; Herpesvirus 3, Human; Humans; Immune Tolerance; Immunoglobulin G; Kidney Transplantation; Leukemia; Lymphocyte Activation; Male; Recurrence; Testicular Neoplasms

After a discussion of the principles of antiviral chemotherapy, treatment and chemoprophylaxis of the following virus infections are reviewed in detail: the various manifestations of herpes simplex virus infections, varicella-zoster, cytomegalovirus infections, Epstein-Barr virus infections, laryngeal papillomas, and influenza A. Special reference is made to the treatment of immunocompromized patients. Acycloguanosine (acyclovir) has been found particularly useful in the treatment of herpes simplex virus and varicella zoster virus infections in immunocompromized patients and for herpesencephalitis. Varicella-zoster can also be treated effectively with bromovinyldeoxyuridine (BVDU). Toxicity of the currently used antiviral drugs is discussed as well as the problem of drug resistance.

Topics: Acyclovir; Antiviral Agents; Bromodeoxyuridine; Chickenpox; Child; Clinical Trials as Topic; Cytomegalovirus Infections; Double-Blind Method; Encephalitis; Female; Herpes Genitalis; Herpes Simplex; Herpes Zoster; Humans; Immunologic Deficiency Syndromes; Infant, Newborn; Pemphigoid Gestationis; Pregnancy; Vidarabine; Virus Diseases

During a placebo-controlled trial of oral acyclovir therapy for acute zoster in immunocompetent patients, we examined the blastogenic response of peripheral blood mononuclear cells and antibody titers in both placebo and acyclovir recipients to determine whether the drug affected the cell-mediated or humoral immune responses. Proliferative responses to mitogens and two dilutions of varicella-zoster virus antigen were not inhibited when fresh peripheral blood mononuclear cells were simultaneously tested in autologous sera collected before and on day 7 of a 10-day course of 2 g/day of oral acyclovir (plasma drug levels averaged 4.6 microM). Using cryopreserved cells from study days 0, 3, 7, 14, and 30, thawed and tested simultaneously, there was no significant difference at the p less than or equal to 0.05 level between the net proliferative responses at each time point for the two groups. On day 14, however, the proliferative response of the acyclovir group was approximately 50% lower than that of the placebo group. Geometric mean antibody titer rises to varicella-zoster virus were also lower among drug recipients but not significantly so. Although this dose of acyclovir did not have a statistically significant effect on lymphocyte proliferative responses to varicella-zoster virus antigen or antibody titers, the lower values in drug recipients may be a reflection of the ability of acyclovir to terminate viral replication, thus reducing the patient's antigenic burden.

Topics: Acyclovir; Adult; Aged; Antibody Formation; Antigens, Viral; Cell Division; Clinical Trials as Topic; Female; Freezing; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunity, Cellular; Lymphocytes; Male; Middle Aged; Mitogens; Placebos

Oral acyclovir at a dose of 800 mg five times daily for seven days was compared with placebo in a randomised double blind trial conducted at three centres in the United Kingdom. The study group comprised 205 elderly immune competent patients suffering from herpes zoster who were entered within 72 hours of the onset of rash. Acyclovir significantly reduced the times to arrest of new lesion formation (p = 0.005), loss of vesicles (p less than 0.001), and full crusting (p = 0.02) in those patients entered within 48 hours of the onset of rash. In addition, there was a significant reduction in pain during treatment with acyclovir as compared with placebo (p = 0.008). Of the patients with severe pain on entry, 40% (10/25) of those treated with acyclovir had no or only mild pain at the end of treatment, whereas in the placebo group all had residual moderate or severe pain (p less than 0.001). No clinically important adverse effects of acyclovir were reported. Oral acyclovir may modify acute herpes zoster and reduce pain.

Topics: Acute Disease; Acyclovir; Administration, Oral; Aged; Clinical Trials as Topic; Double-Blind Method; Female; Herpes Zoster; Humans; Male; Pain; Random Allocation

A comparative assessment of vidarabine and acyclovir in the treatment of varicella and disseminated zoster in immunosuppressed patients was undertaken. Thirty-eight immunosuppressed patients with varicella (N = 18) or disseminated zoster (N = 20) were treated intravenously with 10 mg/kg/day of vidarabine or 30 mg/kg/day of acyclovir for 5 days according to a preestablished code within each diagnosis group--varicella and disseminated zoster. Two deaths, although not directly related to VZV infection, were observed in the vidarabine-treated varicella group. The times to cessation of formation of new lesions and to the disappearance of fever were similar for vidarabine and acyclovir in each group. In the varicella group, VZV was isolated on day 5 in four out of five vidarabine patients versus one out of five acyclovir patients. No severe adverse effects were observed with either drug. Neutropenia present in patients of both drug groups was transitory and most often related to previous cytolytic chemotherapy. These data suggest that either vidarabine or acyclovir could be used in the treatment of severe VZV infections in immunosuppressed patients, although a larger number of patients would be required for definitive conclusion. Because of the large amount of solute required for vidarabine administration, acyclovir may be preferred when the risk of cardiorespiratory failure is high.

Topics: Acyclovir; Chickenpox; Clinical Trials as Topic; Female; Herpes Zoster; Humans; Male; Neoplasms; Random Allocation; Vidarabine

Antiviral compounds have been developed for use in chemoprophylaxis and chemotherapy of a variety of infections in humans, including those caused by influenza viruses, respiratory syncytial virus, and herpesviruses. The efficacy of several of these compounds has been demonstrated in rigorously controlled trials. Advances in molecular virology have led to the identification of biochemically defined, virus-specific functions that serve as appropriate targets for the future development of antiviral compounds. Clinical investigators and practicing physicians are now confronting questions previously raised with the use of antibacterial antibiotics. These questions concern appropriate routes of administration for antiviral compounds, optimal dosage regimens, risks of long-term prophylaxis, and the emergence of resistant organisms.

Topics: Acyclovir; Adult; Aged; Amantadine; Antiviral Agents; Chickenpox; Clinical Trials as Topic; Cytomegalovirus; Encephalitis; Foscarnet; Guanosine Triphosphate; Herpes Simplex; Herpes Zoster; Herpesviridae Infections; Humans; Infant, Newborn; Infant, Newborn, Diseases; Influenza A virus; Influenza, Human; Phosphonoacetic Acid; Respiratory Tract Infections; Ribavirin; Rimantadine; Vidarabine; Virus Diseases

In a double-blind, controlled study 35 herpes simplex virus (HSV) antibody-positive patients were randomized to receive oral acyclovir 200 mg X 4 daily or placebo for 28 days following renal transplantation. The incidence of herpes virus infection was compared in both groups by weekly virus demonstration/isolation testing from throat swabs and urine, and by serum antibody demonstration. None of the 18 patients allocated to acyclovir showed any signs of HSV or varicella zoster virus (VZV) infection during the trial period, whereas 9 of 17 receiving placebo had signs of HSV (P less than 0.001) and 2 of VZV (P less than 0.05) infection. Because of systemic as well as local symptoms of infection in five of the placebo patients, the trial was interrupted and treatment with oral acyclovir instituted. All of them responded well with rapid disappearance of all symptoms. Cytomegalovirus (CMV) was isolated from the urine of two patients in both groups during the trial period; a significant antibody rise was seen later in three of them. There was no evidence of drug-related toxicity during the study.

Topics: Acyclovir; Administration, Oral; Adult; Antibodies, Viral; Complement Fixation Tests; Female; Herpes Labialis; Herpes Zoster; Herpesviridae Infections; Humans; Kidney Transplantation; Male; Middle Aged; Random Allocation

Topics: Acyclovir; Adult; Antiviral Agents; Chickenpox; Clinical Trials as Topic; Encephalitis; Herpes Simplex; Herpes Zoster; Herpesviridae Infections; Humans; Idoxuridine; Infant, Newborn; Infant, Newborn, Diseases; Keratitis, Dendritic; Trifluridine; Vidarabine

Topics: Acyclovir; Chickenpox; Clinical Trials as Topic; Cytomegalovirus Infections; Double-Blind Method; Herpes Simplex; Herpes Zoster; Herpesviridae Infections; Herpesvirus 4, Human; Humans; Immune Tolerance; Interferon Type I; Recurrence; Vidarabine

Topics: Acute Disease; Acyclovir; Adult; Clinical Trials as Topic; Creatinine; Female; Herpes Zoster; Humans; Infusions, Parenteral; Male; Nausea; Vomiting

Topics: Acyclovir; Clinical Trials as Topic; Double-Blind Method; Encephalitis; Herpes Zoster; Humans; Immune Tolerance; Male; Middle Aged

Topical acyclovir favorably influences the healing of localized herpes zoster in immunocompromised patients. This therapy, or placebo, was applied to forty-three patients in a random access, double-blind trial, four times daily for 10 days, beginning within 72 hours after the onset of skin lesions. The mean time to pustulation is decreased from 12.4 to 6.7 days and the mean time to crusting is decreased from 16.0 to 11.4 days (p = 0.038 and 0.086, respectively) by topical treatment. The mean time to 50% healing is decreased from 24.5 to 15.2 days and the mean time to 100% healing is decreased from 34.9 to 25.8 days (p = 0.023 and 0.033, respectively). Favorable effects in treated patients are not associated with a more rapid decline in lesion virus titer, but do accrue without any toxicity.

Topics: Acyclovir; Administration, Topical; Adult; Clinical Trials as Topic; Double-Blind Method; Female; Herpes Zoster; Humans; Immunologic Deficiency Syndromes; Lymphoproliferative Disorders; Male; Middle Aged; Random Allocation; Time Factors

The efficacy of oral acyclovir to prevent reactivation of herpes simplex virus (HSV) in seropositive renal allograft recipients was tested in a double-blind placebo controlled study. None of the 18 patients allocated to acyclovir showed any signs of HSV infection. In contrast, 11/17 on placebo (p less than 0.001), had signs of HSV or varicella zoster virus (VZV) infection--in 5 patients severe enough to interrupt the trial and initiate treatment with oral acyclovir. Soon after cessation of the trial, HSV was isolated from the throats of 6 patients on acyclovir, and 1 developed shingles 3 months later. Oral acyclovir prophylaxis thus effectively protected the patients from reactivation of HSV and VZV while they were receiving the drug, but could not prevent disease once off the drug. Treatment with acyclovir brought rapid relief of both local and general symptoms in all patients. No adverse reactions were seen. As a consequence of these experiences our goal in subsequent transplant patients has been either early therapeutic intervention with oral acyclovir whenever signs of HSV or VZV infection have been noted, or prophylactic remedy in patients at particular risk to develop troublesome herpetic lesions after renal transplantation.

Topics: Acyclovir; Administration, Oral; Clinical Trials as Topic; Herpes Simplex; Herpes Zoster; Humans; Kidney Transplantation; Postoperative Complications; Premedication; Random Allocation

Zoster is a common disease that may be associated with severe and protracted pain. Antiviral therapy with acyclovir intravenously has been shown to modify the course of the disease and reduce pain during the acute phase. The results of two studies using doses of 400 mg and 800 mg of acyclovir orally are outlined. The data suggest a significant benefit of the higher dose treatment on the course of the illness and the pain.

Topics: Acyclovir; Administration, Oral; Clinical Trials as Topic; Double-Blind Method; Female; Herpes Zoster; Humans; Male; Random Allocation

A review of the many past and present therapeutic attempts in herpes zoster is given. Serious candidates are interferon, idoxuridine, adenine arabinoside, and acyclovir. Cumbersome administration and risk of side effects make acyclovir today's choice. The treatment with acyclovir has been improved by the availability of an oral formulation. The development of a well-absorbed prodrug, 6-deoxyacyclovir may in the future replace conventional acyclovir tablets in non-emergency cases.

Topics: Acyclovir; Administration, Oral; Clinical Trials as Topic; Double-Blind Method; Drug Resistance, Microbial; Herpes Zoster; Humans; Immune Tolerance; Injections, Intravenous

This paper reviews the clinical evaluation of acyclovir in the treatment of herpes-virus infections, predominantly those due to herpes simplex and varicella-zoster viruses. Intravenous, oral and topical acyclovir have been reported to be effective in the therapy of a wide variety of established herpes simplex virus infections and the systemic drug has been shown to be capable of suppressing reactivation of that virus. Although acyclovir has less activity against varicella-zoster virus, infections caused by this agent are also susceptible to intravenous and possibly oral therapy. Clinical efficacy against Epstein-Barr virus and cytomegalovirus infections has not been demonstrated but several studies are currently in progress. Limited evidence of in vivo activity against hepatitis B virus also requires further evaluation. Continued studies on tolerance of the drug in clinical use has confirmed the early promise of this selective antiviral, whilst initial concern about the development of widespread resistance has not been borne out in practice.

Topics: Acyclovir; Clinical Trials as Topic; Cytomegalovirus Infections; Drug Resistance, Microbial; Female; Herpes Genitalis; Herpes Labialis; Herpes Zoster; Humans; Immunosuppression Therapy; Keratitis, Dendritic; Male; Recurrence

Topics: Acyclovir; Antiviral Agents; Chickenpox; Clinical Trials as Topic; Encephalitis; Female; Herpes Genitalis; Herpes Labialis; Herpes Simplex; Herpes Zoster; Herpesviridae Infections; Humans; Idoxuridine; Infant, Newborn; Keratitis, Dendritic; Keratoconjunctivitis; Male; Vidarabine

Topics: Acyclovir; Administration, Oral; Adult; Aged; Female; Herpes Zoster; Humans; Male; Middle Aged; Time Factors

Topics: Acyclovir; Administration, Oral; Adult; Clinical Trials as Topic; Herpes Zoster; Humans

Topics: Acyclovir; Clinical Trials as Topic; Herpes Zoster; Humans; Immunosuppression Therapy

In a double-blind randomised trial 40 patients above 60 years old with acute herpes zoster received either 5 mg/kg acyclovir three times daily intravenously or 400 mg acyclovir five times daily orally for five days. Identical results were obtained with respect to duration of pain and rate of healing. Twenty per cent of orally administered acyclovir was absorbed and gave satisfactory concentrations of acyclovir in the vesicular fluid.

Topics: Acyclovir; Administration, Oral; Aged; Clinical Trials as Topic; Double-Blind Method; Female; Herpes Zoster; Humans; Injections, Intravenous; Male; Pain; Random Allocation

Topics: Acyclovir; Administration, Topical; Adolescent; Amantadine; Antiviral Agents; Chickenpox; Child; Clinical Trials as Topic; Encephalitis; Female; Herpes Genitalis; Herpes Simplex; Herpes Zoster; Humans; Idoxuridine; Influenza, Human; Keratitis, Dendritic; Male; Rimantadine; Vidarabine

Forty-one patients with herpes zoster were treated with acyclovir or placebo at a dosage of 400 mg five times a day by mouth for five days in a double-blind randomized domiciliary study. Acyclovir was shown to reduce the days of new lesion formation within the effected dermatome after day 0 (P = 0.049). No other statistical difference was demonstrated between the two groups although the trends for new lesion formation outside the dermatome, full crusting, involution and diminution of acute pain all favoured acyclovir.

Topics: Acyclovir; Administration, Oral; Aged; Clinical Trials as Topic; Double-Blind Method; Female; Herpes Zoster; Humans; Male; Middle Aged; Pain; Placebos; Random Allocation; Time Factors

In a double-blind randomized trial, virological studies were carried out in non-immunocompromised patients with herpes zoster who received either acyclovir (5 mg/kg) or placebo intravenously three times daily for five days. Mean duration of virus shedding was not significantly different in the two groups and all patients developed high titres of antibody to varicella-zoster virus. Interferon levels in vesicle fluid reached a peak significantly sooner (P less than 0.025) and at a lower level in eight treated patients compared with eight given placebo, corresponding with significantly earlier cessation of vesicle formation in the treated group (P less than 0.05). Pretreatment virus isolates tested for sensitivity to the drug showed ED50 values from 4 +/- 0.7 to 17.5 +/- 1 microM acyclovir. Treatment with a dose of acyclovir greater than 5 mg/kg, but not exceeding 10 mg/kg, is recommended for herpes zoster.

Topics: Acyclovir; Adult; Aged; Antibody Formation; Herpes Zoster; Humans; Interferons; Middle Aged

Acyclovir (acycloguanosine) is a new antiviral compound with activity against certain herpes viruses. Acyclovir is phosphorylated preferentially in virus-infected cells into its active form, acyclovir triphosphate, an inhibitor of viral-induced DNA polymerase. Acyclovir, which possesses an acyclic carbohydrate moiety, also causes premature DNA chain termination. Acyclovir has shown clinical activity against herpes simplex virus (HSV) types 1 and 2 and varicella zoster virus (VZV), but its usefulness in cytomegalovirus, Epstein-Barr virus, and chronic hepatitis B infections requires further study. In randomized clinical trials of infections caused by HSV and VZV, intravenous acyclovir has been shown to shorten the duration of viral shedding and lesion pain and hasten the resolution of skin lesions, with minimal toxicity.

Topics: Acyclovir; Clinical Trials as Topic; Cytomegalovirus Infections; Drug Resistance, Microbial; Herpes Simplex; Herpes Zoster; Humans; Injections, Intravenous; Kinetics; Virus Diseases

In a randomized, placebo-controlled, double-blind trial of intravenous acyclovir in the treatment of varicella zoster virus (VZV) infections, 8 of 20 immunocompromised children with varicella received acyclovir (500 mg/m2/dose three times daily for 7 days). There was no significant difference in skin healing between the acyclovir and placebo groups although there was a significant reduction in the incidence of development of pulmonary involvement during acyclovir treatment. Nineteen out of 34 patients received vidarabine (10 mg/kg/day for 5 days). Vidarabine significantly shortened the duration of new vesicle formation. Both drugs significantly reduced the incidence of visceral varicella, the most serious complication of VZV infection. An open trial also concluded that early treatment of varicella in these patients is essential. Of the 94 patients with zoster infection, 52 received acyclovir (500 mg/m2/dose infused over one hour three times daily for 7 days). Acyclovir recipients healed more rapidly, had fewer days of pain and shorter duration of viral shedding compared with placebo patients. The most important finding was that acyclovir significantly protected against progression of zoster as defined by development or progression of cutaneous dissemination and development of visceral zoster. Vidarabine seemed to be equally effective in this respect. The likelihood of cutaneous dissemination is related to the nature of the underlying condition. The in vitro sensitivity of VZV isolates from patients with second episode VZV infection during the trial did not change appreciably which suggests that VZV does not become resistant to acyclovir during therapy.

Topics: Acyclovir; Adolescent; Adult; Aged; Bone Marrow Transplantation; Chickenpox; Child; Clinical Trials as Topic; Double-Blind Method; Drug Resistance, Microbial; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunosuppression Therapy; Injections, Intravenous; Kidney Transplantation; Lymphoproliferative Disorders; Male; Middle Aged; Neoplasms; Random Allocation; Vidarabine

Acyclovir (aciclovir) is a nucleoside analogue antiviral drug related to cytarabine, idoxuridine, trifluridine and vidarabine. In common with these earlier antivirals, acyclovir is active against some members of the herpesvirus group of DNA viruses. The efficacy of topical acyclovir has been convincingly demonstrated in ocular herpetic keratitis, and in initial and primary initial genital herpes infection, but little or no clinical benefit was seen when non-primary initial genital infections were assessed separately. Acyclovir ointment demonstrated little benefit in recurrent genital herpes but topical acyclovir cream decreased the course of the infection by 1 to 2 days. Orally and intravenously administered acyclovir were beneficial in initial genital herpes infections, and oral therapy shortened the duration of recurrent infections by 1 to 2 days but did not ameliorate pain. In non-immunocompromised patients with recurrent herpes simplex labialis, generally little clinical benefit was seen with the use of topical acyclovir ointment even when therapy was initiated during the prodromal phase, while topical acyclovir cream effected small but significant improvements in the clinical but not the symptomological course of the disease. However, in immunocompromised patients, both intravenous and topical acyclovir shortened the clinical course of herpes simplex virus infections occurring mainly on the lips, oral mucosa and face, and prophylaxis with either oral or intravenous acyclovir suppressed the appearance of recurrent lesions from latent virus for the period of drug administration, but acyclovir did not eradicate latent herpesviruses. In non-immunocompromised patients, intravenous acyclovir was shown to decrease the acute pain of zoster, especially in the elderly, but postherpetic neuralgia was not ameliorated. When immunocompromised patients were studied, intravenous acyclovir inhibited the progression of zoster infections and shortened the healing time and duration of viral shedding in patients with cutaneous disseminated zoster. However, acute and post-herpetic pain were not significantly affected. Well designed controlled studies are underway to establish the efficacy of acyclovir in herpes simplex encephalitis and cytomegalovirus infections in immunocompromised patients, infections due to Epstein-Barr virus, and neonatal herpesvirus infections. Despite some aspects of the drug's use which require further clarification, acyclovir will make a major imp

Topics: Acyclovir; Animals; Clinical Trials as Topic; Cytomegalovirus; Drug Resistance, Microbial; Encephalitis; Female; Herpes Genitalis; Herpes Simplex; Herpes Zoster; Herpesvirus 4, Human; Humans; Immunity; Keratitis, Dendritic; Kinetics; Male; Mutagens; Recurrence

We conducted a placebo-controlled, double-blind study of acyclovir therapy for acute herpes zoster in immunocompromised patients. Of the 94 patients enrolled in the study, 52 had localized skin lesions at entry, and 42 had disseminated cutaneous zoster. A one-week course of intravenous acyclovir (1500 mg per square meter of body-surface area per day) halted progression of zoster in both groups, as determined by development or progression of cutaneous dissemination, development of visceral zoster, or proportion of cases deemed treatment failures. Significantly fewer patients treated with acyclovir within the first three days after the onset of exanthem had complications of zoster, as compared with patients treated with placebo (P = 0.02 by Fisher's exact test), but acyclovir also stopped progression of zoster in patients treated after three days of rash (P = 0.05 by Fisher's exact test). Acyclovir recipients with disseminated cutaneous zoster had a significantly accelerated rate of clearance of virus from vesicles, as compared with placebo recipients (P = 0.05 by the Breslow test).

Topics: Acyclovir; Adolescent; Adult; Aged; Child; Child, Preschool; Clinical Trials as Topic; Double-Blind Method; Female; Herpes Zoster; Humans; Immunologic Deficiency Syndromes; Leukemia; Lymphoma; Male; Middle Aged; Neoplasms; Transplantation, Homologous

The clinical effects of a new anti-viral 9-(2-hydroxymethoxymethyl) guanine (Aciclovir) against Herpes virus infections have been investigated. The patients had malignant tumours or auto-immune disease complicated by shingles and chicken pox due to Vaicella zoster virus (VZV) (43 cases), Herpes simplex virus (HSV) (10 cases) and 9 cases which were clinically diagnosed as Herpes, though the virus was not confirmed as the causative agent. As a general principle the dosage of Aciclovir was 5 mg/kg, t. i. d. for 5 days by slow intravenous infusion. The clinically effective rate against VZV was 93%, being excellent in 42% and against HSV it was 80%, being excellent in 40% and when the results of the cases of unknown origin were included it was excellent in 40% and the cumulative effective rate was 88%. Concerning the efficacy in reduction of pain, swelling, disappearance of vesicles and new scab formation, the effect was most noticeable after the third day of treatment. Treatment given early in the disease is likely to provide better results. Concerning side effects, one of 62 patients had proteinuria and the other had a drug rash and an abnormal liver function test. It is likely that the combination of treatment and the primary disease had some influence, but the cause/effect relationship to Aciclovir treatment is not clear.

Topics: Acyclovir; Adult; Clinical Trials as Topic; Female; Herpes Simplex; Herpes Zoster; Humans; Leukemia; Male; Middle Aged; Neoplasms

In a double-blind, randomised trial, immune-competent adults with acute herpes zoster received either 5 mg/kg acyclovir (17) or placebo (20) intravenously three times daily. Acyclovir significantly improved rash development, as evidenced by reducing the time of new lesion formation and the times to vesicle collapse and full crusting. Pain at the end of treatment and at three months was less in the treated group but the difference was not statistically significant. Ocular involvement was not affected.

Topics: Acute Disease; Acyclovir; Adult; Clinical Trials as Topic; Double-Blind Method; Female; Herpes Zoster; Humans; Male; Random Allocation

In a randomised, double-blind, controlled trial, 40 patients with zoster of short duration (rash present for less than three days) were given either 10 mg/kg acyclovir (20) or placebo (20) intravenously three times daily for five days. Pain was reduced in the treatment group both in the acute phase and at follow-up, when compared with the placebo group, but this difference did not reach statistically significant levels. Healing of the lesions was also better, but not significantly so, in the acyclovir group. No complications of the disease were seen in the six cases of ophthalmic zoster given acyclovir whereas, of the four cases in the placebo group, two developed seventh cranial nerve palsies and one secondary glaucoma. No evidence of renal or other major toxicity was detected in the acyclovir group, although three patients developed mild thrombophlebitis. We conclude that acyclovir, given by the route and in the dose and frequency as used in this study, is free from major side effects, but is only of marginal benefit in the treatment of zoster.

Topics: Acyclovir; Adult; Aged; Clinical Trials as Topic; Double-Blind Method; Female; Herpes Zoster; Humans; Infusions, Parenteral; Male; Middle Aged

Acyclovir given intravenously in either low dose (5 mg/kg every 8 h) or high dose (500 mg/m2 every 8 h) significantly reduced pain and accelerated skin healing in acute herpes zoster occurring in otherwise healthy adults. The higher dose also significantly reduced the duration of viral shedding. No significant effect on post-herpetic neuralgia could be demonstrated, although the higher dose showed a promising trend. No adverse effects were associated with the lower dose, but acyclovir at 500 mg/m2 resulted in nausea, vomiting and transiently elevated serum creatinine in a substantial number of patients.

Topics: Acyclovir; Adult; Creatinine; Follow-Up Studies; Herpes Zoster; Humans; Injections, Intravenous; Nausea; Pain; Random Allocation; Time Factors; Vomiting

Intravenous acyclovir had a significant effect on the resolution of the skin rash in patients with acute zoster, but the 5-day course of therapy was not, in itself, sufficient to treat coexisting ocular involvement. In an open study, topical acyclovir was found to control herpes zoster kerato-uveitis, without recurrences and in a shorter time than if steroids alone were used. The use of steroids in combination with acyclovir led to prolonged treatment and high recurrence rates. A comparative trial of topical acyclovir versus steroids in the treatment of acute herpes zoster kerato-uveitis showed significant differences in favour of acyclovir in terms of the time to resolution of corneal epithelial disease, total treatment duration and the numbers of patients having a recurrence of infection. The reductions in treatment duration and recurrence rate would be expected to result in a reduced incidence of ocular damage and visual loss in acyclovir treated patients.

Topics: Acyclovir; Administration, Topical; Herpes Zoster; Herpes Zoster Ophthalmicus; Humans; Injections, Intravenous; Recurrence; Skin Diseases, Infectious; Steroids

That acyclovir is effective therapeutically in herpes simplex virus (HSV) and herpes zoster (VZV) infections in immunocompromised patients has been established [13]. This paper reviews our subsequent studies in prophylaxis of herpes group infections in a high risk group of patients suffering from acute leukaemia. In study 1 we randomised HSV seropositive (greater than or equal to 1:8) patients to receive intravenous acyclovir or placebo. In this stratified study bone marrow transplant (BMT) recipients were completely protected from HSV infections by acyclovir compared with a 50% failure rate for those on placebo. There was significant protection also in the non-BMT group [8]. In study 2 oral acyclovir prophylaxis failed to provide complete protection in BMT recipients despite the achievement of apparently adequate blood levels. In study 1 the secretion of EBV in saliva before and during the trial gave inconclusive results. In each of the first two studies one patient on "active" acyclovir developed a cytomegalovirus (CMV) infection. Thus, at the dosage of drug used, prophylaxis of CMV was unsuccessful suggesting that claims of therapeutic efficacy are unlikely to be supported in controlled trials. Study 3 is current and concerns the pharmacokinetics of an acyclovir prodrug (BW 134U) taken by mouth. This drug is near 100% absorbed and achieves approximately twice the level of active acyclovir in vivo, following conversion by adenosine deaminase (ADA), in normal volunteers.

Topics: Acyclovir; Bone Marrow Transplantation; Clinical Trials as Topic; Herpes Simplex; Herpes Zoster; Humans; Immunity; Leukemia; Neutropenia

The effect of acyclovir on the skin rash and herpes zoster keratouveitis has been studied. It has been shown to have a significant effect on both disease processes, and to be superior to topical steroids in the treatment of herpes zoster keratouveitis. Steroids have been found to have an adverse effect with prolonged treatment and frequent recurrences.

Topics: Acyclovir; Administration, Topical; Betamethasone; Clinical Trials as Topic; Female; Herpes Zoster; Herpes Zoster Ophthalmicus; Humans; Injections, Intravenous; Keratitis; Male; Recurrence; Retrospective Studies; Skin Diseases, Infectious; Uveitis

A multicenter trial of Acyclovir was carried out in 50 immunodepressed patients. The dose used was 15 mg/kg/day for 5 days in herpes simplex and 30 mg/kg/day for 10 days in herpes zoster and chicken pox by three one-hourly intravenous infusion per day. Acyclovir had a clear cut effect in 42 cases, a partial effect in 1 case, no effect in 1 case, and its action could not be assessed in 6 cases. The cutaneous and mucous membrane lesions were stabilised after an average of two days' treatment, and regression was observed from the third day. Of the 21 cases of zoster, 15 were cured without sequellae and 5 with post-zoster pain. The treatment failed in one patient. Of the 21 cases of cutaneous and/or mucous membrane herpes simplex, 20 satisfactory and 1 partial result were obtained. The outcomes of the 2 cases of chicken pox were favourable. There were three relapses after the end of therapy (2 herpes simplex, 1 zoster) but their outcomes were favourable after a second course of Acyclovir. In 20 cases it was possible to maintain the immuno-suppressive therapy. General tolerance was satisfactory.

Topics: Acyclovir; Adolescent; Adult; Aged; Chickenpox; Child; Clinical Trials as Topic; Female; Herpes Simplex; Herpes Zoster; Humans; Immune Tolerance; Male; Middle Aged; Prognosis

31 adults took part in a randomised, placebo-controlled, double-blind trial of intravenous acyclovir therapy (500 mg/m2 intravenously 3 times daily for 5 days) for acute herpes zoster. Acyclovir reduced pain, decreased erythema, prevented the formation of new lesions, and healed skin faster than did placebo. The duration of viral shedding was also significantly shorter in acyclovir recipients (2 days versus 5 days). However, 6(35%) of 17 acyclovir recipients had recurrence of pain after the drug was discontinued, and acyclovir did not appear to affect post-herpetic neuralgia. Acyclovir therapy was associated with a transient rise in serum creatinine levels, and may have been related to nausea and vomiting. Intravenous acyclovir was effective therapy for acute herpes zoster but the ideal treatment regimen might be a lower daily dose given for a longer period.

Topics: Acute Disease; Acyclovir; Adult; Aged; Antiviral Agents; Clinical Trials as Topic; Double-Blind Method; Female; Guanine; Herpes Zoster; Humans; Injections, Intravenous; Male; Middle Aged; Pain; Random Allocation

We evaluated Acyclovir therapy in 16 immunodeficient children with varicella (7 cases) and zoster (9 cases) in a controlled open study. infections were serious in 12 patients. Each patient had daily clinical, biological and virological tests. Sixty minutes intra-venous infusions of Acyclovir were given three times a day (5 to 10 mg/kg/8 hours) for 6 ou 11 days. All patients who received therapy before the first four days, ahd a more rapid cessation of new vesicles formation and more rapid scaring, than those with delayed treatment. Ten controlled children had accelerated clearance of viral antigens from vesicles. In 15 cases, virus was not isolated after the third day. Two children with varicellous interstitial pneumonia died, 8 and 25 days after the end of treatment. Fourteen patients recovered in 8 to 10 days. No relapses of varicella-zoster virus infections had been observed 1 to 14 months after therapy. The drug was well-tolerated, but supervising of renal functions is necessary. Acyclovir had a good therapeutic efficacy to treat chickenpox and shingles in the immunocompromised patients.

Topics: Acyclovir; Adolescent; Adult; Antiviral Agents; Chickenpox; Child; Child, Preschool; Clinical Trials as Topic; Female; Herpes Zoster; Humans; Male; Neoplasms

Acyclovir has veen shown to have potent antiviral activity against both herpes simplex and herpes zoster viruses, especially the former, with low cellular toxicity, preferentially affecting virally infective cells by inhibiting viral DNA synthesis [1,2]. In experimental herpes simplex corneal infection, acyclovir has been found to be effective [3,4] and in early clinical trials it has been found to be at least as good as idoxuridine [5-7]. Acyclovir has also been found to have antiviral activity against the herpes zoster virus in tissue culture [1] and to affect favorably the course of the disease in immunosuppressed patients [8]. This paper describes the use of acyclovir in patients with either herpes simplex or herpes zoster ocular infections. Topical acyclovir has been compared with adenine arabinoside in the treatment of herpes simplex corneal ulceration in a coded clinical trial. The use of acyclovir will also be described in patients with complicated herpes simplex eye disease. Our initial results with topical acyclovir in herpes zoster keratouveitis are also described.

Topics: Acyclovir; Antiviral Agents; Drug Evaluation; Drug Therapy, Combination; Female; Guanine; Herpes Zoster; Humans; Keratitis, Dendritic; Male; Steroids; Uveitis

Topics: Acute Disease; Acyclovir; Adult; Age Factors; Aged; Antiviral Agents; Double-Blind Method; Drug Evaluation; Female; Guanine; Herpes Zoster; Humans; Male; Middle Aged; Pain

Topics: Acute Disease; Acyclovir; Aged; Clinical Trials as Topic; Double-Blind Method; Female; Guanine; Herpes Zoster; Humans; Injections, Intravenous; Male; Pain; Random Allocation

Topics: Acyclovir; Antiviral Agents; Dermatitis; Herpes Zoster; Herpesvirus 3, Human; Humans; Valacyclovir

The varicella zoster virus (VZV) is a ubiquitous, neurotropic pathogen capable of reactivation from sensory ganglion cells to cause dermatomal herpes zoster infection, alongside a range of pathologies within the central nervous system. The presence of VZV cerebellitis without skin manifestations, however, is exceedingly rare in immunocompetent adults.We report a case of VZV cerebellitis in an immunocompetent woman in her 70s, in the absence of a rash. The patient presented with a 2-week history of progressive gait ataxia, headache and mild confusion. Serological tests and neuroimaging were unremarkable. Diagnosis was confirmed through cerebrospinal fluid (CSF) analysis which revealed lymphocytosis and the presence of VZV DNA on PCR analysis. The patient showed symptomatic improvement following empirical acyclovir treatment, corroborated by favourable CSF analysis 10 days post-treatment initiation.Infective aetiology, including VZV, should be considered in patients presenting with acute cerebellar ataxia, even in immunocompetent adults with an absence of dermatological signs.

Topics: Acyclovir; Adult; Central Nervous System; Cerebellar Ataxia; Female; Herpes Zoster; Herpesvirus 3, Human; Humans

Meningoencephalomyelitis and visceral dissemination infection are rare but life-threatening complications of either the primary infection or reactivation of varicella-zoster virus (VZV) in immunocompromised patients. To date, few studies have reported the co-existence of VZV meningoencephalomyelitis and the visceral dissemination of VZV infection.. A 23-year-old male was diagnosed with lupus nephritis class III and was being treated with oral prednisone and tacrolimus. The patient exhibited herpes zoster 21-day after the initiation of therapy and experienced unbearable abdominal pain and generalized seizures 11 days after the onset of a zoster rash. Magnetic resonance imaging showed progressive lesions in the cerebrum, brainstem, and cerebellum, as well as meningeal thickening and thoracic myelitis. Computed tomography showed pulmonary interstitial infiltration, partial intestinal dilatation, and effusion. Metagenomic next-generation sequencing revealed 198,269 and 152,222 VZV-specific reads in the cerebrospinal fluid and bronchoalveolar lavage fluid, respectively.. Based on the clinical and genetic findings, this patient was finally diagnosed with VZV meningoencephalomyelitis and visceral disseminated VZV infection.. The patient received intravenous acyclovir (0.5 g every 8 hours) combined with plasma exchange and intravenous immunoglobulin. Treatment against secondary bacterial and fungal infections, organ support therapy and rehabilitation training were given simultaneously.. The patient's peripheral muscle strength did not improve and repeated metagenomic next-generation sequencing showed the persistence of VZV-specific reads in the cerebrospinal fluid. The patient finally abandoned therapy due to financial constraints at the 1-month follow-up.. Patients with autoimmune diseases receiving immunosuppressive therapy should be warned about the possibility of developing serious neurological infections and visceral disseminated VZV infections as side effects. Early diagnosis and the early initiation of intravenous acyclovir therapy are important for such cases.

Topics: Acyclovir; Adult; Chickenpox; Encephalomyelitis; Herpes Zoster; Herpesvirus 3, Human; Humans; Lupus Nephritis; Male; Varicella Zoster Virus Infection; Young Adult

Topics: Acyclovir; Antiviral Agents; Herpes Zoster; Herpes Zoster Ophthalmicus; Humans; Male; Meningitis

Topics: Acyclovir; Antiviral Agents; Chickenpox; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Pregnancy

Visceral disseminated varicella zoster virus (VZV) infection is a rare but life-threatening complication in immunosuppressed patients. Herein, we report a survival case of visceral disseminated VZV infection in a patient with systemic lupus erythematosus (SLE).. A 37-year-old woman was diagnosed as SLE and initial induction therapy was started. Two months after starting the immunosuppressive therapy consisting of 40 mg of prednisolone (PSL) and 1500 mg of mycophenolate mofetil (MMF) daily, she suddenly developed strong abdominal pain, which was required opioid analgesics, followed by systemic skin blisters, which were diagnosed as varicella. Laboratory findings showed rapid exacerbation of severe liver failure, coagulation abnormalities and increased numbers of blood VZV deoxyribonucleic acid (DNA). Therefore, she was diagnosed as visceral disseminated VZV infection. Multidisciplinary treatment with acyclovir, immunoglobulin and antibiotics was started, the dose of PSL was reduced, and MMF was withdrawn. By their treatment, her symptoms were resolved and she finally discharged.. Our case highlights the importance of a clinical suspicion of visceral disseminated VZV infections, and the necessity of immediate administration of acyclovir and reduced doses of immunosuppressant to save patients with SLE.

Topics: Acyclovir; Adult; Chickenpox; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Lupus Erythematosus, Systemic; Mycophenolic Acid; Prednisolone; Varicella Zoster Virus Infection

Varicella vaccine, a live-attenuated Oka-strain of varicella zoster virus (VZV), is a recommended childhood vaccine by many countries. As with wild varicella strain, after primary infection, the live-attenuated virus can establish latency in sensory ganglia and reactivate causing vaccine-strain illnesses: herpes zoster (HZ), visceral or peripheral and central nervous system dissemination. We report a case of early reactivation of live-attenuated virus-HZ and meningoencephalitis-in an immunocompromised child.. This is a retrospective descriptive report of a case, in a tertiary pediatric hospital, CHU Sainte-Justine (Montréal, Canada).. An 18 month-year old girl diagnosed with a primitive neuro-ectodermal tumor (PNET) received the day prior to diagnosis, a first varicella vaccine (MMRV). She received chemotherapy 20 days post MMRV vaccine and autologous bone marrow transplantation 3 months post vaccination. She was considered not eligible, to acyclovir prophylaxis prior transplantation (positive for VZV IgG and negative for herpes simplex virus IgG by ELISA). At day 1 post transplantation, she developed dermatomal HZ and meningoencephalitis. Oka-strain varicella was isolated, she was treated with acyclovir and foscarnet. Neurologic status improved in 5 days. Control of VZV viral load in cerebrospinal fluid showed a slow decrease to from 5.24 log 10 copies/mL to 2.14 log 10 copies/mL in 6 weeks. No relapse was observed. She recovered without neurological sequelae.. Our experience highlights the importance of conducting a thorough medical history regarding vaccination and serological status of newly immunocompromised patients. Intensive chemotherapy succeeding live vaccine administration <4 weeks could have influenced early and severe viral reactivation. Early initiation of prophylactic antiviral treatment is questioned in such circumstances.

Topics: Acyclovir; Bone Marrow Transplantation; Chickenpox; Chickenpox Vaccine; Child; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Infant; Meningoencephalitis; Retrospective Studies; Vaccines, Attenuated

This study aimed to explore the safety and clinical efficacy of light emitting diode (LED) golden light combined with acyclovir in treating herpes zoster (HZ). According to the random number table, 54 inpatients with HZ were divided into control group, golden-light group, and red-light group, with 18 cases in each group. The control group received acyclovir intravenous drip, while the patients in the red-light group received acyclovir intravenous drip and red-light LED phototherapy, and the golden-light group received acyclovir intravenous drip and golden-light LED phototherapy. Primary assessments included herpes stopping time, incrustation time, decrustation time, pain visual analog scale scores (VAS), and incidence of postherpetic neuralgia (PHN) on the 30th and 90th days. Golden-light group and red-light group showed a shorter herpes stopping time, incrustation time, and decrustation time (P < 0.05) compared to the control group (P < 0.05), while the golden-light group showed a shorter incrustation time and decrustation time than the red light group (all P < 0.05). After treatment VAS scores, the golden-light group showed a significant improvement compared to the control group. The golden-light group showed a better PHN incidence than the control group at 30 days follow-up. Compared with the comprehensive curative effect, the total effective rates of the golden-light group, red-light group, and control group were 88.89%, 77.78%, and 72.22%, respectively, and the efficacy of the golden-light group was better than that of the control group and red-light group. Golden light combined with acyclovir can shorten the course of HZ, relieve pain, and reduce the occurrence of PHN, and the effect is better than that of the red-light group and the control group.

Topics: Acyclovir; Herpes Zoster; Humans; Neuralgia, Postherpetic; Prospective Studies; Treatment Outcome

We herein report a 90-year-old immunocompromised woman who developed right upper limb weakness and right ptosis with a miotic pupil 1 week after oral therapy for zoster on the right T2 dermatome. The right pupil was dilated with instillation of 1% apraclonidine, indicating Horner's syndrome. The patient was treated with intravenous acyclovir and methylprednisolone. Focal weakness related to zoster, generally known as segmental zoster paresis, improved over five months, but Horner's syndrome remained. We suggest that aggressive intravenous treatment should be considered for rare cases of zoster that occur with a combination of these two neurological conditions.

Topics: Acyclovir; Aged, 80 and over; Blepharoptosis; Female; Herpes Zoster; Horner Syndrome; Humans; Paresis

Herpes zoster (HZ) causes significant morbidity, particularly in older adults. With the advent of a recombinant zoster vaccine, HZ is potentially preventable. However, data on HZ burden and healthcare utilization in primary care populations remains scarce. This study described the prevalence and healthcare utilization in managing HZ in a developed community. A retrospective database review was conducted across a cluster of 8 public primary care clinics in urban Singapore. Data of multi-ethnic Asian patients with a diagnosis code of "herpes zoster" from 2018 to 2020 was extracted from their electronic medical records. Socio-demographic, clinical, visitation, medical leave, prescription, and referral data were analyzed. A total of 2,987 out of 737,868 individuals were diagnosed with HZ over 3 years. The mean age was 59.9 (SD + 15.5) years; 49.2% were male; 78.5% Chinese, 12.2% Malay, and 4.1% Indian. The prevalence was 221, 224, 203 per 100,000 persons in 2018, 2019, and 2020, respectively. The 70 to 79-year age group had the highest prevalence (829/100,000) across 3 years. Oral acyclovir (median daily dose 4,000 mg; median duration 7 days) and topical acyclovir were prescribed in 71.6 and 47.6%, respectively. Analgesia prescribed were gabapentin (41.0%), paracetamol combinations (30.1%), oral NSAIDs (23.7%), opioids (6.0%), and tricyclic antidepressants (1.9%). Most individuals consulted only once (84.3%); 32.7% of them required medical leave and 5.6% had more than 7 days of absenteeism. HZ-related referrals to the hospital were required in 8.9% (4.9% emergency, 2.8% ophthalmology). The findings of this study suggest a need for HZ vaccination among older age groups. Visitation and referral rates were low. The use of topical acyclovir was uncovered, and further research should evaluate the underlying reasons, benefits, and harms of such practice. The use of analgesia combinations may be explored further.

Topics: Acyclovir; Aged; Child, Preschool; Female; Herpes Zoster; Herpes Zoster Vaccine; Herpesvirus 3, Human; Humans; Male; Middle Aged; Patient Acceptance of Health Care; Prevalence; Primary Health Care; Retrospective Studies; Urban Population

Topics: Acyclovir; Aged, 80 and over; Antiviral Agents; Brain Diseases; Herpes Zoster; Humans; Male

We herein report the case of a 78-year-old woman who was diagnosed as having disseminated herpes zoster (DHZ) complicated with probable varicella-zoster pneumonia during maintenance therapy for microscopic polyangiitis. Because the patient had severe renal dysfunction, amenamevir administration was started to avoid any neurotoxicity of acyclovir, which is suggested to be optimal for treatment. It ameliorated her symptoms without any adverse events. This is the first report suggesting the efficacy of amenamevir in the treatment of severe herpes zoster infection with coexisting DHZ and probable varicella-zoster pneumonia. Amenamevir could thus be a treatment option for severe varicella zoster virus infections.

Topics: Acyclovir; Aged; Antiviral Agents; Chickenpox; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunocompromised Host; Oxadiazoles; Pneumonia; Varicella Zoster Virus Infection

Topics: Acyclovir; DNA; DNA, Viral; Herpes Zoster; Herpesvirus 3, Human; Humans; Infant

A 72-year-old woman presented with acute-progressive muscle weakness after a rash in the left upper limb. Muscle weakness was restricted to the left C5 innervated muscles. Short inversion time inversion recovery magnetic resonance imaging (MRI) showed a high-intensity signal in the left C5 nerve root, and nerve ultrasound showed its enlargement. She was diagnosed with segmental zoster paralysis (SZP) and treated with acyclovir and methylprednisolone. Her muscle strength gradually recovered, and the abnormal signal and enlargement in the left C5 nerve root improved. This is the first SZP case of confirmed improvement of abnormal findings on MRI and nerve ultrasound in association with muscle power recovery.

Topics: Acyclovir; Aged; Female; Herpes Zoster; Humans; Magnetic Resonance Imaging; Muscle Weakness; Paralysis; Paresis

Topics: Acyclovir; Adolescent; Coinfection; COVID-19; COVID-19 Vaccines; Herpes Zoster; Humans; Male; Meningitis, Viral; SARS-CoV-2

A man in his 70s with rheumatoid arthritis presented with seizures and coma and was transferred to our emergency department. Two months prior to admission, he started to take tofacitinib 10 mg/day. On admission, we noted a rash with a blister on the forehead, and herpes zoster was diagnosed. Cerebrospinal fluid examination suggested meningitis. An MRI of the brain showed no abnormality. Based on these findings, he was suspected with herpes zoster meningitis. We discontinued tofacitinib and treated the patient with intravenous acyclovir for 2 weeks. He regained complete consciousness, but right forehead skin lesion, severe vision loss in the right eye and right facial nerve paralysis remained as sequelae. Six weeks after admission, we restarted tofacitinib with oral valaciclovir as antiviral prophylaxis. Two years after admission, we administered Shingrix, an adjuvant recombinant vaccine for herpes zoster, and discontinued oral valaciclovir.

Topics: Acyclovir; Antiviral Agents; Arthritis, Rheumatoid; Herpes Zoster; Humans; Male; Piperidines; Pyrimidines

We present a case of a 55-year-old man with a rash on his right foot that was biopsied and diagnosed as a Varicella Zoster virus infection with an accompanying positive immunohistochemical study with antiviral antibodies. He concomitantly suffered from a Varicella Zoster virus meningitis. The skin biopsies not only showed clear histologic signs of viral cytopathic effects but also showed intercellular IgG and C3 intraepidermal staining by direct immunofluorescence study, findings which are typically consistent with pemphigus vulgaris. However, the patient did not have any history of pemphigus; there was no mucosal involvement, and serum antibodies to desmoglein 1 and 3 were negative. After discharge, the patient continued to have right-sided foot pain, and he continued the acyclovir treatment.

Topics: Acyclovir; Antiviral Agents; Chickenpox; Herpes Zoster; Herpesvirus 3, Human; Humans; Male; Middle Aged; Pemphigus; Varicella Zoster Virus Infection

Although varicella zoster virus (VZV) disease is a common complication after allogeneic hematopoietic cell transplantation (HCT), research into the long-term incidence of VZV disease in adults receiving cord blood transplantation (CBT) has been limited. The objective of this study was to evaluate the incidence, risk factors, and clinical impact of VZV disease after CBT with long-term follow-up in our institution. We retrospectively analyzed the data for 156 adult patients who received single-unit CBT at our institution between 2007 and 2020 and who achieved neutrophil engraftment and survived at least 100 days without recurrence of the underlying disease. VZV disease occurred in 61 patients at a median of 608 days (range, 36 to 4090 days) after CBT. The cumulative incidence of VZV disease was 14% (95% confidence interval [CI], 9% to 20%) at 1 year post-CBT and 40% (95% CI, 31% to 48%) at 5 years post-CBT. Multivariate analysis identified the cessation of antiviral prophylaxis as an independent risk factor for an elevated risk of VZV disease (hazard ratio, 15.65; 95% CI, 6.59 to 37.21; P < .001). The cumulative incidence of VZV disease was significantly lower in the long-term antiviral prophylaxis group (who received prophylaxis for approximately 1 year after CBT or to the end of immunosuppressive therapy) compared with the short-term antiviral prophylaxis group (who received prophylaxis for 35 days after CBT) (P = .005). Among the patients who developed VZV disease, the median time to onset of VZV disease was significantly delayed in the long-term antiviral prophylaxis group compared with the short-term antiviral prophylaxis group (694 days versus 130 days; P < .001), but the median onset of VZV disease after the cessation of antiviral prophylaxis was not significantly different between the 2 groups (166 days versus 95 days; P = .087). These data demonstrate that the long-term incidence of VZV disease is relatively high in adult patients undergoing CBT. Given that the incidence of VZV disease remained high after the cessation of antiviral prophylaxis, additional interventions, such as recombinant zoster vaccine administration, could be required to prevent VZV disease in long-term adult survivors after CBT.

Topics: Acyclovir; Adult; Antiviral Agents; Cord Blood Stem Cell Transplantation; Hematopoietic Stem Cell Transplantation; Herpes Zoster; Herpesvirus 3, Human; Humans; Incidence; Retrospective Studies; Transplantation, Homologous; Virus Activation

BACKGROUND Varicella zoster virus (VZV) infection can increase the risk of cerebrovascular disease, involving small and large arteries, especially in immunosuppressed patients with ophthalmic division of the trigeminal nerve involvement. We present the case of a patient with intracerebral VZV vasculopathy without overt clinical manifestation but with abnormal imaging findings in the brain magnetic resonance (MR). CASE REPORT A 59-year-old woman with systemic lupus erythematosus (SLE), without other traditional cardiovascular risk factors, presented to the hospital due to headache, vertical diplopia, decreased of visual acuity of right eye, and disseminated varicella zoster virus (VZV) infection with predominant skin lesions distributed along the ophthalmic division of the right trigeminal nerve. Cerebrospinal fluid (CSF) testing revealed meningitis and positive polymerase chain reaction (PCR) for VZV, and a brain MRI scan showed a right occipital hemorrhagic lesion; thus, she was diagnosed with disseminated VZV infection with neurological involvement. She received intravenous acyclovir for 10 days. One month later, a physical examination was unremarkable and she was asymptomatic, but control brain MR angiography showed stenosis of the right internal carotid and the right middle cerebral artery, compatible with VZV vasculopathy. The PCR for VZV turned negative in CSF but the titers of anti-VZV IgG antibodies in CSF were high, and no increase of plasma autoimmune biomarkers were detected at any time in the course of the clinical evolution. CONCLUSIONS Discordance between imaging findings and clinical manifestations can appear in intracerebral VZV vasculopathy. A differential diagnosis is mandatory, especially if there is underlying immunosuppression.

Topics: Acyclovir; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Lupus Erythematosus, Systemic; Magnetic Resonance Imaging; Middle Aged

Herpes zoster (HZ) is a frequent complication after autologous stem cell transplantation (ASCT). The option of zoster prophylaxis with an antiviral drug is described in the literature, but there is no consensus on the drug and the dosage.. We analyzed the records of 310 patients treated with ASCT who were controlled regularly regarding HZ inter alia for at least 24 months following ASCT. Since 01/2015 patients received prophylactic low-dose acyclovir (400 mg per day) during the first 12 months following discharge after ASCT (n = 107).. Twenty percent of patients without this kind of prophylaxis and 2.8% of patients with prophylaxis developed HZ (p < .001). No patient with this prophylaxis developed HZ in the first year after ASCT, 2.8% of patients in the second year after ASCT. A prognostic factor was the kind of diagnosis: 30% of lymphoma patients and 14% of myeloma patients developed HZ in the first 24 months after ASCT without prophylaxis, but only 6.3% and 0% of patients with prophylaxis, respectively. Neither an increase of HZ cases following prophylaxis nor acyclovir refractory HZ cases were observed.. Zoster prophylaxis with low-dose acyclovir over 12 months after ASCT is effective and well tolerated.

Topics: Acyclovir; Hematopoietic Stem Cell Transplantation; Herpes Zoster; Herpesvirus 3, Human; Humans; Lymphoma; Multiple Myeloma; Retrospective Studies; Stem Cell Transplantation; Transplantation, Autologous

Topics: Acyclovir; Herpes Zoster; Herpes Zoster Ophthalmicus; Humans

The objective of this study was to assess the status and trends of antiviral treatment in outpatients with herpes zoster in China.. Prescription data on antiviral drugs were extracted from the database of the Hospital Prescription Analysis Program of China according to the inclusion criteria. Yearly prescriptions and costs were calculated, and trends were analyzed. The trends were further stratified by age, sex, and specific drug use. The distribution of defined daily costs (DDCs) of valaciclovir and famciclovir were analyzed, and trends in the median DDCs were identified.. A total of 132,911 prescriptions from 49 hospitals located in six major areas of China were included in the analysis. The yearly prescriptions containing antivirals increased from 8,819 in 2010 to 16,361 in 2019. The percentage of prescriptions for patients aged 65 years and above also increased (27.7% in 2010 to 31.0% in 2019), and the number of prescriptions for females was higher than those for males (. The use of antivirals has increased over the decade, while the cost has not. Antiviral treatments adhere well to recent recommendations, except for the use of topical antivirals. The findings of this study may benefit the healthcare source allocation and management of herpes zoster in China.

Topics: Acyclovir; Antiviral Agents; China; Famciclovir; Female; Herpes Zoster; Humans; Male; Outpatients; Valacyclovir

Varicella-zoster virus (VZV) reactivation is a serious complication of hematopoietic stem cell transplantation (HSCT). Although low-dose acyclovir can prevent VZV reactivation after HSCT in adults, the efficacy of a dose of acyclovir lower than the recommended dose, such as 60-80 mg/kg/day in children, is unclear. In this study, we aimed to evaluate the incidence of VZV reactivation after HSCT during and after low-dose acyclovir administration for preventing VZV reactivation in children.. This single-center retrospective study included children aged ≤15 years who received oral acyclovir (at 15 mg/kg/day) to prevent VZV reactivation after HSCT. We examined the cumulative incidence of VZV reactivation after HSCT, during and after prophylactic acyclovir administration.. Fifty-three eligible patients were included in this study, of whom 37 underwent allogeneic HSCT. The median duration of prophylactic acyclovir therapy was 264 days (range: 69-1140 days). VZV reactivation occurred in 13 patients (24.5%, 95% confidence interval [CI]: 14.9-37.6). The cumulative incidence of VZV reactivation 1 and 2 years after HSCT was 6.26% (95% CI: 1.60-15.5) and 20.9% (95% CI: 10.3-34.0), respectively. While only one patient developed VZV reactivation during the administration of prophylactic acyclovir, the cumulative incidence of VZV reactivation increased to 24.2% (95% CI: 12.5-38.0) 1 year after the cessation of acyclovir.. Low-dose acyclovir (15 mg/kg/day) could be effective for preventing VZV reactivation after HSCT in children because VZV reactivation seldom occurs during the administration of 15 mg/kg/day acyclovir.

Topics: Acyclovir; Adult; Antiviral Agents; Child; Hematopoietic Stem Cell Transplantation; Herpes Zoster; Herpesvirus 3, Human; Humans; Retrospective Studies; Transplantation, Homologous; Virus Activation

Meningitis retention syndrome (MRS) is a rare condition that presents with acute urinary retention as a complication of aseptic meningitis. Cases of MRS due to varicella zoster virus (VZV) infection without a rash are rare. We report the case of a patient who had no signs of meningitis or VZV infection, including a rash.. A 58-year-old man presented with dysesthesia of the lower limbs and acute urinary retention. He had fever but no rash and no signs of meningitis. He was diagnosed to have VZV infection based on the detection of VZV DNA in the cerebrospinal fluid. He responded satisfactorily to a course of intravenous acyclovir and experienced no sequelae during a 2-year follow-up period.. MRS due to aseptic meningitis of viral origin should be considered in the differential diagnosis of acute urinary retention even in the absence of specific signs and symptoms of meningitis or a suggestive rash.

Topics: Acyclovir; Antiviral Agents; Exanthema; Herpes Zoster; Herpesvirus 3, Human; Humans; Male; Meningitis, Aseptic; Middle Aged

Herpes zoster reactivation is a frequently encountered condition that can result in several uncommon complications. This case report highlights one such frequently overlooked complication, segmental zoster paresis. We discuss a case of prolonged fever and lower limb weakness in an immunocompromised patient with breast cancer on active chemotherapy after resolution of a herpetiform rash in the L2, L3 and L4 dermatomes. Early investigation with lumbar puncture, looking for cerebrospinal fluid pleocytosis, varicella zoster virus detection by PCR or molecular testing and immunoglobulins against varicella zoster virus, should be undertaken to support the diagnosis. Nerve conduction studies, electromyography and MRI of the spine can sometimes help with neurolocalisation. Intravenous acyclovir and a tapering course of steroids can help with resolution of symptoms. The variegate presentation can make diagnosis challenging. Awareness and a high index of suspicion can prevent delays in diagnosis and treatment and improve patient outcomes.

Topics: Acyclovir; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunocompromised Host; Paresis

Acyclovir is an antiviral drug frequently used in clinical practice. It is indicated for the treatment of infections caused by herpes simplex virus and varicella zoster virus. The drug has a good safety profile; however, severe side effects may rarely occur during therapy. These include renal failure as a major risk factor for neurotoxic side effects potentially developing within 24-48 hours of therapy initiation. The paper presents the cases of two patients developing neurotoxic side effects while treated for herpes zoster. The aim of the authors is to highlight the potential for developing neurotoxic side effects in high-risk groups such as the elderly, patients with impaired renal function or multiple comorbidities on polypharmacy, or those using nephrotoxic drugs. Acyclovir use could lead to renal impairment and an increase in its plasma and CNS concentrations with severe neuropsychiatric side effects. The neurotoxic side effects are reversible after therapy withdrawal. Thus, in patients developing mental impairment or showing other neurological symptoms during acyclovir therapy, the patient should be promptly assessed for potential drug neurotoxicity, their therapy should be discontinued and drug elimination with forced diuresis or hemodialysis considered. Early recognition of acyclovir neurotoxic side effects can significantly improve a patient's prognosis.

Topics: Acyclovir; Aged; Antiviral Agents; Herpes Zoster; Herpesvirus 3, Human; Humans; Mental Disorders

Herpes zoster is an infection caused by reactivation of varicella-zoster virus presenting as multiple grouped vesicular eruptions in a dermatomal pattern with associated pain. Recurrent herpes zoster is an uncommon event in an immunocompetent host. Here, we report a case of a young male presenting with herpes zoster over the T9 and T10 dermatome with the previous scarring of herpes zoster over the T6 dermatome over the right upper trunk. The patient improved on treatment with oral acyclovir and analgesics. In any patient with recurrenrt hepes zoster, work-up should be done to rule out immunosuppresion.

Topics: Acyclovir; Exanthema; Herpes Zoster; Herpesvirus 3, Human; Humans; Male; Pain

Knowledge of the epidemiology and clinical characteristics of varicella zoster virus (VZV) encephalitis remains limited.. Nationwide prospective cohort study of adults treated for microbiologically confirmed VZV encephalitis at Danish departments of infectious diseases from 2015 to 2019. Modified Poisson regression analysis was used to compute adjusted relative risks (RRs) of unfavorable outcome.. We identified 92 adults (49% female) with VZV encephalitis, yielding an incidence of 5.3/1 000 000 per year (95% CI, 4.2-6.6). Median age was 75 years (IQR, 67-83) and immunocompromising conditions were frequent (39%). Predominant symptoms were confusion (76%), headache (56%), nausea (45%), gait disturbance (42%), and personality changes (41%). Cranial imaging showed cerebral vasculitis (including infarction and hemorrhage) in 14 (16%) patients and encephalitic abnormalities in 11 (13%) with predilection for the brainstem and deep brain structures. Intravenous acyclovir treatment was initiated a median (IQR) of 13.4 hours (5.2-46.3) since admission, while cranial imaging and lumbar puncture were performed after 6.3 hours (2.5-31.0) and 18.5 hours (4.9-42.0). In-hospital, 1-month, and 3-month mortalities were 4%, 9%, and 11%, respectively. Unfavorable outcome (Glasgow Outcome Score of 1-4) was found in 69% at discharge, with age (adjusted RR [aRR], 1.02; 95% CI, 1.01-1.03), vasculitis (aRR, 1.38; 95% CI, 1.02-1.86), and Glasgow Coma Scale (GCS) <15 (aRR, 1.32; 95% CI, 1.01-1.73) identified as independent risk factors.. VZV encephalitis occurs primarily in elderly or immunocompromised patients with a higher incidence than previously estimated. The diagnosis is often delayed; risk factors for unfavorable outcome are age, cerebral vasculitis, and GCS <15.

Topics: Acyclovir; Adult; Aged; Denmark; Encephalitis, Varicella Zoster; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Male; Prospective Studies

Cranial polyneuropathy (CP) is a rare complication of herpes zoster (HZ) infection. This entity often produces situations of a diagnostic dilemma, as can be seen in a wide spectrum of clinical presentations. The aim of this study was to report the clinical characteristics, treatment, and outcomes of 11 patients from a single-institution experience.. A retrospective analysis of patients treated for HZ CP over a 12-year period was performed.. The present study included 11 patients with CP caused by HZ infection-7 (63.63%) females, and 4 (36.36%) males. The mean age at presentation was 63 years (range, 38-85 years). Cranial nerve VII was affected in nine (81.82%) cases, CN VIII in six (54.55%) cases, CN V in five (45.45%) cases, CN III and IX in two (18.18%) cases, and CN VI and X in one (9.09%) case. The treatment of choice was acyclovir in all patients, while corticosteroids were administered in six (54.55%) patients. Complete CN recovery was observed in seven (63.63%) patients, while four (36.36%) patients suffered from permanent CN damage-two (18.18%) CN VII, one (9.09%) CN VII and VIII, and one (9.09%) CN VI.. Herpes zoster CP presents an interesting diagnostic and therapeutic challenge. Successful management of these patients depends on a thorough knowledge of the anatomy and topodiagnostic of CNs. Early administration of antiviral agents is crucial in terms of responsiveness to treatment and expedite recovery.

Topics: Acyclovir; Antiviral Agents; Female; Herpes Zoster; Herpes Zoster Oticus; Humans; Male; Polyneuropathies; Retrospective Studies

Topics: Acyclovir; Herpes Zoster; Herpesvirus 3, Human; Humans; Optic Nerve; Optic Nerve Diseases

Varicella zoster virus (VZV) reactivates more frequently in immunocompromised patients than immunocompetent subjects and is a significant cause of morbidity and mortality. Acyclovir is frequently used for treatment against VZV reactivation. However, long-term use of acyclovir can result in the emergence of VZV strain resistant to acyclovir. Here, we report a 67-year-old man with adult T-cell leukemia who suffered from herpes zoster with acyclovir-resistant VZV after long-term prophylaxis. The isolated viruses from his skin lesions were a mixture of acyclovir-resistant and acyclovir-susceptible strains. Sequence analysis showed the presence of thymidine kinase (TK) mutations in the resistant clones. Interestingly, oral administration of famciclovir, a prodrug form of penciclovir, resulted in resolution of his herpes zoster, although most acyclovir-resistant strains of VZV were reported to be resistant to penciclovir. This implied that a certain amount of susceptible VZV with wild-type viral TK gene was present in vivo, and that famciclovir could be phosphorylated intracellularly by the intact viral kinases. As famciclovir is more potent and longer-acting than acyclovir, the susceptible strains might have suppressed the generation and proliferation of the resistant in vivo. Even when VZV is developing resistance to acyclovir, famciclovir might be effective at least in the early resistant phase.

Topics: Acyclovir; Aged; Antiviral Agents; Famciclovir; Herpes Zoster; Herpesvirus 3, Human; Humans; Male

A 78-year-old woman was diagnosed with herpes zoster in the first branch of the trigeminal nerve and was treated with amenamevir. Subsequently, she was hospitalized for postherpetic neuralgia. Fever and unconsciousness were observed, and a diagnosis of varicella-zoster virus meningoencephalitis and vasculitis was made. In addition to the antithrombotic therapy, she was treated with intravenous acyclovir and steroid pulse therapy; however, her unconsciousness persisted. Amenamevir was not transferrable to the spinal fluid and resulted in an incomplete treatment of herpes zoster in the cerebral nerve region, suggesting that this case may be related to the severe course of the disease.

Topics: Acyclovir; Aged; Antiviral Agents; Female; Herpes Zoster; Humans; Infusions, Intravenous; Magnetic Resonance Imaging; Meningoencephalitis; Methylprednisolone; Oxadiazoles; Pulse Therapy, Drug; Severity of Illness Index; Trigeminal Nerve; Vasculitis

Varicella zoster reactivation ("shingles" or "herpes zoster") usually presents as a self-limiting, unilateral, dermatomal vesicular rash in older adults. We present the case of a 73 year-old woman with unilateral brachial plexopathy, an unusual but debilitating complication of shingles. Despite treatment with intravenous acyclovir and immunoglobulin she had a marked residual motor paresis that required an upper limb rehabilitation program after discharge.

Topics: Acyclovir; Aged; Brachial Plexus Neuropathies; Female; Herpes Zoster; Herpesvirus 3, Human; Humans

We conducted an observational retrospective study of all adults hospitalized for documented varicella-zoster virus (VZV) meningitis or encephalitis during years 2000-2015 in one referral centre. Thirty-six patients (21 males, 15 females) were included, with meningitis (n = 21), or meningoencephalitis (n = 15). Median age was 51 years [interquartile range, 35-76], and 6 patients (17%) were immunocompromised. Aciclovir was started in 32 patients (89%), with a median dose of 11 mg/kg/8 h [10-15]. No patient died, but 12 (33%) had neurological sequelae at discharge. Age was the only variable associated with adverse outcome (OR 1.98 [1.17-3.35] per 10-year increment, P = 0.011).

Topics: Acyclovir; Adult; Aged; Antiviral Agents; Central Nervous System Infections; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunocompromised Host; Male; Middle Aged; Retrospective Studies

A 70-year-old man with a history of invasive anal squamous cell carcinoma treated with excision and chemoradiation presented to the emergency department with right-sided neck pain and submandibular lymphadenopathy. CT imaging of the head and neck was unrevealing. The patient eventually developed cranial nerves X and XI dysfunction, manifesting as severe vocal cord paralysis (dysphonia), dysphagia, asymmetric palate elevation/deviation and trapezius muscle atrophy, in addition to scalene muscle atrophy. After an extensive workup, the patient's symptoms were determined to be due to sequelae of varicella zoster infection, which was confirmed with antibody titers. The patient's dysphagia and dysphonia eventually improved with vocal cord medialisation injection and Botox injection. However, despite delayed treatment with acyclovir and valacyclovir, the patient continued to have neuropathic pain and exhibit signs of CN X and CN XI paresis, in addition to scalene muscle atrophy.

Topics: Accessory Nerve; Acyclovir; Aged; Herpes Zoster; Humans; Male; Vagus Nerve; Valacyclovir

Intractable or persistent hiccups and nausea (IHN) are rarely associated with herpes zoster (HZ-IHN). We aimed to identify the clinical characteristics of HZ-IHN by comparing them with those of neuromyelitis optica spectrum disorder associated with IHN (NMOSD-IHN).. We collected 8 patients with HZ-IHN and 12 patients with NMOSD-IHN diagnosed between 2002 and 2020 from medical databases. Medical records including clinical information, laboratory data on serum anti-aquaporin 4 (AQP4) antibodies, serological or cerebrospinal fluid findings for the varicella zoster virus, medullary MRI findings, and efficacy of intravenous methylprednisolone pulse (IVMP) therapy were analyzed retrospectively.. The age of onset (69 ± 13 years versus 46 ± 17 years, P = 0.003), percentage of men [7/8 patients (88%) versus 3/12 patients (25%), P = 0.020], serum CRP levels (1.41 ± 1.17 mg/dL versus 0.14 ± 0.33 mg/dL, P = 0.018), and frequency of hemi-cranial nerve involvement [6/8 patients (75%) versus 1/12 patients (8%), P = 0.004] were significantly higher in patients with HZ-IHN than in those with NMOSD-IHN. The hypoglossal and vagus nerves were involved in 5/8 patients (63%) with HZ-IHN. Other clinical parameters, excluding anti-AQP4 antibodies, were similar to those of NMOSD-IHN. MRI revealed ipsilateral hemi-dorsal medullar hyper-intense lesions in 5/8 patients (63%) with HZ-IHN. Acyclovir with IVMP therapy was effective for HZ-IHN.. Clinicians should include HZ-IHN in the differential diagnosis for IHN, and promptly administer acyclovir and IVMP therapy. HZ-IHN is frequently accompanied by lower hemi-cranial nerve palsies and ipsilateral hemi-dorsal medullary hyper-intensity on MRI.. The authors confirm that the data supporting the findings of this study are available within the article (Tables 1 and 2), or its supplementary materials (Table S1).

Topics: Acyclovir; Adult; Aged; Aged, 80 and over; Antiemetics; Antiviral Agents; Cranial Nerve Diseases; Diagnosis, Differential; Female; Herpes Zoster; Hiccup; Humans; Male; Methylprednisolone; Middle Aged; Nausea; Neuromyelitis Optica; Retrospective Studies

Topics: Acyclovir; Antiviral Agents; Herpes Zoster; Humans; Oxadiazoles

A 52-year-old woman with HIV and recent antiretroviral therapy non-adherence presented with a 5-day history of widespread painful vesicular skin lesions. Direct fluorescent antibody testing of the skin lesions was positive for varicella zoster virus (VZV). On day 3, she developed profound right upper extremity weakness. MRI of the brain and cervical spine was suggestive of VZV myelitis. Lumbar puncture was positive for VZV PCR in the cerebrospinal fluid (CSF) and CSF HIV viral load was detected at 1030 copies/mL, indicating 'secondary' HIV CSF escape. She was treated with intravenous acyclovir for 4 weeks and subsequent oral therapy with famciclovir then valacyclovir for 6 weeks. She also received dexamethasone. The patient had an almost full recovery at 6 months. Myelitis is a rare complication of reactivated VZV infection that can have atypical presentation in immunocompromised patients. Such 'secondary' HIV CSF escape should be considered in immunosuppressed patients with concomitant central nervous system infection.

Topics: Acyclovir; Central Nervous System Infections; Female; Herpes Zoster; Herpesvirus 3, Human; HIV Infections; Humans; Middle Aged; Myelitis

Varicella zoster virus is a Deoxyribonucleic acid (DNA) virus exclusively affecting humans. Reactivation of varicella zoster virus causes herpes zoster with vesicular eruptions in a restricted dermatomal distribution. Peripheral motor neuropathy is a very rare complication of varicella zoster virus.. A 57-year-old previously well Sri Lankan female presented with acute onset painful weakness of the left upper limb with a preceding history of a febrile illness. Subsequently she developed vesicular eruptions in the dermatomal distribution of cervical 5, 6, and 7. Electromyography was suggestive of acute denervation of cervical 5, 6, and 7 myotomes. Diagnosis of zoster-associated brachial plexopathy was made, and the patient was treated with acyclovir, steroids, and analgesics. She made a good recovery.. Brachial plexus neuritis due to varicella zoster infection should be considered in an acute monoparesis of a limb as it is a treatable and reversible condition.

Topics: Acyclovir; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Middle Aged; Paralysis; Stroke

After primary infection, varicella zoster virus (VZV) becomes latent in ganglionic neurons. If immunity declines, VZV is reactivated and can spread to the dermatome depending from this ganglion and in some cases to the spinal cord. Myelopathy is rare and may develop in the absence of skin rash making the diagnosis very difficult.. From 1994 to 2014, we collected five observations of clinically and laboratory confirmed zoster myelopathy. The age of our patients ranged from 14 to 78. They did not have any significant past medical history. Four patients had a history of radicular rash. After 3 weeks (4-45 days), patients presented paraparesis, sensory loss, and sphincter dysfunction. Cerebrospinal fluid (CSF) analysis revealed an elevated protein level (5/5cases) and pleocytosis (2/5 cases). Spinal cord magnetic resonance imaging (MRI) demonstrated T2 hyper intense lesions with swelling and contrast enhancement. The diagnosis was supported by laboratory evidence, including the detection of VZV antibodies in the CSF. All patients received intravenous acyclovir and two patients received IV methylprednisolone. A marked improvement was observed in most of the patients within 2 months.. Based on our patients and on previous reports, we highlight the possibility of the occurrence of VZV myelopathy in immunocompetent subjects. The diagnosis must be evoked even in the absence of typical skin lesions. In this case, spinal cord MRI and virological tests are useful tools for the diagnosis. We also emphasize on the importance of accurate diagnosis to enable the specific treatment and ameliorate the outcome.

Topics: Acyclovir; Herpes Zoster; Herpesvirus 3, Human; Humans; Spinal Cord Diseases; Spinal Cord Injuries

Recent studies focusing on morbidity and mortality rates of immunocompromised children with varicella-zoster virus (VZV) infections are scarce. We aimed to summarise our experience.. The study was a retrospective analysis of the medical records of children, who were admitted to Hadassah-Hebrew University Medical Centre, Jerusalem, Israel, during the period of 2008-2016. Data regarding baseline characteristics, treatment and outcome were extracted from patient's medical files.. We enrolled 74 patients (43% males) with a mean age of 8 (1-19) years. Most patients (72%) had no reported complications. Clinical outcome was favourable with 73 (99%) patients who had completely recovered and none died. Multivariable analysis identified the presence of fever (P = .005 and 0.02; hazard ratio (HR) 7.72 and 17.61, for total and herpes zoster groups, respectively) and prolonged interval period from clinical presentation to treatment onset (P = .021 and 0.025; HR 1.68 and 2.26, respectively), as associated with higher rates of complications.. Our results found low complication rate of VZV-associated infections in immunocompromised children admitted to a single centre. This should encourage conducting further large multicentre studies evaluating management of low-risk patients with oral acyclovir treatment.

Topics: Acyclovir; Adolescent; Adult; Chickenpox; Child; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunocompromised Host; Israel; Male; Retrospective Studies; Young Adult

Topics: Acyclovir; Adult; Antiviral Agents; Diagnosis, Differential; Herpes Zoster; Humans; Male; Meningitis, Viral; Sexually Transmitted Diseases; Testosterone Congeners

A 32-year-old man presented with a 7-day history of generalised headache, intermittent fever, emesis and diarrhoea. Four days after symptom onset, he developed a vesicular rash on his medial left thigh, without associated pain, paraesthesia or pruritus. He had no significant past medical history, and no HIV risk factors. He was presumed to have enteroviral meningitis and was commenced on supportive therapy. Lumbar puncture was performed and cerebrospinal fluid (CSF) analysis revealed a lymphocytic pleocytosis. While awaiting CSF serology, the formation of a new vesicle was noted at the site of the rash and was swabbed. Results for both the CSF and vesicle swab returned positive for varicella-zoster virus (VZV) confirming concurrent VZV meningitis with atypical painless herpes zoster in a young immunocompetent patient. He was initiated on intravenous acyclovir and made a full recovery after 2 weeks of treatment.

Topics: Acyclovir; Adult; Antiviral Agents; Diagnosis, Differential; Herpes Zoster; Herpesvirus 3, Human; Humans; Male; Meningitis, Viral

Topics: Acyclovir; Administration, Oral; Aged; Antiviral Agents; Diagnosis, Differential; Foot; Herpes Zoster; Herpesvirus 3, Human; Humans; Leg; Male; Skin; Skin Diseases, Vascular; Skin Diseases, Viral; Treatment Outcome; Vasculitis, Leukocytoclastic, Cutaneous

Topics: Acyclovir; Aged; Analgesics; Betacoronavirus; Coronavirus Infections; COVID-19; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Lymphocyte Count; Male; Pandemics; Pneumonia, Viral; SARS-CoV-2

Ixekizumab is a recently developed biopharmaceutical used since 2016 in the US and Europe for the treatment of plaque psoriasis. Few adverse effects have been reported in the literature and ixekizumab is not known to increase the risk of viral reactivation. Herein we report the case of an immunocompetent female patient treated with ixekizumab who presented meningoradiculitis due to varicella zoster virus (VZV) reactivation.. A 51-year-old woman, treated with ixekizumab for psoriasis, consulted in March 2018 for left hemicrania headache associated with left facial paralysis, but without fever. Brain MRI scans revealed cerebral venous thrombosis of the superior sagittal sinus. Analysis of cerebrospinal fluid (CSF) revealed lymphocytic meningitis and positive VZV-PCR. PCR blood assay for VZV was negative. Blood concentrations of anti-VZV IgG antibody increased while Anti-VZV IgM antibodies remained negative. The final diagnosis was VZV meningoradiculitis complicated by cerebral thrombophlebitis. The absence of skin rash, the rapid increase in anti-VZV IgG antibodies, the absence of anti-VZV IgM antibodies, and the negative blood PCR assay suggested viral reactivation rather than primary infection. The patient received acyclovir and coumadin and her condition improved rapidly. After multidisciplinary discussion, ixekizumab was reintroduced together with valacyclovir prophylaxis.. This case raises the question of the risk of viral reactivation during treatment with an IL-17 inhibitor and with biologics in general. Neurological and vascular complications of VZV may occur without skin lesions and their occurrence during ixekizumab therapy must be investigated by PCR testing of CSF for VZV DNA.

Topics: Acyclovir; Antibodies, Monoclonal, Humanized; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Middle Aged

Varicella-zoster virus vaccination is recommended for virtually all young children in the United States, Canada, and several other countries. Varicella vaccine is a live attenuated virus that retains some of its neurotropic properties. Herpes zoster caused by vaccine virus still occurs in immunized children, although the rate is much lower than in children who had wild-type varicella. It was commonly thought that 2 varicella vaccinations would protect children against the most serious complication of meningitis following herpes zoster; however, 2 meningitis cases have already been published. We now report a third case of varicella vaccine meningitis and define risk factors shared by all 3 immunized adolescents. The diagnosis in cerebrospinal fluid in this third case was verified by amplifying and sequencing portions of the viral genome, to document fixed alleles found only in the vaccine strain. Viral antibody was also detected in the cerebrospinal fluid by confocal microscopy. When compared with the other 2 cases, remarkably all 3 were 14 years old when meningitis occurred. All 3 were treated with intravenous acyclovir, with complete recovery. The adolescent in our case report also had recurrent asthma, which was treated with both prednisone tablets and beclomethasone inhaler before onset of meningitis. When the 3 cases were considered together, they suggested that immunity to varicella-zoster virus may be waning sufficiently in some twice-immunized adolescents to make them vulnerable to varicella vaccine virus reactivation and subsequent meningitis. This complication rarely happens in children after wild-type varicella.

Topics: Acyclovir; Adolescent; Antiviral Agents; Chickenpox Vaccine; Female; Herpes Zoster; Humans; Immunocompetence; Male; Meningitis; Valacyclovir

Topics: Acyclovir; Antiviral Agents; Child; Diagnosis, Differential; Herpes Zoster; Herpesvirus 3, Human; Humans; Laryngitis; Larynx; Lymphadenopathy; Male; Pharyngitis; Pharynx; Tomography, X-Ray Computed; Treatment Outcome

Topics: Acyclovir; Analgesics; Antiviral Agents; Gabapentin; Herpes Zoster; Humans; Lumbosacral Region; Male; Middle Aged; Radiculopathy

A 34-year-old man developed right-dominant lower limb paraplegia, and then upper limb paresis with radicular pain following disseminated herpes zoster (HZ) in his right forehead, back of the trunk, and lumbar and right lower limb regions. Cerebrospinal fluid (CSF) findings revealed an increase in lymphocytes (32 cells/μl) and protein content (50 mg/dl), and polymerase chain reaction (PCR) for varicella-zoster virus (VZV) DNA was negative in CSF, but VZV antigen was positive in the patient's vesicle smear. Lumbar root MRI using 3D Nerve VIEW (Philips) imaging showed high-intensity lesions on the L2-L5 spinal roots with contrast enhancements, and cervical MRI showed similar findings on both sides at the C4-Th1. Peripheral nerve conduction study revealed prolonged distal latency to 4.9 ms, decreased MCV to 38 m/s, and complete loss of F-wave was seen in the right peroneal nerve study. Minimal F-wave latency was prolonged in the right tibial nerve. Thus, the patient was diagnosed with VZV polyradiculoneuritis caused by disseminated HZ. Regarding the possible pathogenesis of polyradiculoneuritis in this patient with disseminated HZ, we speculate that VZV reached by retrograde transmission from the involved peripheral nerves to the spinal ganglia, which, then, produced polyradiculoneuritis.

Topics: Acyclovir; Adult; Antiviral Agents; Diagnostic Techniques, Neurological; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunoglobulins, Intravenous; Infusions, Intravenous; Magnetic Resonance Imaging; Male; Neural Conduction; Polyradiculoneuropathy; Prednisolone; Sural Nerve; Treatment Outcome

Topics: Acyclovir; Aged; Antiviral Agents; Breast Neoplasms; Diagnosis, Differential; Exanthema; Facial Dermatoses; Female; Forehead; Herpes Zoster; Humans; Immunocompromised Host; Lung Neoplasms; Neoplasms, Multiple Primary

When skin abnormalities in patients extend over several dermatomes, disseminated herpes zoster should be suspected. This complication is most often seen in immunocompromised patients.. An 87-year-old patient came to the dermatology outpatient clinic with several vesicles scattered over her body. She was being treated with methotrexate for rheumatoid arthritis. Upon physical examination, we found groups of vesicles in the area of the maxillary nerve as well as several solitary vesicles scattered over her body. We made the diagnosis of 'disseminated herpes zoster'. PCR test of fluid from one of the vesicles found Varicella zoster virus. We treated the patient with intravenous acyclovir for 48 hours after which we treated her with oral acyclovir for another 8 days. We temporarily halted methotrexate. Outpatient follow-up found that the patient's skin abnormalities had diminished significantly.. The risk of disseminated herpes zoster depends on several factors. Use of immunosuppressants is often not the only contributing factor. Risk of disseminated herpes zoster in a patient who is being treated with methotrexate depends on age, comorbidities and co-medication of the patient.

Topics: Acyclovir; Aged, 80 and over; Antiviral Agents; Arthritis, Rheumatoid; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunocompromised Host; Methotrexate; Risk Factors

This case describes an uncommon presentation of herpes zoster in an adolescent with viral meningitis and concomitant genital shingles. A 15-year-old immunocompetent girl with background of well-controlled Graves' disease presented with 3 days of fever, frontal headache, terminal neck stiffness and photophobia. This was preceded by 4 days of pain and itch over vaginal and anal region. She had one dose of varicella vaccination at 18 months old and developed mild primary varicella infection around 5 years of age. Varicella zoster virus DNA was detected both in cerebrospinal fluid and in vesicles over her right labial majora. While there is no international consensus on the recommended duration of treatment for zoster with neurological complications, she was treated with intravenous acyclovir for 10 days with good clinical response. Her fever, headache and neck stiffness resolved after 2 days and genital lesions resolved after 9 days of antiviral therapy.

Topics: Acyclovir; Adolescent; Antiviral Agents; Diagnosis, Differential; Female; Genitalia; Graves Disease; Herpes Zoster; Herpesvirus 3, Human; Humans; Meningitis, Viral; Varicella Zoster Virus Infection

Herpes Zoster (HZ), caused by the reactivation of the latent Varicella Zoster Virus infection is a disease that may rarely develop in childhood. HZ is considered to be a disease of adult, but recent reports show an increase in the number of cases in childhood. This study was designed to evaluate the demographic and clinical features of children with HZ. Data from patients under 18 years of age that were diagnosed with HZ at two different dermatology outpatient clinics were retrospectively evaluated between October 2012 and December 2018. Out of 60 cases enrolled in the study, 37 were male and 23 were female. The mean age of patients was 8 ± 4.93 years. Of all the cases, 46 had a history of chickenpox. Three patients had been vaccinated against chickenpox. Itching, observed in 48 subjects, was the most common symptom, while 38 subjects complained of pain. Acyclovir was prescribed as antiviral therapy in 33 cases. None of the cases showed any complication. HZ may occur in healthy children without any immunosuppression, too. Pain in children is less common than in adults whereas, itching is more frequent. Complications are rare in these subjects.

Topics: Acyclovir; Adolescent; Antiviral Agents; Chickenpox; Chickenpox Vaccine; Child; Child, Preschool; Female; Herpes Zoster; Humans; Infant; Male; Retrospective Studies

A 76-year-old Japanese female who was treated with long-term use of prednisolone at 10 mg/day for interstitial pneumonia developed acute right-dominant lower limb paralysis and then upper limb paralysis with herpes zoster eruptions on the right C7-Th1 dermatomes. On admission, right predominant quadriplegia was observed with sensory symptoms; Hughes functional grade was level 4; the hand grip power was right, 0, and left, 7 kg, the deep tendon reflexes were abolished throughout without pathologic reflexes. Twenty days after the onset of the symptoms, the cerebrospinal fluid (CSF) revealed mild increases of lymphocytes (13 cells/μl) and protein content (73 mg/dl). Varicella-zoster virus (VZV) PCR was negative in the CSF, but an enzyme immunoassay for VZV was positive in her serum and CSF, and the high titers were prolonged. Peripheral nerve conduction and F wave studies suggested right-dominant demyelinating polyradiculoneuropathy. A T

Topics: Acyclovir; Aged; Antibodies, Viral; Antiviral Agents; Biomarkers; Diffusion Magnetic Resonance Imaging; Female; Guillain-Barre Syndrome; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunocompromised Host; Immunoglobulins, Intravenous; Oxadiazoles; Polyradiculoneuropathy; Quadriplegia; Varicella Zoster Virus Infection

We report a case of acyclovir encephalopathy in a 77-year-old man who was introduced to peritoneal dialysis three years earlier. He developed herpes zoster and was treated with acyclovir (ACV) at 800 mg daily per oral. Two days later, he developed consciousness disturbance, hallucinations and asterixis. Acyclovir was stopped and continuous ambulatory peritoneal dialysis (CAPD) was switched to hemodialysis, which resulted in the resolution of his symptoms. Because the optimal dose of ACV varies among individuals depending on the bioavailability of ACV and metabolic enzyme activity, ACV encephalopathy can occur even when the acyclovir dose is modified according to the renal function of the affected patient. Because CAPD provides a poorer ACV clearance than hemodialysis, CAPD patients tend to have a higher risk of developing ACV encephalopathy and to recover more slowly. If CAPD patients develop ACV encephalopathy, a temporary change in the type of dialysis to hemodialysis should be considered.

Topics: Acyclovir; Administration, Oral; Aged; Antiviral Agents; Brain Diseases; Herpes Zoster; Humans; Male; Peritoneal Dialysis; Renal Dialysis

Varicella-zoster virus (VZV) causes herpes zoster. Pneumocystis jirovecii (PJ) also causes pneumonia in immunocompromised hosts. Although both cause opportunistic infections, it is rare to have a co-infection in a non-human immunodeficiency virus carrier.. An 84-year-old woman with hemolytic anemia referred because of acute respiratory failure. She had received prednisolone without PJ pneumonia prevention. She developed dyspnea and desaturation while eating, and thus was treated based on a presumptive diagnosis of aspiration pneumonia. Physical examination revealed a vesicular rash on the left side of her neck suggesting herpes zoster infection. Polymerase chain reaction of her sputum for PJ and VZV was positive, which confirmed a diagnosis of pneumonia due to PJ and VZV co-infection. Despite acyclovir and sulfamethoxazole and trimethoprim administration, she died on hospital day 19.. Clinicians should suspect PJP when patients on systemic corticosteroids develop pneumonia and they have not received prophylactic treatment for PJP in non-HIV carriers. When such patients have a VZV rash, clinicians should aggressively seek signs of opportunistic infections. Our case hereby highlights the importance of recognizing the possibility of a VZV and PJ co-infection.

Topics: Acyclovir; Aged, 80 and over; Anti-Infective Agents, Urinary; Antiviral Agents; Coinfection; Fatal Outcome; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunocompromised Host; Opportunistic Infections; Pneumocystis carinii; Pneumonia, Pneumocystis; Polymerase Chain Reaction; Sputum; Sulfamethoxazole; Trimethoprim; Varicella Zoster Virus Infection

Topics: Abdominal Wall; Acyclovir; Administration, Intravenous; Aged; Colonic Pseudo-Obstruction; Hernia; Herpes Zoster; Humans; Male; Radiography, Abdominal; Tomography, X-Ray Computed; Treatment Outcome

Topics: Acyclovir; Administration, Intravenous; Aged; Antiviral Agents; Bromodeoxyuridine; Female; Herpes Zoster; Humans; Paresis; Physical Therapy Modalities

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

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

Disseminated herpes zoster infection occurs mostly in immunocompromised hosts. There have been recent reports of disseminated zoster with chemotherapeutic regimens and newer monoclonal antibodies.. The present case describes a 61-year-old patient presenting with disseminated herpes zoster after initiation of benralizumab, an anti-IL-5 monoclonal antibody for severe persistent asthma. His initial vesicular lesions limited to left lumbar dermatomes progressed extensively resulting in dissemination on his body. The diagnosis was confirmed with PCR and he had remarkable clinical improvement with acyclovir and supportive medical management.. Clinical trials have reported an association of mepolizumab, another anti-IL-5 monoclonal antibody with herpes zoster. This report of herpes zoster following initiation of benralizumab might suggest a possibility of a class effect of anti-IL-5 monoclonal antibody.

Topics: Acyclovir; Antibodies, Monoclonal, Humanized; Asthma; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunocompromised Host; Male; Middle Aged; Treatment Outcome

Herpes zoster (shingles) is the reactivation of dormant varicella zoster virus in individuals who previously experienced varicella infection or vaccination. Herpes zoster can occur in pregnancy, although it is rare. This case report describes the clinical presentation and diagnosis of herpes zoster and reviews current recommendations for treatment. Preventative measures and the role of immunization are discussed in addition to clinical implications for intrapartum, postpartum, and newborn care to guide practitioners in caring for women experiencing or exposed to herpes zoster in pregnancy.

Topics: Acyclovir; Adult; Antiviral Agents; Female; Herpes Zoster; Humans; Postnatal Care; Pregnancy; Pregnancy Complications, Infectious; Treatment Outcome

We report a case of fatal disseminated varicella zoster virus (VZV) with delayed-onset rash in a 66-year-old female more than 2 years following uncomplicated deceased donor renal transplantation. Whilst on a stable regimen of maintenance immunosuppression, the patient presented with chest and abdominal pain with concomitant hepatitis and pancreatitis. After pursuing multiple other potential causes of her symptoms, the correct diagnosis of VZV was only suspected after the development of a widespread vesicular rash-11 days after her initial symptoms. Despite antiviral therapy and inotropic support in the intensive care unit, the patient died. Simultaneous VZV hepatitis and pancreatitis in solid organ transplant recipients is uncommon. The new inactivated VZV vaccines have the potential to prevent post-transplant infections, with promising early clinical data on safety and efficacy in renal transplant recipients. VZV is an important preventable infection that should be considered in immunocompromised patients, even in the absence of rash.

Topics: Acyclovir; Aged; Antiviral Agents; Exanthema; Fatal Outcome; Female; Hepatitis; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunocompromised Host; Kidney Transplantation; Pancreatitis

Herpes zoster (HZ) tends to affect the elderly population and immunocompromised younger patients. However, HZ cases in healthy children have also been reported.. This paper is a reminder to physicians, that Herpes Zoster can still be present in children, even in the era after the development of the varicella vaccine and its introduction in the national immunization programs globally.. We present the case of an immunocompetent 11-year old vaccinated male patient, who developed a HZ infection. The child had received two doses of the VZV vaccination (Varivax®), nine years (first dose) and six years (second dose) prior to the infection.. Together with the case presentation, we summarize in this report the most recent published data, concerning the HZ prevalence in healthy varicella zoster vaccinated children.. Vaccinated pediatric patients are not completely free of risk concerning HZ. Physicians, especially pediatricians and dermatologists, should be alert in order to recognize and treat HZ early, so as to avoid further complications.

Topics: Acyclovir; Analgesia; Antiviral Agents; Chickenpox Vaccine; Child; Herpes Zoster; Herpesvirus 3, Human; Hospitalization; Humans; Immunization, Secondary; Immunocompetence; Male; Time Factors; Vaccination

Topics: Acyclovir; Antibodies, Viral; Antigens, Viral; Biopsy; DNA, Viral; Folliculitis; Hair Follicle; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunohistochemistry; Male; Meningitis, Viral; Young Adult

Topics: Acyclovir; Adult; Antiviral Agents; DNA, Viral; Drug Resistance, Viral; Drug Substitution; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunocompromised Host; Oxadiazoles; Treatment Outcome

Although much less common than localized zoster, initial presentation of varicella-zoster virus (VZV) as visceral infection can occur especially after allogeneic hematopoietic stem cell transplantation (HSCT). We herein report a case of post-transplant visceral VZV infection presenting as fatal acute liver failure. It developed 4 years after allogeneic HSCT when a long-term prophylactic anti-VZV agent administration was discontinued. VZV should be listed as a causative pathogen of acute liver failure even years after allogeneic HSCT. Indication for, and duration of anti-VZV prophylaxis should be further investigated.

Topics: Acyclovir; Adult; Antiviral Agents; Female; Hematopoietic Stem Cell Transplantation; Herpes Zoster; Herpesvirus 3, Human; Humans; Liver Failure, Acute; Male; Middle Aged; Virus Activation; Young Adult

Topics: Acyclovir; Antiviral Agents; Ear Auricle; Female; Glossopharyngeal Nerve; Herpes Zoster; Herpesvirus 3, Human; Humans; Laryngeal Muscles; Methylprednisolone; Middle Aged; Paresis; Pulse Therapy, Drug; Recurrent Laryngeal Nerve; Skin; Treatment Outcome; Vocal Cord Paralysis

Herpes zoster (zoster) also commonly known as "shingles," occurs following re-activation of the varicella zoster virus. It contributes a large cost burden to the U.S. health care system, with an estimated 1 million cases costing $1 billion annually. The current gold standard treatment is acyclovir, which limits viral replication. However, acyclovir has been reported to cause neurotoxicity in patients with acute or chronic kidney disease.. This case presents an occurrence of acyclovir-induced toxic encephalopathy in a patient with normal renal function. A 63-year-old male presented to the emergency department with ataxia, tremors, fluctuating aphasia, confusion, agitation, and fatigue. Results of imaging, lumbar puncture, and laboratory studies directed clinicians toward acyclovir toxicity, despite a normal creatinine level. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians will likely be the first point of contact in the health care system following the onset of acyclovir toxicity. With an increasing incidence of zoster disease, such atypical toxic manifestations may increase. Early recognition is important to avoid permanent neurologic compromise.

Topics: Acyclovir; Antiviral Agents; Brain Diseases; Ceftriaxone; Emergency Service, Hospital; Exanthema; Herpes Zoster; Herpesvirus 3, Human; Humans; Male; Middle Aged; Neurotoxicity Syndromes

Development of neurological complications of varicella zoster virus reactivation is relatively uncommon, particularly in an immunocompetent child.. An 11-year-old Asian girl presented with headache and skin rash on her left chest. She was diagnosed with meningitis, and herpes zoster was confirmed by polymerase chain reaction using cerebrospinal fluid. Acyclovir was administered intravenously. Given the favorable evolution of the clinical course, she was discharged from the hospital on day 8 of her illness. She had no apparent sequelae or comorbidities at the time of the 6-week follow-up.. Neurological complications such as meningitis due to varicella zoster virus reactivation are uncommon, especially in an immunocompetent child; no specific immune deficiency was identified in our patient. We conclude that, although rare, varicella zoster virus should be recognized as a potential cause of viral meningitis in immunocompetent children.

Topics: Acyclovir; Administration, Intravenous; Antiviral Agents; Cerebrospinal Fluid; Child; Exanthema; Female; Headache; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunocompetence; Meningitis, Viral; Treatment Outcome

Topics: Acyclovir; Aged, 80 and over; Antiviral Agents; Female; Follow-Up Studies; Herpes Zoster; Humans; Psychoses, Substance-Induced; Valacyclovir; Valine

Topics: Acyclovir; Aged; Bendamustine Hydrochloride; Drug Eruptions; Epidermis; Herpes Zoster; Humans; Immunoblastic Lymphadenopathy; Keratinocytes; Lymphocytes; Lymphoma, T-Cell; Male; Programmed Cell Death 1 Receptor; Skin

To observe the clinical efficacy and safety of topical ozone therapy for patients with herpes zoster by reflectance confocal microscopy (RCM).
 Methods: A total of 60 patients with herpes zoster were divided into a control group and an ozone treatment group (n=30). In the control group, patients took oral valacyclovir tablets or granules (0.3 g per day, three times a day) and they were subjected to local weak laser irradiation treatment plus topical 2% mupirocin ointment twice a day. In the ozone group, the treatment is same as the control group except mupirocin ointment was replaced with topical ozone treatment (hydrotherapy every day plus ozonated oil twice a day). The clinical symptoms, discoid cell and adverse reactions were observed and taken records at day 0, 3, 7 and 14. Statistical analysis was performed to compare the clinical efficacy between the 2 groups. 
 Results: On the seventh day of treatment, the discoid cells of the ozone group disappeared, and the difference between the control group and the ozone group was statistically significant (P<0.05). The difference of decreased percentage of pain scores at each time point between the 2 groups was statistically significant (P<0.05). The clinical efficacy was 100% in the ozone group and 86.7% in the control group, with significant difference between the 2 groups (P<0.05).
 Conclusion: Topical ozone therapy in patients with herpes zoster is helpful in relieving pain, shortening the course as well as improving the clinical efficacy without obvious adverse reactions. It is worth to be popularized.. 目的：应用反射式共聚焦显微镜(reflectance confocal microscope，RCM)观察臭氧外用治疗带状疱疹的临床疗效及安全性。方法：将60例带状疱疹患者分为对照组和臭氧组(n=30)。对照组口服伐昔洛韦片剂或颗粒剂(每日300 mg，每日3次)，同时采用局部弱激光照射治疗，外用2%莫匹罗星软膏(每日2次)；臭氧组将莫匹罗星改为臭氧水湿敷(每日1次)和臭氧油外用(每日2次)，分别在治疗前和治疗的第3，7，14天观察临床症状和体征的变化，并用RCM检测靶部位水疱内圆盘状细胞的变化，比较两组的临床疗效并记录不良反应。结果：治疗第7天，臭氧组包涵体消失，与对照组比较，差异有统计学意义(P<0.05)；各时间点臭氧组疼痛评分下降百分比明显高于对照组(P<0.05)；臭氧组患者总有效率为100%，对照组为86.7%，两组比较差异有统计学意义(P<0.05)；两组患者均未见明显不良反应和并发症发生。结论：臭氧外用治疗带状疱疹有助于缓解患者疼痛、缩短病程、提高临床疗效，无明显不良反应，值得临床推广应用。.

Topics: Acyclovir; Administration, Oral; Administration, Topical; Antiviral Agents; Case-Control Studies; Combined Modality Therapy; Drug Administration Schedule; Herpes Zoster; Humans; Hydrotherapy; Low-Level Light Therapy; Microscopy, Confocal; Mupirocin; Oils; Ozone; Pain Management; Pain Measurement; Treatment Outcome; Valacyclovir; Valine

A retired woman with left ophthalmic shingles of over 2 years' duration attended with bilateral vision loss and systemic upset. Acute retinal necrosis with detachment was detected on right fundus examination. Cataract in left eye precluded funduscopy. Ocular ultrasonography revealed fibrotic retinal detachment in the left eye. MRI brain and orbits also showed signals of retinal detachment. No abnormal MRI signal within the optic nerve or brain was found. Varicella zoster virus was detected in ocular aqueous and blood samples. High-dose intravenous acyclovir was administered. HIV test was positive with a very low CD4 count. Antiretroviral medications were prescribed. There was no recovery of vision. She was certified as blind, and social services were involved in seeking to provide alterations to her home in view of her severe disability. This case highlights the importance of suspecting HIV in patients with severe or chronic ophthalmic shingles. Images and implications for clinical practice are presented.

Topics: Acyclovir; AIDS-Related Opportunistic Infections; Anti-Retroviral Agents; Antiviral Agents; Blindness; Diagnosis, Differential; Female; Herpes Zoster; HIV Infections; Humans; Magnetic Resonance Imaging; Patient Safety; Retinal Detachment; Retinal Diseases; Retinal Necrosis Syndrome, Acute; Ultrasonography; Varicella Zoster Virus Infection

A 62 year-old man, who was taking prednisolone for nephrotic syndrome, was diagnosed with herpes zoster of the trigeminal nerve and treated with oral valacyclovir. One month later, he reported pain from the right side of the head and vomiting. MRI revealed an acute infarction in the right frontal lobe and dissection of the internal carotid artery of the right cervix. Trauma or other potential triggers were not observed. In consideration of the preceding condition of varicella zoster virus infection, acyclovir was administered in addition to unfractionated heparin, but an intramural hematoma emerged in the left internal carotid artery. Furthermore, evidence showing progression of these lesions was found. On the fifth day, prednisolone was increased to 1 mg/kg/day, and progression of vascular lesions was not observed. This case may prove valuable because it suggests a relationship between cervical artery dissection and herpes zoster.

Topics: Acyclovir; Antiviral Agents; Carotid Artery, Internal, Dissection; Disease Progression; Heparin; Herpes Zoster; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Prednisolone; Treatment Outcome; Trigeminal Nerve

In 2016, the live attenuated zoster vaccine (Zostavax, Merck and Co, USA) was introduced into the Australian National Immunisation Program for people aged 70 years who are not significantly immunocompromised. We report the administration of Zostavax in an immunocompromised patient with chronic lymphocytic leukaemia and no evidence of primary varicella zoster virus (VZV) infection. The patient presented with a bilateral vesicular facial rash 22 days after receiving Zostavax and was initially managed as an outpatient with oral acyclovir. He re-presented three days later and was diagnosed with disseminated VZV infection complicated by meningoencephalitis. The patient died following cardiac arrest on day 10 of hospitalisation. This unfortunate case highlights the challenge of safely implementing a high titre live vaccine in a population where contraindications are prevalent. The non-live recombinant herpes zoster subunit vaccine (Shingrix, GSK) may provide a safe and effective option to protect immunocompromised patients from shingles and post-herpetic neuralgia.

Topics: Acyclovir; Aged; Antiviral Agents; Australia; Contraindications, Procedure; Exanthema; Fatal Outcome; Heart Arrest; Herpes Zoster; Herpes Zoster Vaccine; Hospitalization; Humans; Immunocompromised Host; Leukemia, Lymphocytic, Chronic, B-Cell; Male; Meningoencephalitis; Neuralgia, Postherpetic; Vaccination; Vaccines, Attenuated; Varicella Zoster Virus Infection

Acyclovir has been used in the treatment of herpes simplex and varicella zoster viral infections for over 30 years. The side effects of oral treatment at standard doses are rare and include headache, diarrhoea, dizziness and malaise. We report a patient with a new diagnosis of systemic lupus erythematosus (SLE) who developed thrombocytopaenia within days on a therapeutic dose with acyclovir. Prompt discontinuation of acyclovir and treatment with intravenous immunoglobulin resulted in reversal of the above potentially serious complication. Therefore a high index of suspicion should be exercised in patients with SLE who require treatment with acyclovir for herpes viral infections. In these patients regular platelet count measurement should be considered while on treatment with the above antiviral agent.

Topics: Acyclovir; Comorbidity; Female; Herpes Zoster; Humans; Immunoglobulins, Intravenous; Lupus Erythematosus, Systemic; Middle Aged; Thrombocytopenia; Treatment Outcome

Herpes zoster, caused by varicella zoster virus (VZV) reactivation, affects mainly the adult population, although it can occur in children. This happens when primary infection (varicella) has occurred at a very young age or in immunocompromised patients. Complications are rare in healthy individuals. They include VZV cutaneous dissemination, which affects 2%-10% of immunocompromised patients.We present a previously healthy child, with history of varicella during her first month of life, which presented at age 8 with a severe case of herpes zoster, complicated with cutaneous dissemination. Immunity study was unremarkable. Causes, management and follow-up are discussed.

Topics: Acyclovir; Administration, Intravenous; Aftercare; Antiviral Agents; Child; Exanthema; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunocompromised Host; Skin Diseases; Treatment Outcome

The lack of an effective anti-viral agent and the emergence of drug-resistant strains dictate a real need for discovery of novel therapies able to ameliorate viral infections. In this regards, medicinal plants and natural products offer safe and inexpensive platforms for discovery of efficient and novel anti-viral agents. We have investigated the potential anti-viral activities of Veronica persica Poir.  as a medicinal plant against herpes simplex viruses (HSVs). In vitro screening of the ethanol plant extract against HSV-1 and HSV-2 infected Vero cells revealed the extract to show a dose-dependent inhibitory activity against both virus strains. After fractionation of the extract by a stepwise methanol gradient and evaluation of each fraction, the 80% methanol fraction displayed a pronounced inhibitory activity against the herpes viruses. The highest antiviral activity was observed when the Vero cells were treated with the extract both during and after infection by viruses. Moreover, the extract showed a prominent synergistic activity in combination with acyclovir anti-HSV therapy. Our findings revealed the potential of V. persica extract, especially its 80% methanol fraction, in inhibition of herpes simplex viral infections.

Topics: Acyclovir; Animals; Antiviral Agents; Chlorocebus aethiops; Ethanol; Herpes Zoster; Herpesvirus 1, Human; Herpesvirus 2, Human; Humans; Plant Extracts; Plants, Medicinal; Vero Cells; Veronica

A 12-year-old girl presented with red spots appearing on the left side of her face. The girl was usually healthy and fully vaccinated, including varicella vaccination.Six years prior to her presentation, she had suffered an episode of blister rash on the left side of her face, including lesions in the ear canal and buccal mucous membrane. A diagnosis of herpes zoster was made, and she was treated with acyclovir with complete skin recovery. A hearing examination demonstrated mild-to-moderate left neurosensory hearing loss.Since then, she is having short episodes of redness on her face without pain or sweating at the exact distribution of the zoster blisters 6 years ago. The appearance of spots is related to sour foods, such as sour flavoured candies, yoghourt and green apples. The diagnosis of postherpetic Frey syndrome was made, and observational approach was adopted due to the benign character of symptoms.

Topics: Acyclovir; Antiviral Agents; Child; Diagnosis, Differential; Female; Herpes Zoster; Humans; Sweating, Gustatory

Topics: Acyclovir; Chickenpox; Herpes Zoster; Humans; Myelitis, Transverse; Varicella Zoster Virus Infection

Although acyclovir prophylaxis against varicella zoster virus (VZV) infection for ≥1 year is recommended after allogeneic hematopoietic cell transplantation (HCT), the emergence of acyclovir-resistant viruses and adverse drug effects cannot be ignored. We investigated the cumulative incidence of VZV infection after allogeneic HCT in children receiving a shorter duration of acyclovir prophylaxis than recommended and evaluated the appropriateness of the short duration of acyclovir prophylaxis.Medical records of 217 children who received allogeneic HCT were retrospectively reviewed until a median of 25 months (range = 1-59 months) after HCT. Acyclovir prophylaxis was given for a median of 9 weeks (range = 3-24 weeks) after HCT.VZV infection was diagnosed in 33 (15.2%) children at a median time of 5 months (range = 2-41 months) after HCT. The 1-year and 2-year cumulative incidences of VZV infection after allogeneic HCT were 11.2% and 15.5%, respectively. These incidences were between the previously reported 1-year incidence of 25% to 30% in patients not receiving prophylaxis and 1-year incidence of 4% to 5% in patients receiving ≥1 year duration of prophylaxis. Male sex and older age were significantly associated with VZV infection after allogeneic HCT. Only 1 chickenpox patient experienced severe complications because of VZV infection, and there were no deaths attributable to VZV infection.In conclusion, a shorter duration of acyclovir prophylaxis may be appropriate for children receiving allogeneic HCT, based on the rare occurrence of severe complications because of VZV infection and the expected discomfort because of daily oral medication for a long time.

Topics: Acyclovir; Adolescent; Antiviral Agents; Chickenpox; Child; Child, Preschool; Female; Hematopoietic Stem Cell Transplantation; Herpes Zoster; Herpesvirus 3, Human; Humans; Infant; Male; Postoperative Complications; Republic of Korea; Retrospective Studies; Transplantation, Homologous; Young Adult

Herpes zoster (HZ), or shingles, is commonly seen in older adults but does occur in children. Routine administration of the varicella vaccine started in 1995 in the United States; since then, the incidence of varicella and HZ has declined. We report a case of HZ in an otherwise healthy 19-month-old boy who had been vaccinated at 13 months of age and recovered fully after acyclovir treatment. We review previously reported cases of HZ in healthy vaccinated children.

Topics: Acyclovir; Antiviral Agents; Chickenpox; Chickenpox Vaccine; Herpes Zoster; Humans; Infant; Male

An 82-year-old man with a history of end-stage renal disease presented with progressively worsening confusion and somnolence for the past 4-5 days. The patient was diagnosed with herpes zoster by his primary care physician 5 days ago and was started on a course of valacyclovir 1 g three times a day (dose not adjusted for renal impairment).A lumbar puncture was performed and cerebrospinal fluid (CSF) studies revealed 37 white blood cells (WBCs)/hpf (100% monocytes), protein 64 mg/dL and glucose 52 mg/dL. He was started on ceftriaxone, ampicillin and acyclovir. MRI of the brain was done and was unremarkable. Acyclovir-induced encephalopathy was high on differential, but his CSF findings were concerning for viral encephalitis. Nonetheless, all antimicrobials were discontinued and he was scheduled for a 5-hour dialysis session. The very next day, he showed immense improvement and eventually recovered completely. CSF PCR tests for both herpes simplex virus and varicella zoster virus came back negative.

Topics: Acyclovir; Aged, 80 and over; Antiviral Agents; Herpes Zoster; Humans; Male; Neurotoxicity Syndromes; Valacyclovir; Valine

Topics: Acyclovir; Anal Canal; Antiviral Agents; Child; Herpes Zoster; Humans; Male; Perineum; Precursor Cell Lymphoblastic Leukemia-Lymphoma

Topics: Acyclovir; Administration, Intravenous; Aged, 80 and over; Antiviral Agents; Cerebrospinal Fluid; Encephalitis, Varicella Zoster; Female; Herpes Zoster; Humans

We report a 57-year-old woman with end-stage renal disease (ESRD) on maintenance peritoneal dialysis (PD), who presented to the emergency room (ER) by ambulance with complaints of confusion and altered sensorium for 48 hours. She had been reviewed in a walk-in clinic 72 hours earlier and had been prescribed the standard 1000 mg three times per day of valacyclovir for an acute attack of shingles instead of 500 mg once a day on ESRD. In the ER, she received further 500 mg of intravenous acyclovir as herpes encephalitis was clinically suspected. CT of the brain and lumbar puncture were non-contributory to the diagnosis. Valacyclovir and acyclovir were discontinued when the diagnosis of valacyclovir-associated neurotoxicity became clinically evident. As the patient's Glasgow Coma Scale declined, we intensified her PD regimen from one to six exchanges per day and 24 hours later there was a significant neurological improvement.

Topics: Acyclovir; Administration, Intravenous; Antiviral Agents; Confusion; Consciousness Disorders; Diagnosis, Differential; Encephalitis, Herpes Simplex; Female; Herpes Zoster; Humans; Kidney Failure, Chronic; Middle Aged; Neurotoxicity Syndromes; Peritoneal Dialysis; Valacyclovir; Valine

Topics: Acyclovir; Aged; Antiviral Agents; Chickenpox; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunocompetence; Male; Real-Time Polymerase Chain Reaction; Varicella Zoster Virus Infection

Disseminated cutaneous varicella herpes zoster with visceral involvement is rare and seen almost exclusively in immunocompromised patients. We describe an unusual case of fulminant herpes zoster (HZ) in a healthy, immunocompetent 37-year-old woman. She initially presented to an urgent care centre with a classic HZ rash localised to her neck, and upper respiratory symptoms and was treated with prednisone and cephalexin. Within 1 week, the rash became diffuse and her clinical status rapidly deteriorated with development of severe acute respiratory distress syndrome. Varicella zoster infection was confirmed via skin biopsy, bronchial viral PCR and serology for varicella antibodies. She was successfully treated with intravenous acyclovir and aggressive supportive care. Though physicians readily recognise typical zoster infection, this case reminds clinicians that HZ infection can be fulminant and potentially life-threatening in younger, immunocompetent individuals. Early recognition and antiviral therapy is important to reduce morbidity and mortality.

Topics: Acyclovir; Adult; Antiviral Agents; Diagnosis, Differential; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunocompetence; Infusions, Intravenous; Respiratory Distress Syndrome

Herpes zoster (HZ) is caused by reactivation of the varicella zoster virus (VZV), and typically causes a painful, vesicular, dermatomal rash in adults over the age of fifty. However, HZ has been known to present in immunocompetent pediatric patients, which account for under 1% of total cases. Pediatric cases are typically caused by natural infection with VZV, but among vaccinated children up to half of cases can be due to vaccine-strain VZV. We present two such cases of vaccine-strain HZ in pediatric patients.. This is a retrospective study of two cases seen at UCLA-affiliated sites. PCR and Sanger sequencing, using previously described PCR primers, determined the presence of two vaccine-strain-specific single nucleotide polymorphisms.. We report two cases of vaccine-strain HZ in immunocompetent pediatric patients who had previously received the varicella vaccine, affecting the right thigh in the first patient and the left leg in the second. Varicella-strain VZV positivity was confirmed by PCR. Both patients had received the varicella vaccine at 12 months of age. Both patients achieved complete resolution of symptoms after 7-day courses of acyclovir.. While vaccination against VZV has overall reduced the incidence of both varicella and HZ in US children, given the widespread use of the VZV vaccine, awareness of the possibility of vaccine-induced HZ remains an important consideration.

Topics: Acyclovir; Antiviral Agents; Child, Preschool; Female; Herpes Zoster; Herpes Zoster Vaccine; Herpesvirus 3, Human; Humans; Male; Polymerase Chain Reaction; Retrospective Studies; Sequence Analysis, DNA

Varicella Zoster Virus (VZV) is associated with many disorders of the central and peripheral nervous systems including neuralgia, meningitis, meningoencephalitis, cerebellitis, vasculopathy, myelopathy, Ramsay-Hunt syndrome, and polyneuritis cranialis. Cranial nerves V, VI, VII, VIII, IX, X, XI, and/or XII may be affected. The neurological disorders caused by VZV usually present with rash, but may rarely present without rash.. We herein present a case of polyneuritis cranialis without rash caused by VZV affecting cranial nerves VII, VIII, IX, and X. After excluding other causes of the condition, we diagnosed VZV infection based on VZV DNA in the CSF and an elevated anti-VZV IgG level in serum. The patient responded well to antiviral therapy.. VZV infection should be kept in mind during the differential diagnosis of polyneuritis cranialis; it is important to note that VZV re-activation may occur without rash.

Topics: Acyclovir; Antiviral Agents; Cranial Nerve Diseases; Facial Nerve Diseases; Herpes Zoster; Herpesvirus 3, Human; Humans; Male; Middle Aged; Neuralgia, Postherpetic; Polyneuropathies; Treatment Outcome

We report acute retinal necrosis caused by the vaccine Oka strain following immunization of a 78-year-old woman with live zoster vaccine. Whole genome sequencing confirmed the ocular vOka strain to be derived from the vaccine and excluded the presence of new mutations or recombination with wild-type Varicella zoster virus.

Topics: Acyclovir; Aged; Antiviral Agents; DNA Viruses; DNA, Viral; Eye; Female; Herpes Zoster; Herpes Zoster Vaccine; Herpesvirus 3, Human; Humans; Retinal Necrosis Syndrome, Acute; Vaccination; Valacyclovir; Valine; Vitreous Body; Whole Genome Sequencing

We present a 36-year-old woman who was born and raised in Hongkong but currently lived in the Netherlands. She was admitted with a varicella-zoster virus (VZV) primo-infection complicated by pneumonia and hepatitis. The patient was successfully treated with aciclovir. Adult VZV primo-infections are uncommon in Dutch natives but occur more often in immigrants from countries with a temperate climate where less people are infected during childhood.

Topics: Acyclovir; Adult; Chickenpox; Dyspnea; Exanthema; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Netherlands; Treatment Outcome; Varicella Zoster Virus Infection

We report the case of a 6-year-old girl with no notable medical history who presented to the dermatology clinic for evaluation of left leg pain with an overlying erythematous rash of 4 days' duration. Clinical examination revealed pink patches and plaques in a unilateral L5 distribution with an isolated pinpoint vesicle. Direct fluorescent antibody testing confirmed varicella-zoster virus (VZV) infection, establishing a diagnosis of herpes zoster (HZ). The patient previously had received the VZV vaccine in the left leg and arm and had no history of primary VZV infection. We summarize this case and discuss the epidemiology and clinical characteristics of HZ in vaccinated children.

Topics: Acyclovir; Antiviral Agents; Child; Female; Fluorescent Antibody Technique, Direct; Herpes Zoster; Herpes Zoster Vaccine; Herpesvirus 3, Human; Humans; Treatment Outcome; Virus Activation

Reactivation of the varicella-zoster virus (VZV) causes dermatomal herpes zoster (HZ) and more rarely severe disseminated HZ including diffuse rash, encephalitis, hepatitis, and pneumonitis. An atypical form of VZV infection, disseminated HZ has been described primarily in immunocompromised hosts. We report 2 cases of atypical disseminated HZ in immunocompromised patients presenting with diffuse, nondermatomal, vesicular eruptions. We also provide a review of the literature and summarize the current guidelines for the treatment and prophylaxis of HZ in patients with human immunodeficiency virus (HIV) infection, solid organ transplantation (SOT), and hematopoietic stem cell transplantation (HSCT). Given the atypical presentation of VZV infection among some immunocompromised patients, this case series emphasizes the need for clinical suspicion for disseminated HZ to facilitate timely diagnosis and initiation of antiviral therapy. Clinician awareness of methods for prevention and treatment of VZV infection in immunocompromised individuals also is critical to minimize the risk for disease and associated morbidity in these patients.

Topics: Acyclovir; Anti-Retroviral Agents; Biopsy; CD4 Lymphocyte Count; Herpes Zoster; Herpesvirus 3, Human; HIV Infections; Humans; Immunocompromised Host; Male; Microbiological Techniques; Middle Aged; Skin; Superinfection; Treatment Outcome

Disseminated herpes zoster is defined as the presence of more than 20 lesions outside the dermatome. This unusual presentation is more common in immunosuppressed patients. Complications such as hepatitis, encephalitis, and pneumonitis are more likely in individuals with disseminated varicella zoster virus infection.A 63-year-old woman being treated for breast cancer developed multiple pustules and vesicles days after starting doxorubicin and cyclophosphamide chemotherapy. Ten individual lesions appeared on her chest, abdomen, back, and leg. Non-dermatomal disseminated herpes zoster was suspected. She was treated with oral antiviral therapy, as well as with oral and topical antibiotics. Varicella zoster virus infection was confirmed by direct fluorescent antibody staining. After one month, her skin lesions had resolved and she resumed chemotherapy.In a setting of immunosuppression, the rare presentation of disseminated herpes zoster without dermatome should be considered. Appropriate antiviral therapy should be administered while waiting for confirmation of the diagnosis, so as to reduce the risk of visceral dissemination of the varicella zoster virus infection.

Topics: Acyclovir; Antiviral Agents; Breast Neoplasms; Female; Herpes Zoster; Humans; Immunocompromised Host; Middle Aged; Valacyclovir; Valine

Acyclovir is a synthetic guanosine analog, which is a potent and highly selective inhibitor of the DNA polymerases of several herpes viruses. Acyclovir is known as a relatively safe drug with few significant adverse effects, of which nephrotoxicity seems to be the most dreaded one. On the other hand, inflammation and phlebitis at the injection site have been reported to be the most frequent side effects of intravenous acyclovir administration. Although exceptionally rare, there have been case reports of bullous eruption occurring after intravenous acyclovir therapy, a similar of which we have also observed. Here, we present a case of localized bullous eruption and phlebitis associated with intravenous acyclovir treatment in a patient with metastatic breast cancer. Our case distinctively demonstrated two consequential juxtaposing vesiculobullous lesions and phlebitis manifesting as erythema along the course of a vein after intravenous acyclovir injection. We emphasize this hardly known side effect and importance of early recognition and appropriate management of unpredictable side effects of widely used medications.

Topics: Acyclovir; Adult; Antiviral Agents; Blister; Breast Neoplasms; Drug Eruptions; Female; Herpes Zoster; Humans; Injections, Intravenous

Topics: Acyclovir; Aged; Antiviral Agents; Electroencephalography; Herpes Zoster; Humans; Male; Nervous System Diseases

The aim of the article is to highlight the distinguishing features of secondary varicella gingival infection in an older women.. Herpes zoster is an acute sporadic, painful viral infection in older people caused by the reactivation of the latent varicella zoster virus. Herpes zoster affecting the gingiva without any dermal lesions is a rare pathological condition that mimics many intraoral vesiculobullous lesions. The ambiguous nature of this condition creates a diagnostic dilemma.. A 58-year-old woman presented with an acute, unilateral and persistent burning sensation and pain in the gingiva with desqaumating vesicullobulous lesion.. The women was diagnosed with secondary varicella zoster infection.. Herpes zoster of the gingiva could manifest as painful desquamative vesicular lesions, pulpal or other painful neuralgic condition in older individuals which need careful diagnosis before formulating appropiate treatment plan.

Topics: Acyclovir; Antiviral Agents; Female; Gingivitis; Herpes Zoster; Herpesvirus 3, Human; Humans; Middle Aged

Herpes zoster, commonly called shingles, is a disease that results from the reactivation of varicella zoster virus. Local trauma has been reported as a precipitant for reactivation, but this condition is rarely seen localized to a fresh surgical incision. We present the case of a patient who developed shingles overlying the incision site of a recently buried central venous access port, illustrating the need to consider this diagnosis as a unique imposter of localized infection or reaction at sites of recent procedural trauma.

Topics: Acyclovir; Adult; Antineoplastic Combined Chemotherapy Protocols; Breast Neoplasms; Catheter-Related Infections; Central Venous Catheters; Female; Follow-Up Studies; Herpes Zoster; Herpesvirus 3, Human; Humans; Treatment Outcome; Valacyclovir; Valine

Herpes zoster (HZ, shingles) is a frequent medical condition which may severely impact the quality of life of affected patients. Different therapeutic approaches to treat acute HZ are available. The aim of this European project was the elaboration of a consensus-based guideline on the management of patients who present with HZ, considering different patient populations and different localizations. This interdisciplinary guideline aims at an improvement of the outcomes of the acute HZ management concerning disease duration, acute pain and quality of life of the affected patients and at a reduction in the incidence of postherpetic neuralgia (PHN) and other complications. The guideline development followed a structured and pre-defined process, considering the quality criteria for guidelines development as suggested by the AGREE II instrument. The steering group was responsible for the planning and the organization of the guideline development process (Division of Evidence-Based Medicine, dEBM). The expert panel was nominated by virtue of clinical expertise and/or scientific experience and included experts from the fields of dermatology, virology/infectiology, ophthalmology, otolaryngology, neurology and anaesthesiology. Recommendations for clinical practice were formally consented during the consensus conference, explicitly considering different relevant aspects. The guideline was approved by the commissioning societies after an extensive internal and external review process. In this second part of the guideline, therapeutic interventions have been evaluated. The expert panel formally consented recommendations for the treatment of patients with HZ (antiviral medication, pain management, local therapy), considering various clinical situations. Users of the guideline must carefully check whether the recommendations are appropriate for the context of intended application. In the setting of an international guideline, it is generally important to consider different national approaches and legal circumstances with regard to the regulatory approval, availability and reimbursement of diagnostic and therapeutic interventions.

Topics: 2-Aminopurine; Acyclovir; Analgesics; Antiviral Agents; Child; Europe; Famciclovir; Female; Herpes Zoster; Herpes Zoster Ophthalmicus; Humans; Pain Management; Pain Measurement; Pregnancy; Pregnancy Complications; Quality of Life; Societies, Medical

Shingles is the cutaneous expression of the reactivation of latent varicella zoster virus infection in sensory ganglia. It presents as vesicles in the corresponding dermatome. The condition is called disseminated herpes zoster (DHZ) when more than 2 contiguous dermatomes are affected, more than 20 vesicles are observed outside the initial dermatome, or involvement is systemic. DHZ is rare and most frequently occurs in immunocompromised patients.. To describe the epidemiology, predisposing factors, clinical presentation, laboratory findings, and clinical course of patients with DHZ, and to compare the findings in immunocompromised and immunocompetent patients.. We analyzed a retrospective case series of adults hospitalized between February 2010 and October 2015.. Forty-one patients with virologically confirmed manifestations of DHZ were included. Stress as a trigger factor was detected in 39% and immunodepression in 58.5%. Immunocompromised patients were younger than the immunocompetent patients (mean ages, 60.5 vs 82 years, P<.01). The 8 immunocompetent patients with no detectable trigger factors were older (mean age, 85 years). In 95% of cases, DHZ was initially limited to a single dermatome and then spread to other dermatomes or became disseminated. Thrombocytopenia was detected in 56% of cases. Complication rates were similar in immunocompromised and immunocompetent patients (54% vs 59%, P>.01). Six patients died; there was no difference in mortality between the 2 groups.. This study provides evidence on the relationship between DHZ, the presence of underlying immunodepression, and complications. Immunosenescence may play an important role in the onset of this disease in older immunocompetent patients.

Topics: Acyclovir; Aged; Aged, 80 and over; Anemia; Antiviral Agents; Female; Herpes Zoster; Humans; Immunocompetence; Leukopenia; Male; Middle Aged; Neuralgia, Postherpetic; Retrospective Studies; Risk Factors; Spain; Stress, Psychological; Superinfection; Treatment Outcome

We report an acute myelitis in a 53-year-old woman that occurred in 7 days after the diagnosis of Th5-6 herpes zoster. Clinical examination revealed hyperhidrosis of left side of her face, neck, arm and upper chest. She also had muscle weakness of her left leg and sensory impairment for light touch and temperature in her chest and legs. Spinal cord MRI demonstrated a longitudinal T

Topics: Acyclovir; Aquaporin 4; Autoantibodies; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Hyperhidrosis; Immunoglobulin G; Infusions, Intravenous; Methylprednisolone; Middle Aged; Myelitis; Neuromyelitis Optica; Recurrence; Thoracic Vertebrae; Time Factors; Treatment Outcome

The epidemiology of herpes zoster (HZ) in contemporary autologous hematopoietic cell transplant (HCT) recipients, and the impact of acyclovir (ACV)/valacyclovir (VACV) prophylaxis, is not well described. In this observational study from 2002 to 2010, we retrospectively identified 1000 varicella zoster virus (VZV)-seropositive autologous HCT recipients with up to 5 years of follow-up. The incidence of HZ and use of ACV/VACV prophylaxis were determined through review of medical records and mailed questionnaires. Risk factors for HZ were determined by multivariable Cox regression. Over a period of 5 years after autologous HCT, 194 patients developed at least 1 HZ episode, with a cumulative incidence of 21%; 159 of 194 (82%) were not on prophylaxis at the time of HZ. A second episode of HZ occurred in 31 of 194 (16%) patients. Patients taking ACV/VACV had reduced risk for HZ (adjusted hazard ratio [aHR], .59; 95% confidence interval [CI], .37 to .91), whereas those older than the median age (≥55.5 years) had increased risk (aHR, 1.42; 95% CI, 1.05 to 1.9). Disseminated VZV was reported in 8% and postherpetic neuralgia in 13% of patients. We demonstrate a high burden of HZ late after autologous HCT, despite long-term antiviral prophylaxis. Improved prevention strategies are needed to provide sustained protection against HZ after autologous HCT.

Topics: Acyclovir; Female; Hematopoietic Stem Cell Transplantation; Herpes Zoster; Humans; Incidence; Male; Middle Aged; Neuralgia, Postherpetic; Premedication; Retrospective Studies; Risk Factors; Time Factors; Transplantation, Autologous; Valacyclovir; Valine

Topics: Acyclovir; Antiviral Agents; Chickenpox Vaccine; Child; Herpes Zoster; Humans; Immunocompetence; Male; Meningitis; Polymerase Chain Reaction

Infections of the central nervous system (CNS) with varicella zoster virus (VZV) is a rare occurrence after allogeneic hematopoietic stem cell transplantation. We herein report a case of VZV meningitis, radiculitis and myelitis that developed 8 months after cord blood transplantation, shortly after the cessation of cyclosporine and low-dose acyclovir. Although treatment with acyclovir did not achieve a satisfactory response, the patient was successfully treated with foscarnet. Our report indicates that VZV infection should be considered in allo-hematopoietic stem cell transplantation (HSCT) patients with CNS symptoms and that foscarnet may be effective for the treatment of acyclovir-resistant VZV infections of the CNS. The development of optimal prophylactic strategies and vaccination schedules may eradicate post-transplant VZV disease.

Topics: Acyclovir; Antiviral Agents; Foscarnet; Graft vs Host Disease; Hematopoietic Stem Cell Transplantation; Herpes Zoster; Herpesvirus 3, Human; Humans; Meningitis, Viral; Transplantation, Homologous

Topics: Abdominal Muscles; Acyclovir; Antiviral Agents; Herpes Zoster; Humans; Immunoglobulin G; Male; Middle Aged; Pain; Paralysis; Valacyclovir; Valine

A 61-year-old man who was an ex-heavy smoker presented to our ambulatory care centre with a 4-week history of dyspnoea on mild exertion. 2 weeks prior to his symptoms, he had developed right-sided cervical herpes zoster for which he was prescribed oral acyclovir by his general practitioner. On examination, a rash over the right C4-5 dermatomes was noted and dullness on percussion of the right mid and lower zones with markedly reduced air entry. His chest radiograph showed a raised right hemi-diaphragm with associated right middle and lower lobe collapse. Further investigation with CT and bronchoscopy did not identify a cause and showed no evidence of underlying malignancy or endobronchial obstruction. An ultrasound 'sniff test' was performed to confirm diaphragmatic paralysis. We present a rare case of cervical herpes-induced diaphragmatic paralysis, and summarise our approach and the current understanding of this interesting condition.

Topics: Acyclovir; Amitriptyline; Diaphragm; Exanthema; Herpes Zoster; Humans; Male; Middle Aged; Neuralgia; Respiratory Paralysis; Treatment Outcome

Topics: Acyclovir; Aged; Antiviral Agents; Brain Diseases; Herpes Zoster; Humans; Kidney Failure, Chronic; Male; Renal Dialysis

A physician has to perform a benefit-risk assessment each time acyclovir is prescribed "off label" for children. A group of Polish infectious disease experts was created to develop evidence-based guidelines on the use of acyclovir in the treatment and prevention of varicella zoster and herpes simplex infections. In primary varicella zoster virus infections, oral acyclovir treatment is recommended in children over 12 years of age and should be considered in younger children who fall into one of the groups at risk of severe varicella. Intravenous acyclovir therapy in varicella is recommended in patients with immune deficiencies, newborns and in complicated cases. When there is a justified need for prevention of varicella, oral acyclovir prophylaxis may be considered if immunoglobulin cannot be administered, and if it is too late for vaccination. Oral acyclovir treatment of herpes zoster may be beneficial to otherwise healthy patients with a rash in places other than the trunk and in patients over 50 years of age. In immunocompetent patients with herpes simplex infections, indications for treatment with oral acyclovir include primary (genital herpes, skin herpes in children with atopic dermatitis, ocular herpes simplex, severe gingivostomatitis, paronychia and pharyngitis) and recurrent infections. Intravenous acyclovir should be administered for herpes infections in neonates, immunocompromised patients and patients who develop complications including neurological.

Topics: Acyclovir; Antiviral Agents; Child; Child, Preschool; Consensus; Herpes Simplex; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunocompromised Host; Infant; Poland; Simplexvirus

Topics: Abdominal Wall; Acyclovir; Administration, Cutaneous; Aged; Anti-Bacterial Agents; Antiviral Agents; Bacteremia; Body Mass Index; Cellulitis; Dementia; Drug Therapy, Combination; Herpes Zoster; Humans; Immunocompromised Host; Injections, Intravenous; Leukemia, Lymphocytic, Chronic, B-Cell; Male; Malnutrition; Piperacillin; Pseudomonas aeruginosa; Risk Factors; Severity of Illness Index; Skin Cream; Torso; Treatment Outcome

The aim of this multicenter study in a large childhood-onset systemic lupus erythematosus (cSLE) population was to assess the herpes zoster infection (HZI) prevalence, demographic data, clinical manifestations, laboratory findings, treatment, and outcome.. A retrospective multicenter cohort study (Brazilian cSLE group) was performed in ten Pediatric Rheumatology services in São Paulo State, Brazil, and included 852 cSLE patients. HZI was defined according to the presence of acute vesicular-bullous lesions on erythematous/edematous base, in a dermatomal distribution. Post-herpetic neuralgia was defined as persistent pain after one month of resolution of lesions in the same dermatome. Patients were divided in two groups for the assessment of current lupus manifestations, laboratory findings, and treatment: patients with HZI (evaluated at the first HZI) and patients without HZI (evaluated at the last visit).. The frequency of HZI in cSLE patients was 120/852 (14%). Hospitalization occurred in 73 (61%) and overlap bacterial infection in 16 (13%). Intravenous or oral aciclovir was administered in 113/120 (94%) cSLE patients at HZI diagnosis. None of them had ophthalmic complication or death. Post-herpetic neuralgia occurred in 6/120 (5%). After Holm-Bonferroni correction for multiple comparisons, disease duration (1.58 vs 4.41 years, p < 0.0001) was significantly lower in HZI cSLE patients compared to those without HZI. Nephritis (37% vs 18%, p < 0.0001), lymphopenia (32% vs 17%, p < 0.0001) prednisone (97% vs 77%, p < 0.0001), cyclophosphamide (20% vs 5%, p < 0.0001) and SLE Disease Activity Index 2000 (6.0 (0-35) vs 2 (0-45), p < 0.0001) were significantly higher in the former group. The logistic regression model showed that four independent variables were associated with HZI: disease duration < 1 year (OR 2.893 (CI 1.821-4.597), p < 0.0001), lymphopenia <1500/mm(3) (OR 1.931 (CI 1.183-3.153), p = 0.009), prednisone (OR 6.723 (CI 2.072-21.815), p = 0.002), and cyclophosphamide use (OR 4.060 (CI 2.174-7.583), p < 0.0001).. HZI is an early viral infection in cSLE with a typical dermatomal distribution. Lymphopenia and immunosuppressive treatment seem to be major factors underlying this complication in spite of a benign course.

Topics: Acyclovir; Adolescent; Adult; Age of Onset; Antiviral Agents; Brazil; Child; Child, Preschool; Cyclophosphamide; Female; Herpes Zoster; Hospitalization; Humans; Immunosuppressive Agents; Infant; Logistic Models; Lupus Erythematosus, Systemic; Lymphopenia; Male; Nephritis; Prednisone; Retrospective Studies; Severity of Illness Index; Young Adult

Herpes zoster is an acute, cutaneous viral infection caused by the reactivation of varicella-zoster virus (VZV) that is the cause of varicella. It is an acute neurological disease which can often lead to serious postherpetic neuralgia (PHN). Different nerves can be included with the skin rash in the area of its enervation especially cranial nerves (CV) and intercostal nerves.. In this report we present a patient with herpes zoster which involved ulnar nerve with skin rash in the region of ulnar innervations in women with no disease previously diagnosed. The failure of her immune system may be explained by great emotional stress and overwork she had been exposed to with neglecting proper nutrition in that period.. Herpes zoster may involve any nerve with characteristic skin rash in the area of its innervations, and failure in immune system which leads reactivation of VZV may be caused by other factors besides the underlying illness.

Topics: Acyclovir; Administration, Cutaneous; Antiviral Agents; Diagnosis, Differential; Female; Forearm; Hand; Herpes Zoster; Humans; Middle Aged; Pantothenic Acid; Risk Factors; Treatment Outcome; Ulnar Nerve; Virus Activation; Vitamin B Complex

Varicella zoster virus (VZV) is an uncommon cause of folliculitis. We present a case of a 29-year-old woman who presented with an atypical follicularly-based eruption localized to her inner thigh with an associated pain in her lower back and inner thigh prior to the papular eruption. She was successfully treated with valacyclovir 1,000 mg three times daily with no complications.

Topics: Acyclovir; Adult; Antibodies, Viral; Antiviral Agents; Biopsy; Female; Folliculitis; Herpes Zoster; Herpesvirus 3, Human; Humans; Skin; Thigh; Valacyclovir; Valine

The varicella zoster virus (VZV) belongs to cardiotropic viruses, although the frequency of cardiac complications during VZV infection is low. Diagnosis of myocarditis or myopericarditis is rare during varicella - primary infection of VZV and sporadic in zoster - reactivation of latent VZV. Only few such cases have been described. The authors present a case of a 23-year-old male in whom clinical symptoms of myopericarditis developed a week after diagnosis of zoster that was localized in the left-upper part of the thorax. Retrosternal chest pain and fever were accompanied by ECG mimicking acute myocardial infarction. A dynamic pattern of troponin I release and slow normalization of ECG were observed. Serial echocardiography showed normal left ventricular function, transient changes in echogenicity of the interventricular septum and small pericardial effusion. In magnetic resonance imaging subepicardial and intramyocardial areas of late gadolinium enhancement were found. He was treated with intravenous acyclovir. No late sequels of the disease were observed.

Topics: Acyclovir; Chest Pain; Echocardiography; Herpes Zoster; Herpesvirus 3, Human; Humans; Magnetic Resonance Imaging; Male; Myocarditis; Pericarditis; Young Adult

Topics: Acyclovir; Antiviral Agents; Blister; Diagnosis, Differential; Female; Herpes Zoster; Humans; Infant; Pantothenic Acid; Skin Diseases, Viral; Treatment Outcome

Over 26 years, we found 46 infectious episodes in 350 kidney transplant recipients. Fifteen were urinary tract infections, recurrent in 4 patients. There were 8 cytomegalovirus infections, three of them fatal when intravenous (IV) ganciclovir was not available. Seven patients had a reactivation of tuberculosis (TB) in the pleura, cervical spine, lumbar spine, knee, ankle, skin and peritoneum, respectively, and were all resolved satisfactorily with conventional anti-TB therapy. Three patients transplanted before routine prophylaxis with the use of acyclovir developed an extensive herpes zoster infection in the 1st 6 months after transplantation, which was resolved with the use of oral acyclovir, and 1 had a disseminated herpes simplex infection resolved with the use of IV acyclovir. Three patients transplanted before routine prophylaxis with trimethoprim sulfa developed Pneumocystis carinii pneumonia in the 1st 6 months after transplantation, which was fatal in one of them. In 2 patients, we found a Nocardia infection, confined to the lung, which was cured in one of the cases and systemic and fatal in the other. Two patients transplanted before routine prophylaxis with the use of nystatin developed esophageal candidiasis in the 1st 6 months after transplantation. One patient developed infective endocarditis in a stenotic bicuspid aortic valve and died 10 years later after another incident of infective endocarditis at the prosthetic aortic valve. Two patients developed an extensive condyloma at the penis, perianal region, and perineum owing to human papillomavirus, requiring extensive surgical resection and podophyllin applications. Another patient developed fatal post-transplantation lymphoproliferative disease due to Epstein-Barr virus infection 15 years after transplantation. One patient developed a severe and fatal mucocutaneous leishmaniasis with no response to conventional antimonial therapy. It is interesting to note that despite Chagas disease being endemic in Bolivia, we had no patients with reactivation or transmission through the graft even though many of the patients and donors were serologically positive for Chagas disease.

Topics: Acyclovir; Adolescent; Adult; Aged; Bolivia; Child; Cytomegalovirus Infections; Epstein-Barr Virus Infections; Female; Ganciclovir; Herpes Simplex; Herpes Zoster; Humans; Kidney Transplantation; Male; Middle Aged; Opportunistic Infections; Pneumonia, Pneumocystis; Postoperative Complications; Retrospective Studies; Tuberculosis; Young Adult

A 79-year-old man with chronic lymphocytic leukaemia presented with fever and a widespread vesicular rash on 19 November 2014. The patient had not been under immunosuppressive regime for 6 months. He had received a shingles vaccine on 14th October and developed flu-like symptoms after 2 weeks. Intravenous antimicrobial therapy including aciclovir was started. He remained stable with no evidence of systemic involvement. On day 5, he developed respiratory and renal failure that required transfer to intensive care unit. Vesicle fluid, bronchoalveolar lavage and plasma were positive for varicella zoster virus by PCR. Slight clinical improvement allowed extubation on day 16. He subsequently deteriorated and died on day 25. Multiorgan failure was considered the immediate cause of death whereas disseminated varicella zoster infection was stated in the medical certificate as the other condition leading to this outcome. Varicella zoster Oka vaccine strain was detected in vesicle fluid, using PCR.

Topics: Acyclovir; Aged; Fatal Outcome; Herpes Zoster; Herpes Zoster Vaccine; Humans; Leukemia, Lymphocytic, Chronic, B-Cell; Male; Renal Insufficiency; Respiratory Insufficiency

To analyze the clinical presentation and complications of varicella zoster virus (VZV) infection in children with rheumatic diseases treated with immunosuppressive medication such as biological disease-modifying antirheumatic drugs (bDMARDs) and/or conventional disease-modifying antirheumatic drugs (cDMARDs), and to analyze the therapeutic approach to VZV infections with respect to the concomitant immunosuppressive treatment.. Retrospective multicenter study using the Swiss Pediatric Rheumatology registry. Children with rheumatic diseases followed in a Swiss center for pediatric rheumatology and treated with cDMARD and/or bDMARD with a clinical diagnosis of varicella or herpes zoster between January 2004 and December 2013 were included.. Twenty-two patients were identified, of whom 20 were treated for juvenile idiopathic arthritis, 1 for a polyglandular autoimmune syndrome type III, and 1 for uveitis. Of these 22 patients, 16 had varicella and 6 had herpes zoster. Median age at VZV disease was 7.6 years (range 2 to 17 years), with 6.3 years (range 2 to 17 years) for those with varicella and 11.6 years (range 5 to 16 years) for those with herpes zoster. The median interval between start of immunosuppression and VZV disease was 14.1 months (range 1 to 63 months). Two patients had received varicella vaccine (1 dose each) prior to start of immunosuppression. Concomitant immunosuppressive therapy was methotrexate (MTX) monotherapy (n = 9) or bDMARD monotherapy (n = 2), or a combination of bDMARD with prednisone, MTX or Leflunomide (n = 11). Four patients experienced VZV related complications: cellulitis in 1 patient treated with MTX, and cellulitis, sepsis and cerebellitis in 3 patients treated with biological agents and MTX combination therapy. Six children were admitted to hospital (range of duration: 4 to 9 days) and 12 were treated with valaciclovir or aciclovir.. The clinical course of varicella and herpes zoster in children under immunosuppression is variable, with 4 (18 %) of 22 children showing a complicated course. Thorough assessment of VZV disease and vaccination history and correct VZV vaccination according to national guidelines at diagnosis of a rheumatic autoimmune disease is essential to minimize VZV complications during a later immunosuppressive treatment.

Topics: Acyclovir; Adolescent; Antirheumatic Agents; Antiviral Agents; Arthritis, Juvenile; Chickenpox; Child; Child, Preschool; Etanercept; Female; Herpes Zoster; Humans; Immunocompromised Host; Immunosuppressive Agents; Isoxazoles; Leflunomide; Male; Methotrexate; Retrospective Studies; Treatment Outcome; Valacyclovir; Valine; Young Adult

Herpes zoster, defined as the reactivation of a latent varicella-zoster virus (VZV) infection, used to be a serious disease in immunocompromised children until recently. The aim of this study was to describe the clinical presentation of herpes zoster in hospitalized immunocompromised children compared with hospitalized immunocompetent counterparts. We reviewed the hospital charts of 72 children aged 6 months to 18 years diagnosed with herpes zoster and treated with acyclovir in our department covering a 19-year period. Forty-six of the children were immunocompromised which was mainly due to hematologic diseases. There were no differences in the age at which herpes zoster occurred, length of hospitalization, and the location or extent of the skin eruption. General symptoms were observed more frequently in the hospitalized immunocompetent patients compared with the hospitalized immunocompromised children (80% vs. 56%). The average age at which primary VZV infection occurred was higher among the immunocompromised children than the immunocompetent children with the latter group suffering from significantly more primary VZV infections during infancy. The presentation of herpes zoster in immunocompromised children is similar to that of herpes zoster in hospitalized immunocompetent children.

Topics: Acyclovir; Adolescent; Age of Onset; Child; Child, Hospitalized; Child, Preschool; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunocompetence; Immunocompromised Host; Infant; Virus Activation

An 81-year-old woman suffering from sarcoidosis, chronic renal failure caused by hypertention was treated by valacyclovir 500 mg/day, for the diagnosis of herpes zoster of her right back. Her consciousness gradually became worse, and 3 days after taking the drug, she was sent to the emergency department of the hospital. Her conscious level was E2V2M5 (Glasgow Coma Scale) and myoclonus especially in her lower extremities occurred. Head CT and MRI show no obvious, acute abnormal findings other than chronic ischemic lesions, while an electroencephalogram (EEG) shows periodic synchronous discharges (PSDs) and disorganized background activity. Based on these findings, she was diagnosed as valacyclovir-associated acute encephalopathy. After conservative therapy of maintenance hemodialysis, her consciousness gradually improved, and PSDs disappeared accordingly and background activity of EEG became improved. In this case report, we presented valacyclovir-associated neurotoxicity with PSDs in EEG as potentially a surrogate marker. We should be cautious to use valaciclovir which may cause drug-induced encephalopathy especially in elderly or patients with renal failure even though the dose was adjusted in advance.

Topics: Acute Disease; Acyclovir; Aged, 80 and over; Antiviral Agents; Brain Diseases; Electroencephalography; Female; Herpes Zoster; Humans; Kidney Failure, Chronic; Periodicity; Valacyclovir; Valine

Topics: Acyclovir; Administration, Intravenous; Antiviral Agents; Female; Herpes Zoster; Humans; Middle Aged; Torso

Topics: Acyclovir; Antiviral Agents; Brachial Plexus Neuritis; Female; Herpes Zoster; Humans; Middle Aged; Paresis

Brincidofovir (BCV) is a broad-spectrum antiviral agent active in vitro against double-stranded DNA viruses including herpesviruses, adenoviruses, polyomaviruses, and poxviruses. We report successful BCV use in management of disseminated acyclovir- and cidofovir-resistant varicella zoster virus in an immunocompromised hematopoietic stem cell transplant patient with chronic graft-versus-host disease who was intolerant to foscarnet.

Topics: Acyclovir; Adult; Antibiotic Prophylaxis; Antineoplastic Agents; Antiviral Agents; Cytosine; Drug Resistance, Viral; Drugs, Investigational; Female; Foscarnet; Graft vs Host Disease; Hematopoietic Stem Cell Transplantation; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunocompromised Host; Investigational New Drug Application; Leukemia, Myelogenous, Chronic, BCR-ABL Positive; Organophosphonates; Transplantation, Homologous; Valacyclovir; Valine

Infections with adenovirus (AdV) and herpesviruses can result in considerable morbidity and mortality in pediatric hematopoietic stem cell transplant (SCT) recipients. Herpes simplex virus (HSV) reactivations are usually prevented by acyclovir (ACV) prophylaxis, whereas cidofovir (CDV) has been used off indication to manage AdV infections. We report a child with myelodysplastic syndrome undergoing multiple SCT, who experienced HSV-1 disease including severe mucositis and herpetic whitlow, as well as high viral load AdV DNAemia. Both ACV and CDV were ineffective; however, viral loads were decreased with brincidofovir, resulting in viral clearance. A subsequent Epstein-Barr virus disease with relevant meningoencephalitis responded to rituximab.

Topics: Acyclovir; Adenoviridae; Adenovirus Infections, Human; Antibiotic Prophylaxis; Antiviral Agents; Child, Preschool; Cidofovir; Cytosine; DNA, Viral; Drug Resistance, Viral; Epstein-Barr Virus Infections; Female; Foscarnet; Hematopoietic Stem Cell Transplantation; Herpes Simplex; Herpes Zoster; Herpesvirus 1, Human; Herpesvirus 3, Human; Herpesvirus 4, Human; Humans; Immunocompromised Host; Meningoencephalitis; Mucositis; Myelodysplastic Syndromes; Organophosphonates; Rituximab; Viral Load

Rojas J. You're the flight surgeon: F-16 pilot with papular rash. Aerosp Med Hum Perform. 2016; 87(7):661-663.

Topics: Acyclovir; Adult; Analgesics, Opioid; Antiviral Agents; Erythema; Facial Dermatoses; Forehead; Herpes Zoster; Humans; Male; Military Personnel; Pain; Pilots; Vision Disorders

Development of treatment with immunomodulatory agents has improved prognosis of various autoimmune-related diseases. A sphingosin-1-phosphate receptor modulator, or fingolimod, is the first licensed oral drug for relapsing-remitting multiple sclerosis. The agent reduces circulating lymphocytes by trapping T cells in lymph nodes, possibly leading to reactivation of latent viruses. A 41-year-old Japanese woman who had been treated with fingolimod for 2 years presented with unilateral sore throat. Laryngoscopy revealed exudates unilaterally emerging on the left side of her supraglottic region. Serum level of the varicella zoster virus (VZV)-specific IgG was markedly elevated, and a result of genome sequence using the exudates demonstrated VZV as a possible causative pathogen. Fingolimod therapy was discontinued and the patient was successfully treated with intravenous acyclovir. This is the first reported case of fingolimod-associated herpes zoster laryngitis, in which the local VZV reactivation was demonstrated by next-generation sequencing technology. The present case highlights that the occurrence of VZV reactivation should be recalled in any patients undergoing fingolimod therapy.

Topics: Acyclovir; Adult; Female; Fingolimod Hydrochloride; Herpes Zoster; Humans; Immunosuppressive Agents; Laryngitis; Virus Activation

Herpes zoster (HZ) in immunocompetent children is quite uncommon. Initial exposure to the varicella-zoster virus (VZV) may be from a wild-type or vaccine-related strain. Either strain may cause a latent infection and subsequent eruption of HZ. We present a case of HZ in a 15-month-old boy after receiving the varicella vaccination at 12 months of age. A review of the literature regarding the incidence, clinical characteristics, and diagnosis of HZ in children also is provided.

Topics: Acyclovir; Antiviral Agents; Facial Dermatoses; Herpes Zoster; Herpes Zoster Ophthalmicus; Humans; Immunocompetence; Infant; Male; Polymerase Chain Reaction

Topics: Acyclovir; Adult; Antiviral Agents; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Multiple Organ Failure; Skin

A previously healthy 2-year-old girl, vaccinated for varicella at 17 months, was admitted because of left-sided facial herpes zoster caused by vaccine-strain varicella-zoster virus (VZV). She recovered fully with no complication after intravenous treatment using acyclovir. Earlier reports have described that herpes zoster (HZ) rashes caused by vaccine-strain VZV tend to occur on the dermis corresponding to the skin area where the varicella vaccine was received. However, rashes appeared on this girl only in the trigeminal nerve area, which is unrelated to the vaccinated site. Results underscore the importance of distinguishing vaccine-strain VZV from wild-type VZV whenever encountering HZ cases after vaccination, even in immunocompetent children, irrespective of the skin lesion site. Monitoring vaccine-strain HZ incidence rates is expected to elucidate many aspects of varicella vaccine safety.

Topics: Acyclovir; Antiviral Agents; Child, Preschool; Female; Herpes Zoster; Herpes Zoster Vaccine; Herpesvirus 3, Human; Humans; Treatment Outcome; Trigeminal Nerve

Topics: Acyclovir; Antiviral Agents; Child; Hematopoietic Stem Cell Transplantation; Herpes Zoster; Herpesvirus 3, Human; Humans; Leukemia, Myeloid, Acute; Male; Virus Activation

Varicella-zoster virus (VZV) is herpes virus that after its reactivation from nerve ganglia to cause herpes zoster may lead to a variety of neurologic complications, including encephalitis, meningitis, retinal necrosis or myelitis. In addition, VZV can spread to arteries in the central nervous system and cause hemorrhagic or ischemic complications due to an inflammatory vasculopathy. In fact, there is a growing epidemiological and clinical recognition that there is an association between VZV reactivation and subsequent strokes. Herein, we present a case of an immune compromised individual with reactivation of VZV causing dermatomal herpes zoster followed by multifocal vasculopathy. We also review the literature to highlight key aspects of VZV-associated vasculopathy.

Topics: Acyclovir; Antibodies, Viral; Antiviral Agents; Brain Ischemia; Herpes Zoster; Herpesvirus 3, Human; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Stroke

Topics: Acyclovir; Antiviral Agents; Chickenpox Vaccine; Child, Preschool; Female; Herpes Zoster; Humans; Immunogenicity, Vaccine; Infant; Male; Retrospective Studies; Spain

Topics: Abdominal Pain; Acyclovir; Aged; Biopsy, Needle; Colitis, Ulcerative; Female; Follow-Up Studies; Gastric Mucosa; Gastroscopy; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunohistochemistry; Infusions, Intravenous; Rare Diseases; Severity of Illness Index; Treatment Outcome; Viremia

Viral meningitis caused by varicella-zoster virus (VZV) is an uncommon neurological complication of herpes zoster. It may occur before or after the onset of the vesicular rash along the dermatomal distribution, which is the classic presentation of herpes zoster. We describe a case of a 51-year-old immunocompetent Caucasian man who presented with neck and severe right-sided facial pain. Eight days later, he had photophobia and papular rash on his forehead. Cerebrospinal fluid (CSF) examination confirmed aseptic meningitis and CSF PCR detected the presence of VZV DNA. Neurological complications of VZV infection, such as aseptic meningitis, may be difficult to diagnose and can cause delay in treatment, especially in cases with late onset of dermatological manifestations of herpes zoster. Definite diagnosis requires evidence of acute VZV infection in blood or cerebrospinal fluid.

Topics: Acyclovir; Antiviral Agents; Diagnosis, Differential; Exanthema; Herpes Zoster; Humans; Male; Meningitis, Viral; Middle Aged; Polymerase Chain Reaction; Valacyclovir; Valine

Topics: Acute Kidney Injury; Acyclovir; Aged; Attitude to Death; Delusions; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Follow-Up Studies; Herpes Zoster; Humans; Myoclonus; Nervous System Diseases; Neuropsychological Tests; Renal Dialysis; Risk Assessment

Reactivation of varicella zoster virus (VZV) is not uncommon in older patients, particularly in cases of chronic autoimmune disorders and in patients taking immunosuppressant drugs. We present a case of a 57-year-old woman presenting with severe herpes zoster infection, involving the maxillary and ophthalmic branches of the trigeminal nerve. Despite an initial delay in instigating crucial antiviral treatment, the patient achieved an excellent recovery, with only some mild scarring at 2 months postinfection. Trigeminal herpes zoster is a potentially devastating clinical occurrence, and is associated with severe long-term neurological sequelae, including encephalitis, vision loss and postherpetic neuralgia. Physicians must be aware of risk factors and treatment modalities.

Topics: Acyclovir; Antiviral Agents; Clindamycin; Drug Therapy, Combination; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunocompromised Host; Return to Work; Treatment Outcome; Trigeminal Nerve; Virus Activation

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

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

Varicella zoster virus (VZV) is an important pathogen after renal transplant. The aim of this study is to assess the outcome of disseminated Varicella zoster virus infection in renal transplant recipients and to determine potential risk factors for mortality.. From January 2001 to January 2014, we performed 1614 renal transplants at our institution. Varicella zoster virus infection was diagnosed in 41 patients (2.5%). Median time of diagnosis of Varicella zoster virus was 5 years after transplant (range, 3 mo to 13 y).. Thirty-seven patients (90%) had dermatomal distribution of Varicella zoster virus, 4 patients (10%) had disseminated Varicella zoster virus infection. After diagnosis of Varicella zoster virus immunsuppressive therapy was reduced and patients received acyclovir. Cutaneous lesions were healed with a scar in 7 cases (17%). Two patients (5%) developed postherpetic neuralgia. Seventy percent of cases were diagnosed within 5 years, and 92% were diagnosed within 10 years after transplant. Mortality due to Varicella zoster virus was 2% (n = 1). Visceral involvement found to be a risk factor for mortality. Profilactic acyclovir or gancyclovir therapy following transplantation reduced Varicella zoster virus infection. However, Varicella zoster virus seropositivity did not influence fatal outcome.. Early initiation of antiviral therapy may prevent development of complication and visceral dissemination of disease. Active immunization should be applied for all seronegative patients before organ transplant.

Topics: Acyclovir; Adolescent; Adult; Aged; Antiviral Agents; Child; Child, Preschool; Female; Herpes Zoster; Humans; Immunosuppressive Agents; Kidney Transplantation; Male; Middle Aged; Prevalence; Risk Factors; Time Factors; Treatment Outcome; Turkey; Young Adult

The pain of acute herpes zoster (shingles) is severe and difficult to control. The medications used to control pain have a variety of important and potentially serious side effects. To the best of my knowledge, this is the first case report of using a plain topical occlusive dressing to reduce the pain of herpes zoster, avoiding the use of medication.. A 40-year-old Caucasian man and a qualified physician (the author), developed a dermatomal vesicular rash consistent with herpes zoster. Applying plain topical occlusive dressings reduced the severity of his pain to an ignorable level.. Plain topical occlusive dressings provide effective pain relief for acute herpes zoster, thereby avoiding the risks accompanying medication use.

Topics: Acyclovir; Adult; Antiviral Agents; Herpes Zoster; Humans; Male; Occlusive Dressings; Pain; Treatment Outcome; Valacyclovir; Valine

Limited data are available on prophylaxis for herpes simplex virus (HSV) and varicella zoster virus (VZV) disease following autologous hematopoietic stem cell transplantation (auto-HCT). We retrospectively reviewed the clinical charts of 105 consecutive patients who underwent their first auto-HCT at our institution between September 2007 and June 2014. Before August 2009, 30 patients received oral acyclovir at 1000 mg/day until engraftment, whereas after September 2009, 69 patients received oral acyclovir at 200 mg/day. After engraftment, acyclovir was continued at 200 mg/day at the discretion of the attending physicians in both groups. The cumulative incidence of HSV disease at 1 year after auto-HCT was 7.7 and 4.5 % in patients who received oral acyclovir at 1000 and 200 mg/day, respectively (P = 0.75). Patients were next divided into three groups according to the timing at which acyclovir prophylaxis was stopped after auto-HCT; at engraftment, between engraftment and 1 year after auto-HCT, and later than 1 year. The cumulative incidence of VZV disease was 25.8, 7.7, and 0.0 % at 1 year, respectively. This study suggests that low-dose acyclovir prophylaxis may be effective for preventing HSV and VZV disease after auto-HCT. Our findings support the recommendation of acyclovir prophylaxis within the first year after auto-HCT.

Topics: Acyclovir; Adolescent; Adult; Aged; Antiviral Agents; Female; Hematopoietic Stem Cell Transplantation; Herpes Simplex; Herpes Zoster; Humans; Incidence; Male; Middle Aged; Patient Outcome Assessment; Premedication; Retrospective Studies; Risk Factors; Transplantation Conditioning; Transplantation, Autologous; Young Adult

Topics: Acyclovir; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Fingolimod Hydrochloride; Follow-Up Studies; Herpes Zoster; Humans; Immunosuppressive Agents; Middle Aged; Multiple Sclerosis; Recurrence; Risk Assessment; Treatment Outcome; Valacyclovir; Valine

Topics: Acyclovir; Antineoplastic Combined Chemotherapy Protocols; Antiviral Agents; Foot Dermatoses; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunocompromised Host; Lymphoma, B-Cell, Marginal Zone; Male; Middle Aged; Predictive Value of Tests; Risk Factors; Skin; Treatment Outcome; Valacyclovir; Valine; Virus Activation

Clopidogrel is an adenosine diphosphate receptor antagonist used for the prevention of vascular events in patients with atherothrombotic diseases manifested by recent myocardial infarction, ischemic stroke or peripheral arterial disease. Diarrhoea, rash and pruritus are rather common side effects of clopidogrel. Other side effects include epistaxis, nausea, abdominal pain, vomiting, gastritis, gastric and duodenal ulcer. Thrombocytopenia is the most common laboratory abnormality. Leucopenia and neutropenia are rare. We report three cases of purpuric herpes zoster in patients in therapy with clopidogrel. To our knowledge, only one case of haemorrhagic herpes zoster has been published in a patient in therapy with this drug.

Topics: Acyclovir; Aged; Antiviral Agents; Clopidogrel; Female; Herpes Zoster; Humans; Male; Pruritus; Ticlopidine; Treatment Outcome; Valacyclovir; Valine

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

Topics: Acyclovir; Aged; Antiviral Agents; Diagnosis, Differential; Glucocorticoids; Herpes Zoster; Herpesvirus 3, Human; Humans; Male; Neuralgia; Treatment Outcome; Virus Activation

Reactivation of varicella zoster virus occurs more often in the elderly or immunocompromised persons. During pregnancy increased anti-inflammatory cellular response promotes tolerance of foetal antigens. Post-partum a shift towards an inflammatory response may facilitate the reoccurrence of latent infections. Varicella-associated vasculitis can lead to ischaemic lesions in the brain. We report a case of a two-month post-partum woman suffering from headache, nausea, vomiting, photophobia and radicular pain with varicella zoster meningitis and an ischaemic lesion in the splenium of corpus callosum.

Topics: Acyclovir; Adult; Antiviral Agents; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Magnetic Resonance Imaging; Meningitis, Viral; Postpartum Period; Pregnancy; Vasculitis, Central Nervous System

Topics: Acyclovir; Anti-Inflammatory Agents; Antiviral Agents; Brain Stem; Encephalitis; Herpes Zoster; Herpes Zoster Oticus; Humans; Male; Methylprednisolone; Middle Aged

Topics: Acyclovir; Adult; Antiviral Agents; Female; Herpes Zoster; Humans; Trigeminal Nerve

Topics: Acyclovir; Administration, Oral; Adult; Antiviral Agents; Diagnosis, Differential; Facial Dermatoses; Female; Herpes Zoster; Humans; Valacyclovir; Valine

Topics: Acyclovir; Adrenal Cortex Hormones; Adult; Anti-Inflammatory Agents; Antigens, CD; Antiviral Agents; Endophthalmitis; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunophenotyping; Lymphocytosis; Male; Retina; T-Lymphocytes; Vitrectomy; Vitreous Body

Topics: Acyclovir; Adrenal Cortex Hormones; Adult; Aged; Aged, 80 and over; Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Arsenic Trioxide; Arsenicals; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Incidence; Leukemia, Promyelocytic, Acute; Male; Middle Aged; Oxides; Retrospective Studies; Valacyclovir; Valine; Virus Activation

Topics: Acyclovir; Antiviral Agents; Female; Herpes Zoster; Humans; Immunocompetence; Middle Aged; Pain; Skin Diseases, Viral

To evaluate the prophylactic role of long-term ultra-low-dose acyclovir for varicella zoster virus (VZV) disease after allogeneic hematopoietic stem cell transplantation (HSCT).. We evaluated 141 patients who were planned to receive acyclovir at 200mg/day until the end of immunosuppressive therapy and for at least 1 year after HSCT in our center between June 2007 and June 2012.. The cumulative incidence of VZV disease after HSCT was 4.5% at 1 year and 18.3% at 2 years. Protocol violation was the only independent significant factor that increased the incidence of VZV disease (hazard ratio (HR) 7.50, 95% confidence interval (CI) 3.60-15.63). Excluding patients with protocol violation, the discontinuation of acyclovir was the only significant factor for the development of VZV disease (HR 5.90, 95% CI 1.56-22.37). Six patients experienced breakthrough VZV disease, but four of these six had not taken acyclovir for several weeks before breakthrough VZV disease. On the other hand, the cumulative incidence of VZV disease after the cessation of acyclovir was 28.4% at 1 year and 38.0% at 2 years. The proportion of disseminated VZV disease was only 7% and no patient died directly of VZV disease.. This study shows that long-term ultra-low-dose acyclovir appears to be effective for preventing VZV disease, especially disseminated VZV disease, after allogeneic HSCT. We recommend continuing acyclovir until the end of immunosuppressive therapy and for at least 1 year after HSCT, but additional strategies such as the administration of varicella vaccine may be needed to eradicate VZV disease.

Topics: Acyclovir; Adolescent; Adult; Aged; Antiviral Agents; Female; Hematopoietic Stem Cell Transplantation; Herpes Zoster; Herpesvirus 3, Human; Humans; Incidence; Male; Middle Aged; Retrospective Studies; Risk Factors; Time Factors; Transplantation, Homologous; Virus Activation; Young Adult

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

In the era of high-dose chemotherapy and novel antimyeloma agents, the survival of multiple myeloma (MM) patients has substantially improved. Adverse effects, including infections, may however arise in the era of combination antimyeloma therapies. In general, MM patients have shown a risk of varicella zoster virus (VZV) infection of 1-4 %, increasing with bortezomib treatment or transplants, but whether immunomodulatory drugs also bear a risk of VZV/complicated herpes simplex virus (HSV) (e.g., VZV-encephalitis [VZV-E], disseminated VZV-infection [d-VZV-i], or conus-cauda syndrome [CCS]) has not been elucidated. We here assessed VZV, VZV-E, d-VZV-i, and CCS in 93 lenalidomide-treated MM patients, consecutively seen and treated in our department. Patients' data were analyzed via electronic medical record retrieval within our research data warehouse as described previously. Of the 93 MM patients receiving lenalidomide, 10 showed VZV or other complicated VZV/HSV infections. These VZV patients showed defined risk factors as meticulously assessed, including suppressed lymphocyte subsets, substantial cell-mediated immune defects, and compromised humoral immune response. Due to our findings-and in line with an aciclovir prophylaxis in bortezomib and stem cell transplant protocols-we introduced a routine aciclovir prophylaxis in our lenalidomide protocols in May 2012 to minimize adverse events and to avoid discontinuation of lenalidomide treatment. Since then, we have observed no case of VZV/complicated HSV infection. Based on our data, we encourage other centers to also focus on these observations, assess viral infections, and-in those centers facilitating a research data warehouse-advocate an analogue data review as an appropriate multicenter approach.

Topics: Acyclovir; Aged; Aged, 80 and over; Angiogenesis Inhibitors; Antibiotic Prophylaxis; Antiviral Agents; Encephalitis, Varicella Zoster; Female; Germany; Herpes Simplex; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunocompromised Host; Incidence; Lenalidomide; Male; Middle Aged; Multiple Myeloma; Polyradiculopathy; Risk Factors; Simplexvirus; Thalidomide

We retrospectively analyzed 80 instances of varicella zoster virus (VZV) disease in 72 patients who underwent allogeneic hematopoietic stem cell transplantation (HSCT) and examined the clinical differences between localized and disseminated disease. Risk factors for developing VZV dissemination were also evaluated.. Of the 80 instances, 54 instances were localized diseases and 26 were disseminated diseases. Patient characteristics did not differ significantly between the 2 groups, except for the first-line therapy and the duration from symptom onset to treatment. In the disseminated group, intravenous acyclovir was used as the first-line therapy more frequently, and more time elapsed before beginning antiviral therapy compared with the localized group. In multivariate analyses, the duration from symptom onset to treatment was identified as an independent risk factor that significantly affected the development of VZV dissemination. Gender, total body irradiation, and chronic graft-versus-host disease, of which the latter 2 factors were reported as risk factors for the development of VZV disease after HSCT, did not affect the development of VZV dissemination.. Our results suggest that VZV infection or reactivation may easily progress to viremia with delayed use of antiviral agents and may result in VZV dissemination in immunocompromised patients.

Topics: Acyclovir; Adolescent; Adult; Aged; Antiviral Agents; Central Nervous System Viral Diseases; Chickenpox; Disease-Free Survival; Female; Hematopoietic Stem Cell Transplantation; Herpes Zoster; Herpesvirus 3, Human; Humans; Male; Middle Aged; Retrospective Studies; Risk Factors; Survival Rate; Time-to-Treatment; Valacyclovir; Valine; Virus Activation; Young Adult

Herpes zoster is uncommon in the pediatric population. We report a case of herpes zoster in a 2-year-old boy who received the live attenuated varicella zoster virus vaccination at his 12-month pediatric visit. The child was treated with acyclovir and recovered without complications.

Topics: Acyclovir; Antiviral Agents; Chickenpox Vaccine; Child, Preschool; Herpes Zoster; Herpesvirus 3, Human; Humans; Male; Vaccination; Vaccines, Attenuated; Virus Activation; Virus Latency

Topics: Acyclovir; Antiviral Agents; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Infant; Leg; Skin

Topics: Acyclovir; Adult; Antiviral Agents; Diagnosis, Differential; Herpes Zoster; Humans; Male

There is no recommendation for the treatment of herpes zoster neuralgia in pregnancy, as it even sometimes needs administration of strong opioids.. Here, we report a pregnant woman with severe zoster neuralgia who responded favorably to acetaminophen. Due to the drug's safe profile and good efficacy, acetaminophen can be used as an alternative for herpetic neuralgia in pregnant women. However, controlled studies are still needed.

Topics: Acetaminophen; Acyclovir; Adult; Analgesics, Non-Narcotic; Antiviral Agents; Drug Therapy, Combination; Female; Herpes Zoster; Humans; Neuralgia; Pregnancy; Pregnancy Complications, Infectious

The alphaherpesvirus varicella-zoster virus (VZV) causes chickenpox and shingles. Current treatments are acyclovir (ACV) and its derivatives, foscarnet and brivudine (BVdU). Additional antiviral compounds with increased potency and specificity are needed to treat VZV, especially to treat post-herpetic neuralgia. We evaluated β-l-1-[5-(E-2-bromovinyl)-2-(hydroxymethyl)-1,3-(dioxolan-4-yl)] uracil (l-BHDU, 1) and 5'-O-valyl-l-BHDU (2) in three models of VZV replication: primary human foreskin fibroblasts (HFFs), skin organ culture (SOC) and in SCID-Hu mice with skin xenografts. The efficacy of l-BHDU in vivo and its drug-drug interactions were previously not known. In HFFs, 200μM l-BHDU was noncytotoxic over 3days, and l-BHDU treatment reduced VZV genome copy number and cell to cell spread. The EC50 in HFFs for l-BHDU and valyl-l-BHDU were 0.22 and 0.03μM, respectively. However, l-BHDU antagonized the activity of ACV, BVdU and foscarnet in cultured cells. Given its similar structure to BVdU, we asked if l-BHDU, like BVdU, inhibits 5-fluorouracil catabolism. BALB/c mice were treated with 5-FU alone or in combination with l-BHDU or BVdU. l-BHDU did not interfere with 5-FU catabolism. In SCID-Hu mice implanted with human skin xenografts, l-BHDU and valyl-l-BHDU were superior to ACV and valacyclovir. The maximum concentration (Cmax) levels of l-BHDU were determined in mouse and human tissues at 2h after dosing, and comparison of concentration ratios of tissue to plasma indicated saturation of uptake at the highest dose. For the first time, an l-nucleoside analog, l-BHDU, was found to be effective and well tolerated in mice.

Topics: Acyclovir; Animals; Antiviral Agents; Bromodeoxyuridine; Cell Line; Chickenpox; Dioxolanes; Drug Therapy, Combination; Fluorouracil; Foscarnet; Herpes Zoster; Herpesvirus 3, Human; Humans; Mice; Mice, Inbred BALB C; Mice, SCID; Nucleosides; Organ Culture Techniques; Skin; Uracil; Virus Replication

Topics: Acyclovir; Child; Exanthema; Female; Herpes Zoster; Humans; Pain

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

Topics: Acyclovir; Administration, Intravenous; Antiviral Agents; Arm; Blister; Child; Female; Herpes Zoster; Humans

Herpes zoster myelitis is a rare condition, usually seen in aged and immunocompromised patients. Due to atypical presen-tations it can be hard to diagnose. Intraspinal lesions on magnetic resonance imaging (MRI) support the diagnosis. We present a 39-year-old otherwise healthy male with symptoms of viral meningitis and rapidly progressing symptoms of myelitis. Lumbar puncture showed increased levels of monocytes and varicella zoster virus DNA. Despite a negative MRI, based on a few previous case reports and because of lack of progress on antiviral treatment, treatment with steroids was established early, recovering the patient dramatically. This supports that a combination of antiviral treatment and steroids may be a more efficient treatment of zoster myelitis and reminds us that the diagnosis cannot be excluded by a negative MRI.

Topics: Acyclovir; Adult; Antiviral Agents; Drug Therapy, Combination; Glucocorticoids; Herpes Zoster; Herpesvirus 3, Human; Humans; Magnetic Resonance Imaging; Male; Methylprednisolone; Myelitis

In comparison to the range of antibiotics used in medicine, the spectrum of antifungal and antiviral drugs used in primary dental care is relatively limited. In practical terms, there are only three antifungal agents and two antiviral agents that have a role. This paper will describe the clinical presentation of orofacial candidal and viral infections and the use of antimicrobial drugs in their management.

Topics: Acyclovir; Amphotericin B; Antifungal Agents; Antiviral Agents; Candidiasis, Oral; Cheilitis; Dental Care; Fluconazole; Glossitis; Guanine; Herpes Zoster; Humans; Miconazole; Mouth Diseases; Nystatin; Primary Health Care; Stomatitis, Herpetic

Herein we report a rare case of disseminated herpes zoster(HZ) infection involving two widely separated bilateral dermatomes in an immunocompetent host. HZ involving two widely separated areas simultaneously is referred to as HZ duplex bilateralis. It is very rare, with an incidence of less than 0.1 percent of all HZ cases, and usually develops in immunocompromised patients.

Topics: Acyclovir; Antiviral Agents; Herpes Zoster; Humans; Male; Middle Aged; Valacyclovir; Valine

Topics: Acyclovir; Adult; Antiviral Agents; Diagnosis, Differential; Female; Herpes Zoster; Humans; Valacyclovir; Valine

Varicella zoster virus (VZV) disease is one of the major infectious complications that can occur after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Many reports have shown visceral VZV infection, a special type of VZV disease, to be rare. However, few studies so far have included a large number of patients.. Visceral VZV infection was found in 20 (0.8%) of 2411 patients who underwent allo-HSCT at our hospitals. Seventeen (85%) patients were taking immunosuppressive agents at the time of presentation with zoster. The presenting symptom was abdominal pain in 16 patients (80%), unconsciousness in 3 patients (15%), and no symptoms in 1 patient. The mean time interval from allo-HSCT to symptomatic visceral VZV infection was 273 days (103-800 days). The eruptions appeared within 3 days (0-13) after the first symptoms. Treatment with intravenous acyclovir was initiated before the appearance of eruptions in 3 of 18 patients (all 3 survived) with vesicular eruptions, the same day in 12 patients (11 survived, 1 died), and after the appearance in 3 patients (1 survived, 2 died). The overall mortality was 20%.. In conclusion, these data confirm that the incidence of visceral VZV infection is infrequent, but this disease is serious. When patients being treated with immunosuppressive agents demonstrate abdominal pain or unconsciousness, the possibility of visceral VZV infection should be considered as well as earlier therapeutic intervention.

Topics: Abdominal Pain; Acyclovir; Adult; Antiviral Agents; Chronic Disease; Female; Graft vs Host Disease; Hematopoietic Stem Cell Transplantation; Herpes Zoster; Herpesvirus 3, Human; Humans; Incidence; Male; Middle Aged; Transplantation, Homologous; Unconsciousness; Virus Activation; Viscera; Young Adult

We describe a patient with zoster paresis and an MRI that revealed extensive spinal cord lesions from the upper cervical to the lower thoracic spinal cord. Importantly, the patient reported considerable spontaneous improvement in strength 2-3 weeks after zoster. This report reveals a previously undescribed remarkable preponderance of MRI lesions far beyond the site of zoster rash and focal lower motor neuron weakness.

Topics: Acyclovir; Aged; Antiviral Agents; Exanthema; Female; Herpes Zoster; Humans; Magnetic Resonance Imaging; Motor Neuron Disease; Muscle Weakness; Spinal Cord; Spinal Nerve Roots; Valacyclovir; Valine

Urinary retention is a common acute presentation for men in their later decades. Potential contributing pathologies are numerous. We report an unusual case of acute urinary retention requiring catheterisation secondary to sacral herpes zoster reactivation (S2-4) in an 88-year-old man with minimal preceding obstructive symptoms.

Topics: Acyclovir; Aged, 80 and over; Antiviral Agents; Herpes Zoster; Humans; Male; Urinary Catheterization; Urinary Retention

Topics: Acyclovir; Anti-Bacterial Agents; Antiviral Agents; Exanthema; Facial Dermatoses; Floxacillin; Gingival Diseases; Herpes Zoster; Herpesvirus 3, Human; Humans; Male; Maxillary Diseases; Middle Aged; Mouth Mucosa; Osteonecrosis; Penicillin G; Virus Activation

Mielitis cervicodorsal secundaria a infeccion por el virus varicela zoster en un paciente inmunocompetente.

Topics: Acyclovir; Antiviral Agents; Arm; Athetosis; Bromodeoxyuridine; Drug Therapy, Combination; Herpes Zoster; Herpesvirus 3, Human; Humans; Hyperalgesia; Immunocompetence; Male; Methylprednisolone; Middle Aged; Movement Disorders; Myelitis; Neck; Neuralgia, Postherpetic; Somatosensory Disorders; Thorax; Virus Activation

Neurological disorders and conditions affecting the maxillofacial region result in disabilities that affect an individual's functioning. Sensory or motor disturbances of the nerves may be caused by trauma, infections, pressure effect or infiltration by tumours or other health conditions. Two rare cases of nerve afflictions are described here with their typical clinical features. The first case had an involvement of maxillary, mandibular and ophthalmic divisions of the trigeminal nerve (sensory) due to herpes zoster infection in a very young patient and the second case had a unilateral isolated hypoglossal nerve palsy (motor) secondary to infiltration of the nerve by carcinoma of pyriform fossa.

Topics: Acyclovir; Adolescent; Adult; Antiviral Agents; Cranial Nerve Neoplasms; Head and Neck Neoplasms; Herpes Zoster; Humans; Hypoglossal Nerve Diseases; Male; Neoplasm Metastasis; Pyriform Sinus; Tongue Diseases; Trigeminal Nerve Diseases

The development of neurological complications due to varicella zoster virus (VZV) reactivation is relatively uncommon, particularly in the case of immunocompetent patients. Only a few cases have been described in the literature, most of which involved adult or elderly patients.. Two days after his pediatrician had diagnosed herpes zoster and prescribed oral acyclovir 400 mg three times a day, a 14-year-old boy was admitted to our hospital because of mild fever, severe headache, slowness, drowsiness and vomiting. A cerebrospinal fluid examination was performed and showed an increased protein concentration (95 mg/dL), normal glucose level (48 mg/dL; blood glucose level, 76 mg/dL) and lymphocytic pleocytosis (1,400 lymphocytes/μL), and VZV DNA was detected by means of polymerase chain reaction (1,250 copies/mL). The results of immunological screening for HIV, lymphocyte subpopulation counts, serum immunoglobulin and complement (C3 and C4) levels, vaccine responsiveness and lymphocytes stimulation tests were unremarkable. Acyclovir was administered intravenously at a dose of 10 mg/kg three times a day and continued for 10 days. The therapy was highly effective and the patient's clinical condition rapidly improved: fever disappeared after two days, and all of the signs and symptoms of neurological involvement after four days. The skin lesions resolved in about one week, and no pain or dysesthesia was ever reported. Given the favourable evolution of the illness, the child was discharged without further therapy after the 10-day treatment. The findings of a magnetic resonance examination immediately after the discontinuation of the antiviral therapy were normal, and a control examination carried out about four weeks later did not find any sign or symptom of disease.. VZV reactivation can also lead to various neurological complications in immunocompetent children. Prompt therapy with acyclovir and the integrity of the immune system are important in conditioning outcome, but other currently unknown factors probably also play a role.

Topics: Acyclovir; Adolescent; Follow-Up Studies; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunocompetence; Infusions, Intravenous; Magnetic Resonance Imaging; Male; Meningitis, Viral; Rare Diseases; Severity of Illness Index; Treatment Outcome; Virus Activation

Topics: Acyclovir; Antiviral Agents; Cyclophosphamide; Granulomatosis with Polyangiitis; Herpes Zoster; Humans; Immunocompromised Host; Immunosuppressive Agents; Male; Middle Aged

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

Varicella zoster virus (VZV) infections are a relevant cause of morbidity and mortality in hematological patients and especially in hematopoietic stem cell transplant (HSCT) recipients. The present study aimed to investigate the prevalence and clinical significance of viral persistence and antiviral resistance by systematically analyzing all episodes of VZV diagnosed in our laboratory in pediatric and adult hematological patients between 2007 and 2010.. Patient charts were reviewed to document patient and disease characteristics. VZV loads were determined in all available clinical samples from the day of diagnosis and thereafter. Persistent VZV infection was defined as a VZV infection that lasted at least 7 days. Analysis of resistance was performed in all patients with persistent VZV infection by sequence analysis of viral thymidine kinase and DNA polymerase genes.. In total, 89 episodes occurred in 87 patients, of whom 65 were recipients of an allogeneic HSCT. Follow-up samples were available in 54 episodes. Persistent VZV was demonstrated in 32 of these episodes (59%). Complications occurred in 16 of the persistent episodes (50%) vs 2 of 22 nonpersistent episodes (9%). Mutations possibly associated with resistance were found in 27% of patients with persistent VZV, including patients with treatment-unresponsive dermatomal zoster that progressed to severe retinal or cerebral infection.. In hematological patients, VZV-related complications occur frequently, especially in persistent infections. Antiviral resistance is a relevant factor in persistent infections and needs to be investigated in various affected body sites, especially when clinical suspicion of treatment failure arises.

Topics: Acyclovir; Adolescent; Adult; Antibodies, Viral; Antineoplastic Agents; Antiviral Agents; Blood; Child; Combined Modality Therapy; Drug Resistance, Viral; Female; Hematologic Diseases; Hematopoietic Stem Cell Transplantation; Herpes Zoster; Herpesvirus 3, Human; Humans; Male; Polymerase Chain Reaction; Postoperative Complications; Viral Load; Virus Activation; Virus Replication; Young Adult

Valacyclovir induced neurotoxicity is a life-threatening complication, usually starting 24-48 h after drug-peak serum concentrations. The elderly with impaired renal function seem to be the most susceptible group to valacyclovir neurotoxicity. Although hemodialysis is considered the best method for rapid drug removal, our case showed that intensive peritoneal dialysis regimen leads to the recovery of neurotoxicity after 3 days.

Topics: Acute Kidney Injury; Acyclovir; Aged; Antiviral Agents; Female; Follow-Up Studies; Herpes Zoster; Humans; Kidney Failure, Chronic; Kidney Function Tests; Peritoneal Dialysis, Continuous Ambulatory; Risk Assessment; Treatment Outcome; Valacyclovir; Valine

Post-herpetic neuralgia (PHN) is the most significant complication of herpes zoster caused by reactivation of latent Varicella-Zoster virus (VZV). We undertook a heterologous infection in vitro study to determine whether PHN-associated VZV isolates induce changes in sodium ion channel currents known to be associated with neuropathic pain. Twenty VZV isolates were studied blind from 11 PHN and 9 non-PHN subjects. Viruses were propagated in the MeWo cell line from which cell-free virus was harvested and applied to the ND7/23-Nav1.8 rat DRG x mouse neuroblastoma hybrid cell line which showed constitutive expression of the exogenous Nav 1.8, and endogenous expression of Nav 1.6 and Nav 1.7 genes all encoding sodium ion channels the dysregulation of which is associated with a range of neuropathic pain syndromes. After 72 hrs all three classes of VZV gene transcripts were detected in the absence of infectious virus. Single cell sodium ion channel recording was performed after 72 hr by voltage-clamping. PHN-associated VZV significantly increased sodium current amplitude in the cell line when compared with non-PHN VZV, wild-type (Dumas) or vaccine VZV strains ((POka, Merck and GSK). These sodium current increases were unaffected by acyclovir pre-treatment but were abolished by exposure to Tetrodotoxin (TTX) which blocks the TTX-sensitive fast Nav 1.6 and Nav 1.7 channels but not the TTX-resistant slow Nav 1.8 channel. PHN-associated VZV sodium current increases were therefore mediated in part by the Nav 1.6 and Nav 1.7 sodium ion channels. An additional observation was a modest increase in message levels of both Nav1.6 and Nav1.7 mRNA but not Nav 1.8 in PHN virally infected cells.

Topics: Acyclovir; Animals; Cell Line; Gene Expression Regulation; Herpes Zoster; Herpesvirus 3, Human; Humans; Mice; NAV1.6 Voltage-Gated Sodium Channel; NAV1.7 Voltage-Gated Sodium Channel; NAV1.8 Voltage-Gated Sodium Channel; Neuralgia, Postherpetic; Rats; Tetrodotoxin

Topics: Acute Disease; Acyclovir; Antiviral Agents; Confusion; Electroencephalography; Herpes Zoster; Humans; Kidney Failure, Chronic; Male; Middle Aged; Renal Dialysis

Topics: Acyclovir; Aged; Antiviral Agents; Granuloma; Herpes Zoster; Humans; Leukemia-Lymphoma, Adult T-Cell; Male; Skin Diseases

Although varicella zoster virus latency has been demonstrated in several sensory ganglia, herpes zoster usually effects only one single, either left or right, dermatome in half of the body. In immunocompromised patients, more than one contiguous unilateral dermatome may be involved. Bilateral non-contiguous herpes zoster, also termed herpes zoster duplex, is rarely reported. Chronic varicella zoster virus skin infection is another rare entity encountered in HIV-infected and immunocompromised patients, often associated with aciclovir resistance. We describe here a patient with chronic lymphocytic leukaemia, who presented simultaneously non-contiguous bilateral and chronic herpes zoster lasting for more than 2 months, with resistance to aciclovir. To our knowledge, this is the first report of chronic herpes zoster duplex bilateralis. Physicians should be aware of and recognize these atypical manifestations of varicella zoster virus.

Topics: Acyclovir; Aged; Antiviral Agents; Bronchopneumonia; Chronic Disease; Drug Resistance, Viral; Fatal Outcome; Herpes Zoster; Humans; Immunocompromised Host; Leukemia, Lymphocytic, Chronic, B-Cell; Male; Skin Diseases, Viral

Topics: Acyclovir; Adult; Aged; Aged, 80 and over; Antibiotic Prophylaxis; Antibodies, Viral; Female; Hematologic Neoplasms; Hematopoietic Stem Cell Transplantation; Herpes Zoster; Herpes Zoster Vaccine; Herpesvirus 3, Human; Humans; Immunoglobulin G; Male; Middle Aged

Crude ethanol extracts from Ficus benjamina leaves strongly inhibit Herpes Simplex Virus 1 and 2 (HSV-1/2) as well as Varicella Zoster Virus (VZV) cell infection in vitro. Bioassay-guided fractionation of the crude extract demonstrated that the most efficient inhibition of HSV-1 and HSV-2 was obtained with the flavonoid fraction. The present study was aimed to further isolate, purify and identify substances with potent antiviral activity from the flavonoid fraction of F. benjamina extracts. Flavonoids were collected from the leaf ethanol extracts through repeated purification procedure and HPLC analysis. The antiviral activity of each substance was then evaluated in cell culture. Three known flavone glycosides, (1) quercetin 3-O-rutinoside, (2) kaempferol 3-O-rutinoside and (3) kaempferol 3-O-robinobioside, showing highest antiviral efficiency were selected and their structure was determined by spectroscopic analyses including NMR and mass spectrometry (MS). These three flavones were highly effective against HSV-1 reaching a selectivity index (SI) of 266, 100 and 666 for compound 1, 2 and 3, respectively, while the SI of their aglycons, quercetin and kaempferol amounted only in 7.1 and 3.2, respectively. Kaempferol 3-O-robinobioside showed similar SI to that of acyclovir (ACV), the standard anti-HSV drug. Although highly effective against HSV-1 and HSV-2, these flavone glycosides did not show any significant activity against VZV.

Topics: Acyclovir; Antiviral Agents; Biological Assay; Cell Survival; Cytopathogenic Effect, Viral; Ficus; Flavones; Glycosides; Herpes Simplex; Herpes Zoster; Herpesvirus 1, Human; Herpesvirus 2, Human; Herpesvirus 3, Human; Molecular Structure; Plant Extracts; Plant Leaves

Topics: Acyclovir; Adrenal Cortex Hormones; Adult; Aged; Antibodies, Viral; Anticonvulsants; Antiviral Agents; Drug Hypersensitivity; Eosinophilia; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Male; Middle Aged; Retrospective Studies; Virus Activation

Topics: Acyclovir; Adolescent; Antiviral Agents; Enzyme-Linked Immunosorbent Assay; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Injections, Intravenous; Meningitis, Viral; Neurologic Examination

Topics: Acyclovir; Amines; Analgesics; Antiviral Agents; Cyclohexanecarboxylic Acids; Female; gamma-Aminobutyric Acid; Herpes Zoster; Humans; Male; Neuralgia, Postherpetic; Valine

Children infrequently are afflicted with herpes zoster (HZ). Activation of latent varicella-zoster virus (VZV) in a partially immune host results in HZ. Herpes zoster in children can be benign or with varied severity, especially in cases associated with malignancy. Because of its rarity, we report widespread multisegmental HZ primarily presenting on the right side of the body and abdomen in a 6-year-old immunocompetent girl.

Topics: Acyclovir; Antiviral Agents; Child; Female; Herpes Zoster; Humans; Immunocompetence

Topics: Acne Keloid; Acyclovir; Adult; Anti-HIV Agents; Antiviral Agents; Azithromycin; Black People; Cicatrix; Disease Susceptibility; Hair Follicle; Herpes Zoster; HIV Infections; Humans; Male; Neck; Sebaceous Glands; Triamcinolone Acetonide; Valacyclovir; Valine

Topics: Acyclovir; Adult; Antigens, Viral; Antiviral Agents; Biomarkers; Diagnosis, Differential; Herpes Simplex; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunohistochemistry; Male; Penile Diseases; Polymerase Chain Reaction; Treatment Outcome; Valacyclovir; Valine

Topics: Acyclovir; Adrenal Cortex Hormones; Anesthetics; Antiviral Agents; Herpes Zoster; Humans; Neuralgia, Postherpetic

Herpes zoster is a common dermatologic disease characterized by unilateral pain and vesicular lesions over the unilateral sensory dermatomes being caused by the reactivation of varicella zoster virus, and its incidence seems to be increasing recently. In case of involving the ganglion of the fifth cranial nerve (trigeminal nerve), it can descend down the affected nerve into the skin, then producing an eruption in the dermatome. Among the patients with this disease, about 40% to 50% had associated conditions such as diabetes mellitus, hypertension, pulmonary tuberculosis, liver diseases, peptic ulcer, hypothyroidism, or pharyngitis but rarely facial trauma. Generally, herpes zoster was commonly associated with systemic disorders, and the treatment duration was prolonged in associated diseases. However, herpes zoster occurring specifically at the site of previously traumatized facial bone has not yet been reported. Retrospective study of 1 case of herpes zoster with blow-out fracture, which had been treated with acyclovir and steroid, was done. Follow-up length was about 3 months. After treatment, the patient became stable, and there was no complication. We treated herpes zoster developing within a recent operative subciliary scar, and the case is presented with the review of literature. Finally, facial trauma or reconstruction of the orbital floor with alloplastic implant might be a risk factor for herpes zoster in traumatized patient.

Topics: Acyclovir; Adult; Antiviral Agents; Cicatrix; Herpes Zoster; Humans; Male; Orbital Fractures; Risk Factors

This study was performed during an era of partial vaccination with varicella vaccine in Israel to characterize ambulatory pediatric herpes zoster (HZ) cases in a population with partial varicella vaccination coverage.. Data were collected from computerized databases of a population of 114,000 children. Records of children aged 0-18 years, diagnosed with HZ during 2006 to 2008 were reviewed by pediatric infectious diseases experts. Telephone interviews were done with a sample of the parents to get further clinical details.. Of 692 medical records reviewed, 450 cases were approved for analysis, and 77 interviews were conducted. Incidence of HZ was 130 of 100,000 person life-years. Peak incidence was detected in children aged 9-11 years (222/100,000 person life-years). Pain and fever accompanied 52% and 13% of episodes, respectively. Higher risk for HZ was found in children who had varicella during their first year of life (relative risk and 95% confidence interval: 13.5[9.6-18.8]; P < 0.001), and in children who had varicella during the second year of life (relative risk = 2 [1.5-2.6]; P < 0.001). Vaccination was found to be protective against HZ (relative risk = 0.42 [0.33-0.55]; P < 0.001).. The epidemiology of HZ seems to be changing in a population with partial varicella vaccination rate. Our results may suggest that children who contracted chicken pox in their first year of life may benefit from varicella vaccination.

Topics: Acyclovir; Adolescent; Antiviral Agents; Chi-Square Distribution; Chickenpox Vaccine; Child; Child, Preschool; Exanthema; Female; Herpes Zoster; Humans; Incidence; Infant; Interviews as Topic; Israel; Male; Retrospective Studies; Vaccination

Topics: Acyclovir; Aged, 80 and over; Antibodies, Monoclonal, Murine-Derived; Antiviral Agents; Blister; Hemorrhage; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunologic Factors; Male; Opportunistic Infections; Purpura, Thrombocytopenic, Idiopathic; Rituximab; Valacyclovir; Valine

Topics: Acyclovir; Adult; Animals; Antiviral Agents; Blister; Diagnosis, Differential; Female; Hand Dermatoses; Hedgehogs; Herpes Zoster; Humans; Skin

There are no comparative data on the treatment duration of cutaneous herpes zoster (HZ) in patients with HIV infection. We retrospectively reviewed all 51 adult patients with HIV infection presenting with cutaneous HZ in the 15-year period 1995-2009 treated with intravenous aciclovir alone. The median CD4 count was 297 (range 10-703) cells/mm(3). There were 44 episodes of localized and seven episodes of disseminated cutaneous HZ. Patients received a median of nine (range 3-17) doses of intravenous aciclovir given at a median dose of 6.5 (range 2.9-10.8) mg/kg eight hourly. One patient (2%) relapsed early and four patients (7.8%) relapsed late with further episodes of cutaneous HZ. Seven patients (13.7%) developed postherpetic neuralgia. Three days of intravenous aciclovir is effective treatment for cutaneous HZ in patients with HIV infection.

Topics: Acyclovir; Adult; Aged; Antiviral Agents; CD4 Lymphocyte Count; Female; Herpes Zoster; HIV Infections; Humans; Infusions, Intravenous; Male; Middle Aged; Neuralgia, Postherpetic; Recurrence; Retrospective Studies; Treatment Outcome

Solid organ transplantation no longer is considered a rare procedure. After undergoing transplants, patients will require both routine and emergent oral health care, and it can be provided safely in private dental offices. Transplant recipients are immunosuppressed, and for this reason clinicians should be alert for oral abnormalities in such patients.. A 53-year-old man with a history of cardiac transplant and multiple medical comorbidities had unusual mucosal plaques, oral discomfort and skin lesions. As a result of his compromised immune system, the clinical presentation of his condition-which proved to be herpes zoster (HZ) virus, also called "shingles"-was atypical, resulting in a delay of the definitive diagnosis.. and. HZ is a serious infection in the immunocompromised population. Timely diagnosis and treatment of this condition is necessary to prevent treatment delay and medication errors.

Topics: Acyclovir; Antiviral Agents; Heart Transplantation; Herpes Zoster; Humans; Immunocompromised Host; Male; Middle Aged; Mouth Diseases; Mouth Mucosa; Skin

A 40-year-old Japanese man with acute myeloid leukemia received allogeneic bone marrow transplantation. On day 101, varicella-zoster virus (VZV) infection occurred, but was improved by administration of acyclovir and immunoglobulin. On day 119, he complained of numbness and double vision, and he was admitted due to exacerbation of the symptoms. The findings of cerebrospinal fluid and magnetic resonance image examination were consistent with the diagnosis of immune-mediated encephalomyelitis (IMEM). Intravenous immunoglobulin therapy was effective and his neurological findings dramatically improved without recurrence. IMEM is a rare non-infectious inflammatory demyelinating disease that can occur after transplantation. We herein describe a case report with a review of the associated literature.

Topics: Acyclovir; Adult; Antiviral Agents; Encephalomyelitis; Herpes Zoster; Humans; Immunoglobulins, Intravenous; Magnetic Resonance Imaging; Male; Stem Cell Transplantation; Transplantation, Homologous

Topics: Acyclovir; Aged, 80 and over; Antiviral Agents; Diagnosis, Differential; Herpes Zoster; Humans; Male; Skin Diseases, Vesiculobullous

Topics: Acyclovir; Aged; Antiviral Agents; Exanthema; Female; Herpes Zoster; Herpes Zoster Vaccine; Humans; Male; Neuralgia, Postherpetic; Risk Factors; Spouses; Valacyclovir; Valine

Topics: Acyclovir; Adult; Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols; Antiviral Agents; Boronic Acids; Bortezomib; Dose-Response Relationship, Drug; Female; Herpes Zoster; Humans; Male; Middle Aged; Multiple Myeloma; Pyrazines; Retrospective Studies

Topics: Acyclovir; Aged, 80 and over; Antiviral Agents; DNA, Viral; Duodenal Ulcer; Esophageal Diseases; Herpes Zoster; Herpesvirus 3, Human; Humans; Male; Stomach Ulcer; Ulcer

Topics: Acyclovir; Adult; Antiviral Agents; Biopsy; Female; Gastric Mucosa; Gastritis; Herpes Zoster; Herpesvirus 3, Human; Humans; Proton Pump Inhibitors

In patients with multiple myeloma (MM), bortezomib is associated with a significant risk of Varicella zoster virus (VZV) reactivation. There are some reports that acyclovir reduces the risk of VZV reactivation. We assessed whether VZV reactivation could be reduced by using prophylactic valacyclovir at a dose of 500 mg daily.. We retrospectively evaluated 32 patients with MM who received bortezomib and valacyclovir prophylaxis at the Kanazawa Medical University Hospital. Patients received valacyclovir prophylaxis orally at a dose of 500 mg daily, without cessation during bortezomib treatment.. The median age was 69 years (range=45-90 years). Fifteen patients were male and seventeen were female. The median bortezomib dose was 37.0 mg/m(2) (range=5.2-167.6 mg/m(2)). All patients also received corticosteroids. The median duration of valacyclovir prophylaxis was 301 days (range=24-1206 days) and the median valacyclovir dose was 150.5 g (range=12-603 g). VZV reactivation developed in only one patient during valacyclovir prophylaxis. VZV reactivation did not develop in three patients who had a past history of VZV reactivation without valacyclovir prophylaxis. Adverse events over grade 3 associated with valacyclovir were not observed.. Valacyclovir at a dose of 500 mg daily appears to be effective at preventing VZV reactivation and was well-tolerated by patients with MM who received bortezomib.

Topics: Acyclovir; Aged; Aged, 80 and over; Antineoplastic Agents; Antiviral Agents; Boronic Acids; Bortezomib; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Male; Middle Aged; Multiple Myeloma; Pyrazines; Retrospective Studies; Valacyclovir; Valine; Virus Activation

Acyclovir is widely used in the treatment of herpes virus infections, particularly herpes simplex virus and varicella-zoster virus. Acyclovir, when given promptly upon the start of a herpes zoster eruption, speeds healing and diminishes acute pain.. Because acyclovir is a commonly used medication, it is crucial for health providers to be aware of appropriate dosing as well as possible side effects. We present this case to increase awareness of the potential for inappropriate dosing of acyclovir and the presentations of patients with toxic effects.. We report the case of a 65-year-old man with a past medical history significant for chronic kidney disease who presented to the Emergency Department with progressive confusion and ataxia over 2 days. Thorough questioning in the patient's native language revealed that he had recently started a medication for a "rash." Neither he nor his family knew the name of the new medication; further investigation revealed it to be acyclovir. Although other diagnoses were considered in the differential diagnosis for this patient with altered mental status, he was treated for presumed acyclovir toxicity and given prompt dialysis, upon which his symptoms resolved.. It is important for physicians to remember that even common medications such as acyclovir can have serious side effects and complications. In this case, renal dosing was not used in a patient on hemodialysis. Acyclovir must be renally dosed and carefully monitored through drug level measurement in patients with limited kidney function to prevent serious side effects, such as the neurological sequelae demonstrated in this case report. Emergency physicians should be aware of the potential for inappropriate dosing of this medication and the presentations of patients with toxic effects.

Topics: Acyclovir; Aged; Antiviral Agents; Ataxia; Confusion; Herpes Zoster; Humans; Kidney Failure, Chronic; Male; Mental Disorders; Renal Dialysis; Treatment Outcome

Acyclovir prophylaxis has been considered as mandatory for patients receiving bortezomib because herpes zoster is a common adverse event associated with the use of bortezomib. Although the minimal effective dose of acyclovir for prophylaxis has not yet established, the efficacy of low-dose acyclovir prophylaxis, 400 mg once daily, has been suggested.. We retrospectively reviewed the patients receiving the low-dose acyclovir which was defined as the once daily administration of acyclovir 400 or 200 mg. All patients received bortezomib-containing chemotherapy in the setting of relapsed or refractory myeloma.. Eighty patients received bortezomib-containing treatment as a salvage therapy. All patients received at least one or more treatments prior to bortezomib treatment, including autologous stem cell transplantation. Sixty-one patients received 400 mg of acyclovir once daily while 19 patients received 200 mg. Although seven cases of herpes zoster were observed from 80 patients (7/80, 8.75%), two cases of herpes zoster received 400 mg during the limited period from the first to the fourth cycle, and the other five received 200 mg. Therefore, there was no herpes zoster in patients who received 400 mg of acyclovir till the last cycle of bortezomib treatment. There were no adverse events associated with the use of acyclovir prophylaxis.. The administration of acyclovir 400 mg once daily during the bortezomib treatment is an effective prophylaxis for herpes zoster in patients receiving bortezomib irrespective of disease state and the type of chemotherapy regimen.

Topics: Acyclovir; Adult; Aged; Aged, 80 and over; Antineoplastic Agents; Antiviral Agents; Boronic Acids; Bortezomib; Dose-Response Relationship, Drug; Drug Resistance, Neoplasm; Female; Follow-Up Studies; Herpes Zoster; Herpesvirus 3, Human; Humans; Male; Middle Aged; Multiple Myeloma; Neoplasm Staging; Pyrazines; Retrospective Studies; Salvage Therapy; Survival Rate; Treatment Outcome

Topics: Acute Disease; Acyclovir; Antiviral Agents; Colon; Constipation; Diagnosis, Differential; Follow-Up Studies; Herpes Zoster; Herpesvirus 3, Human; Humans; Injections, Intravenous; Intestinal Pseudo-Obstruction; Magnetic Resonance Imaging; Male; Middle Aged; Peristalsis; Radiography, Abdominal; Severity of Illness Index; Thoracic Wall

Topics: Acyclovir; Antiviral Agents; Female; Herpes Zoster; Humans; Kidney Failure, Chronic; Middle Aged; Neurotoxicity Syndromes; Renal Dialysis; Valacyclovir; Valine

Topics: Acyclovir; Adolescent; Antibodies, Viral; Antiviral Agents; Female; Ganglia, Spinal; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunocompetence; Immunoglobulin G; Virus Activation

Topics: 2-Aminopurine; Acyclovir; Antiviral Agents; Famciclovir; Female; Herpes Zoster; Humans; Middle Aged; Neuralgia, Postherpetic; Skin Care; Valacyclovir; Valine

Hip pain and varicella infections are common diagnoses affecting children and adolescents. Hip pain in childhood can be a challenging presenting complaint for the pediatrician or orthopedic physician. The differential diagnosis is broad, and ranges from benign conditions, such as transient synovitis and muscle strains, to more serious infections or malignancies. Acute hip pain is usually referred to an orthopedic surgeon, and the principal concern is to distinguish infection of the hip joint or pelvis from an irritable hip or musculoskeletal pain. The Varicella-zoster virus, a member of the herpes virus family, often presents as a generalized, pruritic, vesicular rash. The primary infection is commonly known as chickenpox. The prevalence of varicella infections has decreased significantly over the past decade with use of the varicella vaccine. Reactivation of varicella infection, or herpes zoster, in patients younger than 20 years is seen in only 68 per 100,000 people. Hip pain as the presenting symptom for onset of a herpes zoster infection is rare. This article presents a case of herpes zoster infection with initial presentation of hip pain in a 13-year-old boy. This case highlights the difficulty in diagnosing atraumatic joint pain in the pediatric population. The clinical importance of a thoughtful differential diagnosis, and the necessity of close follow-up by a pediatrician and/or orthopedic surgeon until there is a confirmed diagnosis cannot be overstated.

Topics: Acyclovir; Adolescent; Amines; Analgesics; Antiviral Agents; Cyclohexanecarboxylic Acids; Diagnosis, Differential; Gabapentin; gamma-Aminobutyric Acid; Herpes Zoster; Hip; Hip Joint; Humans; Low Back Pain; Male; Treatment Outcome

TNF-α antagonists may increase the risk of herpes zoster (HZ), as well as the duration and severity. Recently, the monoclonal antibody ustekinumab, blocking the p40 subunit of IL-12 and IL-23, has been introduced for treating moderate to severe plaque psoriasis. There are no PubMed reports of HZ occurring in people receiving ustekinumab treatment. Common HZ was reported in clinical trials.. Two patients with severe psoriasis treated with ustekinumab developed severe contiguous multidermatomal HZ 1 and 9 months after treatment initiation.. The occurrence of HZ after the instauration of ustekinumab suggests a causal relationship. Indeed, the inhibition of the p40 subunit of IL-12 shifts the immune response towards a Th1 profile with diminished IFN-γ and TNF-α expression, decreasing the antiviral immune response.. Ustekinumab is probably a risk factor for developing HZ. Anti-HZ vaccination prior to ustekinumab treatment should be considered.

Topics: Acyclovir; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Antiviral Agents; Dermatologic Agents; Herpes Zoster; Humans; Male; Middle Aged; Pain; Psoriasis; Severity of Illness Index; Treatment Outcome; Ustekinumab

Worldwide, many patients have been treated with tumor necrosis factor-α (TNF-α) antagonists for indications that include chronic inflammatory diseases such as rheumatoid and psoriatic arthritis, inflammatory bowel disease and others. Since their approval, concerns regarding safety have been raised. Increased susceptibility to bacterial infections, especially due to intracellular bacteria like Mycobacterium tuberculosis that is responsible for the most serious complications associated with this treatment. Viral infections are less frequently reported but probably relatively common, representing an important cause of morbidity to remember. Varicella zoster virus is one of the most frequently implicated viruses. We present the case of a 20-year-old man with Crohn's disease under infliximab treatment who developed herpes zoster at the site of infliximab's 7th and 9th infusion.

Topics: Acyclovir; Adult; Antibodies, Monoclonal; Antiviral Agents; Crohn Disease; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunosuppression Therapy; Infliximab; Infusions, Intravenous; Male; Treatment Outcome; Tumor Necrosis Factor-alpha; Valacyclovir; Valine; Virus Activation; Young Adult

Topics: Acyclovir; Aged; Antiviral Agents; Guillain-Barre Syndrome; Herpes Zoster; Herpesvirus 3, Human; Humans; Kidney Transplantation; Male

The treatment of varicella-zoster virus (VZV) reactivation is based on nucleoside analogues acyclovir (ACV) and bromevinyldeoxyuridine (BVdU) and a phosphonic acid derivative (PFA). Drug-resistant mutants of 3 wild-type (WT) VZV strains were obtained by exposure of human retinal pigment epithelial (hRPE) cells inoculated with cell-free WT virus at increasing concentrations of ACV, BVdU, and PFA. In addition to single-drug resistance, a cross-resistance of isolates vs. ACV was observed for PFA-resistant strains. Single-nucleotide (nt) exchanges resulting in amino acid (aa) substitutions were observed within the DNA polymerase (ORF 28) and/or thymidine kinase (ORF 36) of 3 of 3 ACV-, 2 of 3 BVdU-, and 3 of 3 PFA-resistant strains. Interestingly, aa substitutions were also observed within the immediate-early regulatory protein and major transactivator IE 62 (ORF 62), and the envelope glycoprotein (g) I (ORF 67) of the BVdU-resistant mutant of strain PP. No aa substitutions were observed in the protein sequences of gene products encoded by ORF 5 (gK, a glycoprotein arranging exocytosis of viral-loaded vacuoles), ORF 14 (gC), ORF 31 (gB), ORF 37 (gH), ORF 47 (protein kinase, involved in major phosphorylating processes), ORF 60 (gL, important for syncytia forming of infected cells in combination with gH), ORF 63 (major transactivator, part of the tegument), and ORF 68 (gE, triggers fusion of viral loaded vacuoles with cell membranes by heterodimerizing with gI). Phenotypic analysis revealed a slow-growth phenotype and a formation of smaller plaques of resistant mutants. Future studies should prove the presence of those resistant mutants in herpes zoster patients and the potential consequences of their putative reduced fitness on the success of therapeutical interventions.

Topics: Acyclovir; Amino Acid Substitution; Antiviral Agents; Bromodeoxyuridine; Cell Line; Drug Resistance, Viral; Evolution, Molecular; Foscarnet; Genes, Viral; Herpes Zoster; Herpesvirus 3, Human; Humans; Inhibitory Concentration 50; Microbial Sensitivity Tests; Mutation; Open Reading Frames; Thymidine Kinase; Virus Replication

Topics: Acyclovir; Adult; Female; Fingolimod Hydrochloride; Herpes Zoster; Herpesvirus 3, Human; Humans; Multiple Sclerosis, Relapsing-Remitting; Propylene Glycols; Sphingosine; Treatment Outcome

We report 2 immunocompetent patients with myelitis. The first was a 55-year old man who developed myelitis after intercostal herpes zoster. The second was a 19-year-old boy who presented with myelopathy after varicella infection. Varicella-zoster virus (VZV) myelitis was diagnosed based on the close temporal relationship between rash and onset of clinical symptoms, and by the elevated rate of anti-VZV IgG in the CSF without oligoclonal bands in the first case, and presence of VZV DNA in the second. The course was favorable after a 3-day course of corticosteroids and 3 weeks of acyclovir. Varicella-zoster virus myelitis is uncommon; it affects essentially immunodepressed patients. We highlight the importance of considering the possibility of VZV myelitis, even in immunocompetent patients. The combination of corticoids and acyclovir must be instituted, quickly, to improve functional outcome.

Topics: Acyclovir; Adrenal Cortex Hormones; Antiviral Agents; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunocompetence; Magnetic Resonance Imaging; Male; Medulla Oblongata; Middle Aged; Myelitis; Spinal Cord; Young Adult

Acyclovir resistance of varicella zoster virus (VZV) may arise in stem cell transplant (SCT) recipients with VZV disease and is usually a result of mutations in VZV thymidine kinase (TK), which is the target protein of acyclovir. Early detection of such mutations is necessary to enable timely therapy adaptation, for example, to foscarnet. We aimed to investigate whether TK mutations arise over time, and what sample types might be the most useful for this method.. Spatially and temporally distinct samples from 3 SCT recipients with VZV disease unresponsive to acyclovir treatment were retrospectively investigated for the presence of TK mutations by polymerase chain reaction and sequence analysis.. In all 3 patients, a mutation in the VZV TK coding region was found resulting in an amino acid substitution. TK mutations were not only temporally but also spatially compartmentalized. In particular, plasma samples frequently showed wild-type TK sequences, whereas cerebrospinal fluid or skin vesicle fluid acquired on the same day contained mutant sequences.. This study shows the importance of careful sampling for molecular diagnostics of acyclovir resistance in VZV disease. All affected body sites should be sampled and plasma samples may not be representative for the viral mutation status.

Topics: Acyclovir; Adult; Drug Resistance, Viral; Encephalitis, Varicella Zoster; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Mutation, Missense; Pathology, Molecular; Polymerase Chain Reaction; Thymidine Kinase; Transplantation; Viral Proteins; Young Adult

Topics: Abdominal Pain; Acyclovir; Adult; Antiviral Agents; Azathioprine; Connective Tissue Diseases; Female; Herpes Zoster; Humans; Immunocompromised Host; Immunosuppressive Agents; Prednisolone; Treatment Outcome

To evaluate the efficacy of treatment with gabapentin plus valacyclovir hydrochloride for the prevention of postherpetic neuralgia in patients with acute herpes zoster.. Uncontrolled, open-label study.. A private dermatology clinic.. Consecutive immunocompetent adults (age, ≥ 50 years) who presented with herpes zoster within 72 hours of vesicle formation with moderate to severe pain (≥ 4 on the 10-point Likert scale) were recruited for study participation. Intervention The patients received 1000 mg of valacylovir hydrochloride 3 times a day for 7 days plus gabapentin at an initial dose of 300 mg/d, titrated up to a maximum of 3600 mg/d, side effects permitting.. Proportion of patients with zoster pain (pain > 0) at 3, 4, and 6 months as well as average pain severity, the proportion of patients with sleep disturbance, and quality-of-life measures (determined by the Medical Outcome Study Short Form 36-Item Health Survey).. A total of 133 patients (mean age, 64.6 years) were enrolled in the study. The overall incidence of zoster pain at 6 months was 9.8%.. The combination of gabapentin and valacyclovir administered acutely in patients with herpes zoster reduces the incidence of postherpetic neuralgia. Trial Registration clinicaltrials.gov Identifier: NCT01250561.

Topics: Acute Disease; Acyclovir; Aged; Amines; Analgesics; Antiviral Agents; Cyclohexanecarboxylic Acids; Drug Therapy, Combination; Female; Gabapentin; gamma-Aminobutyric Acid; Herpes Zoster; Humans; Incidence; Male; Middle Aged; Neuralgia, Postherpetic; Valacyclovir; Valine

Acyclovir resistance of varicella-zoster virus (VZV) has been reported in rare cases of immunocompromised patients. In this study, the natural polymorphism of the thymidine kinase (TK) and DNA polymerase (pol) genes was examined in 51 clinical VZV isolates sensitive to acyclovir (ACV). In addition, 16 VZV strains with clinical resistance to ACV were analyzed. None of the ACV-sensitive strains of the clades 1, 3 and 5 showed gene polymorphism of the TK. By contrast, the DNA pol gene exhibited polymorphism-related substitutions as a function of the VZV clade. The novel substitutions M286I, E824Q, R984H and H1089Y were detected in strains of clades 3 and 5. In the TK gene of 7 VZV strains with clinical ACV resistance, the novel substitutions L73I, A163stop, W225R, T256M, N334stop and the deletion of nucleotides 19-223 were found to be associated most likely with resistance. In one strain showing the substitution W225R, ACV resistance could be confirmed by the viral phenotype. In the DNA pol gene, the novel amino acid substitutions T237K and A955T could be detected, but their significance remains unclear. In conclusion, the characterization of resistance using genetic analysis of the TK and DNA pol genes has to be considered the method of choice for the determination of VZV resistance to antiviral drugs. In a considerable number of patients with clinical ACV-resistant VZV infections, resistance cannot be verified by virological methods.

Topics: Acyclovir; Adolescent; Adult; Antiviral Agents; Child; Child, Preschool; DNA-Directed DNA Polymerase; Drug Resistance, Viral; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Infant; Male; Microbial Sensitivity Tests; Mutation; Polymorphism, Genetic; Thymidine Kinase; Viral Proteins; Young Adult

Infection with varicella-zoster virus (VZV) contemporaneously with malignant disease or immunosuppression represents a particular challenge and requires individualized decisions and treatment. Although the increasing use of varicella-vaccines in the general population and rapid initiation of VZV-immunoglobulins and acyclovir in case of exposure has been beneficial for some patients, immunocompromised individuals are still at risk for unfavourable courses.. In this single center, 6-year analysis we review incidence, hospitalization and complication rates of VZV-infections in our center and compare them to published data. Furthermore, we report three instructive cases.. Hospitalization rate of referred children with VZV-infections was 45%, among these 17% with malignancies and 9% under immunosuppressive therapy. Rate of complications was not elevated in these two high-risk cohorts, but one ALL-patient died due to VZV-related complications. We report one 4-year old boy with initial diagnosis of acute lymphoblastic leukemia who showed a rapidly fatal outcome of his simultaneous varicella-infection, one 1.8-year old boy with an identical situation but a mild course of his disease, and an 8.5-year old boy with a steroid-dependent nephrotic syndrome. This boy developed severe hepatic involvement during his varicella-infection but responded to immediate withdrawl of steroids and administration of acyclovir plus single-dose cidofovir after nonresponse to acyclovir after 48 h.. Our data show that patients with malignant diseases or immunosuppressive therapy should be hospitalized and treated immediately with antiviral agents. Despite these measures the course of VZV-infections can be highly variable in these patients. We discuss aids to individual decision-making for these difficult situations.

Topics: Acyclovir; Antiviral Agents; Chickenpox; Child; Child, Preschool; Cidofovir; Cytosine; Female; Herpes Zoster; Herpesvirus 3, Human; Hospitalization; Humans; Immunocompromised Host; Incidence; Infant; Male; Organophosphonates; Practice Guidelines as Topic

To report of a case of acute retinal necrosis (ARN), successfully treated with intravitreal foscarnet.. Case report.. A 40-year-old man diagnosed with varicella zoster virus (VZV)-induced ARN failed standard acyclovir treatment. He was treated subsequently with intravenous foscarnet, but developed acute renal failure after 1 day of treatment. All systemic anti-viral agents were discontinued, and intravitreal foscarnet was administered weekly. After 5 injections, the retinitis was dramatically improved.. Intravitreal foscarnet was efficacious in the treatment of acyclovir-resistant ARN caused by VZV. It may be used as the sole treatment in patients with intolerance to systemic administration.

Topics: Acyclovir; Adult; Antiviral Agents; Drug Resistance, Viral; Foscarnet; Herpes Zoster; Herpesvirus 3, Human; Humans; Injections, Intravenous; Intravitreal Injections; Male; Retinal Necrosis Syndrome, Acute; Treatment Outcome

Herpes zoster is the most common infection in patients treated with bortezomib-containing regimens for multiple myeloma. Some clinical trials have reported on the use of acyclovir prophylaxis to decrease the incidence of herpes zoster. However, the appropriate acyclovir dose and duration of prophylaxis remain unclear. The primary objective of this study was to evaluate the efficacy of continuous oral 200 mg/day acyclovir prophylaxis and the secondary objective was to determine the risk factors for developing herpes zoster.. We collected medical information from consecutive patients who received bortezomib with or without acyclovir prophylaxis for relapsed or refractory multiple myeloma at our hospital and retrospectively analyzed the efficacy of acyclovir prophylaxis and the parameters for predicting the risk factors for developing herpes zoster. The definition of acyclovir prophylaxis was oral continuous administration of 200 mg of once daily, without cessation, during the entire period of bortezomib treatment.. Six of the 33 patients in the study developed herpes zoster during bortezomib treatment. No varicella-zoster virus reactivation was observed in the 19 patients in the acyclovir prophylaxis group. The incidence of herpes zoster was significantly higher in the group that did not receive acyclovir prophylaxis (43%, 6 of 14 patients) than in the group that did (0%, 0 of 19; P = 0.003). The predictive factors for varicella-zoster virus reactivation were male sex (P = 0.035) and the use of acyclovir (P = 0.003).. Continuous prophylaxis by oral 200 mg/day acyclovir in multiple myeloma patients receiving bortezomib treatment is effective and sufficient in preventing herpes zoster.

Topics: Acyclovir; Administration, Oral; Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols; Antiviral Agents; Boronic Acids; Bortezomib; Drug Administration Schedule; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Male; Middle Aged; Multiple Myeloma; Pyrazines; Retrospective Studies; Risk Factors; Secondary Prevention; Treatment Outcome

Topics: Acyclovir; Antiviral Agents; Crohn Disease; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunosuppressive Agents; Male; Meningitis, Viral; Mercaptopurine; Middle Aged; Polyradiculopathy

Topics: Acyclovir; Antiviral Agents; Glucocorticoids; Hemorrhage; Herpes Zoster; Humans; Immunoglobulins, Intravenous; Male; Middle Aged; Prednisone; Purpura, Thrombocytopenic, Idiopathic; Skin Diseases, Vesiculobullous; Splenectomy; Valacyclovir; Valine

Topics: Acyclovir; Amines; Analgesics; Antiviral Agents; Cyclohexanecarboxylic Acids; Female; Gabapentin; gamma-Aminobutyric Acid; Herpes Zoster; Humans; Male; Neuralgia, Postherpetic; Valacyclovir; Valine

Topics: Acyclovir; Aged; Akathisia, Drug-Induced; Alcoholic Intoxication; Baclofen; Continuity of Patient Care; Diagnostic Errors; Drug Overdose; Emergencies; Herpes Zoster; Humans; Kidney Failure, Chronic; Male; Muscle Relaxants, Central; Myoclonus; Poisoning; Renal Dialysis; Tremor; Uremia

The herpes zoster virus is a rare but potential cause of acute motor weakness. This article describes 2 patients with drop foot secondary to an infection of varicella zoster who were incorrectly referred to an orthopedic clinic from their general practitioners. The first patient was a 74-year-old man who presented with weakness in the right foot and a vesicular rash. The pattern of disease supported the clinical diagnosis of shingles affecting the L5 motor and sensory division. No investigation was required, and the patient was treated with a foot drop splint. The second patient was a 71-year-old man who presented with right leg and foot weakness and a vesicular rash affecting his right buttock and posterior right thigh. Lumbar magnetic resonance excluded a stenotic lesion; electrophysiological studies supported the diagnosis of a lower motor neuron lesion. The patient was treated with a 1-week course of acyclovir and a foot drop splint. The correct diagnosis will aid in correct referral and will prompt management, which will potentially provide a faster and better outcome for the patient.

Topics: Acyclovir; Aged; Antiviral Agents; Electrophysiology; Exanthema; Gait Disorders, Neurologic; Herpes Zoster; Herpesvirus 3, Human; Humans; Magnetic Resonance Imaging; Male; Muscle Weakness; Sciatica; Splints; Treatment Outcome

Tacrolimus ointment 0.1 percent is a well-established topical therapy for treating atopic dermatitis. Efficacy and safety have been described in several trials. Here, we present a patient with rapid onset of extensive varicella zoster infection in tacrolimus-treated skin: a side effect that has only occasionally been reported. Early recognition is important because rapid treatment for herpes zoster may lead to less frequent post-herpetic neuralgia and serious complications.

Topics: Acyclovir; Antiviral Agents; Dermatitis, Atopic; Dermatologic Agents; Drug Therapy, Combination; Female; Fusidic Acid; Herpes Zoster; Herpesvirus 3, Human; Humans; Middle Aged; Ointments; Tacrolimus; Treatment Outcome; Valacyclovir; Valine

Immune Reconstitution Inflammatory Syndromes (IRIS) are exaggerated pathological inflammatory reactions occurring after initiation of highly active antiretroviral therapy (HAART) due to exuberant immune responses to occult or apparent opportunistic infections or cancers. In view of paucity of studies from Nigeria, we report 3 cases of IRIS presenting as disseminated infections in HIV-1 infected patients initiating HAART. The first case was a previously healthy female who developed disseminated tuberculosis after 4 weeks of regular HAART. Her HAART regimen was continued and she improved after commencement of anti-tuberculosis drugs, with evidence of progressive increase in CD4 cell count. The second case was a HAART-experienced female who stopped her drugs for 4 months. Two months after recommencement of her previous HAART regimen, she developed features of disseminated herpes zoster infection, despite evidence of decrease in viral load by 95%. HAART was continued and she recovered completely after receiving valaciclovir tablets and antibiotics. The third patient was a female student who was commenced HAART on account of chronic cough and weight loss. Three months after regular HAART, she developed features of disseminated Kaposi's sarcoma involving the skin, oropharynx and lungs, despite evidence of 42% increase in CD4 cell count. Unfortunately, she rapidly deteriorated and died during the course of management. Clinicians should be alert to the possibility of IRIS in HIV-infected patients initiated or re-initiated on HAART. There is need for future prospective studies determining risk factors for IRIS in HIV-infected patients from Nigeria.

Topics: Acyclovir; Adult; Anti-HIV Agents; Antiretroviral Therapy, Highly Active; Antiviral Agents; CD4 Lymphocyte Count; Disease Susceptibility; Fatal Outcome; Female; Herpes Zoster; HIV Infections; HIV-1; Humans; Immune Reconstitution Inflammatory Syndrome; Nigeria; Respiratory Tract Neoplasms; Sarcoma, Kaposi; Skin Neoplasms; Tuberculosis, Miliary; Valacyclovir; Valine; Viral Load; Viremia; Young Adult

Varicella zoster virus reactivation often occurs in the setting of impaired immunity, which is generally present in patients with end-stage renal disease (ESRD). Therapy for variceIla zoster virus infection is well established. However, it is often been forgotten that acyclovir dosage should be adjusted to renal function. We point to the problem encountered in clinical practice when ESRD patient presents with cutaneous herpes zoster and neurological symptoms. Clinical findings alone may prove inadequate to determine whether neurological deficit is caused by infection of the central nervous system or is a consequence of acyclovir induced neurotoxicity.

Topics: Acyclovir; Aged; Antiviral Agents; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunocompromised Host; Kidney Failure, Chronic; Male; Middle Aged; Renal Dialysis; Virus Activation

Recurrent reactivation of latent Varicella-Zoster virus may cause various neurological complications including encephalitis, myelitis, stroke episodes, and meningitis. It occurs mainly in elderly or immunocompromised patients and is very rare in children. We report a 14-year girl who presented with meningoencephalitis due to reactivation of Varicella-Zoster virus 10 years after she had chickenpox and 4 years after she had zoster. Characteristic skin lesions of varicella were absent. Varicella-Zoster virus DNA was detected in cerebrospinal fluid and magnetic resonance imaging (MRI) findings were consistent with small vessel cerebral vasculitis. Treatment with acyclovir and high dose methylprednisolone resulted in near-complete neurological recovery. Although rare, Varicella-Zoster virus may reactivate to cause significant central nervous system disease even in immunocompetent children. Diagnosis depends on a high degree of suspicion because the typical rash may not associate the disease. Characteristic lesions on MRI and the presence of Varicella-Zoster virus DNA in cerebrospinal fluid are key findings for the correct diagnosis.

Topics: Acyclovir; Adolescent; Antiviral Agents; Brain; Chickenpox; Diagnosis, Differential; DNA, Viral; Encephalitis, Varicella Zoster; Female; Follow-Up Studies; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunocompetence; Meningoencephalitis; Methylprednisolone; Time Factors; Treatment Outcome; Vasculitis, Central Nervous System; Virus Activation

Topics: Acyclovir; Adolescent; Antiviral Agents; Cohort Studies; Dose-Response Relationship, Drug; Female; Fetal Blood; Hematopoietic Stem Cell Transplantation; Herpes Zoster; Herpesvirus 3, Human; Humans; Male; Middle Aged; Virus Activation; Young Adult

The most common presentation of varicella zoster virus (VZV) infection is unilateral distribution of herpetic eruptions and neuralgia. Laryngeal involvement is considered very rare.

Topics: Acyclovir; Aged; Antiviral Agents; Cranial Nerve Diseases; Facial Paralysis; Herpes Zoster; Herpesvirus 3, Human; Humans; Laryngeal Diseases; Male

Retrospective analysis of two recent multiple myeloma (MM) clinical trials suggested that the use of bortezomib may be associated with an increased incidence of herpes zoster infections. Therefore, prophylactic use of antivirals has been advocated by some authors. This article explores the potential risks and pitfalls linked to routine acyclovir prophylaxis in bortezomib-treated MM.. use of antivirals can be associated with important nephro- and neurotoxicity. The nephrotoxicity induced by MM itself and its supportive therapies, superimposed to aging and inherent immunosuppression in myeloma, makes the development of renal impairment even more likely. On the other hand, sensory neuropathy is known to occur both during myeloma progression and in the setting of bortezomib therapy. Furthermore, preexisting nephropathy in MM patients can contribute to the occurrence of serious neurologic toxicity with acyclovir.. long-term acyclovir prophylaxis in MM patients treated with bortezomib may cause severe renal and neurological toxicity. Prevention of these complications can be achieved through either withholding of the antivirals or a very close monitoring of both neurologic status and renal function in this patient population. This highlights the importance of both clinician's and pharmacist's involvement in optimization of myeloma patient care.

Topics: Acyclovir; Antineoplastic Agents; Antiviral Agents; Boronic Acids; Bortezomib; Drug Monitoring; Herpes Zoster; Herpesvirus 3, Human; Humans; Incidence; Multiple Myeloma; Neurotoxicity Syndromes; Pyrazines; Renal Insufficiency; Virus Activation

Varicella-zoster virus (VZV) pneumonia is one of the most serious complications of this infection in adults. The objective of this study was to analyze the epidemiological and clinical characteristics in a large sample of patients with VZV pneumonia. This was a 10-y retrospective, descriptive, observational study. We studied 46 patients with VZV pneumonia, 21 men and 25 women, with a mean age 36 +/-11 y. A contact with an index case was observed in 57%, 76 were active smokers, 6.5% consumed drugs and 2 women were pregnant. The symptoms were: fever (83%), cough (83%), dyspnoea (63%), pleuritic pain (70%), and haemoptysis (6%) and started 3-5 days after the onset of blisters, except in 11% in whom respiratory symptoms appeared first. Arterial blood gases showed a mean PO(2)/FiO(2) of 308 +/-101 and 30 patients had a PO(2) of <55 mmHg--11 of these (4%) were admitted to the ICU, 8 required mechanical ventilation. Comparison of patients in the ICU with those on the general ward showed differences in the duration of fever (6.1 +/- 4.2 vs 3.2 +/- 1.1 days, p <0.001), mean stay (16.8+/-9.3 vs 7.2+/-2.4 days, p <0.001) and complications such as acute renal failure (p = 0.01) and acute respiratory failure (p < 0.001). Despite the severity of disease, no patient died. Once diagnosed, 98% were treated with acyclovir, combined with steroids in 6 and with antibiotics in 3 complicated with bacterial pneumonia. The prevalence for the period was 0.33 cases/100,000 inhabitants/y. In conclusion, VZV pneumonia has a severe course and accounts for a high percentage of admissions to the intensive care unit. The absence of mortality may be related to early treatment with acyclovir. Smoking was a risk factor for VZV pneumonia.

Topics: Acyclovir; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Anti-Inflammatory Agents; Antiviral Agents; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Male; Middle Aged; Pneumonia, Viral; Pregnancy; Prevalence; Retrospective Studies; Steroids; Treatment Outcome; Young Adult

Herpes zoster (HZ) is a common condition among older adults, manifested by pain and the classic presentation of a unilateral rash that follows a dermatomal distribution and does not cross the midline of the body. It is caused by reactivation of the virus that caused chickenpox during an earlier infection. In many cases, acute HZ is followed by a severe and disabling complication known as postherpetic neuralgia (PHN), characterized by pain that persists for months or even years after the HZ rash heals. Using an individual example, this article provides information on the clinical manifestations, evidence-based treatment recommendations for, and prevention of HZ and PHN through use of the zoster vaccine Zostavax, licensed in the United States in 2006.

Topics: Acyclovir; Aged, 80 and over; Antiviral Agents; Chest Pain; Female; Geriatric Nursing; Herpes Zoster; Herpes Zoster Vaccine; Herpesvirus 3, Human; Humans; Neuralgia, Postherpetic; Risk Factors; United States; Vaccination; Valacyclovir; Valine; Virus Activation

Acyclovir is an effective, frequently used antiviral agent. Adverse effects of this drug are well known and are especially seen with high doses and/or dehydration. In this article, we report a 6-year-old boy with leukemia with nonoliguric acute renal failure in normal hydration status after using acyclovir treatment. He had no preexisting renal impairment, and there were no additional symptoms. Dimercaptosuccinic acid radionucleid scyntigraphy and other laboratory findings revealed impairment of proximal tubule function, in addition to distal tubule. We emphasize that renal functions should be monitored carefully during treatment with acyclovir, and asymptomatic nephrotoxicity must be kept in mind.

Topics: Acute Kidney Injury; Acyclovir; Antiviral Agents; Child; Herpes Zoster; Humans; Leukemia; Male; Succimer

Topics: Acyclovir; Antiviral Agents; Forehead; Herpes Zoster; Humans; Male; Middle Aged; Staphylococcal Infections; Staphylococcus aureus

Bortezomib is highly effective in multiple myeloma and is widely used in this disease. Recently, an increased incidence of varicella zoster virus (VZV) reactivation was reported in patients with myeloma undergoing bortezomib treatment.. We investigated the influence of bortezomib on T-cell subpopulations in 53 patients with myeloma before initiation of bortezomib and during therapy.. A decrease of CD4+ T cells was seen in 41 of 53 patients (77%). The median CD3+/CD4+ lymphocyte counts declined from 494/microL (range, 130-2187/microL) to 274/microL (range, 41-1404/microL) during bortezomib treatment (P < .001). In the majority of patients (40 of 53 patients, 75%), CD4+ lymphocytes dropped to < 400/microL during bortezomib treatment, and in 18 of 53 patients (33.9%) the CD4+ T cells fell below 200/microL. The minimum CD4S+ cell count was observed at a median of 6 weeks (range, 2-22 weeks) after initiation of treatment. The incidence of herpes zoster reactivation was 5.7% in the whole population of patients with myeloma receiving bortezomib. Nineteen of 53 patients received acyclovir at a dose of 400 mg daily as prophylaxis against VZV reactivation. In this group, none of the patients developed herpes zoster. The incidence of VZV reactivation in patients not receiving acyclovir was 3 of 34 (8.8%). Importantly, occurrence of herpes zoster was associated with reduced CD4+ T-cell subpopulation: all patients who developed herpes zoster had CD4+ lymphocytes < 400/microL.. Our results show that bortezomib leads to a transient decrease in CD4+ lymphocytes, accompanied by an increased incidence of VZV infections. The antiviral prophylaxis with acyclovir is effective in patients with myeloma treated with bortezomib.

Topics: Acyclovir; Boronic Acids; Bortezomib; CD4 Lymphocyte Count; CD4-Positive T-Lymphocytes; Herpes Zoster; Herpesvirus 3, Human; Humans; Male; Multiple Myeloma; Pyrazines; T-Lymphocytes

Topics: Acyclovir; Adult; Antiviral Agents; Furunculosis; Herpes Zoster; Humans; India; Male

Topics: Acyclovir; Administration, Cutaneous; Adult; Betamethasone; Biopsy, Needle; Diclofenac; Female; Follow-Up Studies; Herpes Zoster; Humans; Immunohistochemistry; Lichen Planus; Physical Examination; Risk Assessment; Severity of Illness Index; Treatment Outcome

Segmental zoster paresis of the left upper limb in a pediatric patient.Segmental zoster paresis is a rare complication of herpes zoster characterized by focal, asymmetrical motor weakness in the myotome that corresponds to the dermatome of the rash. Segmental zoster paresis typically develops within 2-3 wks of cutaneous zoster and predominantly affects the middle-aged and elderly populations. Motor complications rarely develop in children and young adults, but when they do develop, involvement is usually confined to cranial and truncal muscles, with sparing of the limb musculature. A 10-yr-old boy with Fanconi's anemia developed left upper limb weakness because of involvement of C5 motor roots as a complication of herpes zoster. Recognizing motor zoster as a cause of acute motor weakness in a pediatric patient is important in avoiding unnecessary interventions and optimizing treatment.

Topics: Acyclovir; Antiviral Agents; Child; Electromyography; Herpes Zoster; Humans; Male; Muscle Weakness; Neural Conduction; Occupational Therapy; Paresis; Physical Therapy Modalities; Upper Extremity

Topics: Acyclovir; Aged; Anticoagulants; Antiviral Agents; Arterial Occlusive Diseases; Chickenpox Vaccine; Drug Therapy, Combination; Heparin; Herpes Zoster; Herpesvirus 3, Human; Humans; Male; Peripheral Vascular Diseases; Thrombosis; Treatment Outcome; Vaccines, Attenuated

Herpes simplex and herpes zoster infections are common and often treated with antiviral drugs including acyclovir, valacyclovir, and famciclovir. Safety of these antivirals when used in the first trimester of pregnancy is insufficiently documented.. To investigate associations between exposure to acyclovir, valacyclovir, and famciclovir in the first trimester of pregnancy and risk of major birth defects.. Population-based historical cohort study of 837,795 live-born infants in Denmark from January 1, 1996, to September 30, 2008. Participants had no diagnoses of chromosomal aberrations, genetic syndromes, birth defect syndromes with known causes, or congenital viral infections. Nationwide registries were used to ascertain individual-level information on dispensed antiviral drugs, birth defect diagnoses (categorized according to a standardized classification scheme), and potential confounders.. Prevalence odds ratios (PORs) of any major birth defect diagnosed within the first year of life by exposure to antiviral drugs.. Among 1804 pregnancies exposed to acyclovir, valacyclovir, or famciclovir in the first trimester, 40 infants (2.2%) were diagnosed with a major birth defect compared with 19,920 (2.4%) among the unexposed (adjusted POR, 0.89; 95% confidence interval [CI], 0.65-1.22). For individual antivirals, a major birth defect was diagnosed in 32 of 1561 infants (2.0%) with first-trimester exposure to acyclovir (adjusted POR, 0.82; 95% CI, 0.57-1.17) and in 7 of 229 infants (3.1%) with first-trimester exposure to valacyclovir (adjusted POR, 1.21; 95% CI, 0.56-2.62). Famciclovir exposure was uncommon (n = 26), with 1 infant (3.8%) diagnosed with a birth defect. Exploratory analyses revealed no associations between antiviral drug exposure and 13 different subgroups of birth defects, but the number of exposed cases in each subgroup was small.. In this large nationwide cohort, exposure to acyclovir or valacyclovir in the first trimester of pregnancy was not associated with an increased risk of major birth defects.

Topics: 2-Aminopurine; Abnormalities, Drug-Induced; Acyclovir; Adolescent; Adult; Antiviral Agents; Cohort Studies; Denmark; Famciclovir; Female; Herpes Simplex; Herpes Zoster; Humans; Middle Aged; Pregnancy; Pregnancy Trimester, First; Retrospective Studies; Risk; Valacyclovir; Valine; Young Adult

Topics: Acyclovir; Antineoplastic Agents; Antiviral Agents; Bromodeoxyuridine; Diagnosis, Differential; Esophageal Neoplasms; Exanthema; Herpes Zoster; Humans; Leg; Lymphoma, Mantle-Cell; Male; Middle Aged; Paraneoplastic Syndromes; Vasculitis, Leukocytoclastic, Cutaneous

Topics: Acyclovir; Aged; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Antirheumatic Agents; Antiviral Agents; Arthritis, Rheumatoid; Female; Herpes Zoster; Humans; Receptors, Interleukin-6; Treatment Outcome; Virus Activation

Topics: Acyclovir; Aged, 80 and over; Antiviral Agents; Female; Herpes Zoster; Humans; Physical Examination; Valacyclovir; Valine

Topics: Acyclovir; Aged; Amines; Analgesics; Anti-Inflammatory Agents; Antiviral Agents; Cyclohexanecarboxylic Acids; Early Diagnosis; Female; Gabapentin; gamma-Aminobutyric Acid; Herpes Zoster; Humans; Magnetic Resonance Imaging; Methylprednisolone; Myelitis, Transverse; Neuralgia, Postherpetic; Paresthesia; Urinary Retention

Topics: Acyclovir; Adrenal Cortex Hormones; Adult; Antiviral Agents; Herpes Zoster; Humans; Male; Nephrotic Syndrome; Treatment Outcome; Virus Activation

Topics: Acyclovir; Aged, 80 and over; Anti-Bacterial Agents; Antiviral Agents; Blister; Female; Floxacillin; Herpes Zoster; Humans; Irritants; Shoulder Pain

Topics: Acyclovir; Antiviral Agents; Herpes Zoster; Herpesvirus 3, Human; Humans; Infant

Herpes zoster is a common clinical problem but its complications, apart from post-herpetic neuralgia, are comparatively rare. We describe a case of Horner's syndrome and ipsilateral vagal paresis following likely herpes zoster of the third and fourth cervical roots. This unusual combination has not, to our knowledge, been previously described.

Topics: Acyclovir; Antiviral Agents; Dexamethasone; Drug Therapy, Combination; Glucocorticoids; Herpes Zoster; Horner Syndrome; Humans; Male; Middle Aged; Paralysis

Topics: Acyclovir; Aged; Antiviral Agents; Biopsy; Cicatrix; Herpes Zoster; Humans; Male; Myelodysplastic Syndromes; Skin; Valacyclovir; Valine

Drug-related eruptions that appear only on intertriginous or flexural folds and in gluteal areas have recently been termed symmetrical drug-related intertriginous and flexural exanthema (SDRIFE). We report a case of a 56-year-old woman with acute erythematous rash in the intertriginous areas after treatment with the L-valine ester of acyclovir, valacyclovir. Oral-challenge tests resulted in erythematous pruritic rash in the intertriginous area by valacyclovir. The patient was diagnosed as having SDRIFE due to valacyclovir.

Topics: Acyclovir; Antiviral Agents; Axilla; Drug Eruptions; Exanthema; Female; Herpes Zoster; Humans; Middle Aged; Neck; Valacyclovir; Valine

Herpes zoster complicated by meningitis has been mainly reported in immunocompromised patients after reactivation of wild-type varicella-zoster virus. We present one of the first cases of aseptic meningitis after herpes zoster caused by reactivation of vaccine-type varicella-zoster virus in an immunocompetent child. We also highlight the increasing role of both wild-type and vaccine strains of varicella-zoster virus as a cause of viral meningoencephalitis and the use of appropriate laboratory tools to rapidly and accurately identify the virus in order to provide prompt patient care and management.

Topics: Acyclovir; Antiviral Agents; Chickenpox Vaccine; Child; Herpes Zoster; Humans; Immunocompetence; Male; Meningitis, Viral

Humoral-mediated as well as cell-mediated immunity is compromised in myeloma patients receiving treatment. Immunocompromised patients are at risk of developing herpes zoster. There is evidence from clinical trials that bortezomib therapy is associated with a significant risk of herpes zoster. It is the authors' clinical policy to administer long-term acyclovir prophylactically to all symptomatic myeloma patients.. A retrospective review of the records of 125 myeloma patients who were treated with bortezomib and who also received routine acyclovir prophylaxis at the dose of 400 mg daily in >80% of patients was undertaken. Alternatives, used in <20% of patients, were 200 mg of acyclovir, 250/500 mg of valacyclovir, or 500 mg of famciclovir administered daily. This was accompanied by patient education regarding the importance of compliance with these prophylactic medications.. The duration of bortezomib therapy was 1 to 164 weeks (median, 16 weeks). The total duration of exposure to bortezomib was 4150 weeks (80 patient-years). Except for the occasional missed dose, the self-reported compliance with antiviral prophylaxis was 100%. Not a single episode of herpes zoster was reported during this period. No adverse effects were noted that could be definitely attributed to acyclovir, valacyclovir, or famciclovir.. Daily acyclovir (or a suitable alternative) appears to be effective at preventing herpes zoster virus in patients with myeloma who are receiving bortezomib, with or without corticosteroids.

Topics: Acyclovir; Antineoplastic Agents; Antiviral Agents; Boronic Acids; Bortezomib; Herpes Zoster; Herpesvirus 3, Human; Humans; Multiple Myeloma; Pyrazines; Retrospective Studies; Virus Activation

Topics: Acyclovir; Antibodies, Monoclonal; Antibodies, Monoclonal, Murine-Derived; Antineoplastic Combined Chemotherapy Protocols; Antiviral Agents; Carmustine; Cisplatin; Colitis; Combined Modality Therapy; Cyclophosphamide; Cytarabine; Dexamethasone; Doxorubicin; Etoposide; Hematopoietic Stem Cell Transplantation; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunocompromised Host; Immunoglobulins, Intravenous; Intestinal Pseudo-Obstruction; Lymphoma, Large B-Cell, Diffuse; Male; Melphalan; Middle Aged; Postoperative Complications; Prednisolone; Rituximab; Transplantation, Autologous; Vincristine; Virus Activation

A 97-year-old lady was hospitalized for left leg cellulitis. Comorbidity included hypertension and congestive heart failure. While in hospital, she developed a painless vesicular rash localized to the territory of the left trigeminal nerve (third branch), which evolved to pustules and crusts (Figure 1). A chickenpox-like disseminated eruption of vesicles followed within 4 days, with the same evolution pattern (Figure 2).The diagnosis of disseminated zoster was suspected. A PCR analysis confirmed the presence of varicella-zoster-virus (VZV) in an abdominal vesicle. The patient was treated with oral valacyclovir for 7 days. Clinical examination, laboratory tests (including HIV serology), and a chest radiograph revealed no evidence of underlying immunodeficiency or malignancy.

Topics: Acyclovir; Aged, 80 and over; Antiviral Agents; Back; Face; Female; Heart Failure; Herpes Zoster; Herpesvirus 3, Human; Humans; Hypertension; Polymerase Chain Reaction; Valacyclovir; Valine

Topics: Acyclovir; Anti-Bacterial Agents; Antibodies, Viral; Antiviral Agents; Cefotaxime; Chickenpox; Child; Herpes Zoster; Herpesvirus 3, Human; Humans; Male; Meningitis, Aseptic; Polymerase Chain Reaction; Recurrence; Spinal Puncture; Vancomycin

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

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

We present two prostate cancer patients, including one with a castration-resistant cancer whose rising serum prostate-specific antigen (PSA) levels showed a remarkable drop after a reactivated varicella-zoster virus infection treated with valaciclovir. In one patient, we found a temporary decrease in serum PSA lasting for at least 4 mo. In the patient with castration-resistant prostate cancer, serum PSA decreased to <0.01 microg/l and has remained undetectable since.

Topics: Acyclovir; Aged; Antiviral Agents; Herpes Zoster; Humans; Male; Prostate-Specific Antigen; Prostatic Neoplasms; Valacyclovir; Valine

Varicella zoster virus is highly contagious and can cause serious complications in immunocompromised patients. To prevent people exposed to the virus from developing secondary varicella we have used oral aciclovir as post-exposure prophylaxis (PEP) since 2000. Between 2000 and 2007, there were 11 unexpected occurrences of varicella and 11 unexpected occurrences of zoster in our paediatric wards. There were 174 contacts, 131 exposed to varicella and 43 exposed to zoster. A total of 163 (94%) received PEP and 11 (6%) did not. The rates of secondary infection among contacts given prophylaxis with aciclovir only were 2.1% (3/141) for all contacts and 1.3% (1/76) for immunocompetent contacts. The rate of secondary infection among contacts not given PEP was significantly higher (18%, 2/11) (P<0.05). No adverse events due to PEP were reported. We conclude that oral aciclovir PEP following exposure to VZV on paediatric wards is both safe and effective.

Topics: Acyclovir; Administration, Oral; Chemoprevention; Chickenpox; Cross Infection; Herpes Zoster; Humans; Infant

Topics: Acyclovir; Antiphospholipid Syndrome; Antiviral Agents; Drug Therapy, Combination; Female; Herpes Zoster; Humans; Immunosuppressive Agents; Infusions, Intravenous; Lupus Erythematosus, Systemic; Middle Aged; Mycophenolic Acid; Necrosis; Prednisone; Skin

A 58-year-old man with Darier disease and end-stage renal failure on hemodialysis who developed disseminated Herpes Zoster is presented. He was cleared with intravenous acyclovir given at the time of dialysis.

Topics: Acyclovir; Biopsy, Needle; Darier Disease; Follow-Up Studies; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunohistochemistry; Male; Middle Aged; Renal Dialysis; Risk Assessment; Treatment Outcome

Topics: Acyclovir; Antiviral Agents; Blister; Cellulitis; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunocompromised Host; Kidney Transplantation; Middle Aged; Treatment Outcome; Virus Activation

Two adolescents, on immunosuppressive therapy for graft-versus-host disease, developed hemophagocytic lymphohistiocytosis (HLH) after varicella zoster virus (VZV) reactivation. In the absence of dermatome restricted characteristic skin lesions, VZV reactivation was not immediately recognized and treatment with acyclovir was delayed. The first patient developed optical neuritis and died 2 months after the VZV episode due to massive intracranial hemorrhage. The second patient presented with severe abdominal pain and pancreatitis, followed by atypical skin eruptions, which prompted a faster diagnosis. Both patients recovered from their HLH, the first patient being successfully treated with immunosuppressive agents and the second with VZV treatment only. These two cases demonstrate the difficulties in recognizing VZV reactivation, and in order to start adequate and timely treatment, the need to consider VZV as a possible cause of HLH in severely immunocompromised patients.

Topics: Acyclovir; Adolescent; Antiviral Agents; Graft vs Host Disease; Herpes Zoster; Humans; Immunocompromised Host; Leukemia, Myeloid, Acute; Lymphohistiocytosis, Hemophagocytic; Male

Varicella-zoster virus (VZV) reactivation is a common complication in patients with multiple myeloma (MM) treated with bortezomib, with an incidence rate of 10%-60%. The aim of our study was to analyze the effect of acyclovir prophylaxis in this patient population.. We studied 98 consecutive patients with relapsed MM treated with bortezomib. Bortezomib 1.3 mg/m2 was given on days 1, 4, 8, and 11 of a 21-day cycle. At first, patients did not receive any VZV prophylaxis, but because of the high incidence of VZV reactivation, VZV prophylaxis with acyclovir was implemented subsequently.. A total of 11 patients treated with bortezomib did not have any VZV prophylaxis, and 4 of these 11 patients (36%) developed VZV reactivation in the form of herpes zoster. No VZV reactivations were observed in the 32 patients who received acyclovir 400 mg 3 times daily or the 55 patients who received acyclovir in a dose reduced to 400 mg once daily during bortezomib treatment.. Varicellazoster virus reactivation is a common and serious adverse effect of bortezomib treatment. Acyclovir 400 mg once daily is sufficient to protect from VZV reactivation in patients with MM treated with bortezomib.

Topics: Acyclovir; Aged; Aged, 80 and over; Antineoplastic Agents; Antiviral Agents; Boronic Acids; Bortezomib; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Male; Middle Aged; Multiple Myeloma; Prospective Studies; Pyrazines; Virus Activation

Brachial plexus neuritis in the presence of herpes zoster infection is uncommon. Motor involvement is probably due to the spreading of inflammation from the dorsal root ganglia to the ventral roots and may be more extensive than the affected dermatomes. We present a case of herpes zoster brachial plexopathy with pure motor involvement both clinically and electrophysiologically.

Topics: Acyclovir; Aged; Antibodies, Viral; Antiviral Agents; Arm; Axons; Brachial Plexus Neuropathies; Electrodiagnosis; Electromyography; Exanthema; Herpes Zoster; Herpesvirus 3, Human; Humans; Male; Motor Neuron Disease; Motor Neurons; Muscle Weakness; Muscle, Skeletal; Muscular Atrophy; Neural Conduction; Spinal Nerve Roots; Treatment Failure; Wallerian Degeneration

To assess the incidence of and risk factors associated with postherpetic neuralgia (PHN) after hematopoietic cell transplantation (HCT) varicella zoster virus (VZV) infection, we conducted a retrospective chart review of 418 consecutive patients who underwent HCT between April 2005 and March 2007. The male/female ratio was 221/197, median age at HCT was 47 years (range: 0-69 years), and autologous/allogeneic/syngeneic HCT ratio was 154/263/1. Seventy-eight patients developed VZV infection after HCT. Sixty-two patients had localized zoster, 11 patients had disseminated zoster (rash like chicken pox), and 4 patients had visceral zoster. All cases were treated with acyclovir (ACV) or valacyclovir (VACV), and there was no VZV infection-related death. Twenty-seven (35%) of the 78 patients with VZV infection suffered PHN after resolution of VZV infection. Multivariate analysis showed that advanced age is the only risk factor in autologous HCT (P = .0075; odds ratio [OR] = 1.14; 95% confidence interval [CI], 0.97-1.33). On the other hand, advanced age (P = .0097; OR = 1.06; 95% CI, 1.01-1.12), male gender (P = .0055; OR = 12.7; 95% CI, 1.61-100.1), and graft-versus-host disease (GVHD) prophylaxis with a tacrolimus-based regimen (P = .0092; OR = 9.56; 95% CI, 1.44-63.3) were associated with increased risk of PHN in allogeneic HCT. This study for the first time clarified the risk of PHN in HCT recipients.

Topics: Acyclovir; Adolescent; Adult; Aged; Chickenpox; Child; Child, Preschool; Female; Genetic Diseases, Inborn; Hematopoietic Stem Cell Transplantation; Herpes Zoster; Humans; Incidence; Infant; Infant, Newborn; Japan; Male; Middle Aged; Neoplasms; Neuralgia, Postherpetic; Postoperative Complications; Retrospective Studies; Risk; Transplantation, Autologous; Transplantation, Homologous; Valacyclovir; Valine; Virus Activation; Young Adult

Topics: Acyclovir; Aged; Antiviral Agents; Biopsy; Dermis; Diagnosis, Differential; Female; Follow-Up Studies; Granuloma Annulare; Hand Dermatoses; Herpes Zoster; Humans; Injections, Intravenous; Remission, Spontaneous; Scalp Dermatoses; Thoracic Wall

Topics: Acyclovir; Aged; Anti-HIV Agents; Antiviral Agents; Herpes Zoster; HIV Infections; Humans; Keloid; Male

A novel molecular targeting drug, a proteasome inhibitor, bortezomib (Bor), has been reported to be highly effective for relapsed/refractory, as well as for newly diagnosed multiple myeloma, but is also associated with a high frequency of herpes zoster (HZ) infection (13%). We conducted a retrospective survey on HZ infection (profile) after Bor therapy in our hospital. Six of 30 patients developed HZ infection during bortezomib-dexamethasone treatment (BD therapy). Age, performance status, and stem cell transplantation were not related risk factors for HZ infection. HZ developed when acyclovir (ACV) was not administrated to all six cases. Continuous administration of ACV decreased the incidence of HZ infection. Based on these results, we started an anti- HZ prophylaxis program using ACV for all patients receiving BD therapy. Further study is warranted to establish the optimal dose and duration of ACV for appropriate prophylaxis of HZ infection.

Topics: Acyclovir; Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Antiviral Agents; Boronic Acids; Bortezomib; Dexamethasone; Drug Administration Schedule; Female; Herpes Zoster; Humans; Male; Middle Aged; Multiple Myeloma; Protease Inhibitors; Pyrazines; Retrospective Studies

It has been reported that the diagnosis of multidermatomal herpes zoster in HIV-infected patients occurs at a lower CD4 level than zoster involving a single dermatome. Herein, we describe 3 cases of HIV-infected patients presenting with disseminated zoster at high CD4 counts and low HIV viral loads.

Topics: Acyclovir; Adult; AIDS-Related Opportunistic Infections; Anti-HIV Agents; CD4 Lymphocyte Count; Follow-Up Studies; Herpes Zoster; HIV Infections; Humans; Infusions, Intravenous; Male; Middle Aged; Risk Assessment; Sampling Studies; Severity of Illness Index; Treatment Outcome

Tumor necrosis factor-alpha (TNFalpha)-blocking agents are immunomodulating agents introduced for treatment of a variety of chronic inflammatory disease conditions. Adverse effects include an increased incidence of infections. Clinically, these infections often have atypical presentations that may hamper prompt diagnosis. In our report of a patient on etanercept therapy for rheumatoid arthritis, the correct diagnosis was delayed because disseminated herpes zoster was clinically mimicking vasculitis. Initially assuming rheumatoid vasculitis, immunosuppression was increased, resulting in worsening of skin lesions. Only an extended work-up, including a skin biopsy and viral cultures, established the correct diagnosis. Management of varicella zoster virus (VZV) infection primarily focuses on early initiation of antiviral therapy to control VZV replication. Therapy with intravenous acyclovir followed by oral valacyclovir allowed complete resolution of acute skin changes. In immunosuppressed patients, the possibility of infection with atypical presentation must always be kept in mind, and that this might mimic other disease conditions. Broad differential diagnosis and an extended diagnostic workup help in establishing the correct diagnosis.

Topics: Acyclovir; Aged; Antiviral Agents; Arthritis, Rheumatoid; Biopsy; Diagnosis, Differential; Drug Therapy, Combination; Etanercept; Female; Herpes Zoster; Humans; Immunoglobulin G; Immunosuppressive Agents; Receptors, Tumor Necrosis Factor; Rheumatoid Vasculitis; Risk Factors; Treatment Outcome; Valacyclovir; Valine

To characterise predisposition to post herpetic neuralgia following herpes zoster.. Late follow up of patients originally admitted with acute zoster to a double blind randomised placebo controlled study of oral acyclovir over 60 years of age.. Two UK cities of 1.5 million population.. 158 of the 298 patients from the original study were available for evaluation at a mean follow up of 9 years. Thirty four (21%) described experiencing pain from the zoster within the previous 12 months. Pain at follow up was associated with characteristics at the time of acute zoster of: moderate or severe acute pain (p = 0.006), prodromal pain >72 h before rash (p = 0.006), severity of rash (p = 0.033) and female gender (p = 0.046). There was no association between pain at 9 year follow up and use of placebo or aciclovir nor with the presence or absence of pain at the point of discharge from the original study. Further analysis of 17 of the 34 patients with long term pain who have full data available, the median pain score was 4 out of 10 and more than 50% described persistent pain and interference with sleep.. Long term pain in the elderly following zoster is associated with identifiable characteristics during the acute illness.

Topics: Acyclovir; Aged; Aged, 80 and over; Causality; Female; Follow-Up Studies; Herpes Zoster; Humans; Male; Middle Aged; Neuralgia, Postherpetic; Randomized Controlled Trials as Topic; United Kingdom

Topics: Acyclovir; Adult; Antiviral Agents; Arm; Ecchymosis; Female; Giant Cells; Herpes Zoster; Histological Techniques; Humans; Kidney Failure, Chronic; Lupus Nephritis; Purpura; Thrombocytopenia; Valacyclovir; Valine

Topics: Acyclovir; Adult; Anti-Inflammatory Agents; Antiviral Agents; CD4 Lymphocyte Count; Herpes Zoster; Humans; Male; Prednisone; Retinal Necrosis Syndrome, Acute; Valacyclovir; Valine

Topics: Acyclovir; Antiviral Agents; Herpes Zoster; Humans; Neuralgia, Postherpetic; Valacyclovir; Valine

Herpes zoster rarely occurs in healthy children, but may occur frequently and may take a complicated course in children receiving chemotherapy. We aimed to assess morbidity from herpes zoster in children with acute lymphoblastic leukemia (ALL).. Reviewing records, treatment and course of zoster eruptions were registered in a cohort of 67 children with newly diagnosed ALL. Of these, 45 had had varicella at the time of diagnosis and 15 contracted varicella or were vaccinated during the course of therapy.. Eleven children had a total of 17 eruptions while receiving chemotherapy. All eruptions were treated with acyclovir, in eight cases intravenously, and in six cases chemotherapy was interrupted. Cutaneous dissemination occurred in two cases, visceral dissemination in none. One child had postherpetic trigeminal neuralgia for two months. The eruption rate was higher among small children than among school-aged children (0.22 vs. 0.13 per year of chemotherapy) and was related to the intensity of chemotherapy (0.30 per year of consolidation treatment vs. 0.13 for maintenance therapy). Three children on prolonged intensive chemotherapy had recurrent zoster episodes.. Chemotherapy causes zoster eruptions in approximately one quarter of children with ALL, and with intensive protocols recurrent zoster can cause significant morbidity. Attempts to improve immunity by vaccine boosting after attaining remission seems warranted.

Topics: Acyclovir; Adolescent; Antineoplastic Agents; Antiviral Agents; Chickenpox; Child; Child, Preschool; Cohort Studies; Herpes Zoster; Humans; Immunocompromised Host; Infant; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Recurrence; Risk Factors

Topics: Acyclovir; Adult; Antiviral Agents; DNA, Viral; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Lower Extremity; Neuralgia; Pregnancy; Pregnancy Complications, Infectious; Treatment Outcome; Valacyclovir; Valine

Intracranial aneurysms in the pediatric population are relatively rare entities. Immunocompromised patients (often from HIV/AIDS or pharmacological immunosuppression) represent a significant fraction of children with cerebral aneurysms. One proposed mechanism of aneurysm formation in these patients is from direct infection of the affected arteries. In this study, the authors report on a case of a 14-year-old girl with common variable immunodeficiency with T-cell dysfunction and a CSF polymerase chain reaction test positive for varicella-zoster virus who underwent evaluation for carotid and basilar artery fusiform aneurysms.

Topics: Acyclovir; Adolescent; Aneurysm; Angiography, Digital Subtraction; Antiviral Agents; Aspirin; Basilar Artery; Carotid Artery Diseases; Carotid Artery, Internal; Cerebral Angiography; Common Variable Immunodeficiency; Female; Herpes Zoster; Humans; Image Processing, Computer-Assisted; Intracranial Aneurysm; Magnetic Resonance Angiography; Platelet Aggregation Inhibitors; T-Lymphocytes; Tomography, X-Ray Computed; Valacyclovir; Valine; Vasculitis; Vertebral Artery

Topics: Acetaminophen; Acyclovir; Analgesics, Non-Narcotic; Analgesics, Opioid; Antiviral Agents; Diagnosis, Differential; Female; Herpes Zoster; Humans; Leg; Lidocaine; Male; Middle Aged; Tramadol; Valacyclovir; Valine

Topics: Acyclovir; Antiviral Agents; Central Nervous System; Herpes Zoster; Humans; Renal Insufficiency; Risk Factors

The synthesis of original imidazo[1,2-a]pyridines bearing a thioether side chain at the 3 position and diversely substituted on the 6 or 8 position, and their antiviral activities are reported. From the synthesized compounds, the imidazo[1,2-a]pyridines bearing a 5 membered heterocycle (thiophene, furane or pyrrole) in the 6 position or a phenylthio group in the 6 or 8 position were the most potent against human cytomegalovirus (CMV) and varicella-zoster virus (VZV), whereas several other congeners, while less potent, were more selective in their inhibitory activity against VZV and CMV. These compounds showed similar activity against thymidine kinase competent (TK+) and deficient (TK-) VZV strains, demonstrating a mechanism of action independent of the viral thymidine kinase.

Topics: Antiviral Agents; Cell Survival; Cells, Cultured; Cytomegalovirus; Cytomegalovirus Infections; Herpes Zoster; Herpesvirus 3, Human; Humans; Imidazoles; Lung; Molecular Structure; Pyridines; Structure-Activity Relationship

The orbital apex syndrome is defined by the association of visual loss, ophtalmoplegia, blepharoptosis, proptosis along with forehead and upper eyelid anesthesia. This syndrome is secondary to traumatism, malignancy or infection of orbital apex. Herpes zoster is an uncommon cause. We discuss the physiopathologic mechanism, evolution and management of this affection.

Topics: Acyclovir; Aged; Antiviral Agents; Female; Herpes Zoster; Humans; Orbital Diseases; Syndrome

Topics: Acyclovir; Antiviral Agents; Child, Preschool; Female; Herpes Zoster; Herpesvirus 3, Human; Humans

Topics: Acyclovir; Aged; Antiviral Agents; Colonic Pseudo-Obstruction; Herpes Zoster; Humans; Infusions, Intravenous; Male

Acyclovir-induced nephrotoxicity is well known, but published literature lacks information on the safety of substitution with other antiviral agents. We describe four patients with acyclovir-induced renal toxicity that were subsequently managed with hydration and famciclovir. All four patients subsequently had improvements in their symptoms with full recovery of their baseline renal function.

Topics: 2-Aminopurine; Acyclovir; Aged; Aged, 80 and over; Antiviral Agents; Famciclovir; Female; Herpes Simplex; Herpes Zoster; Humans; Kidney Diseases; Male; Middle Aged

Topics: Acyclovir; Antiviral Agents; Carcinoma, Non-Small-Cell Lung; Endoscopy, Gastrointestinal; Esophagitis; Herpes Simplex; Herpes Zoster; Humans; Immunocompromised Host; Lung Neoplasms; Male; Middle Aged

To assess the rate of occurrence and outcomes of herpes zoster in patients taking TNFalpha antagonists.. Retrospective review of the medical records of 300 patients who received TNFalpha antagonists to treat chronic inflammatory joint disease.. We identified 9 (9/300, 3%) patients who experienced herpes zoster, 6 women and 3 men, with rheumatoid arthritis (n=7) or ankylosing spondylitis (n=2). The drug was infliximab in 4 patients, adalimumab in 2 patients, and etanercept in 3 patients, including 2 patients with a prior history of infliximab therapy (for 12 and 36 months, respectively). Mean treatment duration at the occurrence of herpes zoster was 27 months (range, 6-42 months).. Glucocorticoid therapy (n=7) and methotrexate therapy (n=6) were the only risk factors identified in our study. Mean follow-up was 26 months. All 9 patients achieved a full recovery with antiviral treatment and interruption of the TNFalpha antagonist. One patient experienced a recurrence after resuming TNFalpha antagonist therapy.. The scant data in the literature suggest a higher risk of herpes zoster with anti-TNFalpha antibodies than with the soluble receptor. The role for concomitant treatments (glucocorticoids and methotrexate) should be taken into account.

Topics: Acyclovir; Adalimumab; Adult; Aged, 80 and over; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Antirheumatic Agents; Antiviral Agents; Arthritis, Rheumatoid; Drug Therapy, Combination; Etanercept; Female; Glucocorticoids; Herpes Zoster; Humans; Immunoglobulin G; Immunosuppressive Agents; Infliximab; Male; Methotrexate; Middle Aged; Receptors, Tumor Necrosis Factor; Retrospective Studies; Risk Factors; Spondylitis, Ankylosing; Tumor Necrosis Factor-alpha; Valacyclovir; Valine

A 60-year-old man presented with a plaque lesion on the upper right half of the face, which had developed after ophthalmic varicella zoster infection about 2 years previously. The lesion, which was burning and itchy, included a few tiny erythematous pustules, and was slightly squamous and infiltrated. The lesion covered the upper two-thirds of the right trigeminal nerve dermatome, involving half of the face with the forehead, the periorbital area, upper part of the cheek and the nose. The lesion became more marked after continuous topical anaesthetic and corticosteroid use. A standardized skin-surface biopsy was taken, and revealed a large number of Demodex folliculorum (38/cm(2)) in the lesion area. The lesions completely abated after topical 5% permethrin treatment, and no recurrence was observed during follow-up. Demodicosis may have atypical clinical presentations, other than the well-known classic forms. To our knowledge, this is the first unilateral trigeminal, pseudozoster presentation in the literature.

Topics: Acyclovir; Animals; Antiviral Agents; Diagnosis, Differential; Ectoparasitic Infestations; Facial Dermatoses; Herpes Zoster; Humans; Insecticides; Male; Middle Aged; Mite Infestations; Mites; Permethrin; Trigeminal Nerve; Trigeminal Nerve Diseases

Between 6000 and 7000 women in the United States infected with human immunodeficiency virus (HIV) give birth annually. It is well known that HIV-related immunosuppression significantly increases the risk for acquiring opportunistic infections (OIs). However, there is limited information regarding the relationship of pregnancy in the setting of HIV/AIDS infection, subsequent development of OIs, and maternal and fetal outcomes. A pregnant 36-year-old woman with AIDS was diagnosed with varicella zoster meningitis. Weight-based therapy with acyclovir was initiated with clinical improvement in symptoms. Care of a pregnant HIV-infected patient with an OI poses a unique diagnostic and therapeutic challenge for clinicians. Early diagnosis and initiation of appropriate treatment may provide an opportunity to improve both maternal and fetal outcomes.

Topics: Acyclovir; Adult; AIDS-Related Opportunistic Infections; Female; Follow-Up Studies; Gestational Age; Herpes Zoster; Humans; Labor, Induced; Meningitis, Viral; Monitoring, Physiologic; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Outcome; Prenatal Care; Prenatal Diagnosis; Risk Assessment; Severity of Illness Index

Topics: Acyclovir; Adult; Antiviral Agents; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunocompetence; Male; Skin Diseases, Vesiculobullous; Time Factors; Treatment Outcome; Valacyclovir; Valine

Despite recent evidence suggesting that Bell's palsy is associated with reactivation of alfa-herpes viruses, the disease has been treated empirically, and the use of valacyclovir has not been definitively established. In 2007, two prospective, randomised, placebo-controlled trials evaluating valacyclovir were reported in patients with Bell's palsy. One demonstrated that valacyclovir/prednisolone therapy was statistically more effective than placebo/prednisolone therapy in improving the recovery of patients with Bell's palsy, excluding zoster sine herpete. However, considering the cost-benefit ratio of this treatment and the limitations of virological diagnoses, we recommend that valacyclovir should be used in cases of severe palsy within 3 days after the onset of Bell's palsy.

Topics: Acyclovir; Antiviral Agents; Bell Palsy; Cost-Benefit Analysis; Drug Therapy, Combination; Herpes Zoster; Humans; Prednisolone; Randomized Controlled Trials as Topic; Valacyclovir; Valine

Topics: Acyclovir; Aged; Antiviral Agents; Diagnosis, Differential; Drug Therapy, Combination; Hernia, Abdominal; Herpes Zoster; Humans; Male; Treatment Outcome; Vitamin B Complex

Reactivation of latent varicella zoster virus is one infectious complication associated with the extensive immunosuppression necessary for hematopoietic stem cell transplant. Most cases are limited to skin and mortality is low. Isolated visceral zoster is rare, presenting with ileus/abdominal pain, hepatitis, and/or hyponatremia. We present 2 cases of visceral varicella zoster virus in adolescents with chronic graft-versus-host disease after hematopoietic stem cell transplant. Both presented with elevated liver enzymes, severe abdominal pain, and hyponatremia but lacked cutaneous involvement. Both received high-dose acyclovir and showed improvement, but eventually expired from hepatic failure. The diagnosis of visceral zoster can be difficult especially without cutaneous manifestations. Vigilance is necessary in patients with chronic graft-versus-host disease, abdominal pain, and/or hepatitis and antiviral therapy should be initiated promptly.

Topics: Acyclovir; Antiviral Agents; Chronic Disease; Fatal Outcome; Female; Graft vs Host Disease; Hematopoietic Stem Cell Transplantation; Herpes Zoster; Herpesvirus 3, Human; Humans; Leukemia, Myeloid, Acute; Opportunistic Infections; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Transplantation, Homologous; Virus Activation; Viscera; Young Adult

Topics: Acyclovir; Antiviral Agents; Cervical Vertebrae; Ganglia, Spinal; Herpes Zoster; Herpesvirus 3, Human; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Muscle Weakness; Radiculopathy; Spinal Nerve Roots; Spondylosis; Tomography, X-Ray Computed; Virus Activation

Varicella zoster virus (VZV) infection is one of the frequent opportunistic infections after allogeneic bone marrow transplantation, with a high incidence of 30-50%. However, no data have been reported on VZV infection after allogeneic peripheral blood stem cell transplantation (PBSCT).. We report a retrospective analysis of VZV infection in 192 allogeneic PBSCT recipients. Twenty-seven patients (14%) received long-term prophylaxis of low-dose acyclovir (200 mg twice daily orally > or =3 months) for recurrent oral (n=21) or genital herpes simplex virus infection (n=5) or for a previous history of recurrent VZV infection (n=1).. Forty-two patients (22%) developed VZV infections: localized (n=37) and disseminated infection (n=5). The incidence of VZV infection at 1 and 3 years was 19.3+/-3.3% and 36.8+/-5.2%, respectively. Complications included post-herpetic neuralgia (n=18, 43%), secondary bacterial infections (n=3), and intracranial hemorrhage (n=1) with 2 deaths. A higher risk factor for VZV infection was pre-transplant diagnosis of a lymphoproliferative disorder (LPD): chronic lymphocytic leukemia, Hodgkin's disease, or non-Hodgkin's lymphoma (P=0.021, 52.5% in LPD vs. 32.6% in non-LPD group). The use of low-dose acyclovir prophylaxis (P=0.043, 14.7% in acyclovir vs. 41.6% in nonacyclovir group) was found to be protective. Although no VZV infection episodes were noted during the period of acyclovir prophylaxis, 3 episodes of VZV infection were noted after acyclovir cessation.. The incidence of VZV infection after PBSCT was high at 36.8%, with patients transplanted for LPDs at higher risk. The long-term use of low-dose acyclovir may be protective for VZV infection, although it does not completely prevent rebound of late VZV infection.

Topics: Acyclovir; Adolescent; Adult; Aged; Antibiotic Prophylaxis; Antiviral Agents; Female; Herpes Simplex; Herpes Zoster; Humans; Lymphoproliferative Disorders; Male; Middle Aged; Multivariate Analysis; Peripheral Blood Stem Cell Transplantation; Retrospective Studies; Risk Factors

Voiding dysfunction is a rare but important complication of lumbo-sacral herpes zoster. Although the symptoms are transient, the clinical impact on immunocompromised patients cannot be overlooked.. To clarify the time course of voiding dysfunction in herpes zoster, 13 herpes zoster patients with voiding dysfunction were retrospectively analyzed.. Of 13 patients, 12 had background disease, and six of these were hematopoietic malignancies; four of these patients were hematopoietic stem cell transplant (HSCT) recipients. Ten patients had sacral lesions, two had lumbar, and one had thoracic lesions. Interestingly, patients with severe rash, or with hematopoietic malignancy had later onset of urinary retention than did patients with mild skin symptoms (Mann-Whitney U analysis, P = 0.053) or with other background disease (P = 0.0082). Patients with severe skin rash also had longer durations (P = 0.035). In one case, acute urinary retention occurred as late as 19 days after the onset of skin rash.. In immune compromised subjects, attention should be paid to patients with herpes zoster in the lumbo-sacral area for late onset of acute urinary retention even after the resolution of skin symptoms.

Topics: Acyclovir; Adult; Aged; Aged, 80 and over; Antiviral Agents; Dysuria; Female; Hematologic Neoplasms; Herpes Zoster; Humans; Immunocompromised Host; Lumbosacral Region; Male; Middle Aged; Retrospective Studies; Urinary Catheterization; Urinary Retention

Topics: Acyclovir; Antiviral Agents; Bell Palsy; Diagnosis, Differential; Drug Therapy, Combination; Facial Paralysis; Glucocorticoids; Herpes Zoster; Herpesvirus 3, Human; Humans; Prednisolone

Topics: Acyclovir; Antiviral Agents; Bell Palsy; Drug Therapy, Combination; Glucocorticoids; Herpes Zoster; Herpesvirus 3, Human; Humans; Prednisolone; Virus Activation

To evaluate the efficacy of long-term prophylaxis with ultra-low-dose acyclovir against varicella-zoster virus (VZV) reactivation, we analyzed the records of 242 Japanese adult patients who underwent allogeneic hematopoietic stem cell transplantation for the first time from 1995 to 2006 at our hospital. We started long-term oral acyclovir at 200 mg/day in July 2001. Acyclovir was continued until the end of immunosuppressive therapy and at least 1 year after transplantation. Sixty-six patients developed VZV reactivation at a median of 248 days after HSCT, with a cumulative incidence of 34.7%. Only one breakthrough reactivation occurred during long-term acyclovir, which responded well to therapeutic dose of valacyclovir. The use of long-term acyclovir was the only independent determinant that significantly decreased the overall incidence of VZV reactivation (20% vs. 50%, P < 0.0001). With this prophylaxis, visceral dissemination and serious complications other than post-herpetic neuralgia was completely eliminated, and thereby need for hospitalization was significantly reduced (21% vs. 71%, P = 0.0034). Fifteen of the 57 patients who discontinued acyclovir developed VZV reactivation, with a cumulative incidence of 32.1%. VZV reactivation following discontinuation tended to occur in patients who were receiving immunosuppressive therapy at the cessation of acyclovir. These findings suggested that long-term prophylaxis of ultra-low-dose acyclovir resulted in a successful prevention of severe VZV-related symptoms and death, with a significantly decreased overall incidence of VZV reactivation. Prolongation of prophylactic acyclovir on profound immunosuppression might be important for thorough suppression of VZV reactivation.

Topics: Acyclovir; Adult; Antiviral Agents; Female; Hematopoietic Stem Cell Transplantation; Herpes Zoster; Herpesvirus 3, Human; Humans; Japan; Male; Premedication; Retrospective Studies; Transplantation, Homologous; Treatment Outcome; Virus Activation

A hematopoietic stem cell transplant recipient developed abdominal pain, pneumatosis intestinalis, hepatitis, pancreatitis, and inappropriate antidiuretic hormone secretion. Blood for varicella-zoster virus (VZV) DNA polymerase chain reaction was positive. She was treated with acyclovir and subsequently developed VZV antigen-positive zoster. Detection of VZV DNA in blood may be useful for early diagnosis in immunocompromised hosts who present with zoster without skin lesions.

Topics: Abdominal Pain; Acyclovir; Adult; Antiviral Agents; DNA, Viral; Female; Hematopoietic Stem Cell Transplantation; Herpes Zoster; Herpesvirus 3, Human; Humans; Pancreatitis; Pneumatosis Cystoides Intestinalis; Polymerase Chain Reaction; Vasopressins

Topics: Acyclovir; Adrenal Cortex Hormones; Antiviral Agents; Herpes Simplex; Herpes Zoster; Herpesvirus 1, Human; Herpesvirus 2, Human; Herpesvirus 3, Human; Humans; Polymerase Chain Reaction; Retinal Necrosis Syndrome, Acute

Herpes zoster (HZ) is a public health problem worldwide. Although, there is paucity of data of this disease from South American countries. The objective of this study was to evaluate clinical and epidemiological aspects of HZ in a population of patients from South America. We underwent a retrospective analysis of clinical charts of an infectious diseases reference center (period: 2000-2005). Univariate analysis was performed to assess variables related to post herpetic neuralgia (PHN). From a total of 302 cases, 62% were in women. The median age was 57 years: 16.1% of the patients had a predisposing condition for the development of HZ. Most frequent dermatomes involved were: thoracic, ophthalmic and lumbar; 93.5% of the patients received antiviral drugs and 94% complementary medications. The most frequent complication was PHN and was related with age over 50 years. Clinical and epidemiological aspects of HZ and the frequency of complications in our population were similar to data from developed countries.

Topics: Acyclovir; Adolescent; Adult; Age Distribution; Aged; Aged, 80 and over; Analysis of Variance; Antiviral Agents; Argentina; Child; Female; Herpes Zoster; Humans; Male; Middle Aged; Neuralgia, Postherpetic; Retrospective Studies; Young Adult

A novel series of 2-aryl-2-hydroxyethylamine substituted 4-oxo-4,7-dihydrothieno[2,3-b]pyridine-5-carboxamides have been identified as potent antivirals against human herpesviruses. These compounds demonstrate broad-spectrum inhibition of the herpesvirus polymerases HCMV, HSV-1, EBV, and VZV with high specificity compared to human DNA polymerases.

Topics: Antiviral Agents; Binding, Competitive; Cytomegalovirus; DNA-Directed DNA Polymerase; Enzyme Inhibitors; Ethylamines; Exodeoxyribonucleases; Herpes Zoster; Herpesviridae; Herpesvirus 1, Human; Herpesvirus 4, Human; Humans; Models, Chemical; Nucleic Acid Synthesis Inhibitors; Pyridines; Structure-Activity Relationship; Viral Proteins

Topics: Acyclovir; Anti-Inflammatory Agents; Antineoplastic Agents; Antiviral Agents; Boronic Acids; Bortezomib; Dexamethasone; Exanthema; Herpes Zoster; Humans; Male; Middle Aged; Multiple Myeloma; Pyrazines; Skin; Treatment Outcome

Topics: Acyclovir; Aged; Antiviral Agents; Diagnosis, Differential; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Larynx; Mouth; Oropharynx; Treatment Outcome

Varicella zoster virus (VZV) infection is uncommon in patients with gastrointestinal stromal tumour (GIST) and who have not been exposed to extensive radiotherapy and/or high-dose chemotherapy. We report a 56-year-old Nigerian man with GIST who developed VZV infection while on imatinib mesylate therapy. From August 2003 to November 2005, 64 patients (GIST/CML = 6/58) were enrolled into an ongoing Glivec (imatinib mesylate) international patient-assistance programme therapy for Philadelphia/bcr-abl-positive chronic myeloid leukaemia (CML) and CD117-positive GIST patients at Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria. The patient developed herpes zoster (HZ) infection 23 months into therapy with Glivec. With his absolute lymphocyte count at 2,774 cells per microlitre and CD4 count at 950 cells per microlitre, no obvious immunological defect was observed. Prompt resolution of symptoms without sequelae was achieved by treating with acyclovir, analgesic and dressing of lesions with desiccant. To our knowledge, this is the first reported case of HZ infection in a patient with GIST on Glivec therapy, and the response is similar to that of CML patients who developed VZV while on similar therapy.

Topics: Acyclovir; Antiviral Agents; Bandages; Benzamides; Diagnosis, Differential; Gastrointestinal Stromal Tumors; Herpes Zoster; Humans; Imatinib Mesylate; Male; Middle Aged; Piperazines; Protein-Tyrosine Kinases; Pyrimidines

The authors report a case of breastfeeding strike temporally related to the onset of a herpes zoster prodrome involving the left breast.

Topics: Acyclovir; Adult; Antiviral Agents; Breast Feeding; Female; Herpes Zoster; Humans; Infant; Skin; Treatment Outcome

Topics: Acyclovir; Antiviral Agents; Blood Coagulation Disorders; Female; Fibrin; Herpes Zoster; Humans; Hyperlipidemias; Infarction, Middle Cerebral Artery; Lymphangiectasis, Intestinal; Middle Aged; Paraproteinemias; Protein S; Protein-Losing Enteropathies; Urinary Tract Infections

Disseminated varicella-zoster virus infection after organ transplantation in adults is a rare but serious event causing significant morbidity and mortality. We describe our 10-year experience of 13 cases in a single center, including risk factors for infection, lack of protection from pre-existing anti-varicella-zoster virus antibodies, and unusual modes of presentation, including disseminated intravascular coagulation. We also report our preliminary observation of resolution of infection without sequelae in 4 patients with severe disseminated varicella-zoster virus infection who were treated with the combination of intravenous acyclovir and polyspecific intravenous immunoglobulin.

Topics: Acyclovir; Adult; Antiviral Agents; Disseminated Intravascular Coagulation; Drug Therapy, Combination; Female; Heart-Lung Transplantation; Herpes Zoster; Humans; Immunoglobulins, Intravenous; Injections, Intravenous; Male; Middle Aged; Pulmonary Fibrosis; Respiratory Insufficiency; Retrospective Studies

Medical prescription errors are frequent in community settings and information exploring its magnitude during antiviral treatment of herpes zoster is scarce. A questionnaire was applied to 31 physicians working in hospital- or community-based settings in Santiago, Chile in order to characterize their dosing and timing preferences for aciclovir or valaciclovir prescriptions. Aciclovir was more often prescribed than valaciclovir (71.9 and 28.1%, respectively), but less than a third of prescription (27.3%) fulfilled the minimal aciclovir dosing and timing criteria for clinical efficacy (4 gr per day and <72 hours since rash initiation). The limited size of the simple prevented exploring factors linked to a misleading prescription. Appropriate knowledge on dosing and timing of aciclovir/valaciclovir therapy for herpes zoster was infrequent in a sample of physicians working in various clinical settings in Chile.

Topics: Acyclovir; Adult; Antiviral Agents; Female; Herpes Zoster; Humans; Male; Medication Errors; Middle Aged; Surveys and Questionnaires; Valacyclovir; Valine

We describe a patient with acute lymphocytic leukemia (ALL) who developed visceral varicella-zoster virus (VZV) infection following cord blood stem cell transplantation (CBSCT) and was successfully treated with intravenous acyclovir (ACV). A 24-year-old woman with ALL developed severe epigastric pain 168 days after CBSCT, followed by blistering eruptions 2 days later. A diagnosis of visceral varicella-zoster disease was made, and early intravenous ACV therapy successfully alleviated the epigastric pain and skin lesions within 2 weeks. Polymerase chain reaction analysis of the serum showed dramatic decreases in the viral DNA copy number and revealed large viral concentrations prior to the skin manifestations. The viral DNA copy number in whole blood remained positive, however, but was reduced. Further treatment with intravenous ACV led to VZV DNA becoming undetectable in whole blood, a result not achieved with oral valacyclovir.

Topics: Acyclovir; Adult; Antiviral Agents; Cord Blood Stem Cell Transplantation; DNA, Viral; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Injections, Intravenous; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Viscera

Topics: Acyclovir; Aged; Antiviral Agents; Graft Rejection; Hemorrhage; Herpes Zoster; Humans; Kidney Transplantation; Male; Treatment Outcome

Topics: 2-Aminopurine; Acyclovir; Adult; Antiviral Agents; Attitude of Health Personnel; Australia; Famciclovir; Female; Health Care Surveys; Herpes Simplex; Herpes Zoster; Humans; Valacyclovir; Valine

Two live, attenuated varicella zoster virus-containing vaccines are available in the United States for prevention of varicella: 1) a single-antigen varicella vaccine (VARIVAX, Merck & Co., Inc., Whitehouse Station, New Jersey), which was licensed in the United States in 1995 for use among healthy children aged > or = 12 months, adolescents, and adults; and 2) a combination measles, mumps, rubella, and varicella vaccine (ProQuad, Merck & Co., Inc., Whitehouse Station, New Jersey), which was licensed in the United States in 2005 for use among healthy children aged 12 months-12 years. Initial Advisory Committee on Immunization Practices (ACIP) recommendations for prevention of varicella issued in 1995 (CDC. Prevention of varicella: recommendations of the Advisory Committee on Immunization Practices [ACIP]. MMWR 1996;45 [No. RR-11]) included routine vaccination of children aged 12-18 months, catch-up vaccination of susceptible children aged 19 months-12 years, and vaccination of susceptible persons who have close contact with persons at high risk for serious complications (e.g., health-care personnel and family contacts of immunocompromised persons). One dose of vaccine was recommended for children aged 12 months-12 years and 2 doses, 4-8 weeks apart, for persons aged > or = 13 years. In 1999, ACIP updated the recommendations (CDC. Prevention of varicella: updated recommendations of the Advisory Committee on Immunization Practices [ACIP]. MMWR 1999;48 [No. RR-6]) to include establishing child care and school entry requirements, use of the vaccine following exposure and for outbreak control, use of the vaccine for certain children infected with human immunodeficiency virus, and vaccination of adolescents and adults at high risk for exposure or transmission. In June 2005 and June 2006, ACIP adopted new recommendations regarding the use of live, attenuated varicella vaccines for prevention of varicella. This report revises, updates, and replaces the 1996 and 1999 ACIP statements for prevention of varicella. The new recommendations include 1) implementation of a routine 2-dose varicella vaccination program for children, with the first dose administered at age 12-15 months and the second dose at age 4-6 years; 2) a second dose catch-up varicella vaccination for children, adolescents, and adults who previously had received 1 dose; 3) routine vaccination of all healthy persons aged > or = 13 years without evidence of immunity; 4) prenatal assessment and postpartum v

Topics: Acyclovir; Adolescent; Adult; Antibodies, Viral; Antiviral Agents; Chickenpox; Chickenpox Vaccine; Child; Child, Preschool; Drug Storage; Herpes Zoster; Humans; Immunization Schedule; Infant; Measles-Mumps-Rubella Vaccine; Vaccines, Combined

A 70-year-old man developed herpes zoster over the right L5-S2 region for 3 days and was admitted for acyclovir therapy. He had a medical history of rectal cancer status post-colostomy and end-stage renal disease undergoing thrice weekly hemodialysis. Without a prior loading dose, acyclovir 500 mg (7.7 mg/kg) daily was given intravenously in two divided doses. On the third dosage, the patient became confused and agitated and developed insomnia. Within the following 24 h, delirium, visual and auditory hallucinations, disorientation to place and time, as well as impaired recent memory occurred. At the same time, a transient low grade fever (38 degrees C) was noted but resolved spontaneously after ice pillow (Fig. 1). The etiology was vigorously explored. He had no history of any neurological or psychiatric disorders. Drug history was reviewed, but no other medications besides acyclovir were currently being used. Physical examination revealed neither meningeal signs nor focal neurological deficits. Serum blood urea nitrogen, glucose, and electrolytes were within normal limits except for an elevated creatinine level at 6.2 and 5.7 mg/dl (before and after neuropsychotic symptoms, respectively). Complete blood count with differentiation was also unremarkable. Cerebrospinal fluid examination was not possible as the patient's family refused the lumbar puncture. Moreover, an electroencephalograph study and head computed tomography scan disclosed no abnormalities. Acyclovir-induced neurotoxicity was suspected. Therefore, acyclovir was discontinued. Subsequently, serum acyclovir and CMMG were checked by enzyme-linked immunosorbent assay. Serum acyclovir level was 1.6 mg/l (normal therapeutic level, 0.12-10.8 mg/l) and CMMG level was 5 mg/l. Emergent hemodialysis (4-h/session) was given; the neuropsychotic symptoms, including agitation, delirium, and visual and auditory hallucinations, greatly abated after the second session. The patient fully recovered after three consecutive days of hemodialysis; the serum was rechecked and revealed that the acyclovir level was below 0.5 mg/l and the CMMG level was undetectable. At the same time, his herpetic skin lesions resolved well.

Topics: Acyclovir; Aged; Antiviral Agents; Delirium; Guanine; Hallucinations; Herpes Zoster; Humans; Kidney Failure, Chronic; Male; Renal Dialysis

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

A previously healthy 75-year-old man complained of persistent fever, headache, nausea, mild gait disturbance, memory disorder, and sporadic vesicular skin lesions. Viral meningoencephalitis was diagnosed, based on cerebrospinal fluid (CSF) analysis. Intensive CSF analysis suggested that the patient's illness was caused by varicella zoster virus (VZV). The patient recovered completely after treatment with intravenous acyclovir. VZV infection should be considered as a possible cause of central nervous system disease, even in an immunocompetent patient. VZV reactivation was strongly suspected because of the results of anti-VZV antibody evaluations in serum and CSF, although the skin lesions were not similar to those of herpes zoster.

Topics: Acyclovir; Aged; Antiviral Agents; Encephalitis, Varicella Zoster; Herpes Zoster; Humans; Immunocompetence; Male; Skin Diseases

Segmental zoster paresis is a relatively rare complication characterized by focal motor weakness, which may occur in limbs affected by herpes zoster. We demonstrate the clinical characteristics of segmental zoster paresis by reviewing the cases of 138 patients, including 3 of our patients.. We report 3 patients with zoster paresis of the limbs. Patients 1 and 3 showed motor weakness in the left shoulder and arm after developing a herpetic rash in the left C5-C6 dermatomes. Patient 2 showed weakness in the right thigh and groin after a right L2-L3 herpetic eruption. The electromyograms of all 3 patients showed abnormal spontaneous activity in the affected muscles. Intravenous acyclovir and corticosteroid pulse therapy were added to oral antiviral drugs for patients 1 and 2. All 3 patients recovered favorably. Our review of the literature revealed that antiviral treatment may prevent the occurrence of zoster paresis; however, there is insufficient evidence to show what treatment hastens recovery from zoster paresis.. Segmental zoster paresis is still underrecognized by neurologists. Awareness of this disorder is important because it may eliminate unnecessary invasive investigations and lead to appropriate treatment. Further studies on the treatment are necessary.

Topics: Acyclovir; Aged; Antiviral Agents; Diabetes Complications; Electromyography; Exanthema; Female; Herpes Zoster; Humans; Lower Extremity; Magnetic Resonance Imaging; Male; Middle Aged; Muscle Weakness; Neural Conduction; Paralysis; Risk Factors; Skin; Upper Extremity

A 5-year-old boy was vaccinated with the Oka strain of varicella zoster virus vaccine before cord blood transplant for chronic granulomatous disease in 2005. In 2006, he developed herpes zoster on his left arm. DNA from the vesicular rash confirmed the Oka vaccine strain of varicella zoster virus caused this complication. He responded well to 10 days of aciclovir treatment.

Topics: Acyclovir; Antiviral Agents; Chickenpox Vaccine; Child, Preschool; Fetal Blood; Granulomatous Disease, Chronic; Herpes Zoster; Humans; Male

Only a few reports have focused on ocular motor paralysis in herpes zoster ophthalmicus. We report a case of ocular motor paralysis resulting from herpes zoster. The patient, an 80-yr-old woman, presented with grouped vesicles, papules, and crusting in the left temporal area and scalp, with diplopia, impaired gaze, and severe pain. Her cerebrospinal fluid analysis was positive for varicellar zoster virus IgM. Magnetic resonance imaging was performed to rule out other diseases causing diplopia; there were no specific findings other than old infarctions in the pons and basal ganglia. Therefore, she was diagnosed of abducens nerve palsy caused by herpes zoster ophthalmicus. After 5 days of systemic antiviral therapy, the skin lesions improved markedly, and the paralysis was cleared 7 weeks later without extra treatment.

Topics: Abducens Nerve Diseases; Acyclovir; Aged, 80 and over; Antiviral Agents; Female; Herpes Zoster; Herpes Zoster Ophthalmicus; Humans; Skin Diseases, Viral; Treatment Outcome

Corneal involvement in maxillary herpes zoster is very rare. This report presents the case of a 32 years old 7 months pregnant para2+1 female, who presented with vesiculopapular rashes with hyperpigmented crusts over the maxillary area of the face on the left side with periocular oedema, conjunctivitis and mild punctate keratitis in the left eye. She was HIV positive and was on treatment with the highly active antiretroviral therapy. She was treated with topical and systemic acyclovir with rapid resolution of the ocular features.

Topics: Acyclovir; Adult; Antiretroviral Therapy, Highly Active; Antiviral Agents; Corneal Diseases; Female; Herpes Zoster; Herpes Zoster Ophthalmicus; HIV Infections; Humans; Maxillary Nerve; Ophthalmic Nerve; Pregnancy; Pregnancy Complications, Infectious

Topics: Acyclovir; Adult; Antiviral Agents; Attitude to Death; Bipolar Disorder; Delusions; Female; Herpes Labialis; Herpes Zoster; Humans; Male; Middle Aged; Syndrome

We presented an unusual case of ophthalmic herpes zoster masquerading as orbital cellulitis, resulting in delay in appropriate treatment. A 65-year-old woman presented with left periorbital pain and swelling of a week duration. Examination revealed periorbital edema and inflammation but no proptosis. The erythema extended onto the brow. There was no change in visual acuity and cranial nerve function was normal. She was apyrexial and all other parameters were within normal limits. The patient was admitted with an initial diagnosis of sinusitis with orbital cellulitis/dacryocystitis and intravenous co-amoxiclav and a non-steroidal anti-inflammatory drug were administered. The following day, there was little change in her condition with the ocular movements being normal and vision remaining unaffected. She was apyrexial but the periorbital swelling persisted. Computed tomography of the sinuses did not show sinusitis or a periorbital collection. The third day after admission and 10 days after the initial appearance of pain, vesicles appeared on the left forehead, which enabled a diagnosis of herpes zoster of the ophthalmic branch of the trigeminal nerve. She was then treated with acyclovir with a good result.

Topics: Acyclovir; Aged; Antiviral Agents; Diagnosis, Differential; Female; Herpes Zoster; Humans; Orbital Cellulitis; Trigeminal Nerve

Topics: Acyclovir; Antiviral Agents; Eye Infections, Viral; Ganciclovir; Herpes Zoster; Humans; Retinal Necrosis Syndrome, Acute; Valacyclovir; Valganciclovir; Valine

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

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

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

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

Two cases of varicella zoster virus (VZV) meningitis are described in an 18-year-old girl and an 18-year-old boy. They occurred, respectively, 9 days and 9 months after allogeneic bone marrow transplantation. VZV nucleic acid was detected in the cerebrospinal fluid during the 1st week of illness. This recurrence occurred despite valaciclovir prophylaxis and without skin lesions. The two patients received aciclovir intravenously and immunoglobulins infusion. They responded to treatment and their clinical state improved rapidly.

Topics: Acyclovir; Adolescent; Antiviral Agents; Bone Marrow Transplantation; Cerebrospinal Fluid; Chemoprevention; Chickenpox; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Male; Meningitis, Viral; Valacyclovir; Valine

In March 2003, a 34-year-old man with left facial palsy, dysphagia, and hoarseness treated with acyclovir suffered worsened dermatological and neurological problems. A routine blood test in early April showed the patient to be HIV-antibody positive, so he was transferred to our hospital. Blood analysis showed serum HIV-RNA at 96,000 copies/mL and a CD 4 count of 170/microL. Brain MRI taken on admission showed a T 2 high lesion in their left medulla. Acyclovir was thought to be ineffective due to reduced cell-mediated immunity because of the HIV infection, and HAART therapy was begun. After two months of HAART, skin lesions and the T 2 high lesion in left medulla improred. HIV-RNA became undetectable and the CD 4 count exceeded 500/microL. Intracellular cytokine analysis by flow cytometry showed a shift from Th 2 to Th 1 dominance. The elimination of VZV may thus have been promoted by the combination of acyclovir and HAART.

Topics: Acyclovir; Adult; Antiretroviral Therapy, Highly Active; Antiviral Agents; Herpes Zoster; HIV Infections; Humans; Male; Polyneuropathies

In 2001, a 45-year-old man with severe aplastic anemia received a bone marrow transplantation from his HLA-identical sister, 2.5 years after which he developed severe liver dysfunction together with abdominal pain, disturbance of consciousness and generalized vesicles. Disseminated varicella-zoster virus infection was diagnosed by the detection of VZV DNA. Acyclovir and plasma exchange rapidly controlled his VZV-related symptoms and signs. Disseminated VZV infection is often fatal, but acyclovir and plasma exchange may be useful for such infection by reducing the circulating viral load.

Topics: Acyclovir; Anemia, Aplastic; Antiviral Agents; Bone Marrow Transplantation; Combined Modality Therapy; Herpes Zoster; Herpesvirus 3, Human; Humans; Male; Middle Aged; Plasma Exchange

Detection of Varicella-Zoster virus (VZV) DNA in plasma can facilitate the early recognition of complicated VZV-infection in immunocompromised hosts. The correlation of VZV-DNA in plasma with clinical presentations of VZV-infection and subsequent aciclovir treatment in allogeneic stem cell transplant (allo-SCT) recipients was studied. In 81 consecutive VZV-IgG positive allo-SCT recipients, VZV-DNA was measured at regular time points (1, 2 and 4 months) following allo-SCT and patient records were screened for VZV-related symptoms and aciclovir treatment. Subsequently, possible VZV-cases were studied in detail for the course of VZV-DNA and treatment effects. During the initial screening, VZV-DNA was detectable in seven patients. The survey of VZV-related symptoms revealed five additional possible VZV-cases. In cases where suitable plasma samples were available (10 out of 12), VZV-DNA was present almost simultaneously with the first clinical manifestations. No evidence of a preceding phase detectable by VZV-DNA only could be observed. Treatment with aciclovir was associated with a prompt reduction of VZV-DNA load. Detection of VZV-DNA in plasma in allo-SCT recipients accurately reflected the clinical presentation of VZV-infection and treatment with aciclovir. VZV-DNA detection in plasma of allo-SCT recipients appears clinically relevant as this may support early recognition and therapeutic management of VZV-infections following allo-SCT.

Topics: Acyclovir; Adult; Aged; Antibodies, Viral; Antiviral Agents; Cohort Studies; DNA, Viral; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Male; Middle Aged; Polymerase Chain Reaction; Predictive Value of Tests; Sensitivity and Specificity; Stem Cell Transplantation; Time Factors; Transplantation, Homologous; Treatment Outcome; Viremia

We report on a 54-year-old male patient with an aggressive T cell non-Hodgkin's lymphoma with abdominal manifestation undergoing autologous peripheral blood stem cell transplantation after high-dose chemotherapy in April 2003. About 4 months after transplantation, he developed severe upper abdominal pain. Ultrasound examination, X-ray, computed tomography of the abdomen and cardiac diagnostics could not explain the symptoms. While empiric therapy with high-dose acyclovir was started, we could document herpetic lesions in the gastric antrum by endoscopy. The epigastric pain rapidly decreased within several days after the start of acyclovir therapy. No herpetic skin lesions were observed at any time during the disease. This report demonstrates the importance of viral-induced gastritis in the differential diagnosis of severe abdominal pain in patients receiving autologous peripheral blood stem cell transplantation.

Topics: Abdomen, Acute; Acyclovir; Antiviral Agents; Diagnosis, Differential; Gastritis; Gastroscopy; Herpes Zoster; Herpesvirus 3, Human; Humans; Lymphoma, Non-Hodgkin; Male; Middle Aged; Peripheral Blood Stem Cell Transplantation; Pyloric Antrum; Transplantation, Autologous

A case of trigeminal herpes zoster (HZ) infection affecting the left maxillary and ophthalmic divisions of the fifth cranial nerve in an immuno-competent patient is presented. Extremely rare complications such as osteonecrosis, spontaneous tooth exfoliation, secondary osteomyelitis and facial scarring were observed. Sequestrectomy, aciclovir and erythromycin stearate were effectively used in managing the case.

Topics: Acyclovir; Adult; Anti-Bacterial Agents; Antiviral Agents; Cicatrix; Erythromycin; Facial Dermatoses; Herpes Zoster; Humans; Immunocompetence; Male; Maxillary Diseases; Osteomyelitis; Tooth Exfoliation; Trigeminal Nerve Diseases

Varicella-zoster virus (VZV) infection of the central nervous system (CNS) is rare after hematopoietic stem cell transplantation (SCT). Here, we describe the first patient who developed VZV encephalitis after cord blood transplantation (CBT). A 35-year-old man with myelodysplastic syndrome-overt leukemia underwent CBT. On day +23, a neutrophil count consistently greater than 0.5 x 10(9)/L was achieved. On day +42, 1 mg/kg per day of prednisolone therapy was initiated for grade III acute graft-versus-host disease (GVHD). Then, the dose of prednisolone was slowly reduced. For exacerbation of chronic GVHD, the dose of prednisolone was again increased to 1 mg/kg per day on day +231. On day +265, localized cutaneous zoster in the left thoracic region occurred, but soon resolved after acyclovir therapy. On day +309, he suddenly developed diplopia. Subsequently, right facial palsy and hearing impairment occurred. No skin rash was observed. Magnetic resonance imaging (MRI) scans revealed multifocal abnormal high-signal intensity in the CNS. A high level of VZV DNA was detected in a cerebrospinal fluid specimen. He was diagnosed with VZV encephalitis. Acyclovir was given intravenously for 40 days. Four months after the onset, the neurologic symptoms had incompletely resolved. MRI scans showed substantial resolution but with mild residual lesions. The present report indicates that VZV should be considered as a possible causative agent in patients who develop multifocal neurologic symptoms of the CNS after SCT.

Topics: Acyclovir; Adult; Anti-Inflammatory Agents; Antiviral Agents; Cord Blood Stem Cell Transplantation; DNA, Viral; Encephalitis, Varicella Zoster; Graft vs Host Disease; Herpes Zoster; Herpesvirus 3, Human; Humans; Leukemia; Male; Myelodysplastic Syndromes; Prednisolone; Radiography; Remission Induction; Skin Diseases, Viral

To establish the frequency of occurrence of delayed facial nerve paralysis following tympano-mastoid surgery in our department and to determine the aetiological factors and long term prognosis.. Tertiary care academic centre.. A retrospective review of all patients who had undergone tympano-mastoid surgery in our department over the previous five years was carried out. A total of 219 patients were included in the study. Only two patients were identified as having delayed onset facial nerve palsy over this period of time. The patients' medical records were reviewed and the patients clinically assessed.. The frequency of delayed onset facial nerve palsy following tympano-mastoid surgery in our series was 0.91 per cent. Facial weakness set in on day eight and day 14 in the two patients. Serological investigations in both patients revealed raised titres of immunoglobulin (Ig) M and IgG to varicella-zoster virus, confirming the presence of varicella-zoster infection. In our experience, the combined use of prednisone and acyclovir was an effective form of treatment for both patients, whose facial nerve function fully recovered within six months of onset.. The incidence of delayed facial nerve palsy following tympano-mastoid surgery is low. It can occur up to two weeks after the surgery. Our two cases confirm viral reactivation to be an important aetiological factor in the development of delayed onset facial nerve palsy. The overall prognosis for delayed facial nerve palsy following tympano-mastoid surgery appears to be good.

Topics: Acyclovir; Adult; Antiviral Agents; Facial Nerve; Facial Paralysis; Female; Herpes Zoster; Humans; Male; Mastoid; Middle Aged; Postoperative Period; Prednisone; Prognosis; Retrospective Studies; Time Factors; Tympanoplasty; Virus Activation

Topics: Acyclovir; Aged, 80 and over; Antiviral Agents; Herpes Zoster; Humans; Male; Pancreatitis; Treatment Outcome; Ultrasonography

Mostly, herpes zoster affects adults and therefore childhood presentation can represent a diagnostic challenge. Childhood herpes zoster, when it occurs, can also be associated with peripheral nerve complications, as illustrated by this case. A 3-year-old child who had herpes zoster developed a nasolabial scar resulting in a shallow non-healing ulcer from being repeatedly picked. Healing was only achieved after nocturnal sedation, with chloral hydrate.

Topics: Acyclovir; Antiviral Agents; Child, Preschool; Chloral Hydrate; Face; Facial Pain; Female; Herpes Zoster; Humans; Hypnotics and Sedatives; Ulcer

Localised herpes zoster infection ('shingles') in older patients is a common presentation to primary, and sometimes secondary, care physicians. However, symptoms of hyponatraemia, caused by the rare complication of 'syndrome of inappropriate antidiuretic hormone secretion' (SIADH), may be mistaken for constitutional symptoms of the infection itself. Such patients may require closer monitoring or hospitalisation.

Topics: Acyclovir; Aged, 80 and over; Antiviral Agents; Female; Herpes Zoster; Humans; Hyponatremia; Inappropriate ADH Syndrome

Topics: Acyclovir; Adult; Antibodies, Viral; Antiviral Agents; Chickenpox Vaccine; Child; Child, Preschool; Contraindications; Disease Transmission, Infectious; Environmental Exposure; Hematopoietic Stem Cell Transplantation; Herpes Zoster; Herpesvirus 3, Human; Humans; Immune Sera; Immunization, Passive; Infant; National Institutes of Health (U.S.); Postoperative Complications; Practice Guidelines as Topic; Premedication; Sensitivity and Specificity; United States; Valacyclovir; Valine

Viral invasion of the motoneurons and the subsequent inflammation in the anterior horn cells by the varicella zoster virus results in a weakness in the area of the cutaneous eruption. The exact mechanism of zoster paresis is uncertain. The occurrence of symptoms resembling complex regional pain syndrome (CRPS) is common in subjects where the herpes zoster (HZ) outbreak affects an extremity, particularly if it is the distal extremity that is involved. We report the case of a 54-year-old man with monoparesis, hyperalgesia, allodynia, edema, and both color and skin-temperature changes in his left arm after a skin eruption. Electrophysiologic examination revealed the partial degeneration of the superior, middle, and inferior truncus in the brachial plexus, with evidence of HZ infection. Magnetic resonance imaging of the cervical spine and brachial plexus showed degenerative changes without any evidence of nerve root compression. Brachial plexopathy may be the direct cause of the reversible upper-limb paresis resulting from HZ with CRPS-like symptoms.

Topics: Acyclovir; Analgesics, Opioid; Antiviral Agents; Brachial Plexus Neuropathies; Brain; Complex Regional Pain Syndromes; Electric Stimulation Therapy; Electromyography; Herpes Zoster; Herpesvirus 3, Human; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Paresis; Physical Therapy Modalities

The cephalic zoster is a cranial neuritis, with great tendency to diffusion along the nerves. The objective of this article is both to report a case of cranial polineuritis due to herpes zoster infection with laryngeal involvement and review of the relevant literature.. The case of 57-years-old man with unilateral laryngeal mucosal eruptions and complete left vocal paralysis is reported. Laryngeal symptoms, diagnostic criteria and therapeutic result are described.. 1. In cases of head and neck herpes zoster, the investigations of all cranial nerves should be carried out, and the larynx must always be examinated; 2. Co-occurrence of the neuralgic pain (radiating especially to the ear or the occipital region) with unilateral laryngeal palsy should raise a suspicion that herpes zoster infection may by the causative factor; 3. The explanation of the etiologic cause of a vocal fold paralysis in idiopathic cases, may yield not only diagnostic, but also therapeutic value.

Topics: Accessory Nerve; Acyclovir; Ceftriaxone; Herpes Zoster; Herpesvirus 3, Human; Humans; Male; Middle Aged; Paresis; Treatment Outcome; Vagus Nerve; Vocal Cord Paralysis

A 77-year-old woman developed progressive dysesthesia, hypesthesia and weakness in four extremities immediately after improvement of herpes zoster in the left Th10 dermatome area. Examination of the cerebrospinal fluid (CSF) showed an increase in protein concentrations. Evidence of demyelinating polyneuropathy was demonstrated by nerve conduction studies. Her hypesthesia and weakness in the extremities were gradually improved following intravenous immunoglobulin therapy (IVIg). Varicella zoster virus (VZV) titer levels in CSF well correlated both with neurological symptoms and CSF protein concentrations. VZV DNA in the CSF was not detectable. These findings suggested autoimmune Guillain-Barré syndrome (GBS) associated with herpes zoster. An interesting finding in the present patient is that one day after the completion of IVIg, when the neurological symptoms in the extremities were apparently ameliorating, the herpes zoster eruptions again emerged in the left L3 dermatome area. By treatment with intravenous acyclovir, the vesicular eruptions were improved. We assume that IVIg might suppress the immune response against VZV and promote the recurrence of eruptions.

Topics: Acyclovir; Aged; Antiviral Agents; Female; Guillain-Barre Syndrome; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunoglobulins, Intravenous; Immunologic Factors; Injections, Intravenous; Recurrence

A patient developed herpes zoster of the maxillary division of the trigeminal nerve after microvascular decompression. Varicella zoster virus lies dormant in the Gasserian ganglion until reactivation and can cause herpes zoster ophthalmicus. This can result in serious ocular complications including blindness. Antiviral agents are effective if commenced promptly.

Topics: Acyclovir; Aged; Antiviral Agents; Decompression, Surgical; Herpes Zoster; Humans; Male; Treatment Outcome; Trigeminal Nerve; Trigeminal Neuralgia

Topics: 2-Aminopurine; Acyclovir; Antiviral Agents; Cytomegalovirus Infections; Drug Resistance, Viral; Famciclovir; Guanine; Hepatitis B; Hepatitis C; Herpes Simplex; Herpes Zoster; Humans; Influenza, Human; Valacyclovir; Valine; Virus Diseases

We present the description of a successful outcome in a case of varicella-zoster virus (VZV) acute retinal necrosis (ARN).. A healthy 40-year-old patient was admitted for a VZV retinitis.. 10 days after the onset of intravenous (i. v.) acyclovir treatment, new small peripheral retinal necrotic lesions appeared in the right eye. A viral resistance was suspected and the acyclovir therapy was optimised with i. v. foscarnet combined with 2 intravitreal injections of ganciclovir. The outcome was favourable with a final vision of 1.0 after a follow-up of 30 months. No systemic or local complications were observed.. VZV ARN is a severe infection with a poor prognosis. This case demonstrates that combination of antiviral therapies given intravenously (acyclovir + foscarnet) and in the vitreous (ganciclovir) may be safe and efficacious in the management of necrotising herpetic retinopathies affecting immunocompetent patients.

Topics: Acyclovir; Adult; Antiviral Agents; Herpes Zoster; Herpesvirus 3, Human; Humans; Infusions, Intravenous; Male; Ophthalmoscopy; Retinal Necrosis Syndrome, Acute; Vision Disorders

Patients undergoing haemopoietic stem cell transplants (HSCT) are at high risk of varicella zoster virus (VZV) reactivation, with a significant incidence of dissemination. This study reports a retrospective analysis of 247 allogeneic HSCT recipients receiving anti-viral prophylaxis with low-dose oral aciclovir 400 mg/day, administered until immunosuppression was discontinued and the CD4(+) cell count exceeded 200/mm(3). Viral reactivation was successfully suppressed by aciclovir prophylaxis, with only one case of breakthrough infection. The cumulative incidence of zoster infection at 1 year post transplant was 2% and at 5 years 34%. In all, 64 patients discontinued prophylaxis. Zoster developed in 26 of these, giving a cumulative incidence of infection at 1 year after stopping aciclovir of 39% and at 3 years 44%. Infection occurred in a localised dermatomal distribution in 93% of cases. This supports previous findings that aciclovir prophylaxis prevents early VZV reactivation, although the long-term incidence is not affected as infection occurs once prophylaxis is discontinued. Such infection, however, is mild and localised. This study does not support the idea that use of such low-dose aciclovir regimens reduces the zoster incidence by permitting subclinical reactivation during prophylaxis, and therefore the re-establishment of protective anti-viral immunity.

Topics: Acyclovir; Adult; Antiviral Agents; CD4-Positive T-Lymphocytes; Chickenpox; Cohort Studies; Hematopoietic Stem Cell Transplantation; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunosuppressive Agents; Leukemia; Middle Aged; Postoperative Complications; Retrospective Studies; Risk Factors; T-Lymphocytes; Time Factors; Transplantation Conditioning; Transplantation, Homologous

Reduced cellular immunocompetence following allogeneic hematopoietic stem cell transplantation (aHSCT) increases susceptibility to viral infections. Varicella zoster virus (VZV) reactivation in this setting most commonly manifests as dermatomal herpes zoster but in some cases life-threatening VZV encephalitis occurs.. We describe the cases of two patients who presented with shingles 3 and 18 months, respectively, after HLA-matched peripheral blood stem cell transplantation (PBSCT). Unfortunately, in the further clinical course both patients developed fatal VZV encephalitis, despite initial high-dose intravenous therapy with acyclovir and in one case with additional VZV-immunoglobulin.. These two cases suggest that rapid intervention with systemic treatment is warranted and raise the question whether initial combination therapy with intravenous acyclovir and foscarnet, VZV vaccination or long-term low-dose acyclovir are needed to improve treatment and clinical outcome in immunocompromised patients, having undergone allogeneic HSCT.

Topics: Acyclovir; Aged; Encephalitis, Varicella Zoster; Fatal Outcome; Female; Hematopoietic Stem Cell Transplantation; Herpes Zoster; Humans; Immunocompromised Host; Immunoglobulins; Male; Middle Aged

Topics: Acyclovir; Antiviral Agents; Blepharoptosis; Cervical Plexus; Diplopia; Functional Laterality; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunocompetence; Magnetic Resonance Angiography; Magnetic Resonance Imaging; Male; Middle Aged; Oculomotor Nerve; Oculomotor Nerve Diseases; Tomography, X-Ray Computed

While evidence-based medicine may be trumpeted by zealots, managers and politicians, incorporating it into clinical practice is easier said than done. The present article aims to show that it can be achieved and gives some clinical examples to illustrate this. An appendix contains a summary of useful databases and websites for accessing good medical information and evidence, quickly and reliably near the bedside.

Topics: Acyclovir; Adult; Chest Pain; Colchicine; Diagnosis, Differential; Emergency Medicine; Evidence-Based Medicine; Female; Ginkgo biloba; Gout Suppressants; Herpes Zoster; Humans; Male; Migraine Disorders; Myocardial Infarction; Pericarditis; Phytotherapy; Plant Preparations; Troponin

Topics: Acyclovir; Antiviral Agents; Brain Diseases; Female; Herpes Zoster; Humans; Kidney Failure, Chronic; Middle Aged

Post herpes zoster (HZ) reactions have been associated with panoply of neoplastic, inflammatory, and fibro-inflammatory cutaneous disorders. Varicella zoster virus (VZV) DNA has not been identified in most of these reports. After an episode of HZ, a healthy, active 90-year-old female developed ulcerative nodules in the affected trigeminal V1 dermatome and the contra-lateral trigeminal region over a 1-year period. Excision and/or biopsy of all these lesions showed similar pathologic changes that consisted of herpetic folliculitis, adjacent dense mixed nodular lymphocytic infiltrates with germinal centers (cutaneous lymphoid hyperplasia (CLH)), and in the deeper excision specimens, an obliterative vasculitis of a vessel with smooth muscle in its wall. Immunophenotype analysis revealed a mixed, predominate T- and B-cell population without loss of pan-T cell antigens or aberrant expression by B cells of T-cell antigens. Polymerase chain reaction for herpetic DNA was positive for VZV DNA. Lymphocyte gene rearrangement analysis revealed 2 distinct, anatomically and chronologically, monoclonal B-cell populations and a monoclonal T-cell population in one nodule. Treatment with valacyclovir has lead to almost complete resolution of her cutaneous nodules after 6 months of therapy. In this case, it can be surmised that persistence of VZV infection and lack of effective cell-mediated immunity lead to development of both immunopathology (vasculitis) and excessive lymphoid cell proliferation (CLH).

Topics: Acyclovir; Aged, 80 and over; Antiviral Agents; Arteritis; Clone Cells; DNA, Viral; Female; Folliculitis; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunophenotyping; Polymerase Chain Reaction; Pseudolymphoma; Valacyclovir; Valine

Varicella is the most widespread childhood disease in Italy. However, as in many parts of the world, the country does not yet have a unified approach to the management of the disease. A cost-effectiveness analysis of varicella vaccination strategies, using the Latium region in Italy as a case study, was undertaken. Mass vaccination is only recommended if the immunization programme can achieve coverage of over 85% in a short time. However, experience in Italy with non-compulsory vaccinations has shown this is difficult to achieve. Consequently, eradication of the disease is not seen as an attainable short-term goal. For mass varicella vaccination to be successful, it must be run at a national as well as regional level in combination with education programmes, and a reliable surveillance system. The interaction between varicella and herpes zoster must also be taken into account when considering vaccination strategies, as zoster vaccination strategies may have an impact on varicella coverage.

Topics: Acyclovir; Analgesics, Non-Narcotic; Anti-Infective Agents; Chickenpox; Cost-Benefit Analysis; Health Care Costs; Herpes Zoster; Histamine H1 Antagonists; Humans; Italy; Vaccination; Viral Vaccines

Topics: Acyclovir; Antiviral Agents; Emergency Medical Services; Encephalitis, Varicella Zoster; Female; Herpes Zoster; Humans; Middle Aged; Renal Dialysis; Renal Insufficiency

Disseminated cutaneous herpes zoster in healthy persons is uncommon, though it has been described in immunocompromised patients.. We describe a case of disseminated cutaneous herpes zoster in an elderly man with no apparent immunosuppressive condition. The patient was treated successfully with intravenous Acyclovir.. We suggest that disseminated zoster can occur in an immunocompetent host and should be promptly recognized and treated to prevent serious complications.

Topics: Acyclovir; Aged; Antiviral Agents; Early Diagnosis; Herpes Zoster; Humans; Male; Skin Diseases, Vesiculobullous; Time Factors

Topics: Acyclovir; Adolescent; Antiviral Agents; Diagnosis, Differential; Disorders of Excessive Somnolence; Herpes Zoster; Hospitalization; Humans; Male

Topics: Acyclovir; Aged; Aged, 80 and over; Antiviral Agents; Brain Diseases, Metabolic; Diabetes Complications; Diagnosis, Differential; Herpes Zoster; Humans; Hypertension; Male; Myoclonus; Renal Dialysis; Renal Insufficiency; Valacyclovir; Valine

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

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

Medication errors may involve prescribing, dispensing, preparation and administration of drugs. We report a case in which an administration error occurred due to ambiguous labelling of a commercial drug. Tablets were packed in sets of two tablets per blister with the print on the blister 'Zelitrex 500', making the amount of drug per tablet unclear. A short survey among nurses and pharmacy technicians showed that the majority interpreted the strength of the tablets incorrectly. This case shows that, despite regulations for controlling and accepting labelling before marketing, ambiguous labelling may occur and can lead to medication errors.

Topics: Acyclovir; Adult; Antiviral Agents; Drug Labeling; Drug Packaging; Female; Herpes Zoster; Humans; Medication Errors; Valacyclovir; Valine

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; Antiviral Agents; Cidofovir; Cytosine; Drug Resistance, Viral; Fatal Outcome; Female; Foscarnet; Herpes Zoster; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Organophosphonates

Topics: Acyclovir; Antiviral Agents; Drug Eruptions; Herpes Zoster; Humans; Terminology as Topic

Whereas valacyclovir is widely used and is recommended by some authors in moderately immunocompromised HIV-infected patients, its use has not been validated by clinical studies. We report a case of herpes zoster in an HIV-infected patient for whom neurologic complication was not avoided despite valacyclovir therapy. Clinical outcome was favorable after intravenous acyclovir. This case suggests careful monitoring of valacyclovir in HIV-infected patients is necessary.

Topics: Acyclovir; AIDS-Related Opportunistic Infections; Antiviral Agents; CD4 Lymphocyte Count; Drug Monitoring; Electromyography; Herpes Zoster; Humans; Immunocompromised Host; Infusions, Intravenous; Male; Middle Aged; Patient Selection; Radiculopathy; Treatment Failure; Valacyclovir; Valine; Viral Load

Topics: Acyclovir; Adult; Antiviral Agents; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunocompetence; Immunoglobulin M; Leukocytes; Male; Middle Aged; Myelitis

Topics: Acyclovir; Aged; Aged, 80 and over; Anticonvulsants; Antiviral Agents; Female; Herpes Zoster; Humans; Kidney Failure, Chronic; Status Epilepticus; Treatment Outcome; Valacyclovir; Valine

Topics: Acyclovir; Aged; Analgesics, Opioid; Anesthesia, Local; Anticonvulsants; Antidepressive Agents, Tricyclic; Antiviral Agents; Clinical Trials as Topic; Diabetic Neuropathies; Drug Therapy, Combination; Herpes Zoster; Humans; Lidocaine; Methylprednisolone; Middle Aged; Neuralgia

Topics: Acyclovir; Aged; Aged, 80 and over; Anti-Allergic Agents; Antiviral Agents; Clemastine; Facial Dermatoses; Female; Herpes Zoster; Humans; Time Factors; Treatment Outcome

Postherpetic neuralgia (PHN) is a serious complication of herpes zoster that has a predilection for older individuals. PHN is often associated with significant morbidity, and it can cause insomnia, fatigue, depression and interference with daily activities in affected individuals. Treatment for PHN is initiated with antivirals during the acute herpes zoster outbreak. Acyclovir (Zoviraxr, GlaxoSmithKline), valacyclovir (Valtrex, GlaxoSmithKline) or famciclovir (Famvir, Novartis) can be used to treat herpes zoster, and all three have been shown to reduce the duration of the herpetic rash and zoster-associated pain. These antivirals are most effective when used within the first 72 hours of the onset of the rash. Side-effects of these antivirals are low and include nausea, vomiting, abdominal pain and headache. Other treatment options for PHN include topical analgesics, opioid analgesics, tricyclic antidepressants and gabapentin. Because of the complexity of PHN, most patients require a combination of treatment modalities for adequate pain relief.

Topics: 2-Aminopurine; Acyclovir; Age Factors; Aged; Amines; Analgesics; Analgesics, Opioid; Antidepressive Agents, Tricyclic; Antiviral Agents; Cyclohexanecarboxylic Acids; Drug Therapy, Combination; Famciclovir; Gabapentin; gamma-Aminobutyric Acid; Herpes Zoster; Humans; Middle Aged; Neuralgia; Prodrugs; Risk Factors; Time Factors; Valacyclovir; Valine

The purpose of this study was to evaluate patients who contracted the varicella zoster virus infection (VZV) following their allogeneic stem cell transplants. We retrospectively reviewed the incidence and the timing of varicella zoster virus (VZV) infections, including the clinical course, complications, and associated clinical risk factors. Between January 1998 and April 2003, a total of 71 patients received allogeneic stem cell transplants in our hospital. For prophylaxis of the herpes virus infection, all patients were given a daily oral 1000 mg dose of acyclovir from day -7 to day +35. Among the 71 patients, 28 of them (39.4%) developed VZV infection between day 77 and day 980 (median 182 days) following their allogeneic stem cell transplants. In 21 of these infected patients (75%) the occurrence was within the first 300 days after the transplant. Twenty-two patients (78.5%) were under treatment with immunosuppressive agents. Twenty-six patients developed only one episode of the VZV infection after their transplants, but two other patients developed two episodes. Twenty one patients (75%) stricken with the VZV infections had cutaneous reactivation infections of a single dermatome, and in one patient two dermatomes were affected. Five patients (17.8%) developed disseminated cutaneous zoster, and one patient (3.6%) developed a visceral infection. Treatment with acyclovir (oral or drip infusion) was successful in 25 patients. Two patients improved with vidarabine treatment, however the patient with the visceral infection died despite the use of acyclovir. The incidence of visceral infection was low, but the one case was fatal.

Topics: Acyclovir; Adolescent; Adult; Antiviral Agents; Female; Herpes Simplex; Herpes Zoster; Humans; Immunosuppressive Agents; Incidence; Male; Middle Aged; Postoperative Complications; Prognosis; Retrospective Studies; Stem Cell Transplantation; Time Factors; Transplantation, Homologous; Vidarabine

Immunosuppressive agents (azathioprine, methotrexate) are increasingly being used in the treatment of inflammatory bowel disease. The use of immunosuppressive agents is associated with a greater risk of opportunistic infections, the most frequent of which are those caused by cytomegalovirus and varicella zoster virus. We present four cases of opportunistic infections due to Herpesviruses in patients undergoing immunosuppressive treatment with azathioprine for Crohn's disease. We also review the literature published on this topic. Two patients presented cutaneous varicella complicated by pneumonia and esophagitis respectively, one patient had cutaneous herpes zoster and the other had fatal pneumonia possibly caused by the Herpesvirus. In the first three the clinical course of the infection was favorable after withdrawing immunosuppressant treatment and initiating treatment with aziclovir. In patients Crohn's disease azathioprine treatment increases the risk of opportunistic infection by Herpesvirus. However, in the absence of other factors that increase immunosuppression, these infections usually have a benign course with specific antiviral therapy.

Topics: Acyclovir; Adult; Aged; Antiviral Agents; Azathioprine; Chickenpox; Crohn Disease; Disease Susceptibility; Esophageal Diseases; Fatal Outcome; Female; Ganciclovir; Hepatitis, Viral, Human; Herpes Zoster; Herpesviridae Infections; Humans; Immunosuppressive Agents; Leukopenia; Lymphopenia; Male; Opportunistic Infections; Pneumonia, Viral

This paper retrospectively reviews features of postherpetic neuralgia (PHN) in up to 279 personal patients in relation to treatment outcome when treated with tricyclic antidepressants (TCAs). Factors affecting characteristics of PHN: (i) Patients with allodynia (89%) and/or burning pain (56%) have a much higher visual analogue pain intensity score than those without; (ii) Acyclovir (ACV) given for acute shingles (HZ) does not reduce the incidence of subsequent PHN, but reduces the pain intensity in PHN patients with allodynia; (iii) ACV given for acute HZ reduces the incidence of burning pain in subsequent PHN, but not of allodynia; (iv) ACV given for acute HZ reduces the incidence of clinically detectable sensory deficit in subsequent PHN. Factors affecting outcome of TCA-treated PHN: (i) The point in time at which TCA treatment is commenced is by far the most critical factor: started between 3 and 12 months after acute HZ onset, more than two-thirds obtain pain relief (NNT=1.8); between 13 and 24 months, two-fifths (41%) (NNT=3.6); and more than two years, one-third (NNT=8.3). Background and paroxysmal pain disappear earlier and are more susceptible of relief than allodynia. (ii) Twice as many (86%) of PHN patients without allodynia obtain pain relief with TCA treatment than those with (42%); (iii) the use of ACV for acute HZ more than halves the time-to-relief of PHN patients by TCAs; (iv) PHN patients with burning pain are significantly less likely to obtain pain relief with TCAs than those without (p<0.0001).

Topics: Acyclovir; Aged; Antidepressive Agents, Tricyclic; Antiviral Agents; Female; Herpes Zoster; Humans; Male; Middle Aged; Neuralgia; Pain Measurement; Retrospective Studies; Risk Factors; Treatment Outcome

Topics: Acyclovir; Antiviral Agents; Child; Herpes Zoster; Humans

A variable region, R2, on the varicella-zoster virus (VZV) genome contains a repeated 42-bp unit.. The purpose of this study is the derivation of significance from tandem reiteration structure in the R2 region.. Fifty-two specimens were collected from 52 patients with herpes zoster in Osaka and Tokyo, Japan. After treatment of the specimens to release viral DNA, the samples were amplified directly by polymerase chain reaction. In addition, 14 samples were collected from 7 of these zoster patients after valaciclovir or aciclovir therapy.. Analyses of the 52 specimens revealed that the number of repeats ranged from 4 to 13. Interestingly, the numbers of repeats among various VZV strains showed a normal distribution pattern, so that 6-9 repeats were found to be predominant in both Osaka (85%) and Tokyo (72%). The pre- and post-treatment strains taken from the same individuals showed the same numbers of repeats (7-9 in 6 cases and 11 in one).. Our results suggest that the 6-9 repetitions of the 42-bp unit, with presumed stability, may offer these virus strains an advantage in virulence to human skin.

Topics: Acyclovir; Antiviral Agents; Genome, Viral; Herpes Zoster; Herpesvirus 3, Human; Humans; Japan; Phenotype; Tandem Repeat Sequences; Valacyclovir; Valine

Topics: Acyclovir; Antiviral Agents; Child; Herpes Zoster; Humans; Male; Meningitis, Aseptic; Polymerase Chain Reaction

Topics: Acute Disease; Acyclovir; Aged; Anticonvulsants; Antiviral Agents; Carbamazepine; Diagnosis, Differential; Female; Headache; Herpes Zoster; Humans; Oxcarbazepine; Time Factors; Trigeminal Neuralgia; Valacyclovir; Valine

Herpes zoster occurs most often in elderly and immunocompromised individuals, and rarely after surgery. We report 2 cases in which zoster developed in the contralateral dermatome distribution homologous to the surgical site. The mechanism by which unilateral surgery might affect homologous ganglia is likely to involve spinal cord pathways above the dermatomal level of surgical trauma.

Topics: 2-Aminopurine; Acyclovir; Antiviral Agents; Famciclovir; Herpes Zoster; Humans; Male; Middle Aged; Surgical Procedures, Operative

Topics: Acyclovir; Aged; Antiviral Agents; Diagnosis, Differential; Head and Neck Neoplasms; Herpes Zoster; Humans; Male; Melanoma; Pruritus; Scalp Dermatoses; Skin Neoplasms

Acyclovir (ACV) has been used for over two decades to treat herpes virus infections. Serious neurological adverse side effects have occurred during ACV treatment in patients with renal failure, but the cause of the symptoms remains unknown. We hypothesized that increased concentrations of the ACV main metabolite 9-carboxymethoxymethylguanine (CMMG) correlated to these symptoms.. We conducted an observational study from 1991 to mid 1999 based on samples sent for analysis of ACV concentration from various hospital departments in Sweden. Patients with neuropsychiatric symptoms (NS+, n=49) were compared with patients without symptoms (NS-, n=44). ACV and CMMG concentrations were analysed by HPLC. Medical records were analysed for symptoms and compared with pertinent cases identified from Medline.. The serum CMMG levels were significantly higher in the NS+ group (mean=34.1 micro mol/l, 95% confidence interval 23.4-46.1) compared with the NS- group (mean=4.7 micro mol/l, 95% confidence interval 3.3-6.6; P<0.001). CMMG was the strongest predictor in a receiver-operating characteristics curve analysis (ROC), based on 77 patients, of ACV-related neuropsychiatric symptoms. The ROC curve for CMMG demonstrated that neuropsychiatric symptoms could be predicted with a sensitivity of 91% and a specificity of 93% with the use of a cut-off value of 10.8 micro mol/l of CMMG. Thirty-five of 49 patients in the NS+ group showed levels exceeding this concentration compared with only three of 44 of patients in the NS- group (P<0.001). ACV exposure, ACV concentration, creatinine clearance and creatinine concentration were weaker but statistically significant predictors. Haemodialysis reduced CMMG and ACV levels and relieved the symptoms.. The determination of CMMG levels in serum may be a useful tool in supporting the diagnosis of ACV-associated neuropsychiatric symptoms. Furthermore, the monitoring of CMMG levels may prevent the emergence of symptoms.

Topics: Acyclovir; Adult; Aged; Antiviral Agents; Creatinine; Female; Guanine; Herpes Zoster; Humans; Kidney Failure, Chronic; Male; Mental Disorders; Middle Aged; Neurotoxicity Syndromes; ROC Curve; Sensitivity and Specificity

We report the case of a 52-year-old immunocompetent man with varicella-zoster virus large-vessel vasculopathy and multiple bilateral cerebral infarcts who had no history of skin involvement. Etiologic diagnosis was made by isolation of varicella-zoster virus from a cerebrospinal fluid specimen. The patient had marked improvement in mental status after acyclovir therapy was initiated.

Topics: Acyclovir; Adult; Antiviral Agents; Cerebral Infarction; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunocompetence; Male; Skin

Varicella-zoster virus (VZV) infection was studied in 40 adult patients who underwent cord blood transplantation (CBT) from unrelated donors. Twenty-five patients developed VZV reactivation at a median of 5 months after CBT (range 1.7-26 months). The cumulative incidence of VZV reactivation after CBT was 80% at 30 months. Twenty-two patients developed localized herpes zoster. The remaining three patients developed atypical non-localized herpes zoster, which was associated with visceral dissemination in one patient. All the patients responded well to antiviral therapy. Unexpectedly, the absence of grade II-IV acute graft-versus-host disease (GVHD) was associated with a higher rate of VZV reactivation after CBT (100% versus 55%, P=0.01). These results suggest that recovery of VZV-specific immune responses after CBT is delayed even in patients without severe acute GVHD.

Topics: Acute Disease; Acyclovir; Adult; Antiviral Agents; Cord Blood Stem Cell Transplantation; Female; Follow-Up Studies; Graft vs Host Disease; Hematologic Diseases; Herpes Zoster; Herpesvirus 3, Human; Humans; Incidence; Male; Middle Aged; Proportional Hazards Models; Risk Factors; Time Factors; Transplantation Conditioning; Virus Activation

Visceral disseminated varicella-zoster virus (VZV) infection occurred with acute graft-versus-host disease in a 33-year-old Japanese male with non-Hodgkin lymphoma who had undergone allogeneic stem cell transplantation from an HLA-identical sibling after reduced intensity conditioning chemotherapy. Although ganciclovir and acyclovir treatment was effective temporarily, the number of VZV-DNA copies in the blood remained at a high level, and the hepatitis was prolonged. The patient was treated with foscarnet, which led to improvement of the VZV viremia and the hepatic dysfunction. Foscarnet therapy should be considered for acyclovir-resistant VZV infection in the setting of allogeneic hematopoietic stem cell transplantation.

Topics: Acyclovir; Adult; Antiviral Agents; Central Nervous System Neoplasms; Drug Resistance, Viral; Foscarnet; Graft vs Host Disease; Hematopoietic Stem Cell Transplantation; Herpes Zoster; Humans; Lymphoma, Non-Hodgkin; Male; Recurrence; Transplantation, Homologous

Disseminated varicella zoster virus (VZV) infection is a rare complication after renal transplantation in adults. We report 4 cases diagnosed in our transplant patients. One of which was a primary infection (chicken pox) with multivisceral involvement (hepatitis, pneumonitis, myocarditis, and disseminated intravascular coagulation). The other 3 patients VZV-seropositive before transplantation suffered from disseminated zoster. No immunosuppressive drug was significantly associated with a higher risk of disseminated VZV infection. However, from our experience, we believe that mycophenolate mofetil (MMF), plays a part in the clinical presentation of the disease. Early treatment with high doses of acyclovir is fundamental in infection control. It is essential to perform a pretransplantation serological VZV study on all patients.

Topics: Acyclovir; Adult; Aged; Antiviral Agents; Chickenpox; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunosuppressive Agents; Incidence; Kidney Transplantation; Male; Middle Aged; Mycophenolic Acid

Generally, the need for information about varicella-zoster virus (VVZ) infection in cardiac transplantation (CT) is greater than that for other organ transplants. All cases of VVZ infection among the 175 CT patients included herpes zoster as the clinical syndrome in all 11 cases (men, 90.9%; mean age, 50.3+/-5 years; incidence, 6.3%). The infection was limited to one dermatome in seven patients (63.6%: thoracic, 6%; ophthalmic, 1), or two contiguous dermatomes in four patients (36.4%). The infection onset was after the first semester in seven patients (63.6%). All patients received three drug immunosuppressive therapy. Cardiac rejection during the three previous months occurred in one patient (3A grade). Previous CMV disease was observed in three patients (27.3%: range, 7-14 months). Intravenous acyclovir was administered to five patients (ophthalmic and several dermatome forms), and oral therapy for the rest. All the patients recovered; there were no complications or postherpetic neuralgia (mean follow-up: 16.5 months). VVZ infection, a frequent late infection among CT recipients, presents as a clinical syndrome of herpes zoster, frequently in patients with previous CMV infection. In CT, herpes zoster frequently affects two dermatomes, but the clinical courses and responses to treatment are favorable. There was no postherpetic neuralgia.

Topics: Acyclovir; Antiviral Agents; Female; Heart Transplantation; Herpes Zoster; Humans; Incidence; Male; Middle Aged; Postoperative Complications; Retrospective Studies; Treatment Outcome

Herpes zoster is a common disease of adulthood. Its incidence is low in childhood and adolescence. Certain risk factors like hematological malignancies or immunosuppression due to any cause may lead to onset at an early age. There is a unilateral appearance of grouped vesicular eruption on an erythematous background which may involve contiguous dermatomes. Rarely the lesions may occur bilaterally in an otherwise healthy individual. We present a case of herpes zoster, with lesions having atypical distribution involving bilaterally symmetrical dermatomes over the lower chest.

Topics: Acyclovir; Adult; Antiviral Agents; Herpes Zoster; Humans; Immunocompetence; Male

A 1-year-old boy was vaccinated with the Oka strain of varicella just prior to the discovery of a tumor that required intensive antitumor therapy. Three months later he developed herpes zoster, which developed into chronic verrucous lesions that were refractory to treatment with acyclovir and which subsequently disseminated. DNA from a biopsy specimen of a chronic herpes-zoster lesion indicated that the Oka vaccine strain of the the virus caused this severe complication. Analysis of this viral DNA demonstrated a mutation in the viral thymidine kinase gene. Plasmids containing this altered gene were unable to produce functional thymidine kinase in an in vitro translation system. The presence of this mutation would explain the clinical resistance to acyclovir. This is the first report of Oka-strain varicella virus causing severe disease after reactivation and of resistance to acyclovir during an infection caused by this virus.

Topics: Abdominal Neoplasms; Acyclovir; Antiviral Agents; Chickenpox Vaccine; DNA, Viral; Drug Resistance, Viral; Foscarnet; Herpes Zoster; Herpesvirus 3, Human; Humans; Infant; Male; Neuroblastoma; Polymorphism, Restriction Fragment Length; Vaccination; Vaccines, Attenuated

Infections caused by Varicella Zoster virus in children with cancer have a high rate of complications and mortality.. To report the outcome of this infection in children with cancer.. Retrospective analysis of medical records of 216 children aged less than 15 years old with the diagnosis of an hematological or solid tumor, admitted to the National Program of Antineoplastic Drugs (PINDA).. Eighty seven children had a Varicella Zoster virus infections, 73 (84%) had varicella, 8 (9%) had herpes zoster and 6 (7%) had varicella and herpes zoster. Ninety four percent acquired the infection during antineoplastic treatment and 78% received Acyclovir as antiviral therapy. During a nosocomial outbreak of varicella, three patients with an Acute Lymphoblastic leukemia died in the initial phase of chemotherapy, in spite of an early administration of Acyclovir. No patient with herpes zoster died.. The incidence of varicella was higher in children with leukemia or lymphoma than in children with other types of cancer. Virus reactivation was uncommon and had a benign course. Varicella mortality in these children could be favorably modified through an active immunization of immunocompetent children.

Topics: Acyclovir; Adolescent; Antiviral Agents; Chickenpox; Child; Child, Preschool; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunocompromised Host; Incidence; Infant; Infant, Newborn; Neoplasms; Retrospective Studies

Topics: Action Potentials; Acyclovir; Antiviral Agents; Electrodiagnosis; Electromyography; Female; Glucocorticoids; Herpes Zoster; Humans; Immunocompromised Host; Leukemia, Myelogenous, Chronic, BCR-ABL Positive; Magnetic Resonance Imaging; Median Nerve; Middle Aged; Neural Conduction; Peripheral Nervous System Diseases; Prednisolone; Radial Nerve

We report a case with microscopic polyangiitis (MPA) complicated by varicella zoster encephalitis. A 60-year-old woman caught a common cold and had acute otitis media in April 1998. Proteinuria and hematuria with hyaline cast were noted at the routine medical check in May, and she was referred to our hospital because of high fever and chest pain. MPA was diagnosed with acute progressive renal failure, pleuritis and elevated anti-neutrophil cytoplasmic myeloperoxidase antibody (MPO-ANCA). Corticosteroid therapy was administered under hemodialysis but MPA was flared several times with various symptoms including interstitial pneumonitis, alveolar hemorrhage and erythema multiforme exudativum. During the course of the disease she developed disseminated varicella zoster and encephalitis. Positive polymerase chain reaction to varicella zoster in cerebrospinal fluid helped to differentiate her encephalitis from central nervous system symptoms due to microscopic angiitis and herpes simplex encephalitis. Combination of corticosteroid and acyclovir therapies for MPA and varicella zoster encephalitis under hemodialysis were successful. The diagnostic process and therapies to these complicated contexts were thought to be very important.

Topics: Acute Kidney Injury; Acyclovir; Antiviral Agents; Diagnosis, Differential; Drug Therapy, Combination; Encephalitis, Varicella Zoster; Female; Herpes Zoster; Humans; Immunocompromised Host; Methylprednisolone; Middle Aged; Polyarteritis Nodosa; Pulse Therapy, Drug; Renal Dialysis; Severity of Illness Index; Treatment Outcome

Shingles are caused by an endogenous or exogenous reinfection with varicella zoster virus (VZV). Up to 50% of individuals with Hodgkin's disease develop herpes zoster; however, no association could be shown between the occurrence of herpes zoster and underlying subclinical malignancies.. This study was conducted to investigate whether VZV DNA could be detected by polymerase chain reaction (PCR) in the blood of herpes zoster patients and whether there was an association between VZV viraemia and previous or concurrent neoplasias.. At least five blood samples from 28 patients with herpes zoster were investigated by internally controlled PCR enzyme-linked immunosorbent assay prior to and during therapy with aciclovir.. None of 13 patients, two with a history of neoplasia and two with a neoplasia at the time of the study, showed any signs of viraemia with VZV, and 14 patients had inconsistent viraemia, one with a history of neoplasia and two with neoplasia at the time of the study. In one patient VZV DNA was detected in the blood for 6 days. This patient died soon after from metastatic malignant melanoma.. VZV viraemia may occur during herpes zoster episodes, even in patients without evidence of immunosuppression; however, this viraemia is, in most cases, inconsistent and does not provide any specific information concerning underlying unrecognized malignancies.

Topics: Acyclovir; Adult; Aged; Base Sequence; DNA, Viral; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunocompromised Host; Incidence; Male; Middle Aged; Molecular Sequence Data; Neoplasms; Polymerase Chain Reaction; Prognosis; Prospective Studies; Risk Factors; Sampling Studies; Sensitivity and Specificity; Viremia

Topics: Acyclovir; Aged; Antiviral Agents; Diagnosis, Differential; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Necrosis; Nose; Palate, Hard; Valacyclovir; Valine

Topics: Acyclovir; Aged; Antibodies, Viral; Antiviral Agents; Enzyme-Linked Immunosorbent Assay; Herpes Zoster; Humans; Immunocompetence; Immunoglobulin G; Male; Treatment Outcome; Trigeminal Nerve Diseases; Valacyclovir; Valine

Topics: Acyclovir; Female; Hematopoietic Stem Cell Mobilization; Herpes Zoster; Herpesvirus 3, Human; Humans; Leukemia, Myelogenous, Chronic, BCR-ABL Positive; Male; Middle Aged; Stem Cell Transplantation; Tissue Donors; Transplantation, Homologous

Topics: Acyclovir; Adolescent; Antiviral Agents; Diagnosis, Differential; Electroencephalography; Encephalitis, Varicella Zoster; Fever; Headache; Herpes Zoster; Humans; Male; Migraine Disorders; Photophobia; Vomiting

Topics: Acyclovir; Adult; Antiviral Agents; Chickenpox; Chickenpox Vaccine; Controlled Clinical Trials as Topic; Female; Herpes Genitalis; Herpes Zoster; HIV Infections; Humans; Infant; Influenza Vaccines; Influenza, Human; Male; Public Health; Vaccination; Valacyclovir; Valine

The investigation was aimed to determine prognostic factors related to postherpetic neuralgia (PHN), and treatment options for preventing PHN. The data showed 34 (17.0%) out of 188 patients with herpes zoster had severe pain after 4 weeks, and 22 (11.7%) after 8 weeks, compared with 109 (58.0%) at presentation. The age (>/=50 yr), surface area involved (>/=9%), and duration of severe pain (>/=4 weeks) might be the main factors that lead to PHN. On the other hand, gender, dermatomal distribution, accompanied systemic conditions, and interval between initial pain and initiation of treatment might not be implicated in PHN. The subjects were orally received antiviral (valacyclovir), tricyclic antidepressant (amitriptyline), and analgesic (ibuprofen) as the standard treatment in the group 1. In addition to the standard medication, lidocaine solution was sub- and/or perilesionally injected in the group 2, while lidocaine plus prilocaine cream was topically applied to the skin lesions in the group 3. The rates of PHN in the 3 treatment groups were not significantly different, suggesting adjuvant anesthetics may not be helpful to reduce the severity of pain.

Topics: Acyclovir; Adolescent; Adult; Aged; Amitriptyline; Anti-Inflammatory Agents, Non-Steroidal; Antidepressive Agents, Tricyclic; Antiviral Agents; Child; Drug Therapy, Combination; Female; Herpes Zoster; Humans; Ibuprofen; Male; Middle Aged; Neuralgia; Prognosis; Time Factors; Valacyclovir; Valine

Topics: Acyclovir; Aged; Antiviral Agents; Female; Giant Cells; Herpes Zoster; Humans; Kidney Transplantation; Pneumonia; Skin

Topics: Acyclovir; Antiviral Agents; Chickenpox Vaccine; Hematopoietic Stem Cell Transplantation; Herpes Zoster; Humans; Opportunistic Infections; Research Design

Two male patients aged 40 and 45 years with HIV infection and paraplegia are presented. The two had sub-acute onset paraplegia with a sensory level, which developed 10 days after herpes zoster dermatomal rash. They both had asymmetrically involvement of the lower limbs. Investigation including imaging of the spinal cord did not reveal any other cause of the neurological deficit. The two responded very well to treatment with acyclovir. Herpes zoster myelitis is a condition likely to rise with the upsurge of HIV infection and there is a need to identify the condition early. We also review the literature on the subject.

Topics: Acyclovir; Adult; AIDS-Related Opportunistic Infections; Antiviral Agents; Diagnosis, Differential; Disease Progression; Herpes Zoster; Humans; Male; Middle Aged; Myelitis; Paraplegia; Time Factors; Treatment Outcome

Motor neuropathy is an uncommon complication that may follow an outbreak of herpes zoster (HZ). About half of the reported cases have involved the cranial nerves, typically the facial nerve. The remaining cases have affected the nerves of the extremities. Interestingly, motor weakness of the thoracic segments is strikingly rare, even though this is where HZ most frequently occurs. The dermatologic literature reports only exceptions to this occurence. We report a new case of motor paresis following HZ infection in an abdominal location, where this complication can be easily misdiagnosed as abdominal herniation.

Topics: Abdomen; Acyclovir; Follow-Up Studies; Herpes Zoster; Humans; Male; Middle Aged; Paresis; Risk Assessment; Treatment Outcome

Topics: Acyclovir; Antiviral Agents; Child; Herpes Zoster; Humans; Injections, Intravenous; Male; Meningitis, Aseptic; Time Factors

Classically, recall dermatitis refers to chemotherapy-induced reactivation of skin damage caused by radiotherapy months, or even years, earlier. The concept of recall dermatitis has now been extended to include radiation recall dermatitis induced by other drugs, ultraviolet radiation, extravasation of drugs, and allergic contact dermatitis. We now describe recall dermatitis along the residual cutaneous lesions of a previous thoracic herpes zoster in a patient who developed a drug eruption after oral administration of aciclovir. The most striking feature consisted of confluent linear erythema along the dermatomes previously involved by the herpes zoster episode. Histopathologic study demonstrated small foci of spongiosis, vacuolar changes involving the basal layer of the epidermis and single necrotic keratinocytes scattered within the epidermis. The papillary dermis appeared oedematous and with dilated blood capillaries surrounded by a sparse inflammatory infiltrate composed mainly of lymphocytes. Serial sections failed to demonstrate cytologic changes of herpes varicella zoster infection. We interpreted this case as an example of recall dermatitis because the widespread cutaneous eruption secondary to aciclovir was more intense in skin previously compromised by herpes varicella zoster infection. To the best of our knowledge, recall dermatitis has not been described before at the site of previous involvement by herpes zoster.

Topics: Acyclovir; Antiviral Agents; Drug Eruptions; Female; Herpes Zoster; Humans; Middle Aged

Visceral dissemination of herpes zoster may follow cutaneous dissemination in immunocompromised patients. The skin is not necessarily the only organ affected and may not even be the presenting organ. Immunohistochemical stains available for routine paraffin-embedded tissue biopsy specimens allow for rapid diagnosis of varicella zoster virus. We describe a patient in whom gastric dissemination of herpes zoster was proven by immunohistochemistry. Unexplained hepatitis, pancreatitis, gastritis, or complaints of abdominal pain in immunocompromised patients with herpes zoster should prompt a high degree of suspicion for visceral zoster and immediate treatment with intravenous acyclovir.

Topics: Acyclovir; Aged; Biopsy, Needle; Follow-Up Studies; Gastric Mucosa; Gastroscopy; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunocompromised Host; Immunohistochemistry; Infusions, Intravenous; Lymphoma, Non-Hodgkin; Male; Risk Assessment; Stomach Ulcer; Treatment Outcome

Varicella-zoster virus (VZV) pneumonitis remains an often-fatal complication of VZV infection. Antiviral agents and supportive care are widely accepted therapies. Cautious use of corticosteroids in life-threatening VZV pneumonitis may be justified. Appropriate patient selection factors are as yet unidentified and the decision to commence corticosteroid therapy in this setting is clinical.

Topics: Acyclovir; Aged; Aged, 80 and over; Antiviral Agents; Drug Therapy, Combination; Female; Glucocorticoids; Herpes Zoster; Herpesvirus 3, Human; Humans; Methylprednisolone; Pneumonia, Viral

In continuous ambulatory peritoneal dialysis (CAPD) patients, acyclovir-induced neurotoxicity is reported to be associated with high serum drug levels even when following the recommended reduced doses for this renal failure population. In view of the high oral bioavailability of valaciclovir (the L-valyl ester of acyclovir) the risk of neurotoxicity becomes more prominent. The present study was conducted in 12 CAPD patients who were administered a single oral dose of 500 mg valaciclovir. Acyclovir was analyzed by high-performance liquid chromatography. Relative pharmacokinetic parameters were estimated based on acyclovir concentrations at 8, 12 and 24 h post-dose. High inter-patient variations were observed with acyclovir apparent total clearance 7.238 +/- 4 l/h and half-life (T1/2) 22.27 +/- 16.82 h. However, dosage simulations confirmed supratherapeutic acyclovir concentrations for all participants when following the recommended dose of 1,000 mg valaciclovir/24 h for varicella zoster infections.

Topics: Acyclovir; Aged; Antiviral Agents; Biological Availability; Female; Herpes Zoster; Humans; Kidney Failure, Chronic; Male; Middle Aged; Peritoneal Dialysis, Continuous Ambulatory; Valacyclovir; Valine

Topics: Acyclovir; Antiviral Agents; Diabetes Mellitus, Type 1; Extravasation of Diagnostic and Therapeutic Materials; Hand Injuries; Herpes Zoster; Humans; Male; Middle Aged

Topics: Acyclovir; Antibodies, Monoclonal; Antiviral Agents; Crohn Disease; Gastrointestinal Agents; Herpes Zoster; Humans; Infliximab; Male; Middle Aged

Topics: Acyclovir; Analgesics; Antiviral Agents; Chest Pain; Female; Herpes Zoster; Humans; Middle Aged; Pain, Intractable; Time Factors

The aim of this study was to determine the incidence and outcome of herpes zoster hospitalised children with cancer in Kota Baru. It was a retrospective review from January 1994 to December 1998. The diagnosis of herpes zoster was a clinical one. Herpes zoster was diagnosed in 10 of 188 (5%) children with malignancy. The most common malignancy was leukaemia. Nine children were treated with acyclovir. No child developed visceral dissemination and there were no deaths.

Topics: Acyclovir; Antiviral Agents; Burkitt Lymphoma; Child; Child, Preschool; Female; Herpes Zoster; Humans; Immunocompromised Host; Leukemia, Myeloid, Acute; Malaysia; Male; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Retrospective Studies; Treatment Outcome

Clinical presentations of varicella-zoster virus (VZV) infection may vary widely among healthy and immunocompromised patients. In addition, the recurrence of VZV infection with cutaneous manifestations in both of these populations is more common than was once believed. Most cases of verrucous varicella infection have been reported in patients with documented immunosuppression (most commonly HIV/AIDS). We present an unusual case of persistent verrucous varicella, which was the initial manifestation of HIV infection, in a previously "healthy" 3-year-old girl with a strong family history of Wiskott-Aldrich Syndrome. Current research, therapeutic options, and differential diagnoses with regard to VZV infection are briefly reviewed.

Topics: Acyclovir; Antiviral Agents; Child, Preschool; Chronic Disease; Female; Follow-Up Studies; Herpes Zoster; Herpesvirus 3, Human; HIV Infections; HIV Seropositivity; Humans; Immunocompromised Host; Risk Assessment; Treatment Outcome

Because of the severe complications that may result from varicella zoster virus (VZV) infection following renal transplantation (Tx), transplanted varicella-susceptible children exposed to varicella are typically given varicella zoster immunoglobulin (VZIG) as prophylaxis or are admitted and treated with parenteral acyclovir if VZIG prophylaxis fails. As both VZIG and hospitalization are costly, prevention of varicella infection by vaccination could potentially result in significant cost savings in addition to decreasing morbidity and mortality. To test this hypothesis, we developed a decision-analysis model to evaluate the cost-effectiveness of vaccinating patients with chronic renal failure (CRF) against varicella prior to renal transplant. Under baseline assumptions, vaccination for varicella pretransplant was a cost-effective strategy, with a cost of $211 per patient vaccinated compared with $1,828 per patient not vaccinated. The magnitude of cost savings from vaccination was sensitive to variations in the cost of varicella vaccine, the percentage of patients hospitalized for treatment with acyclovir, and the percentage of patients exposed to varicella infection. One- and two-way sensitivity analyses confirmed that vaccination was the dominant cost-effective strategy under all conditions examined. We conclude that vaccination for varicella pretransplant is cost-effective for patients with CRF, and that the magnitude of cost savings is sensitive to the cost of hospitalization, the percentage of patients exposed to varicella, and the cost of varicella vaccination. Pending results of ongoing studies of the safety and efficacy of VZV vaccine in children with CRF, we recommend that VZV vaccine be given to all children with CRF.

Topics: Acyclovir; Chickenpox; Chickenpox Vaccine; Child; Child, Preschool; Cost-Benefit Analysis; gamma-Globulins; Herpes Zoster; Humans; Immunization; Kidney Failure, Chronic; Kidney Transplantation

Topics: Acyclovir; Antiviral Agents; Herpes Zoster; Humans; Iceland; London; Middle Aged; Neuralgia

Topics: Acyclovir; Aged; Amitriptyline; Analgesics, Non-Narcotic; Antiviral Agents; Drug Costs; Herpes Zoster; Humans; Middle Aged; Neuralgia

Topics: Acyclovir; Adult; Bone Marrow Transplantation; Female; Follow-Up Studies; Gastric Mucosa; Gastritis; Gastroscopy; Herpes Zoster; Humans; Immunocompromised Host; Leukemia, Promyelocytic, Acute; Risk Assessment; Treatment Outcome

We reviewed 58 cases of varicella-zoster infection that occurred between 1988 and 1998 in 47 pediatric solid-organ transplant recipients. The median age of patients at the time of admission with varicella-zoster infection was 8.0 yr (range 1-17 yr). The median interval between transplantation (Tx) and varicella-zoster virus (VZV) infection was 1.6 yr (range 0.06-9.3 yr). Varicella infection occurred at a rate of one case for every seven transplant recipients. Among the 58 cases of VZV infection, 53% were varicella while 47% were herpes-zoster. Varicella infection occurred despite treatment with varicella-zoster immune globulin (VZIG) in 17 of 31 cases of varicella infection. However, the disease was generally mild with severe disease occurring in only two patients. One patient (1.7%) died as a result of bacterial sepsis. There was no significant relationship between VZV infection and specific immune suppressants. Episodes of rejection were more likely to be temporally associated with the occurence of herpes zoster than with varicella infection (p = 0.02). The data generated provide useful background information in our population in the prevaricella vaccine era.

Topics: Acyclovir; Adolescent; Antiviral Agents; Chickenpox; Chickenpox Vaccine; Child; Child, Preschool; Female; Graft Rejection; Herpes Zoster; Hospitals; Humans; Infant; Male; Nervous System Diseases; Organ Transplantation; Prevalence

Topics: Acyclovir; Adult; Antiviral Agents; Herpes Zoster; Herpesvirus 3, Human; HIV Infections; HIV-1; Humans; Meningitis, Viral; RNA, Viral

Topics: 2-Aminopurine; Acyclovir; Aged; Aged, 80 and over; Chorea; Drug Interactions; Famciclovir; Herpes Zoster; Humans; Kidney Failure, Chronic; Male; Renal Dialysis; Valacyclovir; Valine

In our previous study, we concluded that an epidural blockade combined with intravenous acyclovir is very effective in treating the acute pain in herpes zoster and postherpetic neuralgia. We evaluated the efficacy of oral famciclovir and epidural blockade on the pain of herpes zoster, compared to acyclovir administered intravenously and epidural blockade. For this purpose, we examined a new group treated with famciclovir and epidural blockade to compare with the group treated with acyclovir and epidural blockade in our previously study. The changes in the intensity of pain, the number of days required for relief of pain, and the total duration of pain were checked. We compared the days required for relief of pain (DRP) and the total duration of pain (TDP) of this group with those of the previous studied group treated with acyclovir and epidural blockade. DRP was significantly less, but TDP was similar. DRP and TDP were significantly lower, if the patients were treated within 7 days of symptom onset. The patients had a shorter DRP regardless of pain type than the previously studied group treated with acycolvir and epidural blockade. For the severe and moderate pain grades, there was a shorter DRP from 100 to 10. TDP was not significantly different for the groups regardless of pain type or grade. We believe that famciclovir and epidural blockade are very effective in treating the pain of herpes zoster, with a view to shortening the period of acute pain, providing similar effects on the prevention of postherpetic neuralgia, and being convenient to administer, compared to intravenous acyclovir and epidural blockade in our previous study.

Topics: 2-Aminopurine; Acyclovir; Adult; Analgesia, Epidural; Analysis of Variance; Anesthetics, Local; Antiviral Agents; Bupivacaine; Famciclovir; Female; Herpes Zoster; Humans; Male; Middle Aged; Neuralgia; Pain Measurement; Treatment Outcome

Although the efficacy of modern antiviral agents for the treatment of herpes zoster is unquestioned, their ability to affect the associated pain remains controversial.. We have therefore evaluated the inpatient hospital records of 550 patients with herpes zoster with regard to pain-related clinical aspects and therapeutic responsiveness.. Intensity of pain was quantified by calculating a daily pain equivalence index (PEI) on the basis of different classes of pain medication and the number of tablets used in each category.. The mean age of patients was 66.7 years, cranial segments were predominantly involved (55%), 64% of patients suffered from associated diseases and 77% experienced herpes-related pain. The PEI was 0.90 in the entire patient population, with significantly higher values in women and in patients with 3 or more associated diseases. It was lower in sacral and cranial nerve involvement, and it decreased rapidly in patients prior to discharge from hospital. Although there were significant differences in hospital stay between patients who received aciclovir and those who did not (mean 20.3 vs. 23.8 days), and for high- versus low-dose oral or intravenous administration, no significant differences were noted between the two groups for initial PEI values and during the course of observation, irrespective of the route of administration or the dose of aciclovir and the individual patient's PEI value. The groups were otherwise closely similar with regard to basic demographic and clinical data. 23.3% predominantly aged female patients with more associated diseases than the total patient population had a persistently elevated PEI and stayed in hospital beyond 21 days (mean 35.1 days), representing patients who went on to postherpetic neuralgia.. These data further delineate clinical aspects of acute herpes zoster neuralgia, underline the unsolved therapeutic problems associated with this condition despite otherwise effective antiviral treatment, and characterise a subgroup of patients at risk to develop postherpetic neuralgia.

Topics: Acute Disease; Acyclovir; Administration, Oral; Adolescent; Adult; Aged; Aged, 80 and over; Antiviral Agents; Female; Germany; Herpes Zoster; Humans; Infusions, Intravenous; Length of Stay; Male; Medical Records; Middle Aged; Neuralgia; Pain Measurement; Retrospective Studies; Treatment Outcome

Herpes zoster (HZ) in childhood is rather unusual. This reactivation of chickenpox, the primary varicella-zoster virus (VZV) infection that lies dormant within sensory ganglia, is seen with increased frequency in otherwise healthy children who acquire chickenpox either in utero or within the first year of life. Our patient is a good example of this; he was exposed to chickenpox at the age of 3 months (by his 2 siblings) and developed HZ at 6 years of age.

Topics: Acyclovir; Antiviral Agents; Child; Herpes Zoster; Herpesvirus 3, Human; Humans; Male

A unique feature of herpesviruses is their ability to establish latent infection within the nervous system by colonizing peripheral sensory ganglia, which results in subsequent episodic outbreaks of infection triggered by precipitating events. Despite the latent nature of both herpes simplex virus type 1 (HSV-1) and varicella-zoster virus (VZV) within these sensory ganglia, simultaneous outbreaks of these viruses are uncommon. This is generally attributed to the differing reactivation features of these 2 viruses. Four cases of concurrent HSV-1 and VZV infection are described in the literature. We report concurrent infection of HSV-1 and VZV within the same V2 dermatome in an immunocompetent patient.

Topics: Acyclovir; Aged; Aged, 80 and over; Fatal Outcome; Follow-Up Studies; Herpes Simplex; Herpes Zoster; Herpesvirus 1, Human; Herpesvirus 3, Human; Humans; Immunocompetence; Injections, Intravenous; Male

The incidence of varicella infection is increasing in adults, where primary pneumonitis is the main complication. Little information exists concerning treatment of those patients who require admission to a high dependency unit (HDU) facility. A study was performed to examine the risk factors for developing varicella pneumonitis (VP), to document disease progression and assess prognosis for patients with VP requiring HDU admission.. A 10-year retrospective casenote review of patients admitted to the Regional Infectious Diseases Unit HDU. Varicella pneumonitis (VP) was defined as diffuse nodular shadowing on a chest X-ray (CXR) of a patient with a classical chickenpox rash. Severe pneumonitis was defined as an hypoxaemia index (pO2 in mmHG/FiO2) of less than 150 at any time during hospital stay. All patients were treated with intravenous acyclovir at a dose of 10 mg/kg.. A total of 33 patients were admitted to the HDU with VP over the study period, 30 were included in the study. Annual admission rates remained constant. Most patients (76.7%) had at least one recognised risk factor for severe VP: smoking 18/30, pregnancy 9/30, chronic lung disease 7/30. Twelve (40%) patients had severe VP, eight (26.7%) required assisted ventilation. The presence of greater than one risk factor (p < 0.02) was associated with progression to severe VP. There was one death: a 63-year-old man with a long history of chronic airflow limitation whose treatment had included domicillary long-term oxygen therapy. Nine (30%) patients developed secondary bacterial pneumonia; all recovered with appropriate antibiotic treatment. The period of stay in HDU for the majority of patients was short (mean 4.5 days).. The prognosis for severe adult VP with current available treatment is good. The only predictor on admission for severe VP is the presence of more than one recognised risk factor for developing VP.

Topics: Acyclovir; Adolescent; Adult; Antiviral Agents; Chickenpox; Critical Care; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Lung Diseases; Male; Middle Aged; Pneumonia; Pregnancy; Prognosis; Retrospective Studies; Risk Factors; Smoking; Statistics, Nonparametric; Treatment Outcome

To evaluate the efficacy of long-term administration of acyclovir as prophylaxis against varicella-zoster virus (VZV) reactivation, we analyzed the medical records of 86 consecutive adult patients who obtained engraftment after allogeneic hematopoietic stem cell transplantation from January 1996 to March 2000. We started long-term low-dose (400 mg/day) oral administration of acyclovir in June 1999, and this was continued until the end of immunosuppressive therapy after transplantation. There was no breakthrough reactivation of VZV in patients receiving acyclovir. Five patients who were receiving cyclosporine or prednisolone developed VZV reactivation after discontinuing acyclovir. With this prophylaxis, the cumulative incidence of VZV reactivation at 1 year after transplantation decreased from 33% to 10% (P = 0.025). On multivariate analysis, the use of long-term acyclovir was identified as a significant independent parameter for the development of VZV reactivation. These findings suggest the efficacy of long-term prophylaxis with low-dose acyclovir. Resumption of acyclovir upon restarting immunosuppressive therapy might be important for the further prevention of VZV reactivation. The benefit of long-term low-dose acyclovir should be confirmed prospectively.

Topics: Acyclovir; Administration, Oral; Adolescent; Adult; Antiviral Agents; Cyclosporine; Drug Administration Schedule; Female; Follow-Up Studies; Hematopoietic Stem Cell Transplantation; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunologic Surveillance; Immunosuppressive Agents; Incidence; Injections, Intravenous; Male; Middle Aged; Multivariate Analysis; Prednisolone; Retrospective Studies; Transplantation Conditioning; Transplantation, Homologous; Virus Activation

Topics: Acyclovir; Adult; Antiviral Agents; Chickenpox; Female; Fetal Diseases; Genital Diseases, Male; Gestational Age; Herpes Zoster; Herpesvirus 3, Human; Humans; Infant; Male; Maternal-Fetal Exchange; Pregnancy; Pregnancy Complications, Infectious; Virus Cultivation

The current communication describes clinical findings in two recipients of allogeneic bone marrow transplantation (BMT) with varicella zoster virus infection who complained of acute severe abdominal pain preceding cutaneous manifestations. Physical examination, laboratory data and gastroscopic findings were nonspecific. In these cases, acyclovir was very effective for the symptoms. Varicella zoster virus infection should be suspected in BMT recipients who have rebellant acute abdominal pain but no characteristic skin eruptions.

Topics: Abdominal Pain; Acute Disease; Acyclovir; Adolescent; Adult; Antiviral Agents; Bone Marrow Transplantation; Herpes Zoster; Herpesvirus 3, Human; Humans; Male; Skin Diseases, Infectious; Transplantation, Homologous

Multiple lower cranial nerve palsies are a rare complication following varicella zoster virus (VZV) reactivation, especially if typical herpetic eruptions are lacking. We report a case of a 45-year-old, immunocompetent male with unilateral involvement of the cranial nerves VIII, IX, X, and XI without skin lesions. Cerebrospinal fluid (CSF) studies revealed mononuclear pleocytosis with intrathecal antibody synthesis against VZV, while polymerase chain reaction (PCR) did not detect VZV or HSV (herpes simplex virus). The patient almost completely recovered after aciclovir administration. VZV reactivation without rash (zoster sine herpete) may lead to multiple cranial nerve palsies. PCR is a useful tool to detect VZV-DNA in CSF, but negative results do not exclude a reactivation. In case of multiple cranial nerve palsies of unknown etiology with mononuclear pleocytosis in CSF tumors of the skull base, meningitis tuberculosis, and meningeosis have to be excluded, and antiviral therapy should be discussed.

Topics: Acyclovir; Cranial Nerve Diseases; Diagnosis, Differential; Herpes Zoster; Herpesvirus 3, Human; Humans; Male; Middle Aged; Neurologic Examination; Otorhinolaryngologic Diseases; Patient Care Team; Polymerase Chain Reaction; Virus Activation

In 1983, varicella zoster virus (VZV) disease was first recognized in the context of infection with the human immunodeficiency virus (HIV). Since that time, there have been many reports discussing the occurrence and clinical manifestations of hepes zoster in HIV-infected patients. We describe the development of prolonged herpes zoster in a patient with acquired immunodeficiency syndrome (AIDS) over the course of 104 days. Viral isolates at the three different clinical stages of the skin lesions were sensitive in vitro to acyclovir, and supposed to be a same strain by polymerase chain reaction (PCR) analysis. We also discuss an effective treatment for prolonged cases of zoster.

Topics: Acyclovir; Adult; AIDS-Related Opportunistic Infections; Antiviral Agents; Back; Chronic Disease; DNA, Viral; Herpes Zoster; Humans; Male; Polymerase Chain Reaction; Skin Diseases, Viral

We report a retrospective analysis of VZV infection after haematopoietic stem cell transplantation (HSCT) in children. Thirty-three (30%) of the total 109 children who were transplanted during a 7 year period developed post-transplant VZV infection. Twenty-four of these 33 (73%) children had VZV infection within 1 year following HSCT. The cumulative incidences of post-transplant VZV infection at 1 and 5 years were 26% and 45%, respectively. The positive and negative predictive values of pretransplant VZV serology in recipients on the development of HZ following HSCT were 39% and 88%, respectively. Pretransplant VZV seropositivity in recipients was the only risk factor for post-transplant herpes zoster (HZ) infection on multivariate analysis. All patients responded to acyclovir. The median duration of VZV infection was 5 days. Three (11%) and one (3%) children with HZ developed visceral dissemination and post-herpetic neuralgia, respectively. No mortality was directly attributed to VZV infection. VZV infection remains a major cause of morbidity in children after HSCT. Further studies are warranted to evaluate the potential use of VZV vaccine in these children. Bone Marrow Transplantation (2000) 25, 167-172.

Topics: Acyclovir; Adolescent; Adult; Antibodies, Viral; Antiviral Agents; Blood Transfusion, Autologous; Chickenpox; Chickenpox Vaccine; Child; Child, Preschool; Hematopoietic Stem Cell Transplantation; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunosuppression Therapy; Incidence; Infant; Infant, Newborn; Retrospective Studies; Risk Factors; Treatment Outcome

Of 264 patients aged 15 years or more who underwent hematopoietic stem cell transplantation between 1989 and September 1998 at the Tokyo Metropolitan Komagome Hospital, 47 were infected by the varicella-zoster virus (VZV). In 2 patients, visceral disease preceded cutaneous dissemination. One of these patients exhibited gastrointestinal symptoms followed by disseminated skin rash 6 days later. In the other patient, epigastralgia developed and was followed by seizures secondary to meningitis; the appearance of a skin rash 5 days after these initial symptoms yielded the diagnosis. Early diagnosis and treatment of VZV infection are important, especially for patients who present with visceral symptoms suspected to be due to VZV.

Topics: Acyclovir; Adult; Antiviral Agents; Female; Hematopoietic Stem Cell Transplantation; Herpes Zoster; Humans; Male; Treatment Outcome

We have characterized the susceptibility and genetic stability of varicella-zoster viruses (VZV) isolated from skin lesions of three patients with herpes zoster and six patients with varicella treated with conventional short-term acyclovir (ACV) administration. The susceptibilities to ACV of the serial isolates from the patients were examined, and there was no significant difference in the susceptibility to ACV among the isolates before and during the ACV treatment, indicating that conventional short-term ACV treatment did not generate ACV-resistant VZV infections. Polymerase chain reaction (PCR) analyses of these as well as seven thymidine kinase-deficient VZV strains derived from in vitro ACV treatment were carried out to examine their genomic stability. Five regions containing tandem direct reiterations (R1-R5) were amplified by PCR and compared, and the region containing the Pst I-site was also examined. PCR analyses demonstrated that the R1, R5 and the Pst I-sites were stable and useful in epidemiological studies even after ACV treatment. The R2, R3 and R4 sites were far less stable in these experimental conditions. In this paper we discuss the results of the PCR analyses with regard to the dynamics of VZV population in patients with VZV infection treated with conventional short-term ACV administration.

Topics: Acyclovir; Aged; Antiviral Agents; Base Sequence; Chickenpox; Child, Preschool; DNA, Viral; Drug Resistance, Microbial; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Infant; Male; Molecular Epidemiology; Polymerase Chain Reaction; Skin; Thymidine Kinase

Topics: Acute Disease; Acyclovir; Adrenal Cortex Hormones; Antiviral Agents; Drug Therapy, Combination; Herpes Zoster; Humans; Pain

Topics: Acyclovir; Antiviral Agents; Brain Stem; Encephalitis, Viral; Herpes Zoster; Humans; Male; Middle Aged

Cutaneous lesions arising in herpes zoster (HZ) scars are rare. We report a 34-year-old woman with acute lymphoblastic leukemia underwent allogenic bone marrow transplant (BMT). Ten days after the BMT, she developed clusters of vesicles over the right neck, scapula, shoulder and chest. She was treated with intravenous acyclovir and foscarnet. One month after the vesiculous episode of HZ she showed 5 mm to 2 cm clustered flat violaceous lichenoid papules and confluent plaques within the HZ scars. Histopathologic examination revealed a inflammatory infiltrate present in the papillary dermis with granulomatous aggregated formed by histiocytes, multinucleated giant cells and lymphocytes. She was treated with topic steroids with significant improvement. Pathologic findings are similar to those of an unusual lichenoid reaction named "giant cell lichenoid dermatitis". We present the first reported case of giant cell lichenoid dermatitis at the sites of HZ scars.

Topics: Acyclovir; Adult; Antiviral Agents; Bone Marrow Transplantation; Cicatrix; Dermatitis; Female; Foscarnet; Giant Cells; Glucocorticoids; Graft vs Host Disease; Herpes Zoster; Humans; Lichenoid Eruptions; Precursor Cell Lymphoblastic Leukemia-Lymphoma

Purine analogs and alkylating agents are the most active drugs in the treatment of patients with chronic lymphocytic leukemia (CLL). Although fludarabine is the most widely tested purine analog in CLL, myelosuppression has limited its use in combination chemotherapy regimens. Because pentostatin (Nipent; SuperGen, San Ramon, CA), a related purine analog with proven activity in CLL, has less myelosuppression, we postulated that it would prove advantageous and could be more readily combined with alkylating agents. We are conducting a phase I/II trial of combination chemotherapy with pentostatin and cyclophosphamide for previously treated patients with CLL. Patients need to have Rai high-risk disease or "active" intermediate-risk disease. The treatment regimen consists of a fixed dose of pentostatin (4 mg/m2) combined with an increasing dose of cyclophosphamide. We plan to treat cohorts of three patients each at cyclophosphamide dose levels of 600, 900, 1,200, 1,500, and 2,000 mg/m2. Cycles will be repeated every 21 days. If unacceptable toxicity is encountered at one dose level, then three additional patients (total of six patients) will be accrued to that dose level before further dose escalations will be permitted. A second instance of unacceptable toxicity will close that dose level and identify the preceding level as the phase II dose. Additional patients will be accrued to the phase II dose level to better assess response. Supportive measures include the use of granulocyte colony-stimulating factor (5 microg/kg/d) to limit neutropenia. Sulfamethoxazole/trimethoprim will be given as prophylaxis against Pneumocystis carinii pneumonia and acyclovir will be administered as prophylaxis for herpes zoster. Response will be assessed according to standard criteria, and flow cytometry and fluorescent in situ hybridization will be used to assess for minimal residual disease in patients with trisomy 12.

Topics: Acyclovir; Anti-Infective Agents; Antibiotics, Antineoplastic; Antineoplastic Combined Chemotherapy Protocols; Antiviral Agents; Chemoprevention; Chromosomes, Human, Pair 12; Clinical Trials, Phase I as Topic; Clinical Trials, Phase II as Topic; Cohort Studies; Cyclophosphamide; Dose-Response Relationship, Drug; Flow Cytometry; Granulocyte Colony-Stimulating Factor; Herpes Zoster; Humans; Immunosuppressive Agents; In Situ Hybridization, Fluorescence; Leukemia, Lymphocytic, Chronic, B-Cell; Neutropenia; Patient Selection; Pentostatin; Pneumonia, Pneumocystis; Remission Induction; Risk Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Trisomy

Managing the infectious complications associated with pentostatin (Nipent), used alone or in combination with other agents in patients with low-grade lymphomas, poses a significant problem for clinicians. Since there is limited experience with these therapies, definitive treatment recommendations concerning prophylaxis cannot be made. The panel members discussed the use of valacyclovir (Valtrex) to provide prophylaxis for herpes zoster, trimethoprim/sulfamethoxazole for Pneumocystis, and acyclovir (Zovirax) for varicella zoster. They also considered combinations of pentostatin with agents such as interferon, rituximab (Rituxan), and chlorambucil (Leukeran) and their effect on the immune system. The biology of B and T cells was discussed, with an emphasis on clinical application.

Topics: Acyclovir; Anti-Infective Agents; Anti-Infective Agents, Urinary; Antibiotics, Antineoplastic; Antibodies, Monoclonal; Antibodies, Monoclonal, Murine-Derived; Antineoplastic Agents; Antineoplastic Agents, Alkylating; Antineoplastic Combined Chemotherapy Protocols; Antiviral Agents; Chlorambucil; Encephalitis, Varicella Zoster; Herpes Zoster; Humans; Interferons; Lymphoma; Pentostatin; Pneumocystis Infections; Rituximab; Sulfamethoxazole; Trimethoprim; Valacyclovir; Valine

Herpes zoster is uncommonly followed by cerebral infarction. The pathophysiological mechanism remains uncertain. Outcome is favorable after early specific treatment. We report the case of a 70-year-old woman who developed right hemiparesis with aphasia 15 days after thoracic herpes zoster. The herpes zoster induced cerebral vasculitis was hypothesized as no other etiology could be identified after detailed assessment of the cerebral infarction including brain MRI and cerebrospinal fluid study, and as the clinical course responded to antiviral therapy.

Topics: Acyclovir; Aged; Anti-Inflammatory Agents; Antiviral Agents; Aphasia; Brain Ischemia; Cerebral Angiography; Drug Therapy, Combination; Female; Herpes Zoster; Humans; Magnetic Resonance Imaging; Methylprednisolone; Paresis; Vasculitis, Central Nervous System; Vertebrobasilar Insufficiency

Topics: Acute Disease; Acyclovir; Antiviral Agents; Evidence-Based Medicine; Herpes Zoster; Humans; Male; Middle Aged; Time Factors

Topics: Acyclovir; Antiviral Agents; Combined Modality Therapy; Herpes Zoster; Humans; Nerve Block; Pain; Pain Management

Herpes zoster infections are frequently observed after allogeneic bone marrow transplantation (alloBMT). In the majority of cases, the infection is restricted to specific dermatomes and responds to oral acyclovir, without visceral dissemination. We report the case of a 40-year-old male who developed dermatomal herpetic infection 8 months post alloBMT. The herpetic rash responded well to treatment with high-dose oral acyclovir. However, within a week of cessation of therapy, the patient re-presented with dermatomal zoster and meningoencephalitis. Although the cutaneous lesions resolved with intravenous acyclovir, clinical features of meningoencephalitis persisted, along with evidence of varicella zoster virus (VZV) DNA in cerebrospinal fluid (CSF). A satisfactory response to treatment was observed only after the addition of intravenous foscarnet to acyclovir. Based on our experience with this patient, we suggest that in a subset of alloBMT recipients, late dermatomal herpes zoster infections may respond only partially to treatment with standard oral acyclovir. The use of oral acyclovir preparations with higher bioavailability (valacyclovir) or intravenous acyclovir early on may prevent the considerable morbidity associated with disseminated zoster infection. Bone Marrow Transplantation (2000) 26, 795-796.

Topics: Acyclovir; Adult; Antiviral Agents; Bone Marrow Transplantation; DNA, Viral; Encephalitis, Varicella Zoster; Foscarnet; Herpes Zoster; Herpesvirus 3, Human; Humans; Male; Skin Diseases; Transplantation, Homologous

Varicella zoster virus (VZV) infection involving the posterior segment of the eye after fludarabine treatment has not previously been described. Two patients, who had completed fludarabine treatment 3 and 18 months previously, presented with visual loss that had been preceded by a recent history of cutaneous zoster. The use of the polymerase chain reaction (PCR) for VZV DNA from ocular specimens allowed rapid confirmation of clinical diagnosis and treatment with a good outcome in one patient. With the increasing use of fludarabine and other purine analogues, an awareness of such complications is important because of their potentially sight-threatening consequences.

Topics: Acyclovir; Aged; Aged, 80 and over; Antiviral Agents; DNA, Viral; Eye Infections, Viral; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunosuppressive Agents; Lymphoma, Follicular; Male; Middle Aged; Polymerase Chain Reaction; Retinal Necrosis Syndrome, Acute; Vidarabine; Waldenstrom Macroglobulinemia

Topics: Acyclovir; Administration, Oral; Adolescent; Antiviral Agents; Child; Child, Preschool; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunocompromised Host; Male; Precursor Cell Lymphoblastic Leukemia-Lymphoma

Topics: Acyclovir; Adult; Anticoagulants; Antiviral Agents; Blood Component Transfusion; Drug Therapy, Combination; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunoglobulins, Intravenous; Immunosuppressive Agents; Kidney Transplantation; Male; Postoperative Complications

Our aim was to study the frequency, severity, and outcome of patients with Crohn's disease and ulcerative colitis treated with 6-mercaptopurine (6MP) who developed shingles during treatment, and to recommend management. While varicella can be severe in young people immunocompromised by steroids, the incidence of herpes zoster in older people with inflammatory bowel disease (IBD) and whether its severity is influenced by 6MP and azathioprine are unknown.. Data were collected from our IBD Center on 550 patients with IBD to identify those who developed shingles while on 6MP, its severity, the dose and duration of 6MP, and the management of the 6MP.. Twelve of 550 patients with IBD treated with 6MP developed shingles. In two with herpes zoster ophthalmicus the pain was prolonged, and one patient developed encephalitis which was brief and uncomplicated; in nine patients the course was benign. Acyclovir should be the treatment of choice even though it was available in only three cases.. Shingles occurs more often in IBD patients treated with 6MP than in those who are not, but the course is usually benign and there has been no mortality. The 6MP should be stopped temporarily until severity is established but if the underlying disease warrants further treatment the 6MP should be restarted.

Topics: Acyclovir; Adult; Aged; Antiviral Agents; Child; Colitis, Ulcerative; Crohn Disease; Female; Herpes Zoster; Humans; Immunosuppressive Agents; Incidence; Male; Mercaptopurine; Risk Factors; Severity of Illness Index

We have characterized the differential actions of acyclovir and penciclovir against varicella-zoster virus (VZV) in cell culture by comparing the frequency of appearance of resistant viruses followed by their characterization. Cells were infected with cell-free virus and the cultures were successively treated with increasing concentrations of acyclovir or penciclovir. Drug-resistant viruses were selected in the presence of 6 microg/ml of acyclovir or penciclovir. The emergence frequency of resistant viruses was significantly higher following acyclovir exposure than following penciclovir exposure (Fisher's exact test, P<0.0001), possibly reflecting virus growth differences under these experimental conditions. Based on antiviral drug susceptibility and thymidine kinase (TK) activity assays, 11 acyclovir-resistant variants from seven experiments using three virus strains (Kawaguchi strain, Oka varicella vaccine strain and a clinical isolate from a zoster patient) were found to be TK-deficient. Sequence analysis of TK-deficient variants of the Kawaguchi strain revealed deletions that caused frameshifts, resulting in premature termination in the TK gene.

Topics: Acyclovir; Antiviral Agents; Cells, Cultured; DNA, Viral; Drug Resistance, Microbial; Genes, Viral; Guanine; Herpes Zoster; Herpesvirus 3, Human; Humans; Lung; Microbial Sensitivity Tests; Sequence Analysis, DNA; Thymidine Kinase; Viral Plaque Assay

The treatment of herpes zoster relies on the intravenous or oral administration of antiviral drugs. Oral aciclovir for shingles is hindered by its low bioavailability. New antiviral drugs with improved oral bioavailability (famciclovir and valaciclovir) allow a better efficacy. The opportuneness of treating herpes zoster is different in the immunocompetent and immunocompromised patients, and during childhood and pregnancy.

Topics: 2-Aminopurine; Acyclovir; Administration, Oral; Adult; Antiviral Agents; Biological Availability; Child; Famciclovir; Female; Herpes Zoster; Humans; Immunocompetence; Immunocompromised Host; Injections, Intravenous; Pregnancy; Pregnancy Complications, Infectious; Prodrugs; Valacyclovir; Valine

Over a 2 year period, we identified five HIV-infected patients who presented with central nervous system infection caused by varicella-zoster virus, three with myelitits, and two with meningoencephalitis. All five patients were profoundly immunocompromised. Clinical presentation of these patients overlapped to a significant extent with diseases caused by other viruses, e.g. CMV. Indeed, in one case, a dual infection with CMV was diagnosed, but the respective role of each virus was ascertained by in situ hybridisation. At the time of CNS involvement, only one patient had active VZV cutaneous lesions, which were instrumental in diagnosing her condition. In contrast, PCR for VZV DNA in the CSF was helpful in making a diagnosis in the four other cases, one of which was confirmed by a post mortem. Of these five patients, two patients developed VZV disease while receiving oral acyclovir and had foscarnet treatment initiated when MRI demonstrated widespread lesions. They did not respond to antiviral therapy. The three other patients had intravenous acyclovir initiated at a time when no or limited parenchymal lesions were observed by MRI. Two of these three patients had VZV infection diagnosed solely on the basis of PCR: all three responded to treatment. Our data show that reactivation of VZV involving the central nervous system occurs frequently in the absence of cutaneous lesions. PCR of cerebrospinal fluid may help in making an early diagnosis which is probably a prerequisite for successful treatment of VZV infection of the CNS.

Topics: Acyclovir; Adult; AIDS-Related Opportunistic Infections; Antiviral Agents; Central Nervous System Infections; Cytomegalovirus; DNA, Viral; Female; Foscarnet; Herpes Zoster; Herpesvirus 3, Human; HIV Infections; Humans; Immunocompromised Host; In Situ Hybridization; Male; Middle Aged; Polymerase Chain Reaction

A 34-year-old male with a history of chickenpox developed primary abdominal non-Hodgkin's lymphoma (diagnosed in August 1995). Treatment with cyclophosphamide, doxorubicin, vincristine, and prednisolone achieved a partial remission. In July 1996, the disease recurred, and the patient received chemotherapy with carboplatine, etoposide, mitoxantrone, and prednisolone, but no response was noted. Involvement of the central nervous system and meninges was diagnosed on September 12, 1997. Blast cells were detected in the peripheral blood on September 26. Based on these findings, he was diagnosed as having leukemia. On September 27, painless vesicles developed on the left gluteal region. On October 13, the patient was hospitalized because the vesicles had spread over his entire body. Pathologic examination of the roofs of the blisters showed masses of inclusion bodies. Based on this, a diagnosis of varicella-zoster infection was made. Treatment with acyclovir (750 mg/day) for seven days failed to form crusts. New vesicles developed after the drug was discontinued, but crusts formed after acyclovir therapy was resumed. He died of interstitial pneumonia on December 21. Autopsy could not be performed. Histopathologic examination of pulmonary tissue obtained by necropsy did not reveal the presence of inclusion bodies characteristic of herpes simplex or varicella-zoster infection. Varicella-zoster virus (VZV) antigen was negative by an immunochemical staining method using monoclonal antibodies against VZV. Continuous long-term administration of acyclovir has been reported to be effective for non-Hodgkin's lymphoma complicated by recurrent intractable herpes zoster.

Topics: Acyclovir; Adult; Herpes Zoster; Humans; Lymphoma, Non-Hodgkin; Male; Recurrence

Topics: 2-Aminopurine; Acyclovir; Administration, Oral; AIDS-Related Opportunistic Infections; Antiviral Agents; Biological Availability; CD4 Lymphocyte Count; Drug Resistance, Microbial; Famciclovir; Herpes Zoster; Humans; Valacyclovir; Valine

Topics: Acyclovir; Adult; Antiviral Agents; Female; Herpes Zoster; Humans; Pregnancy; Pregnancy Complications, Infectious

The most effective antiviral therapy of varicella and zoster has become acyclovir. Using polymerase chain reaction specific for VZV ORF 14, ORF 29, ORF 63 as well as nucleic acid sequence-based amplification (ORF 63, ORF 68) we tested PBMC of patients with VZV-associated diseases for the presence of viral DNA and RNA, respectively. In PBMC of patients treated with acyclovir neither DNA nor RNA was detectable already one day after the onset of therapy. In three blood sample pairs from zoster patients we were able to detect viral nucleic acid before but not after acyclovir treatment. These results confirm clinical and epidemiological data. It can be concluded that treatment with acyclovir prevents VZV replication in peripheral blood mononuclear cells.

Topics: Acyclovir; Adult; Aged; Antiviral Agents; Chickenpox; Child; DNA, Viral; Herpes Zoster; Herpesvirus 3, Human; Humans; Leukocytes, Mononuclear; Middle Aged; RNA, Viral; Viremia; Virus Replication

Topics: Acyclovir; Administration, Oral; Antiviral Agents; Chickenpox; Herpes Zoster; Humans; Immunity, Cellular; Immunocompetence; Infant; Male

Varicella-zoster virus, an ubiquitous human pathogen, causes vesicular rash during varicella, the primary infection of the host and zoster corresponding to reactivation. The symptoms could be various, nervous systems and lung being involved. Usually mild, varicella could be severe in immunocompromised patients, during pregnancy for the mother and the foetus, for the newborn and also for adults. Post herpetic neuralgia in old patient is the main complication of zoster. Various methods for virological diagnosis (culture, cytology, serology, PCR) with different sensibilities and specificities depending mainly of sample type are available. Various antiviral drugs are available, acyclovir being the reference one.

Topics: Acyclovir; Adult; Aged; Antiviral Agents; Child; Diagnosis, Differential; DNA, Viral; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunocompromised Host; Polymerase Chain Reaction; Pregnancy; Pregnancy Complications, Infectious

Topics: 2-Aminopurine; Acetamides; Acyclovir; Aged; Amantadine; Animals; Anti-HIV Agents; Antiviral Agents; Child; Child, Preschool; Dose-Response Relationship, Drug; Drug Resistance, Microbial; Enzyme Inhibitors; Famciclovir; Ganciclovir; Guanidines; Guanine; Herpes Simplex; Herpes Zoster; History, 18th Century; HIV Infections; Humans; Injections, Intravenous; Interferon-alpha; Lamivudine; Neuraminidase; Oseltamivir; Pyrans; Rats; Ribavirin; Sialic Acids; Teratogens; Valacyclovir; Valine; Zanamivir

To examine the relationship between acyclovir use and survival in AIDS, we performed a retrospective analysis of data collected through an observational cohort of the 17-site Community Program for Clinical Research on AIDS (CPCRA), under the sponsorship of the National Institute of Allergy and Infectious Diseases. Data were analyzed regarding 2,368 patients with CD4+ lymphocyte counts of < 500/mm3, and 7,836 follow-up visits were conducted from September 1990 to July 1994. Factors associated with use of acyclovir were studied by stratified analysis of variance and Mantel-Haenzel chi 2 tests. The association between acyclovir and survival was studied with use of the proportional hazards regression model. Individuals reporting acyclovir use were more likely to be white, male, and homosexual; to have a history of herpes simplex and zoster; and to have lower CD4+ T cell counts than those who did not. After adjustments for differences in baseline factors, acyclovir use was not associated with prolonged survival.

Topics: Acyclovir; Adult; CD4 Lymphocyte Count; Female; Follow-Up Studies; Herpes Simplex; Herpes Zoster; HIV Infections; Humans; Male

Topics: Acyclovir; Aged; Antiviral Agents; Female; Herpes Zoster; Humans; Male; Middle Aged; Neuralgia; Time Factors

A 26-year old man was admitted because of acute abdominal pain. He had received an allogeneic bone marrow transplant (BMT) for aplastic anemia 6 months before. All physical, laboratory, roentgenographic, and ultrasonographic studies were performed but nondiagnostic. On the fourth hospital day the patient developed visual disturbance and on the following day skin eruption appeared. Laboratory findings revealed severe liver dysfunction. We diagnosed this case as varicella-zoster virus (VZV) infection with visceral dissemination. Antiviral therapy with acyclovir was initiated and abdominal pain markedly reduced and visual acuity was recovered after 4 days. In case of VZV infection, acute abdominal pain prior to skin eruptions is rare. However in such cases the patients are highly fatal due to visceral dissemination. Antiviral therapy begun before visceral dissemination of VZV is highly effective in preventing serious disease, whereas it is less effective after dissemination. We consider that early diagnosis and treatment of VZV infection is necessary for BMT recipients who are undergoing immunosuppressive therapy.

Topics: Abdominal Pain; Acute Disease; Acyclovir; Adult; Anemia, Aplastic; Antiviral Agents; Bone Marrow Transplantation; Herpes Zoster; Humans; Immunocompromised Host; Male; Opportunistic Infections; Transplantation, Homologous

Topics: Acyclovir; Antiviral Agents; Female; Herpes Zoster; Humans; Kidney Failure, Chronic; Middle Aged; Nervous System Diseases; Renal Dialysis

We report on a 29-year-old severely compromised acquired immunodeficiency syndrome patient who developed retrobulbar optic neuritis 5 weeks after an episode of cutaneous herpes zoster infection. During the optic neuritis, varicella zoster virus could be demonstrated in the cerebrospinal fluid. The neuritis responded well to treatment with foscarnet, but, 3 weeks into therapy, varicella zoster retinitis developed. Additional treatment with intravenous acyclovir stopped progression of the retinitis and resulted in healing of the retinal lesions. This case suggests that retrobulbar optic neuritis can be regarded as a prodrome of imminent acute retinal necrosis. Early recognition and prompt therapy with combined antivirals may prevent the development of this devastating ocular complication of varicella zoster infection.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; AIDS-Related Opportunistic Infections; Antiviral Agents; Female; Foscarnet; Herpes Zoster; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Male; Optic Neuritis; Visual Acuity

Medical records of 105 patients admitted to Tayside hospitals with acute Herpes zoster without underlying immunosuppression were examined retrospectively for the period 1984-1992. In this elderly population (median age: 79 years) there was a female preponderance (70.5%), most admissions were for trigeminal zoster (49.5%) and length of stay ranged from 1-70 days (median: 11 days), indicating significant morbidity. There was a wide variation in both pre-admission and inpatient treatment; 53.3% of patients did not receive any anti-viral therapy prior to admission, and prescribing patterns for in-patients revealed marked differences, according to the dermatome affected. Idoxuridine 5% solution was prescribed by 15.24% of General Practitioners. Given the significant morbidity and associated costs of Herpes zoster, and that existing anti-viral agents exert maximal benefit when administered early in the course of the disease, recommendations are made with respect to appropriate therapy, and auditing current management of this serious illness, which is expected to increase in prevalence as the population ages.

Topics: Acyclovir; Age Factors; Aged; Aged, 80 and over; Antiviral Agents; Female; Herpes Zoster; Humans; Idoxuridine; Length of Stay; Male; Retrospective Studies; Scotland

Neurological complications caused by varicella-zoster virus, excluding post-herpetic neuralgia and aseptic meningitis, are infrequent and varied. Other complications, which have been described are peripheral motor neuropathy, cranial nerve palsies, meningoencephalitis, Guillain-Barré syndrome, myelitis, herpes zoster ophthalmicus with delayed contralateral hemiparesis and Reye syndrome. We present 4 patients with infrequent neurological complications associated with varicella-zoster virus: 3 cases of meningoencephalitis and one case of myelitis.

Topics: Acyclovir; Adult; Aged; Anti-Inflammatory Agents; Antiviral Agents; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Male; Meningoencephalitis; Middle Aged; Myelitis; Steroids

Topics: Acyclovir; Aged; Antiviral Agents; Female; Herpes Zoster; Humans; Keratosis; Skin

A man with acquired immunodeficiency syndrome (AIDS) developed zoster of the right arm which was resistant clinically to acyclovir. Varicella-zoster virus (VZV) was cultured from a skin biopsy performed at the beginning of acyclovir therapy (isolate 1) and after its failure (isolate 2). The emergence of acyclovir resistance during treatment was investigated by developing a simple and rapid drug sensitivity assay based on the plaque reduction reference method. This late-antigen synthesis reduction assay involved serial dilutions of cell-associated virus. The 50% inhibitory concentration (IC50) of acyclovir was 16 +/- 7.5 microM for the susceptible reference strain OKA, in agreement with published data. The acyclovir IC50 increased from 6.5 microM for isolate 1 to 100 microM for isolate 2. In comparison with the sequence of isolate 1, isolate 2 had a single mutation consisting of a C to T change at position 907 of the thymidine kinase gene, which changed a glutamine codon into a stop codon at position 303 of the thymidine kinase protein. These results show the emergence of acyclovir resistance through a single previously undescribed mutation in the thymidine kinase gene, and confirm the heterogeneity of mutations inducing acyclovir resistance.

Topics: Acyclovir; Adult; AIDS-Related Opportunistic Infections; Antiviral Agents; Drug Resistance, Microbial; Genes, Viral; Herpes Zoster; Herpesvirus 3, Human; Humans; Male; Microbial Sensitivity Tests; Mutation; Polymerase Chain Reaction; Sequence Analysis, DNA; Thymidine Kinase; Viral Plaque Assay

Topics: Acyclovir; Amitriptyline; Antidepressive Agents, Tricyclic; Antiviral Agents; Drug Therapy, Combination; Herpes Zoster; Humans; Male; Middle Aged; Pain

The clinical studies of series of children with herpes zoster (HZ) are rather limited.. The purpose of this study was to evaluate the epidemiologic conditions, clinical manifestations, therapy, and outcome of HZ in children.. Twenty-one patients with HZ have been studied. Five patients who had herpes simplex virus infection were excluded. The laboratory diagnosis was made by fluorescent techniques. Acyclovir was administered systematically for 2 more days after no new lesions had developed.. Thirteen patients (group A) were immunocompromised; eight patients (group B) were otherwise healthy. Two patients from group B had intrauterine varicella; the other six patients had had varicella under the age of 4 years. Three patients were recently exposed to varicella. The duration of HZ was significantly longer in group A than in group B, but the outcome was good in all patients.. Herpes simplex virus infection may simulate the pattern of HZ; varicella in early childhood is a risk factor for HZ in otherwise healthy children; exposure of a child to varicella may cause reactivation of latent HZ virus; and acyclovir therapy within 3 days of exanthem onset prevents significant morbidity and death in immunocompromised children with HZ.

Topics: Acyclovir; Adolescent; Antiviral Agents; Child; Female; Herpes Zoster; Humans; Immunocompetence; Immunocompromised Host; Infant; Male; Prospective Studies; Time Factors

Topics: Acyclovir; Antiviral Agents; Drug Evaluation; Herpes Zoster; Humans; Neuralgia; Prodrugs

Resistance to antiviral therapy is getting actually more frequent. Immunocompromised host are more concerned with this problem.. We present a case of disseminated zoster resisting to acyclovir (ACV) therapy, but healing with foscarnet in a man treated with chemotherapy for lymphoma and seronegative for HIV. CI50 of VZV strain was 48 microM for ACV, which was 2.8 times higher than value of the reference OKA strain tested simultaneously, which confirmed the resistance for ACV.. Immunocompromised patients often present varicella zoster virus (VZV) infection. They usually heal in response to ACV therapy, but some HIV infected patients have already presented with resistant strains of VZV. This case is the first described in a non-HIV infected patient. Foscarnet therapy resulted twice in complete healing because of its direct activity on viral DNA polymerase, so it is efficaceous therapy for patients with thymidine-kinase-deficient ACV-resistant VZV infection.

Topics: Acyclovir; Antiviral Agents; Drug Resistance, Microbial; Foscarnet; Herpes Zoster; HIV Seronegativity; Humans; Immunocompromised Host; Lymphoma, T-Cell; Male; Middle Aged

Topics: Acyclovir; Adult; Brain Ischemia; Central Nervous System; Diagnosis, Differential; Herpes Zoster; Herpesvirus 3, Human; Humans; Magnetic Resonance Imaging; Male; Vasculitis

We report a case of bilateral acute retinal necrosis (ARN) following an acute optic neuromyelitis (AONM) in an immunodepressed patient (T CD4 lymphocyte count under 50/mm3) suffering from acquired immunodeficiency syndrome (AIDS). Despite the medical treatment the evolution led to blindness by bilateral total retinal detachment. The neuro-ophthalmological features occurred prior to the retinal manifestation, and the acute optic neuromyelitis occurred after a spreading zoster. The varicella-zoster virus (VZV) seemed to be involved because of recurring cutaneous zoster, spreading of this zoster just before the AONM, previous reports showing a link between VZV and AONM, and VZV and ARN. However, our patient had first an AONM responding well to corticosteroid therapy following one month later by an ARN leading to blindness despite the antiviral treatments received as soon as possible. There is a chronical viremia+ in immunodepressed patients with recurring and spreading zoster. The rupture of the hemato-encephalic barrier observed in AONM could facilitate the invasion of the eye by the virus, leading to an ARN. This hypothesis could explain the two complications due to the VZV, the AONM and the ARN, the first one is of dysimmunitary origin and the second one could probably result of a direct viral attack of the retina. This should incite to treat as soon as possible each retrobulbar optic neuritis in patients with AIDS, especially if past history of zoster.

Topics: Acyclovir; Adult; AIDS-Related Opportunistic Infections; Antiviral Agents; Blood-Brain Barrier; Female; Herpes Zoster; Herpes Zoster Ophthalmicus; Humans; Neuromyelitis Optica; Retinal Necrosis Syndrome, Acute; Treatment Refusal

A previously healthy 26-year-old man complained of gradually increasing headache after an attack of flu. After 4 days an erythema with papules but no blisters was noted in the area of distribution of the left 10th thoracic nerve. As a child he had varicella (chickenpox) without complications.. Lymphocytic pleocytosis and evidence of an abnormal blood-brain barrier were noted in cerebrospinal fluid (CSF). Serology for varicella zoster virus revealed an IgG titre of > 7400 IU/l in serum and 21 IU/l in CSF. The corresponding IgM titres were negative.. The headaches and cutaneous changes regressed under i.v. treatment with acyclovir, 10 mg/kg body weight, 3 x daily for 10 days. Repeat CSF examination after 10 days showed merely minimal residual changes of inflammation.. This case illustrates the risk of severe neurological complications of herpes zoster infection. A seemingly minor rash with headache must be correctly diagnosed and immediate high-dosage acyclovir treatment instituted to prevent life-threatening and severe complications of herpes zoster meningitis or encephalitis.

Topics: Acyclovir; Adult; Antibodies, Viral; Antiviral Agents; Cerebrospinal Fluid; Erythema; Headache; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunoglobulin G; Male; Meningitis, Viral; Thoracic Nerves

Four cases of herpes zoster-induced bullous erythema multiforme (EM) are reported. Three patients presented with widespread skin lesions 10 to 14 days after an episode of thoracic herpes zoster. In these patients a high increase in varicella-zoster virus (VZV) antibody titer was detected, indicating secondary VZV infection. Histologic examinations of skin biopsy from a patient with widespread lesions (case 4) revealed a mixture of EM, toxic epidermal necrolysis and herpetic virus infection. VZV should be included in the list of infectious agents able to trigger EM and Stevens-Johnson syndrome.

Topics: Acyclovir; Adult; Aged; Aged, 80 and over; Antibodies, Viral; Antiviral Agents; Erythema Multiforme; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Male; Skin

Urinary retention is uncommon in patients with herpes zoster and anogenital herpes simplex. Seven patients (four men, three women) with a mean age of 68.1 years (range, 35-84) with urinary retention due to herpes zoster (n = 6) or anogenital herpes simplex (n = 1) were studied. Six patients had unilateral skin eruption in the saddle area (S2-4 dermatome) and one patient with herpes zoster had a skin lesion in the L4-5 dermatome. All patients had detrusor areflexia without bladder sensation, and two of them had inactive external sphincter on electromyography at presentation. Clean intermittent catheterization was performed, and voiding function was recovered in 4-6 weeks (average, 5.4) in all patients. Urodynamic study was repeated after recovery of micturition in three patients, and they returned to normal on cystometrography and external sphincter electromyography. Acute urinary retention associated with anogenital herpes infection has been thought to occur when the meninges or sacral spinal ganglia were involved, and, in conclusion, this condition may be considered to be reversible.

Topics: Acyclovir; Adult; Aged; Aged, 80 and over; Anal Canal; Antiviral Agents; Dermatitis; Female; Genitalia; Herpes Simplex; Herpes Zoster; Humans; Male; Middle Aged; Treatment Outcome; Urinary Retention; Urination; Urodynamics

Topics: Acyclovir; Adult; Antiviral Agents; Chickenpox; Herpes Zoster; Humans

The efficacy of early versus late treatment with acyclovir and valaciclovir on zoster-associated pain was assessed from two databases (1076 patients) that were compiled from randomized trials. Early treatment was started < 48 h and late treatment was started 48-72 h after the onset of cutaneous herpes zoster. Median times to complete resolution of zoster-associated pain were 28 and 62 days, respectively, for patients (> or = 18 years of age) treated with acyclovir and placebo within 48 h (hazard ratio [HR], 1.68; 95% confidence limit [95% CL], 1.19, 2.38) and 28 and 58 days, respectively, for those treated later (HR, 2.20; 95% CL, 1.03, 4.71). In the valaciclovir versus acyclovir study (in patients > or = 50 years of age), the corresponding figures were 44 and 51 days for patients treated early (HR, 1.28; 95% CL, 1.03, 1.60) and 36 and 48 days for those treated later (HR, 1.40; 95% CL, 1.04, 1.87). Acyclovir significantly shortened the time to complete resolution of zoster-associated pain compared with placebo (and valaciclovir was superior to acyclovir in this regard) even when therapy was delayed up to 72 h after rash onset.

Topics: Acute Disease; Acyclovir; Adolescent; Adult; Antiviral Agents; Databases, Factual; Drug Administration Schedule; Female; Herpes Zoster; Humans; Male; Middle Aged; Pain; Randomized Controlled Trials as Topic; Valacyclovir; Valine

Famciclovir and valaciclovir were approved for use in the treatment of herpes zoster despite controversy over antiviral therapy in zoster due to high costs and uncertain benefits. To explore these issues, a Markov decision model was developed, and the incremental cost effectiveness of antiviral treatment for herpes zoster was estimated using these agents compared with no antiviral therapy. A third-party payer perspective was taken. Sensitivity analyses were performed, modeling differences in antiviral efficacy, postherpetic neuralgia (PHN) risk, and other illness parameters. Treatment of severely symptomatic acute zoster was found reasonable from a cost-effectiveness standpoint in base-case and worst-case scenarios. Treatment of mildly symptomatic acute zoster was more expensive but would likely be considered cost effective in scenarios where PHN risk was higher, PHN duration longer, or antiviral shortening of PHN greater. Further research comparing antiviral efficacy in herpes zoster is needed.

Topics: 2-Aminopurine; Acute Disease; Acyclovir; Aged; Aged, 80 and over; Antiviral Agents; Computer Simulation; Cost-Benefit Analysis; Famciclovir; Herpes Zoster; Humans; Markov Chains; Middle Aged; Models, Economic; Neuralgia; Risk Factors; Valacyclovir; Valine

Two patients, a man aged 33 years and a woman aged 30, suffered from a varicella zoster induced pneumonia. In adults a varicella zoster infection may be accompanied by a very severe pneumonia. In one patient mechanical ventilation was necessary. A chest X-ray and blood gas analysis must be made in adults suffering from a varicella zoster virus infection who have pulmonary complaints. In case of abnormalities in one of these two examinations the patient must be observed in a clinical setting. The pneumonia can be treated with aciclovir.

Topics: Acyclovir; Adult; Female; Herpes Zoster; Humans; Lung; Male; Oxygen Inhalation Therapy; Pneumonia, Viral; Radiography

In differential diagnosis of a delir also adverse effects of medicaments have to be taken into account beside other causes. We report a case of an agitated delir with nocturnal disturbance of consciousness, confusion, restlessness and sleeplessness. This delir existed exclusively during the therapy of a cutaneous herpes zoster with zovirax-pills which can only be explained by a causal connection--after exclusion of other causes. As a so far undescribed predisposition for neurotoxicity of oral therapy with acyclovir signs of vascular encephalopathy were found in the patient's cranial magnetic resonance imaging. The central nervous side effects of acyclovir were summarized shortly.

Topics: Acyclovir; Aged; Antiviral Agents; Brain; Delirium; Dementia, Vascular; Diagnosis, Differential; Herpes Zoster; Humans; Magnetic Resonance Imaging; Male; Psychoses, Substance-Induced

A 51 year old man developed Herpes zoster on the right arm (C5/C6) treated subsequently with aciclovir infusions (500 mg, 3/day). Ten months before hospital admission he did have a radical resection of a epi-oro-hypopharyngeal carcinoma (T4/N1/G2, M0; lymphangiosis carcinomatosa) as well as a partial laryngeal resection for a recurrence 3 months later and removal of a cervical lymph node metastasis after two further months. During aciclovir treatment the patient experienced repeated bradycardia with hypotension verifiable with the tilt-table test. The bradycardias could not be further characterized by ECC. Neither sonography nor CT-scans gave an indication for infiltration of the cervical course of the vagus or glossopharyngeal nerves. Serum catecholamines were, however, markedly reduced. After cessation of aciclovir the bradycardias and hypotensive episodes disappeared. A final tilt-table test was unremarkable. A reversible autonomic neuropathy induced by aciclovir seems a possible explanation.

Topics: Acyclovir; Antiviral Agents; Bradycardia; Herpes Zoster; Humans; Hypotension; Male; Middle Aged; Tilt-Table Test

We retrospectively studied 18 consecutive cases of acyclovir-resistant zoster. All the patients had chronic skin lesions that failed to heal despite treatment with intravenous acyclovir (30 mg/[kg.d]) in 15 cases and oral acyclovir (4 g/d) in three cases for > 10 days. The mean CD4+ cell count was 20 x 10(6)/L. The mean number of previous zoster episodes was 1.53. Fifteen of the 16 patients evaluable for previous acyclovir treatment had received the drug. Thirteen patients were treated with intravenous foscarnet (200 mg/[kg.d]) for a mean of 17.8 days. Complete healing was observed in 10 (77%) of the 13 treated patients. Zoster relapsed after cessation of foscarnet therapy in five of the 10 responding patients. The median time to relapse was 110 days. Four patients died of varicella-zoster virus-associated visceral complications. These results show that acyclovir-resistant zoster has a poor prognosis but responds well to foscarnet therapy.

Topics: Acyclovir; Adult; AIDS-Related Opportunistic Infections; Anti-HIV Agents; Antiviral Agents; Drug Resistance, Microbial; Foscarnet; Herpes Zoster; HIV Infections; Humans; Retrospective Studies; Treatment Outcome

A comparative placebo-controlled trial involving 419 adults showed that a one-week course of famciclovir started within 3 days of onset of skin lesions had no effect on the acute phase of zoster, the time required for scabs to fall, the end of skin lesion progression, or pain. In this trial famciclovir failed to reduce the incidence of post-zoster pain, but it did reduce its median duration by approximately 2 months. According to a subgroup analysis (not planned for by the protocol), only patients over 50 benefited from this effect. Three other trials suggest that the approved dose regimen in France (500 mg 3 times a day) may not be optimal. The dose recommended in the United Kingdom (750 mg in one daily intake or 250 mg 3 times a day) seems to be more in line with the clinical assessment file. The three available comparative trials show no statistically significant difference between famciclovir and aciclovir in terms of efficacy or tolerability. An indirect comparison suggests that the risk-benefit ratio of famciclovir and valaciclovir are probably similar. However, the effects of famciclovir on post-zoster pain were observed in a clinical trial, while those of aciclovir were found only in meta-analyses.

Topics: 2-Aminopurine; Acyclovir; Adult; Antiviral Agents; Clinical Trials as Topic; Drug Evaluation; Europe; Herpes Zoster; Humans; Middle Aged; Treatment Outcome

Varicella zoster virus retinitis (VZVR) in patients with AIDS, also called progressive outer retinal necrosis (PORN), is a necrotising viral retinitis which has resulted in blindness in most patients. The purposes of this study were to investigate the clinical course and visual outcome, and to determine if the choice of a systemic antiviral therapy affected the final visual outcome in patients with VZVR and AIDS.. A review of the clinical records of 20 patients with VZVR from six centres was performed. Analysis of the clinical characteristics at presentation was performed. Kruskall-Wallis non-parametric one way analysis of variance (KWAOV) of the final visual acuities of patients treated with acyclovir, ganciclovir, foscarnet, or a combination of foscarnet and ganciclovir was carried out.. Median follow up was 6 months (range 1.3-26 months). On presentation, 14 of 20 patients (70%) had bilateral disease, and 75% (15 of 20 patients) had previous or concurrent extraocular manifestations of VZV infection. Median initial and final visual acuities were 20/40 and hand movements, respectively. Of 39 eyes involved, 19 eyes (49%) were no light perception at last follow up; 27 eyes (69%) developed rhegmatogenous retinal detachments. Patients treated with combination ganciclovir and foscarnet therapy or ganciclovir alone had significantly better final visual acuity than those treated with either acyclovir or foscarnet (KWAOV: p = 0.0051).. This study represents the second largest series, the longest follow up, and the first analysis of visual outcomes based on medical therapy for AIDS patients with VZVR. Aggressive medical treatment with appropriate systemic antivirals may improve long term visual outcome in patients with VZVR. Acyclovir appears to be relatively ineffective in treating this disease.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; AIDS-Related Opportunistic Infections; Analysis of Variance; Antiviral Agents; Eye Infections, Viral; Female; Foscarnet; Ganciclovir; Herpes Zoster; Herpesvirus 3, Human; Humans; Male; Middle Aged; Retinal Detachment; Retinitis; Retrospective Studies; Treatment Outcome; Visual Acuity

Three patients developed acute colitis, either de novo, or as an exacerbation of pre-existing colitis, following the use of oral acyclovir, prescribed for Herpes zoster or Herpes simplex infection. Rechallenge with oral acyclovir was performed in one patient, and resulted in a recurrence of colitic symptoms. It is speculated that acyclovir can have a direct irritant effect on large bowel mucosa.

Topics: Acyclovir; Adult; Antiviral Agents; Colitis, Ulcerative; Herpes Simplex; Herpes Zoster; Humans; Male; Middle Aged

Topics: Acyclovir; Adrenal Cortex Hormones; Antiviral Agents; Drug Therapy, Combination; Herpes Zoster; Humans

Topics: Acyclovir; Adrenal Cortex Hormones; Antiviral Agents; Drug Therapy, Combination; Herpes Zoster; Humans; Research Design

Topics: Acyclovir; Adrenal Cortex Hormones; Antiviral Agents; Drug Therapy, Combination; Herpes Zoster; Humans; Research Design

Topics: Acute Disease; Acyclovir; Adult; Antiviral Agents; Colonic Diseases; Herpes Zoster; Humans; Intestinal Pseudo-Obstruction; Male

The risk factors for postherpetic neuralgia (PHN), the most common complication of herpes zoster, have not been well established.. To elucidate the risk factors for PHN.. Automated medical, claims, and pharmacy records of a health maintenance organization were used to identify cases of PHN and obtain data on risk factors. A case-base design was used to assess the impact of various patient, disease, and treatment factors on the prevalence of PHN 1 and 2 months after developing zoster.. There were 821 cases of herpes zoster that met all eligibility criteria. The prevalence of PHN more than 30 days after onset of zoster was 8.0% (95% confidence interval [CI], 6.3%-10.1%) and 4.5% (95% CI, 3.2%-6.2%) after 60 days. Compared with patients younger than 50 years, individuals aged 50 years or older had a 14.7-fold higher prevalence (95% CI, 6.8-32.0) 30 days and a 27.4-fold higher prevalence (95% CI, 8.8-85.4) 60 days after developing zoster. Prodromal sensory symptoms and certain conditions associated with compromised immunity were also associated with PHN. Systemic corticosteroids before zoster and treatment of zoster with acyclovir or corticosteroids did not significantly affect the prevalence of PHN.. Increased age and prodromal symptoms are associated with higher prevalence of PHN 1 and 2 months after onset of zoster. Overall, systemic acyclovir appears not to confer any protection against PHN, although benefit among elderly patients cannot be excluded.

Topics: Acyclovir; Adult; Age Factors; Aged; Antiviral Agents; Case-Control Studies; Comorbidity; Female; Health Maintenance Organizations; Herpes Zoster; Humans; Immunocompromised Host; Male; Middle Aged; Neuralgia; Prevalence; Risk Factors

Topics: 2-Aminopurine; Acyclovir; Antifungal Agents; Antiviral Agents; Dermatologic Agents; Dermatology; Dermatomycoses; Famciclovir; Herpes Simplex; Herpes Zoster; Humans; Itraconazole; Nail Diseases; Naphthalenes; Prodrugs; Skin Diseases; Terbinafine; Valacyclovir; Valine

Topics: Acyclovir; Aged; Antiviral Agents; Brain; Confusion; Hallucinations; Herpes Zoster; Humans; Male; Tremor

Oral acyclovir is a costly antiviral agent shown to be effective in the treatment of herpes zoster. Herpes zoster runs a relatively benign course in young, healthy individuals, as compared with elderly and immunologically compromised patients, in whom complications are common. This study attempts to assess the cost-benefit of treatment with oral acyclovir in young healthy adults with herpes zoster.. The records of 42 healthy young adults suffering from herpes zoster and treated with oral acyclovir (800 mg five times daily for 7 days) were compared with those of 40 healthy young adults with herpes zoster seen during the same period but treated without oral acyclovir. The duration of zoster-associated pain and the presence of complications were noted.. There was no statistically significant difference in the duration of zoster-associated pain between the two groups of patients (P = 0.11). Other complications of herpes zoster were few and similar in the two groups.. At a cost of $250 to $300 for a 7-day course of oral acyclovir, the use of this antiviral agent in healthy young individuals with herpes zoster is not justified, especially in developing countries with limited resources.

Topics: Acyclovir; Administration, Oral; Adolescent; Adult; Age Factors; Aged; Antiviral Agents; Cost-Benefit Analysis; Developing Countries; Drug Costs; Female; Health Resources; Herpes Zoster; Humans; Immunocompromised Host; Male; Neuralgia; Pain; Retrospective Studies; Safety; Saudi Arabia; Time Factors; Treatment Outcome

Topics: Acute Kidney Injury; Acyclovir; Aged; Antiviral Agents; Coma; Drug Overdose; Herpes Zoster; Humans; Male; Sleep Stages

The animal model of necrotic hepatitis caused by HSV-1 infection in juvenile mice was used to compare the efficacies of the oral antiherpes agents famciclovir (FCV), valaciclovir (VACV) and brivudin (BVDU). The experimental infection allows the measurement of viral replication in the liver by macroscopic lesions and the evaluation of mortality from encephalitis. Mice intravenously inoculated with a highly virulent clinical HSV-1 isolate were orally treated by gavage over a period of 3 days starting on day 2 post infection. The reference drug acyclovir (ACV) was administered subcutaneously. Necrotic hepatitis was significantly (p < 0.01) reduced by treatment with FCV, VACV and ACV at a dose of 50 mg/kg per day divided into 3 doses. No significant effect was achieved with BVDU at 200 mg/kg per day. Treatment with FCV at 50 mg/kg per day, ACV at 100 mg/kg per day, and VACV at 200 mg/kg per day significantly (p < 0.001) decreased mortality in mice. BVDU treatment at 200 mg/kg per day did not reduce mortality but significantly prolonged (p < 0.05) the survival time.

Topics: 2-Aminopurine; Acyclovir; Animals; Antiviral Agents; Bromodeoxyuridine; Cell Line; Disease Models, Animal; Famciclovir; Hepatitis, Animal; Herpes Zoster; Herpesvirus 1, Human; Liver; Mice; Mice, Inbred BALB C; Valacyclovir; Valine; Viral Plaque Assay; Virus Replication

To identify varicella-zoster virus (VZV) infections of the nervous system in patients infected with human immunodeficiency virus (HIV), polymerase chain reaction (PCR) analysis of cerebrospinal fluid (CSF) samples from 514 consecutive HIV-infected patients with neurological disease was performed to detect VZV DNA. VZV DNA was detected in CSF of 13 (2.5%) of 514 patients. Four of 13 patients had VZV encephalitis or meningoencephalomyelitis. These four patients received intravenous acyclovir therapy; CSF became negative for VZV DNA and clinical conditions improved for two, whereas CSF remained positive for VZV DNA and clinical conditions worsened until death for two. In nine of 13 patients, the neurological symptoms were likely caused by other simultaneous HIV-related complications in the central nervous system. After intravenous therapy with high doses of acyclovir or foscarnet, VZV was cleared from CSF in eight of nine patients. VZV DNA can be detected in CSF of HIV-infected patients in association with either manifestations of neurological VZV disease or subclinical reactivation of VZV infection. Antiviral treatment may be effective in suppressing VZV replication in the nervous system.

Topics: Acyclovir; AIDS-Related Opportunistic Infections; Antiviral Agents; Central Nervous System Infections; DNA, Viral; Encephalitis, Viral; Encephalomyelitis; Herpes Zoster; Herpesvirus 3, Human; Humans; Meningoencephalitis; Polymerase Chain Reaction; Recurrence

Topics: 2-Aminopurine; Acyclovir; Antiviral Agents; Famciclovir; Guanine; Herpes Labialis; Herpes Zoster; Humans; Valacyclovir; Valine

A previously healthy, 37-year-old immunocompetent man presented with disseminated cutaneous zoster and aseptic meningitis. Varicella zoster virus DNA was recovered from the cerebrospinal fluid (CSF) by the polymerase chain reaction. Cytological evaluation of the CSF revealed 'reactive, highly atypical lymphocytosis'. The patient fully recovered after treatment with aciclovir.

Topics: Acyclovir; Adult; Antiviral Agents; Blotting, Southern; DNA, Viral; Herpes Zoster; Herpesvirus 3, Human; Humans; Male; Meningitis, Aseptic

Topics: Acne Vulgaris; Acyclovir; Adult; Aged; Antiviral Agents; Epithelium; Female; Follow-Up Studies; Hair Follicle; Herpes Zoster; Humans; Keratins; Lymphocytes; Male; Middle Aged; Skin Diseases, Viral

A sixty-six year old female was admitted to the hospital with an incomplete hemiparesis on the left side combined with a short episode of unconsciousness. According to her husband's account she had a seizure. Relevant laboratory measurements: plasma sodium concentration 113.9 mmol/l, plasma concentration of ADH 10.3 pg/ml, urine sodium concentration 44.4 mmol/l. The plasma concentrations of creatinine and urea were within normal limits. The working hypothesis was SIAD (syndrome of inappropriate antidiuresis) or Schwartz-Bartter-syndrome. The patient was treated immediately with water restriction (500-1000 ml/day), furosemide and i.v. replacement of urinary sodium losses by 3% NaCl. The analysis of cerebrospinal fluid showed pleocytosis and increased concentrations of immunoglobulins G and M. Serological diagnosis was positive for antigen of varicella-zoster virus. These observations were thought to be compatible with a diagnosis of SIAD in the setting of encephalitis. Under water restriction, infusion of 3% saline, treatment with loop diuretics and aciclovir (3 x 750 mg daily) the neurological function returned to normal within 2 days. A standard oral water load on the 14th hospital days showed a return to a normal water metabolism.

Topics: Acyclovir; Aged; Antiviral Agents; Combined Modality Therapy; Diagnosis, Differential; Diuretics; Encephalitis, Viral; Female; Hemiplegia; Herpes Zoster; Herpesvirus 3, Human; Humans; Hyponatremia; Immunoglobulin G; Immunoglobulin M; Inappropriate ADH Syndrome; Unconsciousness

This paper presents a case of HIV-associated fulminating herpes zoster infection (HZI) that culminated in right mandibular necrosis and tooth exfoliation. The occurrence of such infection in immunosuppression and the impending clinical features are briefly reviewed and discussed.

Topics: Acyclovir; Adult; AIDS-Related Opportunistic Infections; Alveolar Bone Loss; Antiviral Agents; Herpes Zoster; Humans; Male; Mandibular Diseases; Osteonecrosis; Tooth Loss

Topics: Acyclovir; Antiviral Agents; Herpes Zoster; Humans; Immunocompetence; Pain

Topics: Action Potentials; Acyclovir; Aged; Antiviral Agents; Electrodiagnosis; Electrophysiology; Female; Follow-Up Studies; Herpes Zoster; Humans; Motor Neurons; Muscle, Skeletal; Neurons, Afferent; Paresis; Peroneal Nerve; Sural Nerve; Tibial Nerve; Time Factors

Topics: Acyclovir; Antiviral Agents; Female; Herpes Zoster; Humans; Immunocompromised Host; Male; Middle Aged; Retrospective Studies; Treatment Outcome

These recommendations represent the first statement by the Advisory Committee on Immunization Practices (ACIP) on the use of live, attenuated varicella virus vaccine--VARIVAX--manufactured by Merck and Company, Inc. and licensed in March 1995 for use in healthy persons > or = 12 months of age. In addition to presenting information regarding vaccine, this statement updates previous recommendations concerning the use of varicella zoster immune globulin (VZIG) as prophylaxis against varicella (MMWR 1984; 33:84-90, 95-100).

Topics: Acyclovir; Adolescent; Adult; Age Distribution; Aged; Antibodies, Viral; Antiviral Agents; Chickenpox; Chickenpox Vaccine; Child; Child, Preschool; Contraindications; Cost-Benefit Analysis; Cross Infection; Drug Storage; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Immune Sera; Immunization, Passive; Incidence; Infant; Infant, Newborn; Middle Aged; Pregnancy; Product Surveillance, Postmarketing; Serologic Tests; Vaccination; Vaccines, Attenuated; Viral Vaccines

Topics: Acyclovir; Adult; Antiviral Agents; Brain Diseases; Herpes Zoster; Humans; Kidney Failure, Chronic; Male; Renal Dialysis; Skin Diseases, Viral

Topics: Acyclovir; Anti-Inflammatory Agents; Antiviral Agents; Drug Therapy, Combination; Herpes Zoster; Humans; Prednisone; Randomized Controlled Trials as Topic; Research Design

To study the complication rate of varicella zoster virus (VZV) reactivation and the relationship between complications, presentation and localization of zoster and immune function in HIV disease.. A total of 142 episodes of VZV reactivation in 113 out of 544 HIV-1-infected participants in the Amsterdam Cohort Study of homosexual men were studied. Persistent hyperkeratotic or necrotic skin lesions, post-herpetic neuralgia, other neurological events, ocular events and pneumonitis occurring within 6 months of the onset of the last episode of VZV reactivation were defined as complications, provided that other possible diagnoses were excluded and the event had been previously described in the literature as related to VZV reactivation.. Twenty-four complications occurred in 15 (11%) of these 142 episodes. Complications occurred exclusively in the 40 episodes with either multidermatomal or disseminated presentation, or a trigeminal localization, or both. In the group of episodes of unidermatomal zoster at a non-trigeminal localization no complications occurred. Twenty-one episodes of herpes zoster were localized in the trigeminal area. Localization was not significantly associated with the level of immune function. Compared to unidermatomal presentation (n = 120), multidermatomal (n = 15) and disseminated presentation (n = 7) occurred at lower median CD4+ cell counts (330, 240 and 50 x 10(6)/l, respectively; P = 0.003) and significantly lower levels of CD3 monoclonal antibodies or phytohaemagglutinin-induced T-cell reactivity in vitro. Complications were related to CD4+ cell counts, but in the cases of disseminated, multidermatomal or trigeminal zoster a CD4+ cell measurement provided no additional information on the risk of complications.. In HIV-infected individuals the extent of the clinical presentation and the occurrence of complications of VZV reactivation are related to the degree of immunodeficiency. In episodes of VZV reactivation with either multidermatomal or disseminated presentation or a trigeminal localization, or both the complication rate was high. CD4+ cell counts provided no additional information on the complication risk. Oral acyclovir appears to be sufficient as therapy for unidermatomal zoster at a non-trigeminal localization.

Topics: Acyclovir; Adult; Antiviral Agents; CD4 Lymphocyte Count; Cohort Studies; Herpes Zoster; Herpesvirus 3, Human; HIV Infections; HIV-1; Homosexuality, Male; Humans; Male; Middle Aged; Skin Diseases, Viral; Virus Activation

To determine the frequency of, risk factors for, and clinical course of herpes zoster (HZ) after bone marrow transplantation (BMT) in children.. A total of 107 children with hematologic malignancy or solid tumor who underwent allogeneic or autologous BMT were studied retrospectively.. Of the 107 patients, HZ developed in 35 (33%) after BMT; 31 (89%) of these 35 patients had localized HZ. The median onset of infection was day 96 after BMT, and 89% of cases of HZ occurred before day 365 after BMT. HZ developed in 26 (58%) of 45 patients (13/21 (62%) allogeneic and 13/24 (54%) autologous patients) with hematologic malignancy; most of these patients had undergone total body irradiation. Of 33 patients with solid tumor, HZ developed in 9 (27%). All patients with HZ were treated with acyclovir, and no patients died of complications directly resulting from HZ.. Herpes zoster occurred earlier after BMT than in adults, and it occurred frequently in children who had hematologic malignancy and/or had undergone total body irradiation. Prompt antiviral therapy reduced the mortality rate and significant morbidity associated with HZ.

Topics: Acyclovir; Adult; Antiviral Agents; Bone Marrow Transplantation; Case-Control Studies; Chickenpox; Child; Female; Herpes Zoster; Humans; Incidence; Male; Neoplasms; Retrospective Studies; Risk Factors; Time Factors; Whole-Body Irradiation

Topics: 2-Aminopurine; Acyclovir; Antiviral Agents; Clinical Trials as Topic; Famciclovir; Herpes Zoster; Humans; Neuralgia; Valacyclovir; Valine

A 69-year-old man developed confusion and disorientation, following intravenous administration of acyclovir for herpes zoster at the right C5 area. His consciousness was disturbed four days after the beginning of acyclovir therapy (daily dose: 500 mg, every 12 h), and the symptoms resolved two days after cessation of acyclovir. Neuroradiological examination revealed no intracranial abnormality, and the routine CSF examination was within the normal range of values except for a mild elevation of IgG (7.4 mg/dl). An electroencephalogram showed diffuse slow activities without paroxysmal waves on admission, but the findings of electroencephalograms were gradually normalized in parallel with the recovery of consciousness. Fever, signs of meningeal irritation, involuntary movement or renal dysfunction were not observed during the course of illness. Although the serum concentration of acyclovir was not elevated, we considered the adverse effects of acyclovir had resulted in his consciousness disturbance. Acyclovir is greatly useful for herpes simplex and varicella-zoster virus infections, and its complications are extremely rare. However, several reports described various neuropsychiatric side effects in patients receiving acyclovir. Most of such cases had an association with severe renal failure or malignant tumor; actually, an intense malignancy surveillance over our case revealed thyrogenic papillary adenocarcinoma without metastasis. The excretion of acyclovir is mainly through the kidney, so that the neurotoxicity of acyclovir in cases with renal insufficiency stems from its excessive accumulation in the body. In malignancy complicated patients, on the other hand, some authors surmised about the influences from the co-use of other neurotoxic drugs or radiation therapy, but reasons for such conditions remain obscure. The neuropsychiatric manifestation caused by acyclovir is an entity distinguishable from viral encephalitis, and a careful surveillance for malignancy is required in such cases.

Topics: Acyclovir; Adenocarcinoma, Papillary; Aged; Antiviral Agents; Consciousness Disorders; Diagnosis, Differential; Herpes Zoster; Humans; Male; Thyroid Neoplasms

Topics: Acyclovir; Administration, Oral; Herpes Zoster; Humans; Male; Mental Disorders; Middle Aged; Neuropsychological Tests; Renal Dialysis

This report describes two patients with acquired immunodeficiency syndrome (AIDS) and herpes zoster myelopathy. Patient one had a T-8 myelitis that preceded the onset of T-8-distribution zoster and was followed by cervical myelopathy. Antibody to varicella zoster virus (VZV) was present in the CSF. He never received steroids or other immunosuppressive drugs, and his condition improved dramatically after treatment with intravenous acyclovir. The second patient had a rapidly progressive myelitis with paralysis of both legs. Detection of VZV DNA and antibody to VZV in his CSF led to successful treatment with famciclovir despite discontinuation of dexamethasone and earlier treatment failure with acyclovir. These cases support the idea that VZV myelopathy in the immunosuppressed host is caused by virus invasion. CSF analysis for antiviral antibody and for VZV DNA by polymerase chain reaction are helpful in establishing the diagnosis. Aggressive antiviral therapy is advised.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; DNA, Viral; Herpes Zoster; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Myelitis

We describe a case of connatal herpes zoster present in a newborn girl whose mother had been exposed to varicella infection during the seventh month of pregnancy. A few minutes after delivery, the newborn was examined for an erythematous maculopapular rash with clear grouped vesicles involving the right L2-L4 dermatome. She was given varicella zoster immunoglobulin and oral and topical acyclovir, and all the skin lesions were completely healed eight days later. This report emphasizes one aspect of the relationship between maternal exposure to varicella zoster virus infection and the occurrence of connatal shingles, the benign course of the disease in this case, and the favorable response to acyclovir therapy in neonates.

Topics: Acyclovir; Adult; Chickenpox; Female; Herpes Zoster; Humans; Infant, Newborn; Infectious Disease Transmission, Vertical; Maternal Exposure; Pregnancy

The serological response of patients with acute herpes zoster was studied to determine whether a diagnosis could be made on a single serum sample, and whether this response was modified by treatment with antiviral and/or steroid therapy. The patients received one of four regimes of acyclovir and prednisolone, Varicella zoster virus (VZV) IgG, IgM, and IgA responses were measured by commercial and in-house enzyme immunoassays (EIA) using serum samples taken at days 0, 7, and 21 after entry into the study. Samples were also tested for IgM to Epstein-Barr virus (EBV) viral capsid antigen (VCA), and cytomegalovirus (CMV) IgM and for herpes simplex virus (HSV) antibodies by the complement fixation test (CFT). Analysis was carried out on data from 71 patients. VZV IgM was detected in 72%, VZV IgA in 78%, and either VZV IgM or IgA in 88% of patients tested, at some time during the 3-week study period. The optimal time to detect either class of antibody was approximately 1 week after the onset of the vesicular rash, when 85% of patients had one or both classes of acute phase antibody in their serum. There was no evidence of cross reaction with EBV, CMV, or HSV antibodies. Neither treatment with prednisolone nor the length of therapy with acyclovir affected significantly the VZV IgM or IgA responses. Therefore it is possible to make a serological diagnosis of herpes zoster on a single sample, optimally 1 week after the onset of the rash, in patients treated with acyclovir alone or with acyclovir and steroids.

Topics: Acyclovir; Adolescent; Adult; Antibodies, Viral; Antiviral Agents; Cytomegalovirus; Female; Follow-Up Studies; Herpes Zoster; Herpesvirus 3, Human; Herpesvirus 4, Human; Humans; Immunoglobulin A; Immunoglobulin G; Immunoglobulin M; Male; Prednisolone; Simplexvirus

Although herpes zoster virus usually affects sensory nerves, it can also damage motoneurons. Injury to the phrenic nerve has been described previously, but only anecdotally. We report on a case of left hemidiaphragmatic paralysis with severe axonal degeneration secondary to cervical herpes zoster, and describe its clinical, radiological, pulmonary function and electromyographic evolution during an 18-month follow-up.

Topics: Acyclovir; Antiviral Agents; Female; Herpes Zoster; Humans; Middle Aged; Neuralgia; Phrenic Nerve; Respiratory Paralysis

Progressive outer retinal necrosis syndrome is a variant of necrotizing herpetic retinopathy, a group of retinal infections caused by the herpes viruses. It has been described only in immunosuppressed patients. We present a healthy immunocompetent 16-year-old male who suffered a bilateral progressive outer retinal necrosis. Varicella-zoster virus infection was confirmed on the basis of serologic study. Treatment with intravenous acyclovir and oral prednisone was successful.

Topics: Acyclovir; Administration, Oral; Adolescent; Antibodies, Anti-Idiotypic; Antibodies, Viral; Antiviral Agents; Disease Progression; Drug Therapy, Combination; Eye Infections, Viral; Glucocorticoids; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunocompromised Host; Immunoglobulin M; Infusions, Intravenous; Male; Prednisone; Retinal Necrosis Syndrome, Acute; Visual Acuity

To describe the clinical course of varicella-zoster optic neuropathy preceding acute retinal necrosis in patients with acquired immunodeficiency syndrome.. Case series.. Two tertiary care centers in San Diego, Calif, and London, England.. Three human immunodeficiency virus-positive men with previous cutaneous zoster infection, optic neuropathy, and necrotizing retinitis.. All patients had an episode of zoster dermatitis treated with acyclovir. Visual loss consistent with an optic neuropathy ensued, followed by typical herpetic retinitis. The cause of visual loss was not suspected to be varicella-zoster until after the retinitis occurred. Despite aggressive medical treatment, 4 of 6 eyes progressed to retinal detachment.. Varicella-zoster may cause an optic neuropathy in patients with acquired immunodeficiency syndrome, especially in those with previous shingles. A high index of suspicion is necessary to establish the diagnosis and begin early antizoster treatment.

Topics: Acyclovir; Adult; AIDS-Related Opportunistic Infections; Antigens, Viral; Antiviral Agents; Dermatitis; Fluorescein Angiography; Fundus Oculi; Herpes Zoster; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Immunohistochemistry; Male; Middle Aged; Optic Nerve Diseases; Retina; Retinal Necrosis Syndrome, Acute; Skin Diseases, Viral; Visual Acuity; Vitreous Body

Topics: Acyclovir; Aged; Anti-Inflammatory Agents; Antiviral Agents; Drug Therapy, Combination; Evaluation Studies as Topic; Female; Herpes Zoster; Humans; Male; Middle Aged; Pain; Prednisone; Randomized Controlled Trials as Topic; Reproducibility of Results; Treatment Outcome

A patient with AIDS who developed the clinical picture of bilateral progressive outer retinal necrosis (PORN) in combination with varicella zoster encephalitis is described. The picture developed more than 2 years after an episode of ophthalmic zoster infection, and following intermittent exposure to oral acyclovir because of recurrent episodes of cutaneous herpes simplex infection.. Aqueous humour, obtained by paracentesis of the anterior chamber, was analysed using immunofluorescence and polymerase chain reaction (PCR). Postmortem analysis of eye and brain tissue was performed by using conventional techniques and in situ hybridisation.. While conventional techniques all failed to detect a causative agent, analysis of the aqueous humour using PCR, and histological examination of necropsy specimens from eyes and brain using in situ hybridisation were conclusive for the diagnosis varicella zoster virus (VZV) infection.. This case documents the presumed association of PORN and VZV encephalitis in a severely immunocompromised AIDS patient.

Topics: Acyclovir; Adult; AIDS-Related Opportunistic Infections; Antiviral Agents; Encephalitis, Viral; Herpes Simplex; Herpes Zoster; Humans; In Situ Hybridization; Male; Necrosis; Polymerase Chain Reaction; Retinal Diseases

Topics: Acyclovir; Adolescent; Adult; Aged; Chickenpox; Child; Child, Preschool; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunocompromised Host; Middle Aged; Pregnancy

Progressive outer retinal necrosis is a destructive retinopathy found in patients with acquired immune deficiency syndrome. Treatment of this disorder has been unsuccessful in reported patient series, with the patients experiencing profound bilateral loss of vision.. We treated six patients with combination antiviral therapy, usually with intravenous foscarnet and either ganciclovir or acyclovir.. These six patients retained a visual acuity of 20/100 or better in at least one eye for the remainder of their lives (a period > 4 months for each patient). Retinal detachments developed in four patients, for which vitrectomy and silicone oil tamponade were required.. A combination of intravenous antiviral therapy and aggressive vitrectomy techniques to repair any associated detachments may allow the preservation of useful visual acuity in patients with progressive outer retinal necrosis. This is the first reported series of successful long-term treatment of patients with this disorder.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; Antiviral Agents; Female; Foscarnet; Fundus Oculi; Ganciclovir; Herpes Zoster; Herpes Zoster Ophthalmicus; Humans; Infusions, Intravenous; Male; Retinal Detachment; Retinal Necrosis Syndrome, Acute; Silicone Oils; Visual Acuity; Vitrectomy

Topics: Acyclovir; Aged; Antiviral Agents; Herpes Zoster; Humans; Valacyclovir; Valine

Topics: Acyclovir; Adolescent; Antiviral Agents; Herpes Zoster; Humans; Male; Myelitis, Transverse

During the early manifestation of peripheral facial paralysis, VZV specific IgA antibodies were detected in the serum in a single case. In similar cases, this serological parameter should be tested for causal diagnosis in connection with early Aciclovir therapy.

Topics: Acyclovir; Antibodies, Viral; Combined Modality Therapy; Facial Paralysis; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunoglobulin A; Male; Middle Aged

We report a 29-year-old female OKT4 epitope deficiency patient with primary Sjögren's syndrome and psoriasis vulgaris. Immunological investigations during the prolonged clinical course of her herpes zoster revealed that she has OKT4 epitope deficiency and primary Sjögren's syndrome. She had been treated for psoriasis vulgaris for 17 years without systemic immunosuppressive therapy. Flow cytometric study revealed that her OKT4 deficiency is heterogeneous and excluded interference with the OKT4 epitope by anti OKT4 autoantibodies. The rare coexistence of primary Sjögren's syndrome and psoriasis implicates an immune disturbance due to an unusual phenotype of CD4.

Topics: Acyclovir; Adult; Biopsy; CD4 Antigens; Epitopes; Female; Flow Cytometry; Herpes Zoster; Humans; Psoriasis; Sjogren's Syndrome; Skin

Topics: Acyclovir; Antiviral Agents; Cytomegalovirus Infections; Ganciclovir; Herpes Simplex; Herpes Zoster; Humans; Kidney Transplantation; Postoperative Complications

A 59-y-old with a history of chronic renal failure on hemodialysis was diagnosed with herpes zoster and begun on 800 mg acyclovir 5 times daily. Two days later the patient developed visual hallucinations, ataxia, confusion and memory loss along with focal myoclonus, nausea and vomiting. No fever, elevated WBC count or significant electrolyte imbalance was found. CT scan of the brain was unremarkable. The patient was then dialyzed for presumed acyclovir toxicity. Her acyclovir level was later found to have been 3.4 micrograms/ml (normal peak range 0.4-2 micrograms/ml) prior to dialysis. After 3 h of hemodialysis, her post-dialysis acyclovir level was 1.9 micrograms/ml. After a second course of hemodialysis the next day the patient's mental status improved, and she was discharged 5 d later. Due to its low volume of distribution (0.6 L/kg), low protein binding (about 15%) and water solubility, acyclovir is an example of the ideal drug that can be removed by hemodialysis. About 45% of the total body amount can be extracted through a 3-h course of hemodialysis with resultant improvement in symptoms.

Topics: Acyclovir; Antiviral Agents; Ataxia; Blood Chemical Analysis; Female; Hallucinations; Herpes Zoster; Humans; Kidney Failure, Chronic; Memory; Middle Aged; Myoclonus; Nausea; Renal Dialysis; Vomiting

Topics: Acyclovir; Chickenpox; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Infant; Infectious Disease Transmission, Vertical; Male; Pregnancy; Pregnancy Complications, Infectious; Serologic Tests

Topics: Acyclovir; Adult; AIDS-Related Opportunistic Infections; Herpes Zoster; Humans; Male; Pneumonia, Viral

Topics: Acyclovir; Administration, Oral; Adult; Female; Herpes Zoster; Humans; Pneumonia, Viral

Topics: Acyclovir; Administration, Topical; Combined Modality Therapy; Drug Resistance, Microbial; Herpes Zoster; Humans; Injections, Intralesional; Interferon alpha-2; Interferon-alpha; Male; Middle Aged; Recombinant Proteins; Skin Diseases, Viral; Treatment Outcome; Trifluridine

Idiopathic (autoimmune) thrombocytopenic purpura has been previously reported as a rare complication in children and in a few adults following chickenpox. We report a case of varicella zoster virus-associated idiopathic thrombocytopenic purpura in an adult liver transplant recipient following dermatomal zoster. Idiopathic thrombocytopenic purpura developed 3 days after the onset of herpes zoster in our patient, with a nadir platelet count of 3000/mm3. The patient was treated with intravenous gamma globulin with recovery of thrombocytopenia after 3 weeks. Transplant clinicians need to be aware that this serious and potentially life-threatening complication may occur with herpes zoster in transplant recipients.

Topics: Acyclovir; Herpes Zoster; Humans; Immunoglobulins, Intravenous; Immunosuppressive Agents; Liver Transplantation; Male; Middle Aged; Platelet Count; Purpura, Thrombocytopenic, Idiopathic

We are presenting the case of a seventy-six year old male infected with Herpes zoster of the trigeminal nerve. He had no previous nephropathology, but developed acute renal failure following the administration of an intravenous bolus of Acyclovir. The existing literature was reviewed. Possible pathogenic mechanisms are discussed, and precautions against nephrotoxicity are emphasized.

Topics: Acute Kidney Injury; Acyclovir; Aged; Antiviral Agents; Cranial Nerve Diseases; Herpes Zoster; Humans; Male; Trigeminal Nerve

Topics: Acyclovir; Adult; Age Factors; Aged; Aged, 80 and over; Antiviral Agents; Female; Herpes Zoster; Humans; Incidence; Male; Middle Aged; Sex Factors; Spain; Time Factors

Three hundred and one patients with acute herpes zoster treated early with oral acyclovir were enrolled in an open, prospective study designed to evaluate painful and neurologic disorders over a 6-month period. Age, initial pain severity, and occurrence of a neurologic deficit influenced the incidence of postherpetic neuralgia. No relationship was found between initial rash severity and either pain incidence or neurologic deficit.

Topics: Acyclovir; Administration, Oral; Aged; Herpes Zoster; Humans; Middle Aged; Nervous System Diseases; Pain; Prospective Studies

Topics: Acyclovir; Adult; Brain Diseases; Diagnosis, Differential; Herpes Zoster; Humans; Kidney Failure, Chronic; Male; Meningoencephalitis

Topics: Acyclovir; Adult; AIDS-Related Opportunistic Infections; Antiviral Agents; Drug Resistance, Microbial; Female; Foscarnet; Herpes Zoster; Herpesvirus 3, Human; Humans

We describe a fatal case of varicella-zoster virus myelitis that was preceded by neurological symptoms for 10 months in a patient with human immunodeficiency virus infection and an extremely low CD4 cell count (20/microL). The patient was also receiving chronic acylovir therapy for suppression of herpes complex. Despite chronic unilateral periauricular and facial pain, which was later accompanied by upper- and lower-extremity weakness, a cutaneous eruption never developed. It is hypothesized that a blunted inflammatory response in the spinal cord--possibly related to a very low CD4 cell count--and long-term acylovir administration might have contributed to the atypical manifestation might have contributed to the atypical manifestation of varicella-zoster virus-related neurological disease in this immunocompromised patient.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; Chronic Disease; Fatal Outcome; Herpes Zoster; Herpesvirus 3, Human; Humans; Male; Myelitis, Transverse

Topics: Acyclovir; Herpes Zoster; HIV Seropositivity; Humans; Myelitis, Transverse

We describe a 28-year-old HIV-infected woman with AIDS, defined by cerebral toxoplasmosis and a CD4-count of less than 10 x 10(6) cells/I, who, after several eruptions of genital herpes and typical dermatomal herpes zoster, all successfully treated with acyclovir, developed chronic cutaneous ulcerating lesions on a finger and on the tibia. The lesions were found to contain varicella zoster virus antigen but repeated treatment courses with acyclovir were unsuccessful. After a course of intravenous foscarnet the lesions resolved. They recurred after discontinuation of foscarnet but finally responded to a second course of treatment.

Topics: Acyclovir; Adult; AIDS-Related Opportunistic Infections; Antiviral Agents; Chronic Disease; Drug Resistance, Microbial; Female; Foscarnet; Herpes Zoster; Herpesvirus 3, Human; Humans; Skin Ulcer

Topics: Acyclovir; Analgesics; Antiviral Agents; Drug Therapy, Combination; Female; Herpes Zoster; Humans; Male; Middle Aged; Neuralgia; Vitamin B 12

The syndrome of inappropriate secretion of antidiuretic hormone is a common consequence of neurologic and pulmonary infections as well as drug intake and many other clinical situations. Its association with herpes varicella-zoster virus infections is scarcely reported in the literature. It generally appears in immunosuppressed patients suffering from serious underlying diseases. There are also a few cases of syndrome of inappropriate secretion of antidiuretic hormone related to vidarabine use. We report the case of a man infected by human immunodeficiency virus who developed a disseminated herpes varicella-zoster virus infection and symptoms due to hyponatremia caused by antidiuretic hormone excess. The patient was cured with saline hypertonic infusion, water restriction, and intravenous administration of acyclovir. To the best of our knowledge, this is the first case of this association in a human immunodeficiency virus infected patient. We propose the use of acyclovir instead of vidarabine in the management of these situations.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; AIDS-Related Opportunistic Infections; Herpes Zoster; HIV-1; Humans; Hyponatremia; Inappropriate ADH Syndrome; Male; Syndrome

The introduction of antiviral agents such as acyclovir has had a remarkable impact on management of patients with viral infections. In this article the authors outline the management of herpes simplex and varicella zoster infections, giving specific guidelines for treatment with acyclovir.

Topics: Acyclovir; Adolescent; Adult; Child; Female; Genital Diseases, Female; Herpes Simplex; Herpes Zoster; Humans; Infant, Newborn; Male; Middle Aged; Recurrence

We report four cases of varicella-zoster virus (VZV)-associated myelopathy in adults. Myelopathy was remitting-exacerbating in two remarkable instances, once acute and once chronic. VZV myelopathy was diagnosed based on the close temporal relationship between rash and onset of myelopathy, and for the first time, by polymerase chain reaction, which revealed VZV DNA in the cerebral spinal fluid of three patients with pleocytosis weeks to months later. Magnetic resonance imaging was abnormal in three of four patients. Although all four patients were treated at some time with intravenous acyclovir, concomitant treatment with steroids and the presence of acquired immunodeficiency syndrome in one patient prevented conclusions about a favorable response to therapy. Myelopathy after VZV infection may be remitting-exacerbating in addition to acute or chronic. Detection of VZV DNA in cerebral spinal fluid months after rash was useful for diagnosis and suggests a role for virus in the pathogenesis of myelopathy.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; Cerebrospinal Fluid; DNA, Viral; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Myelitis; Polymerase Chain Reaction