acyclovir and Pharyngitis

Topics: Acyclovir; Adolescent; Adult; Aged; Antibodies, Viral; Diagnosis, Differential; Hepatitis, Viral, Human; Herpesvirus 4, Human; Humans; Immunoglobulin G; Immunoglobulin M; Infectious Mononucleosis; Liver; Middle Aged; Pharyngitis

Ninety-four patients with infectious mononucleosis and symptoms < or = 7 days were randomized to treatment with oral acyclovir (800 mg 5 times/day) and prednisolone (0.7 mg/kg for the first 4 days, which was reduced by 0.1 mg/kg on consecutive days for another 6 days; n = 48), or placebo (n = 46) for 10 days. Oropharyngeal Epstein-Barr virus (EBV) shedding was significantly inhibited during the treatment period (P = .02, Mann-Whitney rank test). No significant effect was observed for duration of general illness, sore throat, weight loss, or absence from school or work. The frequency of latent EBV-infected B lymphocytes in peripheral blood and the HLA-restricted EBV-specific cellular immunity, measured 6 months after onset of disease, was not affected by treatment. Thus, acyclovir combined with prednisolone inhibited oropharyngeal EBV replication without affecting duration of clinical symptoms or development of EBV-specific cellular immunity.

Topics: Acyclovir; Adolescent; Adult; Antibodies, Viral; Antiviral Agents; Double-Blind Method; Drug Therapy, Combination; Female; Glucocorticoids; Herpesvirus 4, Human; HLA Antigens; Humans; Immunity, Cellular; Infectious Mononucleosis; Male; Pharyngitis; Placebos; Prednisolone; Safety; Saliva; Sweden; Time Factors; United Kingdom

Perorally administered acyclovir was evaluated in the therapy of acute infectious mononucleosis in a multicentered, randomized, double-blind, placebo-controlled trial. A total of 120 patients received 600 mg of acyclovir or placebo five times daily for 10 days. All patients were entered into the study within 7 days of symptom onset and had a positive Monospot test. Analysis of mean values and time to resolution of fever, lymphadenopathy, weight change, hepatomegaly, splenomegaly, liver function tests, atypical lymphocytes, hours of bed rest, sense of well-being, and return to normal activities revealed no significant differences. There was a trend toward suppression of Epstein-Barr virus excretion in the oropharynx in acyclovir recipients. No toxicity was detected in patients treated with acyclovir. Under the conditions of the study, there was no evidence that treatment with perorally administered acyclovir affected the course of infectious mononucleosis.

Topics: Acyclovir; Administration, Oral; Alanine Transaminase; Antibodies, Viral; Antigens, Viral; Aspartate Aminotransferases; Capsid; Capsid Proteins; Double-Blind Method; Epstein-Barr Virus Nuclear Antigens; Hepatomegaly; Herpesvirus 4, Human; Humans; Infectious Mononucleosis; Pharyngitis; Splenomegaly

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: Acute Disease; Acyclovir; Administration, Intravenous; Female; Fever; Herpes Simplex; Herpesvirus 2, Human; Humans; Pharyngitis; Young Adult

Herpes simplex virus (HSV) has various presentations, depending on the patient's immune status, age, and the route of transmission. In adults, HSV type 1 is found predominantly in the oral area, and HSV type 2 (HSV-2) is commonly found in the genital area. HSV-2 infection without genital lesions is uncommon. Herein we report a unique case of pharyngotonsillitis as an initial manifestation of disseminated HSV-2 infection without genital involvement.. A 46-year-old male was admitted to our hospital with a 1-week history of fever and sore throat. His past medical history included hypereosinophilic syndrome diagnosed at age 45 years. Physical examination revealed throat congestion, bilaterally enlarged tonsils with exudates, tender cervical lymphadenopathy in the left posterior triangle, and mild epigastric tenderness. The laboratory data demonstrated bicytopenia, elevated liver enzyme levels, and hyperferritinemia. A bone marrow smear showed hypocellular marrow with histiocytes and hemophagocytosis. The diagnosis of HLH was confirmed, and the patient was treated with methylprednisolone pulse therapy on days 1-3. On day 5, despite initial improvement of the fever and sore throat, multiple, new, small bullae developed on the patient's face, trunk, and extremities. Additional testing showed that he was positive for HSV-specific immunoglobulin M and immunoglobulin G. Disseminated HSV infection was suspected, and intravenous acyclovir (10 mg/kg every 8 h) was begun. A subsequent direct antigen test of a bulla sample was positive for HSV-2. Moreover, tonsillar and esophageal biopsies revealed viral inclusion bodies. Immunohistochemical staining and a quantitative real-time polymerase chain reaction (PCR) assay confirmed the presence of HSV-2. Disseminated HSV-2 infection with multiple bullae, tonsillitis, esophagitis, and suspected hepatic involvement was diagnosed. After a 2-week course of intravenous acyclovir, his hematological status and liver function normalized, and his cutaneous skin lesions resolved. He was discharged on day 22 in good general health and continued taking oral valacyclovir for viral suppression due to his immunosuppressed status.. Disseminated HSV-2 infection should be considered as one of the differential diagnoses in patients with pharyngotonsillitis and impaired liver function of unknown etiology even if there are no genital lesions.

Topics: Acyclovir; Esophagitis; Herpes Simplex; Herpesvirus 2, Human; Humans; Immunocompromised Host; Lymphohistiocytosis, Hemophagocytic; Male; Middle Aged; Pharyngitis; Tonsillitis; Urogenital System

Whereas herpes simplex virus type 1 (HSV-1) is a recognized cause of acute oropharyngeal infection in young adults, HSV-2 infections are mostly associated with genital symptoms. We report a case of acute and prolonged febrile ulcerative pharyngotonsillitis with inflammatory syndrome which persisted despite antibiotic therapy for 8 days and required hospitalization in an 18-year old immune competent and sexually active female patient. HSV-2 was evidenced in tonsillar samples and blood by real time PCR, and HSV type-specific serology showed HSV-2 primary infection. Despite delayed diagnosis, acyclovir treatment led to rapid clinical improvement. This case highlights HSV-2 as an unusual cause of pharyngotonsillitis that should be reminded in sexually active patients.

Topics: Acyclovir; Adolescent; Antiviral Agents; Blood; Female; Herpes Simplex; Herpesvirus 2, Human; Humans; Palatine Tonsil; Pharyngitis; Real-Time Polymerase Chain Reaction; Sexually Transmitted Diseases, Viral; Tonsillitis; Treatment Outcome

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

Topics: Acyclovir; Adult; Deglutition Disorders; Diagnosis, Differential; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Laryngitis; Laryngoscopy; Pain; Pharyngitis; Virus Activation

Topics: Acyclovir; Adult; Anti-Inflammatory Agents; Antiviral Agents; Epiglottitis; Herpes Simplex; Herpesvirus 1, Human; Herpesvirus 2, Human; Humans; Male; Methylprednisolone; Pharyngitis; Recurrence; Stroboscopy

Topics: Acyclovir; Adult; Ear; Female; Herpes Zoster; Humans; Pharyngitis; Vertigo