acyclovir and Neuritis

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adrenal Cortex Hormones; Capsaicin; Carbamazepine; Demyelinating Diseases; Ganciclovir; HIV-1; HTLV-I Infections; Humans; Muscular Diseases; Neuritis; Neuromuscular Diseases; Peripheral Nervous System Diseases; Polyneuropathies; Zidovudine

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

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

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

A 62-year-old woman developed meningitis as well as acute paralysis of glossopharyngeal, vagus, and accessory nerves on the right side and also had dysfunction of the left hypoglossal nerve. Although there was no evidence of a typical cutaneous or mucosal herpetic lesion, PCR detection of varicella zoster virus (VZV)-DNA in cerebrospinal fluid confirmed the clinical diagnosis of polyneuritis cranialis due to VZV infection and zoster sine herpete. After starting intravenous acyclovir and methylprednisolone, her hypoglossal nerve palsy disappeared within a day and all other symptoms and signs dramatically improved. A rapid improvement observed in our patient suggests that the right cranial polyneuropathy could be caused by inflammation associated with epineurial edema (where the ninth, tenth, and eleventh cranial nerves pass through the right jugular foramen), whereas the exact mechanism of the twelfth cranial nerve involvement on the contralateral side is unknown. Our clinical findings indicate that acute lower cranial polyneuropathy in patients with zoster sine herpete should be treated immediately with combined administration of acyclovir and an anti-inflammatory corticosteroid.

Topics: Acyclovir; Antiviral Agents; Cranial Nerve Diseases; Drug Therapy, Combination; Female; Humans; Methylprednisolone; Middle Aged; Neuritis; Treatment Outcome; Zoster Sine Herpete

Although a range of cytomegalovirus (CMV)-induced cutaneous manifestations is described in AIDS patients, skin involvement in immunocompromised patients is rare, and intraneural CMV inclusions or CMV neuritis has not been documented in skin biopsies.. Cutaneous biopsies of CMV lesions were collected prospectively for 12 months. The morphology, sites and symptomatology of the individual lesions, associated systemic illnesses, treatment schedules and disease outcome were recorded. A total of nine biopsies were obtained from three females who presented with extensive painful perineal ulceration and disseminated cutaneous ulcers, nodules and plaques. Clinically, herpes simplex virus (HSV) ulceration was diagnosed and treatment with acyclovir was initiated after biopsies from the natal cleft, perineum and neck were obtained. All were superficial and demonstrated HSV infection. Only the natal cleft biopsy demonstrated coexistent CMV inclusions. Suboptimal healing necessitated two further biopsies from each patient, none of which demonstrated HSV inclusions. Three of four deep perineal biopsies demonstrated CMV inclusions within nerves attended by a lymphocytic infiltrate and architectural disturbances. Two deep cutaneous biopsies of the trunk and abdominal wall confirmed CMV in extraneural locations only. One superficial perineal biopsy did not demonstrate any viral inclusion.. In documenting CMV neuritis in painful perineal ulcers, the histopathological spectrum of perineal CMV ulcers is expanded, a cutaneous neurotropic characteristic of CMV is presented and a direct role for CMV in the pathogenesis of pain is suggested. CMV latency within perineal nerves is also revisited as another potential site of CMV reactivation in immunocompromised patients, and another potential site for possible venereal transmission of CMV infection. The exclusive presence of HSV in initial superficial biopsies highlights the need for optimally biopsied tissue to confirm the coexistence of CMV infection.

Topics: Acyclovir; Adult; AIDS-Related Opportunistic Infections; Antiviral Agents; Cytomegalovirus; Cytomegalovirus Infections; Female; Humans; Immunocompromised Host; Immunohistochemistry; Neuritis; Perineum; Prospective Studies; Skin Ulcer; Treatment Outcome

Topics: Acyclovir; Aged; Aged, 80 and over; Antiviral Agents; Fatal Outcome; Humans; Male; Meningitis, Aseptic; Neuritis; Valacyclovir; Valine

Topics: Acyclovir; Aged; Aged, 80 and over; Anti-Inflammatory Agents; Antiviral Agents; Cranial Nerve Diseases; Facial Dermatoses; Herpes Simplex; Humans; Injections, Intralesional; Male; Neuritis; Skin Ulcer; Syndrome; Triamcinolone; Trigeminal Nerve

Varicella zoster virus (VZV) is recognized as one of the major viral pathogens reactivated in patients with the acquired immune deficiency syndrome (AIDS). We report the case of meningoradiculoneuritis in an AIDS patient,associated with the isolation in the cerebrospinal fluid (CSF) of a thymidine kinase (TK)-deficient, acyclovir (ACV)-resistant strain of VZV. Although the virus was sensitive in vitro to phosphonoformate (PFA), the patient did not improve during PFA therapy and finally died. Several VZV strains isolated from this patient (including two isolates from the patient's CSF) were analyzed for their TK activity and subsequently the viral TK gene was sequenced showing a major deletion leading to a truncated protein. Their susceptibility to several antiviral agents including ACV, PFA, (E)-5-(2-bromovinyl)-2'-deoxyuridine (BVDU), 9-beta-D-arabinofuranosyladenine (vidarabine), (S)-1-(3-hydroxy-2-phosphonylmethoxypropyl) cytosine (HPMPC), and (S)-9-(3-hydroxy-2-phosphonyl-methoxypropyl)adenine (HPMPA) was evaluated. All the virus strains isolated from this patient remained sensitive to HPMPA and HPMPC, pointing to the potential usefulness of these acyclic nucleoside phosphonates for the treatment of ACV-resistant VZV infections in immunocompromised patients.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; Amino Acid Sequence; Base Sequence; Drug Resistance; Female; Herpes Zoster; Humans; Meningitis; Molecular Sequence Data; Neuritis; Radiculopathy; Thymidine Kinase

A promising new nucleoside analog, 9-[[2-hydroxy-1-(hydroxymethyl)ethoxy] methyl]-guanine (BW759), which is structurally similar to acyclovir, was tested against acute herpetic keratitis in the rabbit ocular model. Topical 1-0.1% BW759 given 3-5x per day gave beneficial results in that corneal epithelial involvement, conjunctivitis, iritis, and corneal clouding were reduced even when chemotherapy was initiated at 3 days postinoculation. Under the same conditions, topical BW759 therapy gave slightly better results than acyclovir, and both were better than idoxuridine therapy. Mortality rate and colonization of the trigeminal ganglia by HSV-1 were unaffected by BW759 therapy. Duration of virus, shed into the tear film was reduced by BW759.

Topics: Acyclovir; Animals; Antiviral Agents; Chemical Phenomena; Chemistry; Conjunctivitis; Corneal Opacity; Drug Evaluation, Preclinical; Follow-Up Studies; Ganciclovir; Herpes Simplex; Idoxuridine; Iritis; Keratitis, Dendritic; Male; Neuritis; Ointments; Rabbits; Time Factors; Trigeminal Nerve