acyclovir and Pneumonia--Viral

Pneumonia due to herpes simplex virus (HSV) is uncommon but can be seen in immunocompromised patients and has been associated with poor prognosis in this population.. The aim was to study the results, outcome and mortality of HSV pneumonia in immunocompromised patients and patients receiving mechanical ventilation. Furthermore, it has been unclear whether to initiate prophylactic treatment with acyclovir or not.. We have conducted a literature search using the keywords herpes simplex pneumonia, critically ill patients and intensive care unit for identification of relevant publications.. HSV pneumonia can cause severe infection or even death in immunocompromised patients and critically ill patients. A clear diagnosis of HSV pneumonia can be difficult to establish. Respiratory condition may improve after initiation of acyclovir but data is scarce.. HSV pneumonia should be considered in the immunocompromised patient and/or the intensive care patient who continues to deteriorate despite appropriate treatment. The value of prophylactic treatment with acyclovir is unproven but should be considered.

Topics: Acyclovir; Antiviral Agents; Herpes Simplex; Herpesvirus 1, Human; Humans; Intensive Care Units; Pneumonia, Viral

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

The seroprevalence of chickenpox in countries with temperate climate is very high among young people. Only 4% of the infections occur in adults but the clinical course is usually more severe than in children. In adults, The mortality is approximately 40 times higher and the complication rate 25 times higher than in children. Pneumonia is the most frequent complication in adults and may be extremely severe in immunocompromised patients and in pregnant women. Pneumonia must be promptly treated with intravenous aciclovir. Vaccination is indicated in young seronegative patients with supplemental risk factors for severe complications. It is also effective post exposure, preventing or modifying the illness course in up to 90% of exposed people if given within 3 days. Immunoglobulins may be effective as late as 96 hours after exposure. They are frequently used for exposed people at high risk of severe disease, when varicella vaccine is contraindicated.

Topics: Acyclovir; Adult; Antiviral Agents; Chickenpox; Drug Therapy, Combination; Female; Humans; Pneumonia, Viral; Valacyclovir; Valine

Varicella during pregnancy can be associated with severe illnesses for both the mother and her neonate. Varicella pneumonia must be regarded as a medical emergency, since pregnant women are at risk of life-threatening ventilatory compromise and death. After maternal chickenpox in the first and second trimesters, congenital varicella syndrome may occur in nearly 2% of the cases. The characteristic symptoms consist of skin lesions in dermatomal distribution, neurological defects, eye diseases and skeletal anomalies. If the mother develops varicella rashes between day 4 (5) antepartum and day 2 postpartum, generalized neonatal varicella leading to death in about 20% of the cases has to be expected. Normal zoster has not been shown to be associated with maternal pneumonia, birth defects or problems in the perinatal period. On the basis of the clinical consequences of varicella-zoster virus infections during pregnancy, the present paper summarizes the currently available concepts of prevention, diagnosis and therapy.

Topics: Acyclovir; Antiviral Agents; Chickenpox; Female; Herpesvirus 3, Human; Humans; Infant, Newborn; Infectious Disease Transmission, Vertical; Pneumonia, Viral; Pregnancy; Pregnancy Complications, Infectious

Cigarette smoking is the leading cause of preventable death in the United States. Smoking adversely affects many organ systems, but especially the lung. Carcinoma of the lung and chronic obstructive pulmonary disease account for most smoking-associated respiratory morbidity and mortality, and their association with smoking is both well established and widely recognized. Cigarette smoking also is associated with differences in the incidence, severity, or natural history of a broad array of other respiratory illnesses, ranging from the common cold to pneumothorax, pulmonary hemorrhage, and various interstitial lung diseases. Interestingly, while the general effect of smoking on respiratory diseases is adverse, in the cases of sarcoidosis and hypersensitivity pneumonitis smoking may actually be associated with a decrease in the incidence of disease. In this article, the author briefly discusses some of the pulmonary and systemic effects of smoking that might mediate its effects on an array of lung diseases, then comprehensively reviews less common or less well-recognized smoking-affected lung diseases such as pulmonary infections, spontaneous pneumothorax, Goodpasture's syndrome, eosinophilic granuloma and other interstitial lung diseases, and pulmonary metastatic disease.

Topics: Acyclovir; Alveolitis, Extrinsic Allergic; Antiviral Agents; Arthritis, Rheumatoid; Asbestosis; Bronchiolitis; Chickenpox; Eosinophilic Granuloma; Humans; Lung Diseases; Lung Neoplasms; Pneumonia, Bacterial; Pneumonia, Viral; Pneumothorax; Pulmonary Fibrosis; Respiratory Tract Infections; Risk Factors; Smoking

Human cytomegalovirus (HCMV) infection and disease remain a major cause of morbidity and mortality after bone marrow transplantation. HCMV disease, especially pneumonitis, may be treated with ganciclovir and immunoglobulin but even so the outcome is poor with mortality rates of 30-70%. It is therefore imperative to treat HCMV infection before it develops into disease. The aim of this article is to describe the main strategies used to prevent HCMV infection and to improve the survival after CMV disease in bone marrow transplant recipients.. In the present review, we examined personal papers in this field and articles published in journals covered by the Science Citation Index and Medline.. Major advances have been made in preventing HCMV infection and disease through two different approaches, both of which reduce HCMV induced morbidity and mortality: In pre-emptive therapy, patients are given ganciclovir when HCMV infection is first identified and this is continued 3-4 months after transplantation; in prophylactic therapy ganciclovir is given to all patients at risk of HCMV disease from engraftment up to 3-4 months post transplantation. Each strategy has advantages and disadvantages and there is no evidence for the superiority of one over the other since the overall survival is the same and the incidence of death from HCMV disease is similar.. The use of more sensitive tests such as HCMV PCR or antigenemia may improve the outcome but probably will not eradicate all HCMV disease. Future possible strategies could include adoptive transfer of CD8+ HCMV-specific cytotoxic T lymphocytes clones derived from the donor marrow or boosting donor or patient immunity using subunit anti-HCMV vaccines such as gB or pp65.

Topics: Acyclovir; Adolescent; Adult; Antigens, Viral; Antiviral Agents; Bone Marrow Transplantation; Child; Child, Preschool; Cytomegalovirus; Cytomegalovirus Infections; Foscarnet; Ganciclovir; Hematopoietic Stem Cells; Humans; Immunocompromised Host; Immunoglobulins, Intravenous; Immunotherapy, Adoptive; Infant; Pneumonia, Viral; Risk Factors; Sensitivity and Specificity; T-Lymphocytes, Cytotoxic; Transplantation Conditioning; Transplantation, Homologous; Viral Vaccines; Viremia; Virus Activation

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

Topics: Acute Disease; Acyclovir; Antiviral Agents; Chickenpox; Humans; Male; Middle Aged; Pneumonia, Viral; Respiratory Insufficiency

The recognition of viruses as causes of pneumonia in both immunocompetent and immunocompromised hosts has expanded dramatically. The number of therapeutic agents available for treatment of these illness also has increased in the last decade. Each of these agents has demonstrated a limited therapeutic indication for treatment of viral pneumonia. Many of these agents inhibit viral DNA synthesis through actions as nucleoside analogs (such as acyclovir and ganciclovir). However, a variety of alternative mechanisms of inhibition of viral replication are used. Ribavirin, while being a nucleoside analogue, also appears to exert broad antiviral activity by a variety of enzymatic inhibitory mechanisms. Foscarnet, an inorganic pyrophosphate analogue, offers additional treatment options for herpesviruses by acting as a direct virus DNA polymerase inhibitor. The tricyclic amines amantadine and rimantadine inhibit influenza A replication by interfering with viral uncoating after cell penetration. Thus, these two agents are largely effective as prophylaxis. The search for novel antiviral drugs, such as neuraminadases inhibitors with selective influenza activity, is currently in progress.

Topics: Acyclovir; Amantadine; Antiviral Agents; Foscarnet; Ganciclovir; Humans; Neuraminidase; Pneumonia, Viral; Ribavirin; Rimantadine

Infection by the varicella-zoster virus (VZV) is frequent in patients infected by the HIV-1. Nonetheless, visceral involvement in addition to that of pneumonia is rare, despite the important immune dysfunction found among these patients.. Varicella pneumonia was diagnosed in 2 patients with HIV-1 infection who presented cough with high fever and a characteristic rash in addition to respiratory failure and a micronodular pattern on chest radiography. The medical literature is reviewed (MEDLINE).. An excellent clinical response was achieved with endovenous acyclovir treatment.. The authors underline how rare is varicella pneumonia in patients with HIV-1 infection. The appearance of a pustulous vesicular rash in the context of a febrile episode leads to suspicion of this diagnosis. The treatment of choice is endovenous acyclovir (5 mg/kg/8 h). Varicella pneumonia has also been described in children with HIV-1 infection. The possible increase in patients with varicella pneumonia with be assessed, due to the immunosuppressive state of these patients. Patients not having been in contact with the varicella-zoster virus are particularly susceptible to presenting primoinfection by this virus.

Topics: Acyclovir; Adult; AIDS-Related Opportunistic Infections; Chickenpox; Female; HIV-1; Humans; Male; Pneumonia, Viral

Cytomegalovirus is major infectious pathogen following allogeneic bone marrow transplantation. In infected recipients, the virus is generally detected between 4 and 10 weeks after transplantation. Historically, CMV disease developed in 30-40% of seropositive recipients, the predominante manifestation being interstitial pneumonitis, which was generally lethal. Therapeutic interventions are discussed with special reference to the use of antiviral therapy for both treatment and prevention of CMV disease. The strategies developed in the bone marrow transplantation population to treat or prevent the development of CMV disease can be extrapolated to other patients groups who are immunosuppressed and at risk for developing clinical manifestations of CMV infection.

Topics: Acyclovir; Bone Marrow Transplantation; Cytomegalovirus Infections; Ganciclovir; Humans; Immunocompromised Host; Immunoglobulins, Intravenous; Lung Diseases, Interstitial; Pneumonia, Viral

Varicella in the immunocompetent adult is an infrequent but potentially serious infection. Previous studies in immunocompetent hosts and normal adults have demonstrated the value of intravenous acyclovir in the treatment of varicella-zoster virus infections. Oral acyclovir has also shown efficacy in both normal adults with zoster (shingles) and immunocompetent children with varicella. A recently completed double-blind placebo-controlled study of oral acyclovir in immunocompetent adults with uncomplicated varicella also demonstrated efficacy. Therapy within the first day reduced the time to 100% crusting of skin lesions from 7.4 to 5.6 days, and reduced the duration of fever by one-half day. Symptoms were also diminished. These benefits were observed only when therapy was initiated within 24 hours of the appearance of the rash. Adults with complicated varicella (usually symptomatic varicella pneumonia) should receive intravenous acyclovir. Several new agents for varicella-zoster therapy are being evaluated; brovavir is a new agent currently being compared to placebo in the treatment of adult varicella.

Topics: Acyclovir; Adult; Chickenpox; Humans; Immunocompetence; Pneumonia, Viral

Topics: Acyclovir; Antibodies, Monoclonal; Antibodies, Viral; Cytomegalovirus; Cytomegalovirus Infections; Ganciclovir; Humans; Immunization, Passive; Pneumonia, Viral; Pulmonary Fibrosis; Tissue and Organ Procurement; Transplantation

Herpes simplex virus may cause serious infections in neonates. In case of foetal infection in the first trimenon, abortions, stillbirth, prematurity, intrauterine growth retardation (not obligatory) and various malformations may result. Neonatal HSV infection is mostly the consequence of intrapartum virus acquisition during passage through the birth canal. The infection is mostly localised on the skin, at the eyes or the mouth or disseminated with or without HSV meningoencephalitis. It is difficult to establish the diagnosis, because neonatal herpes disease in the early stage is not easy to distinguish from other diseases in the newborn such as RDS, NEC or ICH. Antiviral therapy with aciclovir is the treatment of choice and seems to improve the outcome of neonatal herpes. Prognosis depends on early therapy. Treatment should be initiated in relation to clinical findings, because available diagnostic techniques do not always permit an early detection of the disease.

Topics: Acyclovir; Diagnosis, Differential; Female; Herpes Simplex; Humans; Infant, Newborn; Pneumonia, Viral; Pregnancy; Viremia

Topics: Acyclovir; Combined Modality Therapy; Cytomegalovirus Infections; Foscarnet; Ganciclovir; Humans; Immunization, Passive; Liver Transplantation; Opportunistic Infections; Pentamidine; Pneumonia, Pneumocystis; Pneumonia, Viral; Trimethoprim, Sulfamethoxazole Drug Combination

Pneumonia is a rare but serious and occasionally fatal complication of varicella. Two cases of varicella pneumonia were successfully treated with acyclovir in our department. We reviewed the pulmonary manifestations of varicella, the risk factors and the effect of acyclovir on varicella pneumonia on immunocompetent adults. Early, aggressive therapy with acyclovir seems to abort the catastrophic consequences of varicella pneumonia, while oral acyclovir chemoprophylaxis is probably beneficial in high-risk populations with chickenpox.

Topics: Acyclovir; Adult; Chickenpox; Drug Therapy, Combination; Humans; Male; Middle Aged; Pneumonia, Viral; Risk Factors

We report five cases of varicella pneumonia among ten otherwise healthy pregnant women who were admitted in our hospital between 1986 and 1991 with chickenpox. The precise frequency of this rare complication is not well known actually but analysis of the literature shows that the mortality rate is about 20%. Beside the problem of the fetal varicella syndrome, the other complication is the severe varicella of the neonate which can appear when varicella occurs in the mother within 5 days before, and 2 days after delivery. When primary varicella infection occurs during pregnancy clinical examination must be repeated for a week after occurring of the exanthema to find elements of severity significance. Acyclovir is the drug of choice (10 to 15 mg/kg every 8 hours) for 7 days when pneumonia is present. Varicella-zoster immunoglobulin is useful for prophylaxis and for neonates with high risk of severe varicella.

Topics: Acyclovir; Adolescent; Adult; Chickenpox; Female; Humans; Maternal Mortality; Pneumonia, Viral; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Outcome; Pregnancy Trimester, Second

The introduction of new protocols of immune suppression and especially the use of cyclosporine have led to a marked reduction of infective pathology in children receiving transplants. Nevertheless, infections still represent a major factor of morbidity and mortality in these patients. The above study lists the main viral infections, according to apparatus involved, that may arise, also with reference to the time elapsed since transplantation. The most up-to-date diagnostic possibilities for each infection are reviewed together with some indications on therapy which may subsequently be examined in greater detail.

Topics: Acyclovir; Age Factors; Child; Child, Preschool; Gastrointestinal Diseases; Heart Transplantation; Humans; Immunoglobulins; Immunosuppressive Agents; Infant; Infant, Newborn; Kidney Transplantation; Lymphoproliferative Disorders; Pneumonia, Viral; Skin Diseases, Infectious; Urinary Tract Infections; Virus Diseases

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

Twenty-one cases (five new and 16 literature) of varicella pneumonia of pregnancy were retrospectively reviewed to evaluate the benefits and risks of intravenous acyclovir on maternal and fetal outcomes. All women were in their second (12 cases) or third (nine cases) trimester. Mean gestational ages at the onset of pneumonia and time of delivery were 27 and 36 weeks, respectively. Twelve patients required mechanical ventilation. The mean duration of treatment was 7 days. No definite adverse drug effects were noted. Three women (14%) died of uncontrolled infection or complications. Two infants died (whose mothers also died): One was stillborn at 34 weeks' gestation, and the other died from prematurity shortly after birth at 26 weeks. No child was born with features of congenital varicella syndrome, and none developed active perinatal varicella infection. Onset of pneumonia during the third trimester was a risk factor associated with fatal maternal outcome. Intravenous acyclovir may reduce maternal morbidity and mortality associated with varicella pneumonia occurring during pregnancy, and appears to be safe for the developing fetus when given during the latter trimesters.

Topics: Acyclovir; Adolescent; Adult; Chickenpox; Drug Administration Schedule; Female; Humans; Injections, Intravenous; Pneumonia, Viral; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Outcome; Retrospective Studies

Varicella pneumonia during pregnancy carries a significant mortality for both mother and fetus. The antiviral drug, acyclovir, appears to have decreased mortality in reported cases. We present a case report and review of the literature summarizing the experience to date with acyclovir in the treatment of varicella pneumonia during pregnancy.

Topics: Acyclovir; Adult; Chickenpox; Female; Humans; Pneumonia, Viral; Pregnancy; Pregnancy Complications, Infectious

Viral pneumonitides are among the known pulmonary complications of human immunodeficiency virus (HIV) infection. Cytomegalovirus (CMV) pneumonitis is the most frequently recognized viral infection involving the lung. Although CMV may occasionally be the sole pathogen found to be responsible for severe pneumonitis in patients with the acquired immunodeficiency syndrome (AIDS), in most cases, its role in causing pulmonary disease is less clear, primarily because of the propensity to infect with a variety of other copathogens. CMV pneumonitis has been difficult to diagnose during life, although techniques utilizing in situ DNA hybridization or monoclonal antibodies for detection of the virus may improve the diagnostic yield of less invasive procedures such as bronchoalveolar lavage. Pneumonitis due to herpes simplex virus, varicella-zoster, and respiratory syncytial virus have occasionally been reported in AIDS patients, and are of practical importance because of the availability of effective treatment. The role of influenza and adenoviruses in causing HIV-related pulmonary complications is unknown, but could be of importance during outbreaks of these infections. Finally, data from several studies now suggest that Epstein-Barr virus or HIV itself or both have a role in the pneumonitis. Further study in this area could provide information leading to more effective management of this common complication of childhood AIDS.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Antiviral Agents; Cytomegalovirus Infections; Ganciclovir; Herpes Simplex; Herpesviridae Infections; Humans; Infectious Mononucleosis; Influenza, Human; Pneumonia, Viral; Retroviridae Infections

CMV disease is a major problem in AIDS, though with a different profile from that seen in other immunosuppressed patients. The novel treatments, ganciclovir and phosphonoformate, have a major role in the management of such infections, but maintenance therapy is often required. Optimal maintenance regimens have yet to be established, especially where zidovudine is also being used.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Addison Disease; Antiviral Agents; Colitis; Cytomegalovirus Infections; Encephalitis; Esophageal Diseases; Foscarnet; Ganciclovir; Humans; Phosphonoacetic Acid; Pneumonia, Viral; Retinitis

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

Although there are as yet no established indications for acyclovir use in pregnancy, the most reasonable uses are for maternal infections such as disseminated herpes simplex, varicella pneumonia, and severe primary genital herpes. Other potential, but more problematic, uses during pregnancy are for uncomplicated primary genital herpes infections, maternal varicella, and for prophylaxis against the recurrence of genital herpes near term. We review each of these potential uses and the pharmacokinetics of acyclovir in pregnancy while emphasizing that at the present time, safety, efficacy, and appropriate dosage of the drug have not been established for any use in pregnancy.

Topics: Acyclovir; Chickenpox; Female; Herpes Genitalis; Humans; Pneumonia, Viral; Pregnancy; Pregnancy Complications, Infectious

Life-threatening opportunistic cytomegalovirus infection is a complication of the acquired immunodeficiency syndrome (AIDS) that occurs in 7.4% or more of patients with AIDS. Cytomegalovirus retinitis, colitis, esophagitis, and gastritis are the commonest manifestations of severe cytomegalovirus end-organ disease. Extensive trials with intravenous ganciclovir, a nucleoside analogue with myelosuppressive toxicity, have shown that ganciclovir halts the progression of cytomegalovirus retinitis and gastrointestinal disease. Since relapse is common when therapy is discontinued, most patients with AIDS need life-long maintenance therapy. The clinical response to ganciclovir therapy is usually accompanied by diminished shedding of the virus. Based on limited data, foscarnet, a pyrophosphate analogue, also appears to have some efficacy in treating cytomegalovirus infection. Unlike ganciclovir, foscarnet does not cause myelosuppression. An important direction for future clinical research is the development of more effective and less toxic therapy, as well as orally bioavailable drugs for maintenance therapy.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Antiviral Agents; Cytomegalovirus Infections; Foscarnet; Ganciclovir; Gastroenteritis; Humans; Opportunistic Infections; Phosphonoacetic Acid; Pneumonia, Viral; Retinitis

Cytomegalovirus (CMV) remains an important pathogen in immunocompromised hosts, though several advances in its management have been made. Primary infection can be prevented by serologic screening of blood and organ donors, and the use of leukocyte-depleted blood products deserves further study in this context. Immunoglobulin prophylaxis may be effective in reducing the severity of infection in some groups. Virus reactivation can be delayed or prevented by high-dose intravenous acyclovir, and results should be improved by use of newer agents with greater anti-CMV activity, such as ganciclovir and foscarnet. However, the bone marrow toxicity of ganciclovir may reduce its prophylactic potential. Recent results with combined antiviral chemotherapy are encouraging, and other approaches in the future will undoubtedly include use of either recombinant or subunit vaccines or adoptive immunotherapy with effector cells generated in vitro for clinical use.

Topics: Acyclovir; Antiviral Agents; Cytomegalovirus Infections; Foscarnet; Ganciclovir; Humans; Immunization, Passive; Phosphonoacetic Acid; Pneumonia, Viral

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Animals; Bone Marrow Transplantation; Combined Modality Therapy; Cytomegalovirus Infections; Ganciclovir; Humans; Immunization, Passive; Opportunistic Infections; Pneumonia, Viral; Postoperative Complications

We have described positive clinical effects of seven different anti-viral drugs in the treatment of viral respiratory diseases; three of these agents are approved for clinical use--amantadine, acyclovir, and vidarabine. Of the remaining four, the most consistent and broadest range of effect was observed with ribavirin while rimantadine was similar to amantadine in its effect. Interferon and enviroxime, under the conditions in which they were tested, showed a range of effect from moderate to no effect. A feature of the use of ribavirin was its administration by inhalation over several hour periods as a small-particle aerosol. This allowed a total dosage not much less than might have been given by other routes, but with the advantage that it was evenly deposited over the surface of the infected respiratory tract beginning within seconds of the start of treatment and reached higher concentration in nasal secretions than in serum. It may be that aerosol administration can be used with other drugs, as suggested by preliminary results with amantadine. We regard the results presented in this chapter as very encouraging, but just a beginning. Effective therapy will set in motion a reexamination of many problems of viral respiratory tract infection, including how to develop more rapid and more precise viral diagnosis, the need for further characterization of both short- and long-term consequences of infection in the untreated host and their modification by treatment. The structure for rapid progress in treatment of viral diseases is in place, and with it should come a resolution of many long-standing problems in this area of medicine.

Topics: Acyclovir; Adult; Amantadine; Animals; Antiviral Agents; Benzimidazoles; Child; Clinical Trials as Topic; Female; Humans; Influenza, Human; Interferons; Oximes; Pneumonia, Viral; Respiratory Tract Infections; Ribavirin; Rimantadine; Sulfonamides; Vidarabine; Virus Diseases

Despite the lack of virus-specified thymidine kinase activity, human cytomegalovirus may be sensitive to acyclovir in vitro at concentrations between 10 and 25 mg/l. The inhibitory effect of acyclovir can be further increased by the presence of small amounts of human alpha or beta interferon. Twenty-one allogeneic marrow graft recipients with biopsy-proven cytomegalovirus pneumonia were treated with either high doses of acyclovir (eight patients) or the combination of acyclovir and human alpha (leukocyte) interferon (13 patients). Acyclovir doses of 400 to 1200 mg/m2/dose and interferon doses of 2 to 40 X 10(4) units/kg/day were used. There was no consistent effect of treatment on the likelihood or duration of survival, titre of virus in paired lung specimens, or shedding of virus. However, four patients survived and four others had 2-log or greater decreases in the amount of virus in paired lung specimens, suggesting a possible effect on cytomegalovirus strains with increased sensitivity to these agents. Acyclovir treatment of cytomegalovirus infection may be more effective in patients with lesser degrees of immunosuppression, but was not effective in the treatment of marrow transplant patients with cytomegalovirus pneumonia.

Topics: Acyclovir; Bone Marrow; Bone Marrow Transplantation; Combined Modality Therapy; Cytomegalovirus Infections; Humans; Immunosuppression Therapy; Interferon Type I; Kidney; Leukemia; Pneumonia, Viral; Tremor

Studies found in the literature which describe the treatment of varicella pneumonia with a combination of acyclovir and corticosteroids tend to be retrospective in nature and limited with regard to the data supplied.. This prospective study was performed at King Abdul Aziz Specialist Hospital in Taif, Saudi Arabia. The study covered adult patients admitted with a diagnosis of varicella pneumonia over a period of 10 years (January 2003 to December 2012). All patients were treated uniformly according to the predefined protocol with acyclovir and corticosteroids. The clinical characteristics, laboratory investigations, hospital course, any complications and the treatment outcomes were studied.. A total of 32 patients (25 males, mean age 43.5 ±14.5 years) were enrolled into this study; 3 patients (2 patients aged <12 years, 1 patient with advanced cardiac failure) were excluded. Of these 32 patients, 18 (58%) were current smokers, 16 patients (50%) were admitted to the intensive care unit and of these, 14 (87.5%) required mechanical ventilation. The mean duration of intensive care unit stay was 5.59 ±5.37 days. All patients were treated with intravenous acyclovir, corticosteroids and antibiotics were added when indicated. 31 patients improved and were discharged home. There was one death (a 32 year-old female with underlying systemic lupus erythematosus).. Patients with varicella pneumonia are at high risk of respiratory failure. Early implementation of supportive therapy seems to positively influence the recovery rate and outcome. Our study supports treatment using a combination of acyclovir and corticosteroids.

Topics: Acyclovir; Adrenal Cortex Hormones; Adult; Aged; Aged, 80 and over; Chickenpox; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Pneumonia, Viral

Lung transplant (LT) recipients among solid organ transplant recipients are at high risk for cytomegalovirus (CMV) infections. We evaluated the effect of CMV-Immunoglobulins (CMV-IG) (Cytotect Biotest) on CMV pneumonia diagnosed in 303 follow-up transbronchial biopsies (TBB) of lung transplant recipients. 24 patients (control group, 155 TBB from 1999 to 2002) received acyclovir for 24 months and 33 recipients (study group, 148 TBB from 2003 to 2008) received a combined CMV prophylaxis consisting of CMV-IG (Cytotect Biotest) for 12 months and a short Ganciclovir or Valganciclovir therapy from 21th to 42th postoperative day followed by acyclovir up to 24 months. In our study the percentage of pneumonia at first month TBB was similar in the study group vs the control group, 9.1% (3/33) vs 8.3% (2/24), p=0.9 ns, but after the first month the percentage was significantly lower in the study group in the first year at follow-up TBB, 1% (1/99) vs 6.4% (5/78), p=0.048, and in first two years follow-up TBB, 0.8% (1/122) vs 6.5% 8/124), p=0.018 (STATISTICAL ANALYSIS: Chi-square test for proportion differences). Our data suggest a strong efficacy of CMV-IG prophylaxis in reducing CMV pneumonia after first month in lung transplant recipients.

Topics: Acyclovir; Antiviral Agents; Biopsy; Cytomegalovirus; Cytomegalovirus Infections; Drug Therapy, Combination; Follow-Up Studies; Ganciclovir; Graft Rejection; Humans; Immunoglobulins; Lung Transplantation; Pneumonia, Viral; Postoperative Complications; Time Factors; Treatment Outcome; Valganciclovir

A randomized case-controlled trial of oral low-dose acyclovir (600-800 mg per day) has been conducted for the prevention of virus infections in 66 recipients of renal allografts since 1990. In comparison with the untreated controls, acyclovir could prevent herpes virus simplex (HSV), reduce morbidity of pneumonia from 10 cases (30%) to 3 cases (9%) (P < 0.05) and lower CMV-IgM positive rate from 30% to 12%. Serum Cr and BUN in acyclovir group were lower than those in control group. These results strongly suggested that oral administration low-dose acyclovir could prevent virus infections after renal transplantation.

Topics: Acyclovir; Administration, Oral; Adult; Antiviral Agents; Female; Herpes Simplex; Humans; Kidney Transplantation; Male; Middle Aged; Pneumonia, Viral; Postoperative Complications

Topics: Acyclovir; Adult; Boston; Candidiasis; Child; Cytomegalovirus; Cytomegalovirus Infections; Female; Ganciclovir; Humans; Immunization, Passive; Immunoglobulins; Immunoglobulins, Intravenous; Immunosuppressive Agents; Liver Transplantation; Male; Muromonab-CD3; Opportunistic Infections; Placebos; Pneumonia, Viral; Risk Factors; Treatment Outcome

Topics: Acyclovir; Antibodies, Monoclonal; Antibodies, Viral; Cytomegalovirus; Cytomegalovirus Infections; Ganciclovir; Humans; Immunization, Passive; Pneumonia, Viral; Pulmonary Fibrosis; Tissue and Organ Procurement; Transplantation

Twenty-five immunocompromised children with varicella were treated with oral acyclovir 800 mg, five times daily for 7 days. Two patients were transferred from the oral to the intravenous route: one had signs of varicella pneumonitis on routine X-ray, the other had continuing new lesion formation on day 4 of oral treatment. The disease healed in all patients, with no other evidence of dissemination. In an historical placebo treated group, 12 of 25 patients were transferred to intravenous acyclovir. The reduction to two of 25 is statistically significant (P < 0.01). The mean peak plasma acyclovir concentration in these patients was 6.56 mumol/l. Mild, self-limiting diarrhoea in nine patients was the only adverse event considered to be related to acyclovir. It is concluded that immunocompromised children with varicella can be treated safely and effectively with oral acyclovir. All patients should be observed closely by a physician.

Topics: Acyclovir; Administration, Oral; Adolescent; Chickenpox; Child; Child, Preschool; Female; Humans; Immunocompromised Host; Infant; Infusions, Intravenous; Male; Pneumonia, Viral

In an effort to prevent cytomegalovirus (CMV) pneumonitis, seven consecutive CMV-seronegative lung transplant recipients of organs from seropositive donors (D+/R-) were given ganciclovir, 2.5-5 mg/kg intravenously twice daily for the first 10-21 days after transplantation, and commercial polyvalent immune globulin, 200-400 mg/kg every 7-14 days intravenously, for the first 2-3 weeks after transplantation. This regimen was followed by oral acyclovir. Six patients developed CMV viremia and all developed CMV pneumonitis. Viremia occurred later in these patients compared with D+/R- patients who received alternative forms of CMV prophylaxis or CMV-seropositive recipients who received no specific prophylaxis (P = .023 and P = .021, respectively). There was no statistical difference in incidence or time to onset of CMV pneumonitis. When given as described, prophylactic ganciclovir and immune globulin followed by oral acyclovir may have delayed CMV viremia but did not prevent it or pneumonitis in high-risk lung transplant recipients.

Topics: Acyclovir; Adult; Cytomegalovirus Infections; Female; Ganciclovir; Humans; Immunoglobulins, Intravenous; Lung Transplantation; Male; Middle Aged; Pneumonia, Viral; Recurrence; Viremia

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

Topics: Acyclovir; Cytomegalovirus Infections; Ganciclovir; Humans; Immunosuppression Therapy; Kidney Transplantation; Pneumonia, Viral; Postoperative Complications

We have described positive clinical effects of seven different anti-viral drugs in the treatment of viral respiratory diseases; three of these agents are approved for clinical use--amantadine, acyclovir, and vidarabine. Of the remaining four, the most consistent and broadest range of effect was observed with ribavirin while rimantadine was similar to amantadine in its effect. Interferon and enviroxime, under the conditions in which they were tested, showed a range of effect from moderate to no effect. A feature of the use of ribavirin was its administration by inhalation over several hour periods as a small-particle aerosol. This allowed a total dosage not much less than might have been given by other routes, but with the advantage that it was evenly deposited over the surface of the infected respiratory tract beginning within seconds of the start of treatment and reached higher concentration in nasal secretions than in serum. It may be that aerosol administration can be used with other drugs, as suggested by preliminary results with amantadine. We regard the results presented in this chapter as very encouraging, but just a beginning. Effective therapy will set in motion a reexamination of many problems of viral respiratory tract infection, including how to develop more rapid and more precise viral diagnosis, the need for further characterization of both short- and long-term consequences of infection in the untreated host and their modification by treatment. The structure for rapid progress in treatment of viral diseases is in place, and with it should come a resolution of many long-standing problems in this area of medicine.

Topics: Acyclovir; Adult; Amantadine; Animals; Antiviral Agents; Benzimidazoles; Child; Clinical Trials as Topic; Female; Humans; Influenza, Human; Interferons; Oximes; Pneumonia, Viral; Respiratory Tract Infections; Ribavirin; Rimantadine; Sulfonamides; Vidarabine; Virus Diseases

Despite the lack of virus-specified thymidine kinase activity, human cytomegalovirus may be sensitive to acyclovir in vitro at concentrations between 10 and 25 mg/l. The inhibitory effect of acyclovir can be further increased by the presence of small amounts of human alpha or beta interferon. Twenty-one allogeneic marrow graft recipients with biopsy-proven cytomegalovirus pneumonia were treated with either high doses of acyclovir (eight patients) or the combination of acyclovir and human alpha (leukocyte) interferon (13 patients). Acyclovir doses of 400 to 1200 mg/m2/dose and interferon doses of 2 to 40 X 10(4) units/kg/day were used. There was no consistent effect of treatment on the likelihood or duration of survival, titre of virus in paired lung specimens, or shedding of virus. However, four patients survived and four others had 2-log or greater decreases in the amount of virus in paired lung specimens, suggesting a possible effect on cytomegalovirus strains with increased sensitivity to these agents. Acyclovir treatment of cytomegalovirus infection may be more effective in patients with lesser degrees of immunosuppression, but was not effective in the treatment of marrow transplant patients with cytomegalovirus pneumonia.

Topics: Acyclovir; Bone Marrow; Bone Marrow Transplantation; Combined Modality Therapy; Cytomegalovirus Infections; Humans; Immunosuppression Therapy; Interferon Type I; Kidney; Leukemia; Pneumonia, Viral; Tremor

Topics: Acyclovir; Adolescent; Adult; Aged; Antiviral Agents; Child; Clinical Trials as Topic; Cytomegalovirus Infections; Double-Blind Method; Female; Guanine; Humans; Immune Tolerance; Kidney Transplantation; Male; Middle Aged; Pneumonia, Viral; Time Factors; Transplantation, Homologous

We present a challenging case of a young patient who presented with focal neurological signs following a course of OC-43 coronavirus-related pneumonia almost 8 months before the COVID-19 outbreak.

Topics: Acyclovir; Antiviral Agents; Aspirin; Coronavirus Infections; Coronavirus OC43, Human; COVID-19; Humans; Ischemic Stroke; Magnetic Resonance Imaging; Male; Nasopharynx; Platelet Aggregation Inhibitors; Pneumonia, Viral; SARS-CoV-2; Treatment Outcome; Young Adult

Recently, a pathogen has been identified as a novel coronavirus (SARS-CoV-2) and found to trigger novel pneumonia (COVID-19) in human beings and some other mammals. The uncontrolled release of cytokines is seen from the primary stages of symptoms to last acute respiratory distress syndrome (ARDS). Thus, it is necessary to find out safe and effective drugs against this deadly coronavirus as soon as possible. Here, we downloaded the three-dimensional model of NSP10/NSP16 methyltransferase (PDB-ID: 6w6l) and main protease (PDB-ID: 6lu7) of COVID-19. Using these molecular models, we performed virtual screening with our anti-viral, inti-infectious, and anti-protease compounds, which are attractive therapeutics to prevent infection of the COVID-19. We found that top screened compound binds with protein molecules with good dock score with the help of hydrophobic interactions and hydrogen bonding. We observed that protease complexed with Cyclocytidine hydrochloride (anti-viral and anti-cancer), Trifluridine (anti-viral), Adonitol, and Meropenem (anti-bacterial), and Penciclovir (anti-viral) bound with a good docking score ranging from -6.8 to -5.1 (Kcal/mol). Further, NSP10/NSP16 methyltransferase complexed with Telbivudine, Oxytetracycline dihydrate (anti-viral), Methylgallate (anti-malarial), 2-deoxyglucose and Daphnetin (anti-cancer) from the docking score of -7.0 to -5.7 (Kcal/mol). In conclusion, the selected compounds may be used as a novel therapeutic agent to combat this deadly pandemic disease, SARS-CoV-2 infection, but needs further experimental research.HighlightsNSP10/NSP16 methyltransferase and main protease complex of SARS CoV-2 bind with selected drugs.NSP10/NSP16 methyltransferase and protease interacted with drugs by hydrophobic interactions.Compounds show good DG binging free energy with protein complexes.Ligands were found to follow the Lipinski rule of five.

Topics: Acyclovir; Ancitabine; Antiviral Agents; Betacoronavirus; Coronavirus Infections; COVID-19; Drug Evaluation, Preclinical; Guanine; Humans; Meropenem; Methyltransferases; Models, Molecular; Molecular Docking Simulation; Pandemics; Pneumonia, Viral; Protein Conformation; Ribitol; SARS-CoV-2; Trifluridine; User-Computer Interface; Viral Nonstructural Proteins; Viral Regulatory and Accessory Proteins

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

Here, we report a case of COVID-19-related acute necrotizing encephalopathy where SARS-CoV-2 RNA was found in CSF 19 days after symptom onset after testing negative twice. Although monocytes and protein levels in CSF were only marginally increased, and our patient never experienced a hyperinflammatory state, her neurologic function deteriorated into coma. MRI of the brain showed pathologic signal symmetrically in central thalami, subinsular regions, medial temporal lobes, and brain stem. Extremely high concentrations of the neuronal injury markers neurofilament light and tau, as well as an astrocytic activation marker, glial fibrillary acidic protein, were measured in CSF. Neuronal rescue proteins and other pathways were elevated in the in-depth proteomics analysis. The patient received IV immunoglobulins and plasma exchange. Her neurologic status improved, and she was extubated 4 weeks after symptom onset. This case report highlights the neurotropism of SARS-CoV-2 in selected patients and emphasizes the importance of repeated lumbar punctures and CSF analyses in patients with suspected COVID-19 and neurologic symptoms.

Topics: Acyclovir; Antiviral Agents; Betacoronavirus; Brain; Coronavirus Infections; COVID-19; Female; Glial Fibrillary Acidic Protein; Humans; Immunoglobulins, Intravenous; Immunologic Factors; Interleukin-6; Leukoencephalitis, Acute Hemorrhagic; Magnetic Resonance Imaging; Middle Aged; Neurofilament Proteins; Pandemics; Plasma Exchange; Pneumonia, Viral; Real-Time Polymerase Chain Reaction; RNA, Viral; SARS-CoV-2; tau Proteins; Tomography, X-Ray Computed; Viral Tropism

At the moment, there are no U.S. Food and Drug Administration (U.S. FDA)-approved drugs for the treatment of COVID-19, although several antiviral drugs are available for repurposing. Many of these drugs suffer from polymorphic transformations with changes in the drug's safety and efficacy; many are poorly soluble, poorly bioavailable drugs. Current tools to reformulate antiviral APIs into safer and more bioavailable forms include pharmaceutical salts and cocrystals, even though it is difficult to classify solid forms into these regulatory-wise mutually exclusive categories. Pure liquid salt forms of APIs, ionic liquids that incorporate APIs into their structures (API-ILs) present all the advantages that salt forms provide from a pharmaceutical standpoint, without being subject to solid-state matter problems. In this perspective article, the myths and the most voiced concerns holding back implementation of API-ILs are examined, and two case studies of API-ILs antivirals (the amphoteric acyclovir and GSK2838232) are presented in detail, with a focus on drug property improvement. We advocate that the industry should consider the advantages of API-ILs which could be the genesis of disruptive innovation and believe that in order for the industry to grow and develop, the industry should be comfortable with a certain element of risk because progress often only comes from trying something different.

Topics: Acyclovir; Antiviral Agents; Betacoronavirus; Biological Availability; Butyrates; Chemistry, Pharmaceutical; Chrysenes; Coronavirus Infections; COVID-19; COVID-19 Drug Treatment; Drug Repositioning; Humans; Ionic Liquids; Pandemics; Pentacyclic Triterpenes; Pneumonia, Viral; SARS-CoV-2; Solubility

Topics: Acyclovir; Administration, Cutaneous; Administration, Oral; Adult; Antiviral Agents; Betacoronavirus; Child; Coronavirus Infections; COVID-19; Drug Therapy, Combination; Female; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Male; Ophthalmic Solutions; Pandemics; Pneumonia, Viral; Prednisolone; SARS-CoV-2; Treatment Outcome; Virus Activation

Herpes simplex virus (HSV) is rarely the cause of pneumonia in immunocompetent patients. We describe a previously healthy child, with no evidence of an immunodeficiency, who presented to the emergency department with severe pneumonia, wheezing, and pleural effusions with a history of orolabial HSV infection. On admission, he was started on antibiotics and systemic corticosteroids but continued to deteriorate. Oral lesions, blood, and pleural fluid tested positive for HSV, and improvement was achieved only after the addition of acyclovir and discontinuation of steroids. We suggest that steroids should be used with caution in patients presenting with lower respiratory tract symptoms and herpetic oral lesions.

Topics: Acyclovir; Adrenal Cortex Hormones; Antiviral Agents; Child; Herpes Simplex; Humans; Male; Pneumonia, Viral; Respiratory Sounds; Simplexvirus

Topics: Acyclovir; Adult; Antiviral Agents; Chickenpox; Humans; Male; Pneumonia, Viral; Respiration, Artificial

Varicella zoster virus (VZV) pneumonia is associated with significant mortality, especially in the immunocompromised host. VZV-specific immunoglobulins (VZIG) are currently used as post-exposure prophylaxis for at-risk patients, but not as adjunctive therapy. A novel case of VZV pneumonia in an immunocompromised patient, treated successfully with intravenous VZIG in combination with acyclovir, is reported here.

Topics: Acyclovir; Adjuvants, Immunologic; Administration, Intravenous; Adult; Antibodies, Viral; Antiviral Agents; Herpesvirus 3, Human; Humans; Immunocompromised Host; Male; Pneumonia, Viral; Varicella Zoster Virus Infection

Chickenpox, an infection of childhood with vesicular skin rash, is caused by varicella-zoster virus (VZV). Although the infection is rare in adults, it can cause serious complications Varicella pneumonia is the most encountered complication. In this report, a VZV pneumonia case in a previously healthy adult is presented. The patient was treated with early intravenous acyclovir and both clinical and radiographic recovery has been observed.

Topics: Acyclovir; Administration, Intravenous; Adult; Antiviral Agents; Chickenpox; Female; Humans; Immunocompetence; Pneumonia, Viral

Granulomatosis polyangiitis (GPA) is an ANCA-related vasculitis (AAV) whose clinical manifestations mainly concern the respiratory tract (upper and lower) and the kidney. The treatment of GPA (as well as other AAV) includes the use of immunosuppressive drugs with numerous side effects; the most frequent complications are infectious and neoplastic. GPA frequently relapses. Epstein Barr Virus (EBV) is a ubiquitous virus; it is estimated that about 90% of the world’s population has BEEN EXPOSED TO with this pathogen and has subsequently developed a latent infection. Under certain conditions including immunosuppression EBV may reactivate. We report the clinical case of a 67-year-old woman who presented with GPA involving the upper respiratory tract and renal failure with the need for hemodialysis treatment. The fourth month of induction therapy with cyclophosphamide and methylprednisone she presented with dyspnea and respiratory failure. After excluding pulmonary embolism and heart failure, a series of investigations including high resolution tomography and fibroscopy with broncoalveolar lavage (BAL) were performed which excluded recurrence of pulmonary vasculitis including alveolar haemorrhage A BAL demonstrated EBV-DNA. On this basis EBV pneumonia was diagnosed, and antiviral therapy with acyclovir was begun, followed by clinical and radiological improvement. In patients with GPA treated with immunosuppressive drugs pulmonary involvement may not only be due to the underlying vasculitis, but also to opportunistic agents, which must always be considered.

Topics: Acyclovir; Aged; Antiviral Agents; Cyclophosphamide; Disease Susceptibility; Dyspnea; Epstein-Barr Virus Infections; Female; Granulomatosis with Polyangiitis; Herpesvirus 4, Human; Humans; Immunocompromised Host; Immunosuppressive Agents; Kidney Failure, Chronic; Pneumonia, Viral; Prednisone; Renal Dialysis; Respiratory Insufficiency

Topics: Acyclovir; Adult; Antiviral Agents; Female; Herpesvirus 3, Human; Humans; Pneumonia, Viral; Radiography, Thoracic; Skin

Although not common, herpes simplex virus (HSV) pneumonia can occur in immunocompromised patients. However, HSV pneumonia in immunocompetent hosts is very rare. The authors encountered a very rare case of severe HSV pneumonia in an immunocompetent host. The patient was an 85-year-old Japanese woman who presented with severe intractable pneumonia refractory to empirical antimicrobial therapy. Furthermore, the causative microorganisms remained unknown. Therefore, cytological examination of bronchoalveolar lavage fluid and protected brush biopsy of the lower respiratory tract were performed, which indicated herpes virus-infected cells with nuclear inclusions; PCR assay was positive for HSV DNA. Accordingly, the patient was diagnosed with HSV pneumonia. Her respiratory condition improved immediately after initiation of acyclovir monotherapy. In selected cases of intractable pneumonia refractory to standard antimicrobial therapy, the possibility of HSV pneumonia should be pursued.

Topics: Acyclovir; Aged, 80 and over; Antiviral Agents; Bronchoalveolar Lavage Fluid; Diagnostic Errors; DNA, Viral; Female; Herpes Simplex; Humans; Immunocompetence; Lung; Pneumonia, Viral; Simplexvirus; Tomography, X-Ray Computed

Cytomegalovirus infection is a major cause of morbidity and mortality in solid-organ transplant. Low doses of valacyclovir have been administered as cytomegalovirus prophylaxis in our institution for years. To the best of our knowledge, there is no published study of a low-dose regimen for cytomegalovirus prophylaxis in heart transplant patients. Therefore, our aim was to determine the results of low doses of valacyclovir in heart transplant.. Between September 2006 and December 2014, sixty-eight patients underwent orthotopic heart transplants. All of the patients received triple immunosuppressive therapy after surgery. During the next 6 months, sulfamethoxazole/trimethoprim was administered for Pneumocystis jiroveci pneumonia, and toxoplasmosis. Additionally all patients received valacyclovir hydrochloride (1000 mg/d, oral) for cytomegalovirus prophylaxis and nystatin oral rinse for prophylaxis of fungal infections.. There was only 1 cytomegalovirus infection at follow-up. The patient had cytomegalovirus pneumonia at 17-month follow-up. In response to treatment with 1-week intravenous ganciclovir, the patient was discharged with a further 6-month oral valacyclovir therapy (1000 mg/d).. In this study, we hypothesized that daily use of low-dose valacyclovir (1000 mg/d) is not only sufficient for cytomegalovirus prophylaxis but also beneficial in terms of cost.

Topics: Acyclovir; Adolescent; Adult; Antiviral Agents; Cytomegalovirus; Cytomegalovirus Infections; Drug Administration Schedule; Drug Therapy, Combination; Female; Heart Transplantation; Humans; Immunocompromised Host; Immunosuppressive Agents; Male; Middle Aged; Opportunistic Infections; Pneumonia, Viral; Risk Factors; Time Factors; Treatment Outcome; Valacyclovir; Valine; Virus Activation; Young Adult

Topics: Acyclovir; AIDS-Related Opportunistic Infections; Antiviral Agents; Humans; Male; Middle Aged; Pneumonia, Viral; Tomography, X-Ray Computed; Treatment Outcome; Varicella Zoster Virus Infection

Topics: Acyclovir; Anti-Bacterial Agents; Antiviral Agents; CD4 Lymphocyte Count; Chickenpox; Child, Preschool; Clindamycin; Drug Therapy, Combination; Exanthema; Floxacillin; Herpesvirus 3, Human; HIV Infections; HIV-1; Humans; Male; Pneumonia, Viral; Trimethoprim, Sulfamethoxazole Drug Combination

Varicella pneumonia (VP) is a critical complication of varicella infection and still carries significant morbidity and mortality, often requiring intensive care unit admission. Current accepted treatment is with intravenous aciclovir and organ support, if required. We report two cases of VP with acute respiratory failure, successfully treated with intravenous steroids in addition to aciclovir. Further research into the benefits of steroid therapy in VP is warranted.

Topics: Acyclovir; Administration, Intravenous; Aged; Antiviral Agents; Chickenpox; Drug Therapy, Combination; Humans; Male; Middle Aged; Pneumonia, Viral; Steroids; Treatment Outcome

Topics: Acyclovir; Antiviral Agents; Bronchoscopy; Herpes Simplex; Humans; Male; Middle Aged; Pneumonia, Viral

Topics: Acyclovir; Adult; Antiviral Agents; Chickenpox; Humans; Male; Pneumonia, Viral; Radiography; Treatment Outcome

Topics: Acyclovir; Administration, Intravenous; Adult; Antiviral Agents; Chickenpox; Glucocorticoids; Humans; Male; Methylprednisolone; Pneumonia, Viral; Smoking

Neonatal Herpes Simplex Virus (HSV) infection is a serious illness with significant mortality and morbidity for disseminated disease. Clinical diagnosis of neonatal HSV infection is often difficult without evidence of HSV exposure, for example, absence of a rash or the presence of non-specified manifestations in an infant. Early recognition and treatment with high-dose Acyclovir may dramatically improve the short and long-term outcomes. We describe an infant with disseminated disease due to HSV-1 infection, who first presented clinical and radiologic features of pneumonia. The diagnosis was performed post-mortem by Real-Time Polymerase Chain Reaction (PCR) analysis of blood, cerebrospinal fluid and pleural liquid of the infant. Tissue PCR revealed a disseminated HSV-1 infection, with a high viral load detected in liver, lungs, brain, heart, striated muscle, kidneys, and thymus tissues. This case report highlights the need for neonatologists to raise awareness about the different clinical manifestations of disseminated neonatal HSV infection. HSV infections should be prominent in the differential diagnosis of an infant under four weeks of age with fever, pneumonia, unexplained seizures or sepsis-like disease, particularly if unresponsive to antibiotics. Early initiation of appropriate antiviral therapy for high-risk infants undergoing testing for HSV infection can be essential to prevent significant morbidity and mortality.

Topics: Acyclovir; Brain; Diagnosis, Differential; DNA, Viral; Early Diagnosis; Fatal Outcome; Heart; Herpes Simplex; Herpesvirus 1, Human; Humans; Infant, Newborn; Kidney; Liver; Liver Diseases; Lung; Lymphoid Tissue; Male; Muscle, Striated; Organ Specificity; Pneumonia, Viral; Pregnancy Complications, Infectious; Radiography; Real-Time Polymerase Chain Reaction; Viral Load

Topics: Acyclovir; Adult; Antiviral Agents; Herpesvirus 3, Human; Humans; Male; Pneumonia, Viral; Radiography

Topics: Acyclovir; Adult; Antiviral Agents; Chickenpox; Female; Humans; Incidental Findings; Pneumonia, Viral; Radiography

Topics: Acyclovir; Adult; Antiviral Agents; Chickenpox; Female; Humans; Immunocompetence; Pneumonia, Viral

Topics: Acyclovir; Antiviral Agents; Chickenpox; Diagnosis, Differential; Female; Humans; Infant, Newborn; Male; Placenta; Pneumonia, Viral; Pregnancy; Pregnancy Complications, Infectious

We aimed to report a case of varicella pneumonia that resulted in respiratory failure requiring mechanical ventilation. The patient was a 40-year-old man whose rashes started after his childeren developed varicella and who had a high fever, sputum and sputum with blood, cough, cold and shiver four days before admission. A treatment was commenced by an antiviral acyclovir and ampiric ampicillin-sulbactam therapy. Although a supporting oxygen treatment, the patient whose oxygen saturation did not increase and respiratory rate was high was commenced by an invasive mechanical ventilation because of a respiratory failure. The patient that had a recovery in clinical symptoms after 36 hours was extubated and was discharged from hospital by the following week.

Topics: Acyclovir; Adult; Antiviral Agents; Chickenpox; Humans; Male; Pneumonia, Viral; Respiration, Artificial; Respiratory Insufficiency; Treatment Outcome

Topics: Acyclovir; Adult; Antiviral Agents; Bangladesh; Chickenpox; Diagnosis, Differential; Disease Transmission, Infectious; Dyspnea; Exanthema; Humans; Lung; Male; Pneumonia, Viral; Pruritus; Radiography

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 simplex virus bronchopneumonitis is a clinical entity described in critically ill patients and classically associated to immunosuppression. Recent reports have shown a higher frequency of virus detection from samples obtained by bronchoalveolar lavage of immunocompetent critically ill patients undergoing mechanical ventilation. This fact suggests its role as an independent pathogenic substrate. We report the case of a female patient who was admitted after an elective surgery of rectal tumor with suspected bronchoaspiration during anesthetic induction. The patient presented persistent fever despite broad spectrum antibiotic treatment. All cultures were negative for bacterial growth. The chest X-ray did not show opacifities. Prolonged mechanical ventilation with repeated failures to wean made it mandatory to perform percutaneous tracheostomy. A fibrobronchoscopy with bronchoalveolar lavage, performed previously, showed positive result for herpes simplex virus (PCR and specific nuclear inclusions in cells). Thus, treatment was initiated with acyclovir, with clinical improvement and weaning from mechanical ventilation.

Topics: Acute Disease; Acyclovir; Adenocarcinoma; Aged; Antimetabolites, Antineoplastic; Antiviral Agents; Bronchoalveolar Lavage Fluid; Bronchopneumonia; Combined Modality Therapy; Diagnosis, Differential; Female; Fluorouracil; Herpes Simplex; Humans; Immunocompromised Host; Pneumonia, Aspiration; Pneumonia, Viral; Postoperative Complications; Radiotherapy, Adjuvant; Rectal Neoplasms; Respiration, Artificial; Respiratory Insufficiency

We describe a rare case of a 79-year-old woman who developed herpes simplex virus pneumonia after mitral valve replacement. The patient showed persistent hypoxemia with bilateral glass-like shadows on chest radiography. Cytopathology examination of intratracheal secretions revealed herpes simplex virus infection. The patient, who improved gradually after acyclovir administration, was taken off the ventilator completely. Physicians should consider viral pulmonary infection to be a potential cause of unexplained hypoxemia that does not respond to conventional antibiotic treatment in critically ill, immunocompromised patients.

Topics: Acyclovir; Aged; Antiviral Agents; Female; Heart Valve Prosthesis Implantation; Herpes Simplex; Humans; Hypoxia; Mitral Valve; Mitral Valve Insufficiency; Pneumonia, Viral; Respiration, Artificial; Time Factors; Tomography, X-Ray Computed; Treatment Outcome; Ventilator Weaning

The clinical significance of herpes simplex virus (HSV) isolated in lower respiratory tract specimens (LRTS) of patients with solid tumors (ST) is unknown. In the current study, the authors attempted to determine the clinical relevance of this finding among ST patients.. The authors reviewed records of ST patients admitted to the study institution between April 2000 and April 2004 with clinical and radiologic evidence of pneumonia, and HSV identified in LRTS by culture alone or culture and cytology. Patients were categorized as having proven (HSV identified by culture and cytology from the LRTS), probable (HSV as the sole pathogen by culture alone), and possible (HSV along with copathogens identified by culture) HSV pneumonia.. Forty-five ST patients with either proven (6 patients), probable (25 patients), or possible (14 patients) HSV pneumonia were identified. When compared with patients with probable or possible HSV pneumonia, more patients with proven infection were on mechanical ventilation (40% vs 50% vs 100%, respectively; P=.03), and had longer length of stay in the intensive care unit (12 days vs 13 days vs 26 days, respectively; P=.05). The overall mortality rate was 22% (10 patients). Four of 25 (16%) patients who received HSV-directed antiviral therapy died during their hospital stay versus 6 of 20 (30%) who were not treated (P=.3). None of the 6 patients with proven HSV pneumonia who were treated with acyclovir died. On univariate analysis, risk factors for mortality included underlying breast cancer, an Acute Physiology and Chronic Health Evaluation (APACHE) II score>15, admission to the intensive care unit, and use of mechanical ventilation and vasopressors (all P15 being found to be independent predictors of death by multiple logistic regression analysis (all P

Topics: Acyclovir; Adult; Aged; Aged, 80 and over; Antiviral Agents; Female; Humans; Intensive Care Units; Length of Stay; Male; Middle Aged; Neoplasms; Pneumonia, Viral; Respiration, Artificial; Retrospective Studies; Simplexvirus

The most common and most serious complication of varicella (chickenpox) in adults is pneumonia, which can lead to severe respiratory failure. Varicella pneumonia is associated with considerable morbidity and even death.. To summarize our experience with varicella pneumonia in terms of clinical, laboratory and radiological characteristics as well as risk factors, management and outcome.. We conducted a retrospective cohort survey in our facility from 1995 to 2008.. Our cohort comprised 21 patients with varicella pneumonia, of whom 19 (90%) were men; their mean age was 35 +/- 10.5 years. Nineteen patients (90%) were Bedouins and 18 (86%) were smokers. Eleven (52%) were admitted to the Medical Intensive Care Unit; 3 of them required mechanical ventilation and the remaining 10 (48%) were admitted to the general medical ward. Median length of stay was 6 +/- 7.7 days. Hypoxemia and elevated lactate dehydrogenase on admission were associated with respiratory failure. Radiological manifestations were variable and nine patients exhibited characteristic findings. All but one patient were treated with acyclovir. All patients fully recovered.. In southern Israel varicella pneumonia is primarily a disease ofyoung male Bedouins who are smokers. Severity ranges from mild disease to severe, resulting at times in respiratory failure requiring mechanical ventilation. Prognosis is favorable with complete recovery.

Topics: Acyclovir; Adolescent; Adult; Aged; Antiviral Agents; Chickenpox; Female; Herpesvirus 3, Human; Humans; Israel; Male; Middle Aged; Pneumonia, Viral; Respiration, Artificial; Retrospective Studies; Smoking; Young Adult

Viral syndromes can present with various cutaneous manifestations, from the morbilliform eruption of measles to the papular lesions of molluscum. The systemic manifestations of viral illness can be similarly varied, with different presentations in each individual. We describe a patient with recently diagnosed AIDS who presented to the emergency department with hemorrhagic papules and shortness of breath. She was found to be severely thrombocytopenic, and a Tzanck smear revealed multinucleate giant cells. She received a diagnosis of immune thrombocytopenic purpura (ITP) and primary varicella pneumonia. Acyclovir and intravenous immunoglobulin (IVIG) were initiated. Her respiratory status improved after 5 days of treatment and her cutaneous lesions healed, with some scarring. We believe the rapid resolution and benign outcome of this patient's varicella infection may have been attributed to the concomitant initiation of IVIG with antiviral therapy.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; Antiviral Agents; Chickenpox; Drug Therapy, Combination; Female; Humans; Immunoglobulins, Intravenous; Immunologic Factors; Pneumonia, Viral; Purpura, Thrombocytopenic

Primary varicella-zoster (VZ) infection is rare in adults, but the rate of morbidity and mortality is higher than in children. Pneumonia is the most common complication of primary VZ infection in adults. Moreover, varicella pneumonia associated with acute renal failure and acute encephalopathy is very rare. This study reports on a case of disseminated VZ infection successfully treated with acyclovir. The patient was otherwise healthy and denied previous systemic or infectious disease. The initial diagnosis was varicella pneumonia. However, multiple organ involvement subsequently was found in several organs, including the kidney, brain, lung, liver, blood, and skin. The reactivation of VZ infection was strongly suspected. Abnormal renal and liver function and thrombocytopenia also were noted. The patient with chickenpox was treated successfully with acyclovir without complication. In conclusion, multiple organ involvement is a rare complication of VZ infection in adults. In the severe case presented here, adequate intravenous acyclovir administration and close observation of the general condition were essential for successfully treating disseminated VZ infection without complications.

Topics: Acute Kidney Injury; Acyclovir; Adult; Antiviral Agents; Chickenpox; Encephalitis, Varicella Zoster; Herpesvirus 3, Human; Humans; Male; Pneumonia, Viral

In the immuno-competent adult Ebstein-Barr virus (EBV) infection is a self-limiting disease that resolves spontaneously.. We report a case of acute respiratory distress syndrome (ARDS) complicating severe EBV pneumonia and requiring prolonged artificial ventilation. The diagnosis was confirmed by specific serology and estimation of the viral load by PCR. Apart from supportive treatment with artificial ventilation the medical treatment included the use of Acyclovir and polyclonal immunoglobulins in the early phase and corticosteroids in the late phase. Recovery was progressive and complete.. ARDS can complicate EBV pneumonia in an immuno-competent subject. Its management represents a diagnostic and therapeutic challenge.

Topics: Acyclovir; Adrenal Cortex Hormones; Adult; Antiviral Agents; Epstein-Barr Virus Infections; Female; Herpesvirus 4, Human; Humans; Immunization, Passive; Pneumonia, Viral; Recovery of Function; Respiration, Artificial; Respiratory Distress Syndrome; Viral Load

HSV causes serious complications in immunocompromised patients, especially SCT recipients. Although ACV is an effective antiviral prophylaxis, the emergence of ACV resistance is a growing problem. The authors describe two cases of fatal ACV-resistant HSV in two pediatric patients following unrelated donor SCT. Despite the in vitro sensitivity of the HSV isolates to foscarnet, both patients failed to respond to foscarnet therapy. Other antiviral therapies should be considered in those patients who fail to show rapid clinical improvement.

Topics: Acyclovir; Adolescent; Antiviral Agents; Child; Drug Resistance, Viral; Fatal Outcome; Female; Follow-Up Studies; Herpes Simplex; Humans; Pneumonia, Viral; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Stem Cell Transplantation

The aim of this study is to describe epidemiology, patogénesis, pulmonary manifestations and Rx findings in adult patients with varicella pneumonia (VP). Four patients were studied. The diagnosis was established by clinical and radiologic criteria. All had fever , esanthem, 3 cough, 2 dyspnea. Chest X-ray showed interstitial micronodular pattern at bases. 1 case developed airspace consolidation by Staphylococcus aureus. 2 were admitted to ICU. The four received IV acyclovir. We concluded that adults patients with VP usually show nodular infiltrates, with favourable course.

Topics: Acyclovir; Adult; Age Factors; Antiviral Agents; Chickenpox; Female; Herpesvirus 1, Human; Humans; Male; Pneumonia, Viral; Radiography, Thoracic; Time Factors; Tomography, X-Ray Computed; Treatment Outcome

Topics: Acyclovir; Adult; Antiviral Agents; Chickenpox; Follow-Up Studies; Humans; Male; Pneumonia, Viral; Radiography, Thoracic; Time Factors; Treatment Outcome

We report a cluster of 3 cases of nosocomial herpes simplex virus type 1 (HSV-1) pneumonia occurring in close temporal and physical proximity during a 1-week period, which suggested a common source. HSV-1 nosocomial pneumonia occurs in immunocompetent intubated patients and presents as otherwise unexplained profound and/or prolonged hypoxemia (decreased F(IO2), increased P(O2), and decreased A-a gradient) and "failure to wean." The diagnosis of HSV-1 pneumonia is determined by demonstration of characteristic cytopathologic findings (Cowdry type A inclusion bodies) in distal respiratory epithelial cells from bronchoscopic specimens. Acyclovir therapy results in rapid improvement and ability to wean.

Topics: Acyclovir; Aged, 80 and over; Antiviral Agents; Cross Infection; Female; Herpes Simplex; Herpesvirus 1, Human; Humans; Intensive Care Units; Male; Middle Aged; Pneumonia, Viral

Retrospective study of the varicella pneumonia in adults, in order to know incidence, environmental and clinical characteristics and treatments of patients with this diagnosis during the last 9 years in Toledo.. Twenty-one adult patients with the diagnosis of varicella pneumonia were studied, using the information of clinical histories and codified data. The backgrounds of pregnancy, smoking habit, concomitant diseases, previous contacts with another patients and the season of the year, were evaluated. Diagnosis was established by clinical and radiologic criteria in the course of varicella infection.. 21 patients (10 males and 11 females, between 25 and 73 years) were studied. 17 (81%) were smokers, in 15 (71.4%) there was documented contact with varicella infection and 4 (19%) were immunocompromised. In the first 3-7 days after the development of skin lesions (100%), there was fever in 20 cases (95.2%) and dyspnea in 14 (66.7%). There were 4 patients (33,3%) without respiratory symptoms and in 5 (23,8%) there was important hypoxemia. Evolution was satisfactory in 20 cases (95.2%); three others requiring admission to Intensive Care Unit. Chest X-ray revealed an interstitial pattern in 11 cases (52.4%), nodular in 4 (19%) and a mixed pattern in 5 (23.8%). 20 patients were treated with acyclovir and in one case with foscarnet. In 28.57% cases, corticosteroids were needed.. We believe smoking habit could be a risk factor related to an increase of varicella pneumonia. A chest X-ray should be made in every patient, despite the symptoms. Adults with pneumonia have a better prognosis if acyclovir is started early in time. Concomitant treatment with corticosteroids should be used in those cases with respiratory insufficiency.

Topics: Acyclovir; Adult; Aged; Antiviral Agents; Chickenpox; Female; Humans; Male; Middle Aged; Pneumonia, Viral; Retrospective Studies; Risk Factors; Treatment Outcome

Topics: Acyclovir; Antineoplastic Combined Chemotherapy Protocols; Antiviral Agents; Daunorubicin; Female; Herpes Simplex; Humans; Leukemia, B-Cell; Middle Aged; Pneumonia, Viral; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Prednisone; Simplexvirus; Vincristine

Topics: Acyclovir; Adult; Age Factors; Antiviral Agents; Chickenpox; Female; Humans; Male; Pneumonia, Viral; Radiography; Smoking; Treatment Outcome

We report two cases of varicella pneumonia in immunocompetent patients, with emphasis on high-resolution computer tomography manifestations. The predominant findings consisted of multiple bilateral nodules, ranging from 1-10 mm in diameter, with or without a surrounding halo of ground-glass attenuation. Other findings include ground-glass opacities, focal areas of consolidation and small pleural effusions.

Topics: Acyclovir; Adult; Antiviral Agents; Chickenpox; Female; Humans; Immunocompromised Host; Pneumonia, Viral; Tomography, X-Ray Computed

The authors report a fatal outcome in a 4-year-old boy with herpes simplex virus (HSV) pneumonia and ependymoma. The patient had respiratory distress that worsened despite antibiotic treatment. Bronchoalveolar lavage showed intranuclear viral inclusions, and culture was positive for HSV type 1. His T-cell count was significantly decreased. Although acyclovir and foscarnet were given, the patient died. Postmortem examination showed HSV pneumonitis with severe alveolar damage and severe involutional changes of the thymus with absence of Hassall's corpuscles. HSV must be considered in the differential diagnosis of patients with interstitial pneumonia and T-cell deficiency, especially after craniospinal irradiation.

Topics: Acyclovir; Antiviral Agents; Brain Neoplasms; Child, Preschool; Drug Therapy, Combination; Ependymoma; Fatal Outcome; Foscarnet; Herpes Simplex; Herpesvirus 1, Human; Humans; Immunity, Cellular; Male; Neoplasm Recurrence, Local; Pneumonia, Viral; T-Lymphocytes

Topics: Acyclovir; Antiviral Agents; Electrocardiography; Extracorporeal Membrane Oxygenation; Female; Herpes Simplex; Herpesvirus 1, Human; Humans; Infant, Newborn; Pneumonia, Viral

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

We report a case of herpes simplex viral (HSV) pneumonia as a post-CABG pulmonary complication in a 70-year-old man. Chest radiography on postoperative day 9, showed a glass-like shadow and pleural effusion in the left lung field, and the man's condition began deteriorating rapidly. Bronchofiberscopy to detect the pathogen and a bronchoalveolar lavage with polymerase chain reaction (PCR) yielded a definitive diagnosis of HSV pneumonia. Once therapy with acyclovir was begun, his condition improved markedly. Our case suggests that 1 viral pulmonary infection should be considered as a possible cause in postoperative cardiac patients with unexplained progressive pulmonary infiltrates, and 2 DNA amplification using PCR is rapid--it can be completed within 1 day--and sensitive and specific in diagnosing such infections.

Topics: Acyclovir; Aged; Coronary Artery Bypass; Herpes Simplex; Humans; Male; Pneumonia, Viral; Postoperative Complications

Topics: Acyclovir; Adolescent; Adult; Aged; Aged, 80 and over; Bronchoalveolar Lavage Fluid; Cohort Studies; Critical Illness; Female; Herpes Simplex; Humans; Incidence; Intubation, Intratracheal; Male; Middle Aged; Pneumonia, Viral; Respiratory Tract Infections; Retrospective Studies; Risk Assessment; Sensitivity and Specificity; Simplexvirus; Treatment Outcome

Extensive reviews of pulmonary infections in AIDS have reported few herpetic infections. Generally these infections are due to Herpes simplex type 1. Pneumonia due to herpes type 2 is extremely rare. We describe a 40 year-old HIV positive woman who complained of fever, cough and dyspnea for seven years. She had signs of heart failure and the appearance of her genital vesicles was highly suggestive of genital herpes. Echocardiography showed marked pulmonary hypertension, right ventricular hypertrophy and tricuspid insufficiency. After a few days of hospitalization she was treated with Aciclovir and later with Ganciclovir. An open pulmonary biopsy revealed an interstitial inflammation, localized in the alveolar walls. Some pulmonary arteries had widened walls and focal hyaline degeneration. Immunohistochemistry indicated that the nuclei had herpes simplex virus type 2 in many endothelial cells (including vessels with widened walls), macrophages in the alveolar septa and pneumocytes. There was clinical improvement after treatment for herpes. We concluded that as a consequence of herpes infection, endothelial involvement and interstitial inflammation supervene, with thickening of vascular walls and partial obliteration of the vessel lumen. A direct consequence of these changes in pulmonary vasculature was pulmonary hypertension followed by heart failure.

Topics: Acyclovir; Adult; AIDS-Related Opportunistic Infections; Antiviral Agents; Cardiac Output, Low; Female; Ganciclovir; Herpes Genitalis; Herpes Simplex; Herpesvirus 2, Human; Humans; Hypertension, Pulmonary; Pneumonia, Viral

To determine the factors associated with an increased risk of developing varicella-zoster virus (VZV) pneumonia during pregnancy, a case-control analysis was done in which 18 pregnant women with VZV pneumonia were compared with 72 matched control subjects. VZV infection was identified clinically, and VZV pneumonia was diagnosed by dyspnea and findings on chest radiographs. Of 347 pregnant women with VZV infection, 18 (5.2%) had pneumonia treated with acyclovir, and none died. Mean gestational age at rash onset was 25.8 plus minus 8.8 weeks for patients with pneumonia and 17.7 +/- 10.3 weeks for control subjects, which was not significant in the multivariable model. Women with VZV pneumonia were significantly more likely to be current smokers (odds ratio [OR], 5.1; 95% confidence interval [CI], 1.6-16.7) and to have > or = 100 skin lesions (OR, 15.9; 95% CI, 1.9-130.2). Pregnant women with VZV infection may be more likely to develop varicella pneumonia if they are smokers or manifest > or = 100 skin lesions.

Topics: Acyclovir; Adult; Chickenpox; Female; Humans; Pneumonia, Viral; Pregnancy; Pregnancy Complications, Infectious; Risk Factors; Smoking

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

To determine the potential role of steroid therapy combined with early antiviral and supportive care in patients infected with human immunodeficiency virus (HIV) with varicella pneumonia.. A retrospective review was conducted of the incidence, clinical course, and outcome of varicella pneumonia in patients with HIV or acquired immunodeficiency syndrome (AIDS).. Seven of 12 patients (58%) who were hospitalized with chickenpox developed clinically severe varicella pneumonia. All patients had advanced immunosuppression and all developed diffuse reticulonodular radiographic abnormalities, although two patients had normal chest radiographs on admission. All patients received antiviral therapy within 12 hours of hospital admission. The overall mortality rate was 43%. Six patients were treated with systemic corticosteroids in addition to antiviral agents, including all four of the survivors.. Hospitalized patients with HIV or AIDS with chickenpox are at high risk for developing varicella pneumonia. There is a potentially high rate of death despite prompt initiation of appropriate antiviral therapy. Intensive care management and adjunctive use of systemic corticosteroids may improve outcome.

Topics: Acyclovir; Adrenal Cortex Hormones; Adult; Antiviral Agents; Chickenpox; Drug Therapy, Combination; HIV Infections; Hospitalization; Humans; Incidence; Male; Pneumonia, Viral; Retrospective Studies; Survival Rate

In the adult, the primary infection by the varicella-zoster virus acquires an unusual severity due to several complications, the most frequent of them being pneumonia. We study the main characteristics of nine patients diagnosed of pneumonia varicellosa.. Clinical, therapeutic and evolutive features of 9 adult patients, both immunocompetents and immunodepressed, diagnosed of pneumonia varicellosa are retrospectively reviewed, in the last ten years, at Hospital de Sant Pau, Barcelona. Diagnosis of varicella was established on the basis of the typical rash in the context of a feverish illness. The antecedents of smoking habit, pregnancy and underlying disease, evaluating especially arterial blood and platelet count at entrance, are assessed.. Nine patients (4 males and 5 women; mean age 38 years) were included in the study. Seventy-eight percent of patients were smokers of more than 20 cigarettes a day; one met criteria of simple chronic bronchitis, another suffered ankylosing spondylitis and three were known carriers of human immunodeficiency virus. None of the female patients was pregnant. Respiratory symptoms began from the third and fifth day after the skin rash, and the most common symptoms were cough (89%), dyspnea (67%) and hemoptysis (22%). Arterial blood gas determination showed hypoxemia in four patients (45%). Chest X-ray revealed an interstitial pattern predominantly at both bases, with a case of right pleural effusion. Intravenous acyclovir was started in 6 patients, foscarnet in one and symptomatic therapy in two patients. All patients had a favourable clinical course, none of them requiring entrance to the Intensive Care Unit.. Adult patients with varicella pneumonia that suffer respiratory insufficiency, thrombocytopenia or are carriers of base illnesses must be early treated with intravenous acyclovir. However, despite clinical, biological and radiological recovery is earlier with such treatment, the evolution seems equally favourable if it is only conducted, for instance, symptomatic therapy with antithermic and antihistaminic compounds.

Topics: Acyclovir; Adult; Age Factors; Antiviral Agents; Chickenpox; Diagnosis, Differential; Female; Humans; Male; Middle Aged; Pneumonia, Viral; Radiography, Thoracic; Tomography, X-Ray Computed

A rare case of a 61-year-old man who developed herpes simplex virus (HSV) pneumonia after cardiac surgery is presented. He was immunocompetent before the operation and had no history of a mucocutaneous herpesvirus infection. This potentially fatal complication was successfully managed with acyclovir treatment after establishing the diagnosis with bronchoalveolar lavage. A depression of the patient's cell-mediated immunity after cardiopulmonary bypass may have been a causative factor. An unusual type of pneumonia such the HSV pneumonia seen in the present case should therefore be considered in patients with severe hypoxemia accompanied with unexplained pulmonary infiltrates after cardiac surgery using cardiopulmonary bypass which does not improve with conventional treatment.

Topics: Acyclovir; Antiviral Agents; Bronchoalveolar Lavage Fluid; Cardiopulmonary Bypass; Coronary Artery Bypass; Herpes Simplex; Humans; Immunity, Cellular; Male; Middle Aged; Pneumonia, Viral

Topics: Acyclovir; Adult; Age of Onset; Antiviral Agents; Bone Marrow Transplantation; Female; Herpes Simplex; Herpesvirus 1, Human; Humans; Leukemia, Myelogenous, Chronic, BCR-ABL Positive; Lung Diseases, Interstitial; Male; Pneumonia, Viral

The impact of cytomegalovirus (CMV) infection post-transplantation is in part influenced by the degree of immunosuppression. While mycophenolate mofetil (MMF) does not increase the overall incidence of CMV infection, we have questioned whether or not it increases its severity. Using a case control study design in which 29 renal transplant patients developed CMV disease [17 (59%) of which received azathioprine (AZA) and 12 (41%) received MMF], increases in the frequency of organ involvement with CMV (58 vs. 18%; p = 0.03) and in the number of organs involved with CMV were noted in the MMF versus the AZA group (2.0 vs. 1.0; p = 0.015). These results indicate that the increased immunosuppressive activity of MMF impacts the morbidity of CMV infection, thus warranting the use of effective anti-CMV preventive regimens while patients are treated with MMF.

Topics: Acyclovir; Adult; Antiviral Agents; Azathioprine; Case-Control Studies; Cohort Studies; Cytomegalovirus Infections; Enteritis; Female; Ganciclovir; Hepatitis, Viral, Human; Humans; Immunosuppressive Agents; Incidence; Kidney Transplantation; Male; Mycophenolic Acid; Pneumonia, Viral; Risk Factors; Severity of Illness Index

Topics: Acyclovir; Adolescent; Antiviral Agents; Chickenpox; Herpesvirus 3, Human; Humans; Immunologic Deficiency Syndromes; Male; Pneumonia, Viral; Radiography

Retrospective study of the varicella pneumonia in adults with clinical, therapeutic and evolutive features in 22 patients in the last 5 years.. The diagnosis was established by clinical and radiologic criteria in the course of varicella infection. The antecedents of pregnancy, smoking habit, previous contact with patients with varicella and underlying disease were evaluated.. Twenty-two patients (14 males and 8 women: mean age 31 years. range: 22-40) were included in the study. None of them were immunocompromised, 16 (72.7%) have had previous contact with varicella patients. 19 (86.3%) were heavy smokers and none of the female patients was pregnant. All patients had fever and exanthem, cough had 20 (90.9%) dyspnea 16 (72.7%), chest pain 9 (40.9%) and hemoptysis 5 (22.7%). Only two patients showed pO2 < 60 mmHg. Chest X-ray revealed an interstitial pattern in 14 cases (63.3%), and micronodular in 8 (36.3%). All patients received treatment with intravenous acyclovir. Three patients (13.6%) were admitted to the Intensive Care Unit due to respiratory insufficiency, needing mechanical ventilation one of them (4.5%). Another three developed failure renal reversible associated with acyclovir. All patients had a favourable clinical course.. We believe, that early, aggressive use of intravenous acyclovir in adult varicella pneumonia may be lifesaving, preventing progressive respiratory failure and reducing the high mortality rate of the disease. Therapy with corticosteroids should be considered in addition to antiviral therapy in patients with severe varicella pneumonia. While oral acyclovir chemoprophylaxis is probably beneficial in populations with chicken pox.

Topics: Acyclovir; Adult; Antiviral Agents; Chickenpox; Female; Humans; Male; Pneumonia, Viral; Retrospective Studies

Varicella (chickenpox) is a contagious, self-limited, usually benign disease common in childhood but uncommon in adulthood. Pneumonia is the most frequent complication of the disease in adults. We retrospectively review 7 cases of varicella pneumonia in previously healthy adults diagnosed in our hospital between 1992 and 1996. All of them were treated with intravenous acyclovir with good therapeutic response save for a patient who developed respiratory insufficiency and died 8 days after his admission. Smoking was the only risk factor detected. Clinical features of our patients are described and the need of an early diagnosis and treatment of varicella pneumonia is emphasized.

Topics: Acyclovir; Adult; Anti-Bacterial Agents; Antiviral Agents; Chickenpox; Drug Therapy, Combination; Female; Humans; Male; Pneumonia, Viral; Retrospective Studies

Topics: Acyclovir; Adult; AIDS-Related Opportunistic Infections; Antiviral Agents; Chickenpox; Child; Female; HIV Seropositivity; Humans; Male; Pneumonia, Viral; Risk Factors; Seasons; Smoking

Topics: Acyclovir; Adult; Antiviral Agents; Chickenpox; Female; Humans; Lung; Pneumonia, Viral; Radiography

We describe a case of adult chickenpox which was complicated by severe varicella pneumonia, mild hepatitis and thrombocytopenia. The hepatitis and the thrombocytopenia were asymptomatic clinically and were diagnosed on biochemistry and blood count results. These eventually improved without specific interventions. The pneumonia, however, deteriorated rapidly despite the early commencement of oxygen supplementation, acyclovir and antibiotic. Subsequently, systemic corticosteroid therapy was initiated and the patient was ventilated in the intensive care unit. The patient eventually recovered.

Topics: Acyclovir; Adrenal Cortex Hormones; Adult; Antiviral Agents; Chickenpox; Drug Therapy, Combination; Humans; Male; Pneumonia, Viral

We report the case of an adult patient with acquired immune deficiency syndrome (AIDS) presenting with acute dyspnoea and cutaneous disseminated lesions suggestive of an atypical varicella. The chest radiograph and the computed tomography (CT)-scan revealed a miliary pneumonia. On a previous serum sample varicella-zoster (VZV)-specific serum immunoglobulin (Ig)G titre was 1/200. A high dose acyclovir treatment was effective, but recurrences occurred twice when the treatment was discontinued. During the first recurrence the polymerase chain reaction (PCR) detected the presence of VZV in the bronchoalveolar lavage (BAL) sample. These findings confirmed the diagnosis of secondary varicella with pulmonary involvement. Secondary varicella pneumonia has not been reported in a human immunodeficiency virus (HIV)-infected adult until now. The use of PCR on a BAL sample was very useful in this case because viral culture remained negative. Recurrences of the varicella pneumonia suggested that a maintenance treatment was required in this deeply immunocompromised patient.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; Antiviral Agents; Bronchoalveolar Lavage Fluid; Chickenpox; Herpesvirus 3, Human; Humans; Male; Pneumonia, Viral; Polymerase Chain Reaction; Recurrence

Varicella pneumonia is the most common complication of adult varicella. Symptoms may be severe and the mortality rate high in patients who are immunodeficient or pregnant. Symptoms may be mild and progression more favorable in adults previously in good health. We report two cases of varicella infection complicated by severe pulmonary involvement in adult patients who were previously healthy. Case 1 was a 36-year-old male who 6 days after developing varicella was clinically observed to have dyspnea and hemopytsis. He died of acute respiratory failure on the following day. Case 2 was a 28-year-old male whose respiratory symptoms started the third day after developing varicella. These symptoms were relieved by treatment with acyclovir and gammaglobulin. Careful observation is and an early treatment of varicella should be undertaken not only for patients with suppressed cellular immunity, but also for healthy adults, to prevent severe complications.

Topics: Acute Disease; Acyclovir; Adult; Antiviral Agents; Chickenpox; gamma-Globulins; Hemoptysis; Humans; Male; Pneumonia, Viral; Respiratory Insufficiency

Topics: Acyclovir; Adult; Chickenpox; Female; Humans; Immunoglobulins; Methylprednisolone; Pneumonia, Viral; Respiratory Insufficiency

Varicella pneumonia that results in respiratory failure or progresses to the institution of mechanical ventilation carries a significant morbidity and mortality despite intensive respiratory support and antiviral therapy. There has been no reported study of the role of corticosteroids in life-threatening varicella pneumonia.. This was an uncontrolled retrospective and prospective study of all adult patients with a diagnosis of varicella pneumonia who were admitted to the ICUs of the Johannesburg group of academic hospitals in South Africa between 1980 and 1996. Patient demographics, clinical and laboratory features, necessity for mechanical ventilation, and complications were reviewed. The outcome and therapy of varicella pneumonia was evaluated with particular reference to the use of corticosteroids. Patients with comorbid disease and those already taking immunosuppressive agents were excluded. Key endpoints included length of ICU and hospital stay and mortality.. Fifteen adult patients were evaluated, six of whom received corticosteroids in addition to antiviral and supportive therapy. These six patients demonstrated a clinically significant therapeutic response. They had significantly shorter hospital (median difference, 10 days; p<0.006) and ICU (median difference, 8 days; p=0.008) stays and there was no mortality, despite the fact that they were admitted to the ICU with significantly lower median ratios between PaO2 and fraction of inspired oxygen than those patients (n=9) who did not receive corticosteroid therapy (86.5 vs 129.5; p=0.045).. When used in addition to appropriate supportive care and early institution of antiviral therapy, corticosteroids appear to be of value in the treatment of previously well patients with life-threatening varicella pneumonia. The observations presented in this study are important and should form the basis for a randomized controlled trial, as no other relevant studies or guidelines are available.

Topics: Acyclovir; Adult; Antiviral Agents; Blood Gas Analysis; Chickenpox; Drug Therapy, Combination; Female; Glucocorticoids; Herpesvirus 3, Human; Humans; Male; Middle Aged; Pneumonia, Viral; Prospective Studies; Radiography; Respiration, Artificial; Retrospective Studies; Treatment Outcome

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

Topics: Acyclovir; Adult; Antiviral Agents; Chickenpox; Female; Humans; Pneumonia, Viral; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Outcome; Treatment Outcome

Lower respiratory tract infection is a major cause of morbidity and death after lung transplantation. The incidence and significance of noncytomegalovirus viral respiratory tract infections has not been reported to date. We report our center's experience with these infections.

Topics: Acyclovir; Adolescent; Adult; Cytomegalovirus Infections; Female; Herpes Simplex; Humans; Immunosuppressive Agents; Lung Transplantation; Male; Middle Aged; Opportunistic Infections; Pneumonia, Bacterial; Pneumonia, Viral; Postoperative Complications; Premedication; Risk Factors

To determine the clinical features, treatment and outcome of severe varicella pneumonia with hypoxic respiratory failure requiring intensive care management, a prospective survey of consecutive cases was undertaken. Fifteen consecutive adult cases of varicella pneumonia with respiratory failure admitted to a 10-bed respiratory intensive care unit over a period of 10 y from 1984-1993 were studied. All patients were given acyclovir immediately on admission. The level of ventilatory support needed was determined by the severity of gas exchange abnormality, and varied from face mask oxygen (three patients), through continuous positive airway pressure (CPAP) by face mask (eight patients), to continuous positive pressure ventilation (CPPV) (four patients). The majority of patients were young females, only one of whom was pregnant. All patients had been in close contact with a known case of chickenpox. All patients responded well to acyclovir and ventilatory support with improved oxygenation. Monitoring with pulse oximetry was important to detect episodes of desaturation on inadvertent discontinuation of positive and expiratory pressure (PEEP). Two patients were admitted with bacterial superinfection, and one patient, who had required intubation and CPPV, developed nosocomial respiratory tract infection. There were no deaths. This experience suggests that intensive care admission, with the early administration of intravenous acyclovir and recognition of the severity of the hypoxaemia resulting from varicella pneumonia (which can be reversed with PEEP), should reduce the mortality of severe varicella pneumonia in adults.

Topics: Acyclovir; Adolescent; Adult; Antiviral Agents; Chickenpox; Critical Care; Female; Humans; Male; Middle Aged; Pneumonia, Viral; Positive-Pressure Respiration; Pregnancy; Pregnancy Complications, Infectious; Prospective Studies

To review the institutional experience of a national tertiary referral center for extracorporeal life support (ECLS) in severe varicella pneumonia.. Hospital records and ECLS flow sheets.. All pediatric (nonneonatal) and adult patients who were treated for varicella pneumonia with ECLS at the University of Michigan Medical Center between 1986 and 1995.. Diagnosis of varicella pneumonia was made by history of recent exposure to chickenpox, progressive dyspnea, fever, a characteristic diffuse, vesicular rash, and a supporting chest roentgenogram. Indications for ECLS included a shunt fraction of > 30% or PaO2/FlO2 ratio of < 80 despite maximal conventional therapy, which included aggressive diuresis, blood transfusions to optimize oxygen-carrying capacity, pressure-controlled/inverse-ratio ventilation, and intermittent prone positioning.. Between 1986 and 1995, 191 patients were referred for ECLS. Among these patients, there were 51 (27%) cases of viral pneumonia, of which nine cases were due to acute varicella-zoster infection. Intravenous acyclovir was administered to eight of the nine patients. Of the nine patients, two patients improved using conventional ventilator management, and seven patients underwent ECLS. Overall survival on ECLS was 71% (5/7). The mean (+/-SD) alveolar-arterial oxygen gradient and PaO2/FlO2 ratio were 533 +/- 101 torr (71.3 +/- 13.5 kPa) and 67 +/- 24, respectively. The median duration of mechanical ventilation before ECLS and the subsequent duration of ECLS were 4 and 12.8 days, respectively. One of the deaths was from progressive right heart failure secondary to pulmonary hypertension and the other death was from overwhelming Pseudomonas sepsis.. Early recognition of imminent pulmonary failure and rapid institution of ECLS are critical in the successful management of severe, life-threatening varicella pneumonia.

Topics: Acyclovir; Adult; Antiviral Agents; Chickenpox; Child; Child, Preschool; Extracorporeal Membrane Oxygenation; Female; Humans; Male; Pneumonia, Viral; Pregnancy; Pregnancy Complications, Infectious

To study the clinical, therapeutic, and evolutive features in 25 patients with the diagnosis of varicella pneumonia (VP) in the last 15 years.. The diagnosis was established by clinical and radiologic criteria in the course of varicella infection. The antecedents of smoking habit, pregnancy, and underlying disease were evaluated. Hypoxemia was defined as a pO2 < or = 65 mmHg with a FiO2 of 0.21.. Twenty-five patients (16 males and 9 women; mean age 31.5 years, range: 24-43 years) were included in the study. Ninety-two percent of patients were smokers of more than 20 cigarettes a day; five met criteria of simple chronic bronchitis, 3 were known carriers of human immunodeficiency virus (HIV) and one had a chronic liver disease caused by hepatitis C virus. In 16 patients (64%) there were no underlying diseases and none of the female patients was pregnant. Respiratory symptoms began from the first and seventh day after the skin rash, and the most common symptoms were cough (76%), dyspnea (48%), and chest pain (44%). In 22 patients an arterial gas determination was obtained and hypoxemia was documented in 8 patients (32%). Hypoxemia was greater and statistically significant in patients with underlying diseases (p < 0.01). Chest X-ray revealed an interstitial pattern predominantly at both bases. Intravenous acyclovir therapy was started in 19 patients (76%) with severe respiratory symptoms and/or underlying disease. Three patients (12%) were admitted to the Intensive Care Unit for mechanical ventilation. All patients had a favourable clinical course.. Adult patients with symptoms of VP had a favourable clinical course with intravenous acyclovir, and the presence of hypoxemia was more commonly observed when underlying diseases were also present.

Topics: Acyclovir; Adult; AIDS-Related Opportunistic Infections; Antiviral Agents; Chickenpox; Female; HIV-1; Humans; Infusions, Intravenous; Male; Pneumonia, Viral; Pregnancy; Retrospective Studies; Smoking

Primary varicella-zoster virus (VZV) infections in adults generally follow a more severe course than in children and are more often associated with life-threatening complications. In the years 1992 to 1995 we observed 7 immunocompetent adults with a severe course of primary VZV infection. All 7 patients presented initially with a characteristic rash. In 6 patients the diagnosis of VZV was confirmed by ELISA on material taken from the lesions, and in all of them it was confirmed by serology. The following complications were observed: pneumonia (5x), elevated liver enzymes (4x), myocarditis (1x), encephalitis (1x) and myelitis (1x). Pulmonary lesions were characterized by bilateral interstitial infiltrates on chest-x-ray and required mechanical ventilation in 2 patients. The liver enzymes were only slightly elevated and clinically not significant. Myocarditis in one case was postulated in view of elevated creatine kinase levels, ECG-repolarization changes and AV-block III which required the insertion of a transitory pacemaker. Encephalitis presented as abnormal behaviour at work followed by seizures. Myelitis was suspected due to ascending sensory motor tetraparesis and confirmed by MRI. All patients were treated with high doses of parenteral acyclovir (3 x 10 mg/kg body weight i.v. per day) for 5-12 days. 6 patients recovered completely and only the patient with myelitis has residual neurological deficits 3 months after discharge. Although we cannot exclude the possibility that supportive therapy without acyclovir would have had the same outcome, we recommend high-dose parenteral acyclovir for treatment of visceral and neurological complications in primary VZV infections in adults.

Topics: Acyclovir; Adult; Antiviral Agents; Chickenpox; Encephalitis, Viral; Female; Herpesvirus 3, Human; Humans; Male; Middle Aged; Myelitis; Myocarditis; Pneumonia, Viral

We describe a case of varicella pneumonia in a 24-year-old healthy man presenting with severe respiratory failure. A chest radiograph showed diffuse, bilateral airspace consolidation; additional complications included liver dysfunction and thrombocytopenia. However, treatment with intravenous acyclovir and gamma-globulin improved his clinical symptoms and signs. A greater than four-fold change in paired titers of the varicella-zoster virus antibody was observed. Bronchoalveolar lavage performed during the recovery phase revealed increased total cell and lymphocyte counts and a decreased CD4:CD8 ratio of T lymphocytes. Transbronchial lung biopsy findings were compatible with a diagnosis of interstitial pneumonia.

Topics: Acyclovir; Adult; Antiviral Agents; Biopsy; Chickenpox; Humans; Immunoglobulins, Intravenous; Male; Pneumonia, Viral; Respiratory Insufficiency

Varicella pneumonia in adults is considered to be a serious complication, with mortality rates of 9-50%, but the true incidence and clinical course is not known. We therefore studied all adult patients in Stockholm County hospitalized during the period 1980-1989 with varicella. 36/305 (12%) varicella patients admitted to hospital were diagnosed as having pneumonia, corresponding to a mean incidence of 0.32/100,000 inhabitants per year. In most patients the pneumonia had a mild to moderate clinical course and no deaths occurred (mortality rate 0%, CI95 [0, 9.7]). However, 13 patients had a severe tachypnoea (> or = 30 breaths/min) and 4 of these required intensive-care treatment. Ten patients were treated with acyclovir, in most cases combined with corticosteroids. We conclude that the incidence of severe varicella pneumonia is low in the adult population, and that the mortality rate of this complication is probably lower than previously described.

Topics: Acyclovir; Adrenal Cortex Hormones; Adult; Antiviral Agents; Chickenpox; Drug Therapy, Combination; Female; Hospitalization; Humans; Incidence; Male; Pneumonia, Viral; Prognosis; Retrospective Studies; Risk Factors; Survival Rate; Sweden

Topics: Acyclovir; Antiviral Agents; Dermatitis; Diagnosis, Differential; Herpes Simplex; Humans; Infant, Newborn; Lung; Male; Pneumonia, Viral; Radiography; Respiration Disorders; Time Factors

Varicella pneumonia is the most common complication of chickenpox and it also has the highest mortality. A retrospective study was carried out on 10 patients with varicella pneumonia over a period of one year. Seven of the 10 patients with varicella pneumonia had a history of smoking. The majority of the patients with varicella pneumonia presented with cough, dyspnoea, hypoxia and a compatible chest radiograph. All the patients with varicella pneumonia were treated with intravenous acyclovir. Four patients required mechanical ventilation. Nine out of the 10 patients were cured with only one death. It may be reasonable to select adults with varicella and who smoke, for early treatment with acyclovir.

Topics: Acyclovir; Adult; Aged; Anti-Bacterial Agents; Antiviral Agents; Chickenpox; Drug Therapy, Combination; Female; Humans; Incidence; Infusions, Intravenous; Male; Middle Aged; Pneumonia, Viral; Prognosis; Retrospective Studies; Risk Factors; Smoking; Survival Rate

In a retrospective study, the strategy of giving high-dose acyclovir (500 mg/m2 every 8 h intravenously) from day 5 before transplantation to day 30 after transplantation was evaluated in 266 cytomegalovirus (CMV)-seropositive autograft recipients. the incidence of CMV pneumonia was compared with that in 85 control patients who did not receive high-dose acyclovir. There was no significant difference in the incidence of CMV pneumonia between groups at day 100 (Kaplan-Meier estimates, 6.3% [acyclovir] vs. 7.7% [controls], P = .63) and day 200 after transplantation (7.6% vs. 13.1%, P = .32). The overall rate of patients who presented with CMV disease without preceding excretion from blood, urine, or throat was 77%. CMV pneumonia was fatal in 9 (56%) of 16 acyclovir recipients compared with 5 (63%) of 8 controls (P = 1.0). Survival after transplantation was not different between groups (P = .68). Thus, high-dose acyclovir does not appear to be effective for prevention of CMV disease after autologous transplantation.

Topics: Acyclovir; Adolescent; Adult; Aged; Antiviral Agents; Bone Marrow Transplantation; Child; Child, Preschool; Cytomegalovirus Infections; Female; Humans; Incidence; Infant; Male; Middle Aged; Pneumonia, Viral; Retrospective Studies; Risk Factors; Transplantation, Autologous; Treatment Outcome

Over a 6-month period, 6 of 54 postthoracotomy patients developed pneumonia and respiratory failure. Pneumonia was secondary to herpes simplex virus type 1 in 3 of the 6 patients. Diagnostic efforts including bronchoscopy with bronchial washing, viral cultures, and cytologic examination permitted early diagnosis and successful treatment with acyclovir. A high index of suspicion for herpes simplex pneumonia must be maintained in critically ill patients with undiagnosed pneumonia.

Topics: Acyclovir; Aged; Female; Herpes Simplex; Herpesvirus 1, Human; Humans; Lung; Lung Neoplasms; Male; Middle Aged; Pneumonia, Viral; Postoperative Complications; Radiography; Thoracic Neoplasms; Thoracotomy

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

Varicella pneumonia can endanger the life of pregnant women. We have a case of varicella pneumonia complicating pregnancy in the third trimester. The patient required intubation, early treatment with acyclovir (700 mg/IV every eight hours), as well as the extraction of the fetus by cesarean section before the time gestation was completed. Early treatment with acyclovir has improved hope for these patients.

Topics: Acyclovir; Adult; Chickenpox; Female; Humans; Intubation; Pneumonia, Viral; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Outcome; Pregnancy Trimester, Third

Topics: Acyclovir; Administration, Oral; Adult; Female; Herpes Zoster; Humans; Pneumonia, Viral

Topics: Acyclovir; Adult; Chickenpox; Diseases in Twins; Female; Humans; Pneumonia, Viral; Pregnancy; Pregnancy Complications, Infectious; Respiration, Artificial; Severity of Illness Index; Twins, Monozygotic

Topics: Acyclovir; Adult; Anabolic Agents; Chickenpox; Critical Care; Herpesvirus 3, Human; Humans; Male; Pneumonia, Viral

A 49 year old man with a long history of severe chronic asthma, treated with oral corticosteroids and weekly doses of methotrexate, contracted chickenpox from his son whose chickenpox rash had developed three weeks before presentation. Five days before admission the patient developed a vesicular skin rash which became extensive, with general malaise, bilateral pneumonia, and acute deterioration of his asthma. He died two weeks after admission despite treatment with acyclovir.

Topics: Acyclovir; Asthma; Chickenpox; Fatal Outcome; Humans; Immunosuppression Therapy; Male; Methotrexate; Middle Aged; Pneumonia, Viral; Radiography

Topics: Acyclovir; Adult; Antiviral Agents; Chickenpox; HIV Seropositivity; Humans; Male; Pneumonia, Viral; Time Factors

A 30-year-female with chronic myelogenous leukemia received allogeneic bone marrow transplantation (BMT). On day 104, low-grade fever, cough, and general malaise developed, resulting in hospitalization 10 days later. Chest X ray revealed diffuse infitrates, suggesting cytomegalovirus interstitial pneumonia. Ganciclovir (DHPG) was given daily and all symptoms disappeared three days later. However, a very few vesicular lesions appeared on her trunk and her two children had chickenpox at that time. Chest CT was taken and disclosed diffuse nodular shadows. Clinical course and chest CT suggested varicella pneumonia. DHPG administration was stopped and acyclovir PO started to be given. She was discharged in excellent condition. In this report, we show a rare case of varicella pneumonia after allogeneic BMT and efficacy of DHPG for the treatment of varicella pneumonia.

Topics: Acyclovir; Adult; Antiviral Agents; Bone Marrow Transplantation; Chickenpox; Female; Ganciclovir; Humans; Immunocompromised Host; Leukemia, Myelogenous, Chronic, BCR-ABL Positive; Opportunistic Infections; Pneumonia, Viral; Tomography, X-Ray Computed; Transplantation, Homologous

We report the case of a 33 year old man with herpetic bronchitis and bilateral pneumonitis. He presented without mucocutaneous lesions, and his cellular and humoral immunity were not compromised. Diagnosis was established on histological and cytological findings and confirmed by serology. Acyclovir treatment led to a favourable outcome.

Topics: Acyclovir; Adult; Herpes Simplex; Humans; Immunocompetence; Male; Pneumonia, Viral

Our data suggest that CMVIG in combination with ganciclovir effectively reduces the incidence, and delays the onset of CMV infections in seropositive lung transplant recipients. In addition, its use may be associated with less severe CMV infection and a lower incidence of bacterial or fungal opportunistic infection. Although the number of patients in the study is small, high-titer CMVIG may be more effective than standard titer immunoglobulin in the prevention of CMV disease in lung transplant recipients. Several questions remain in addition to these: What is the optimal dosage and duration of treatment with CMVIG for prophylaxis of CMV infection and disease in lung transplant recipients; Is this strategy cost-effective; Will it reduce the incidence of obliterative bronchiolitis following lung transplantation and enhance allograft survival? A prospective, random-assignment trial is warranted to answer these questions.

Topics: Acyclovir; Antibodies, Viral; Cytomegalovirus; Cytomegalovirus Infections; Ganciclovir; Humans; Immunization, Passive; Immunoglobulins; Immunoglobulins, Intravenous; Immunosuppressive Agents; Incidence; Lung Transplantation; Opportunistic Infections; Pneumonia, Viral; Survival Analysis; Viremia

Two cases of pneumonia associated with chicken pox in previously healthy patients are described. Their known risk factor was heavy smoking. Both were treated successfully with parenteral aciclovir, although one presented a restrictive spirometric pattern with lowered DLCO that became normal 3 months after discharge.

Topics: Acyclovir; Adult; Age Factors; Chickenpox; Humans; Male; Pneumonia, Viral; Smoking; Spirometry

We present the case of a healthy adult patient without underlying risk factors, who developed bilateral pneumonia and respiratory failure during an outbreak in his family of infection by the Varicella-Zoster virus. IV. acyclovir treatment was begun with good clinical and radiological response and improvement in blood-oxygen levels. We review below risk factors and patients susceptible to treatment with acyclovir.

Topics: Acyclovir; Adult; Chickenpox; Female; Humans; Pneumonia, Viral; Risk Factors

In the adult, the primary infection by the varicella-zoster virus acquires an unusual severity due to several complications, the most frequent of them being pneumonia. The authors analyze the clinical, epidemiological, serological and radiological data of the only two cases of varicellous pneumonia in the adult at a general hospital during the past 5 years. They highlight as the main characteristics: easiness of diagnosis, dissociation between clinical and radiological signs and the excellent therapeutical response to the early administration of intravenous Aciclovir. They comment as well the risk factors of this complication and the criteria for hospitalization.

Topics: Acyclovir; Adult; Chickenpox; Female; Humans; Male; Pneumonia, Viral

Topics: Acyclovir; Adult; Chickenpox; Humans; Lung; Male; Pneumonia, Viral; Radiography

Topics: Acyclovir; Adult; AIDS-Related Opportunistic Infections; Herpes Simplex; Humans; Male; Pneumonia, Viral

Cytomegalovirus pneumonia complicated bone marrow transplantation in 75 (63 allogeneic and 12 autologous) of 1136 recipients (Kaplan-Meier incidence 8.8%). CMV pneumonia occurred more frequently in allogeneic (12.4%) than autologous recipients (3.3%). Increased risk for CMV pneumonia was observed in allogeneic recipients who were seropositive (relative risk = 2.9), older age (RR = 1.4 per decade), those conditioned with total-body irradiation (RR = 2.7), who received antithymocyte globulin (RR = 2.9) or T cell-depleted marrow (RR = 2.7) or who had CMV viruria (RR = 4.0) or viremia (RR = 5.9). Autologous recipients were also at increased risk if they were seropositive (RR = 6.1), or developed viruria (RR = 7.0) or viremia (RR = 15.4). Thirteen of 14 untreated patients died without improvement. Prognosis was poor in patients who were ventilator-dependent at initiation of therapy (median survival 17 days), with only 1 long-term survivor. In contrast, patients ventilator-independent at initiation of therapy with ganciclovir and immunoglobulin (n = 22) had a median survival of > 274 days, with 9 long-term survivors. Ganciclovir alone or acyclovir with immunoglobulin in ventilator-independent patients was less effective (median survivals 80 and 10 days, respectively). Overall, 10 of 75 patients were surviving 10-73 months (median 47) from diagnosis; 9 of these were ventilator-independent at initiation of therapy and received ganciclovir with immunoglobulin. CMV pneumonia was less common, but was severe in autologous recipients, with only 2 of 12 surviving. CMV pneumonia remains a prominent cause of death following BMT. Early therapy with ganciclovir and immunoglobulin before respiratory failure supervenes may improve survival.

Topics: Acyclovir; Adolescent; Adult; Bone Marrow Transplantation; Child; Child, Preschool; Cytomegalovirus Infections; Female; Ganciclovir; Humans; Immunotherapy; Infant; Male; Middle Aged; Pneumonia, Viral; Risk Factors; Survival Analysis

308 consecutive patients with severe or complicated respiratory tract infections underwent fiber-optic bronchoscopy in the search for a microbiological etiology. Protected brush specimens were used for bacterial cultures and bronchoalveolar lavage (BAL) for virus isolation and cytological examination. Herpes simplex virus (HSV) was the most commonly found pathogen and was isolated in 37 patients. 20 (54%) of them also had serological and/or cytological signs of HSV infection. 132 patients required assisted ventilation (AV) and in this group 34 (92%) of the 37 HSV positive patients were found. Isolation of HSV was significantly (p less than 0.001) associated with AV compared to patients not requiring AV. Of all patients treated with AV 26% had positive HSV isolation in conjunction with suspected acute lower respiratory infection. Coinfection with HSV and bacteria occurred in only 8 (22%) patients. HSV was more common in patients with burns (47%) compared to other patient groups such as patients with AIDS (3%) or other immunodeficiencies (9%).

Topics: Acyclovir; Bronchoscopy; Herpes Simplex; Humans; Lung; Pneumonia, Viral; Simplexvirus

The HSV (1 or 2) is the cause of serious pulmonary infections among patients who have had a transplantation. This study in retrospect is based on the analysis of 145 patients who underwent a cardiothoracic transplant at the CHU. in Nancy. Confronted with clinical signs calling to mind breathing difficulties, the analysis of the broncho alveolar lavage (or of the bronchial brushing) revealed the viral aetiological agent. The answer from the laboratory is quickly available by immunofluorescence or by immunoperoxidase with viral anti-protein monoclonal antibodies and by the multiplication in vitro of the virus into cell cultures. The HSV 1 was responsible for 8 herpetic lung infections. The specific Acyclovir treatment was used 6 times successfully. When such a direction of treatment was impossible (in 2 cases) the outcome was fatal. The carry HSV is highly frequent and recurrences under immuno-suppressor treatment require an Acyclovir prophylaxis among patients admittedly carrying the virus in a pre-transplanted serum assessment.

Topics: Acyclovir; Heart-Lung Transplantation; Herpes Simplex; Humans; Pneumonia, Viral; Postoperative Complications

We report a case of adult primary varicella pneumonia. A 34-year-old man was admitted to our hospital with fever, dry cough and eruptions. He had no history of chicken pox and his sons had contracted varicella 2 weeks before the onset of his symptoms. Chest X-ray showed diffuse nodular shadows in both lungs. The diagnosis of primary varicella pneumonia was made based on family history, typical eruptions and high titer of antibody against Varicella zoster virus. An electron micrograph indicated this case to be primary varicella pneumonia with fibrosis and edema of interstitial spaces and the presence of virus-like particles in cells. The patient was treated with antibiotics, an antiviral agent and immunoglobulin. The clinical symptoms and diffuse nodular shadows resolved with this treatment.

Topics: Acyclovir; Adult; Herpes Zoster; Humans; Immunization, Passive; Lung; Male; Pneumonia, Viral

Topics: Acyclovir; Chickenpox; Child; Child, Preschool; Dysgammaglobulinemia; Female; Humans; IgG Deficiency; Immunoglobulin M; Immunoglobulins, Intravenous; Infusions, Intravenous; Lymphocyte Subsets; Male; Oxygen Inhalation Therapy; Pneumonia, Viral

Topics: Acyclovir; DNA, Viral; Erythromycin; Humans; Minocycline; Nucleic Acid Hybridization; Pneumonia, Mycoplasma; Pneumonia, Viral; Polymerase Chain Reaction; RNA, Viral

Varicella pneumonia is a relatively rare disease in the reproductive-aged woman, but has a reported 41 percent maternal mortality rate in pregnancy. Seventeen cases managed with intraveneous acyclovir are reviewed. We report successful management with the unpublished addition of oral acyclovir to complete antiviral therapy on an outpatient basis.

Topics: Acyclovir; Administration, Oral; Chickenpox; Female; Humans; Infant, Newborn; Injections, Intravenous; Male; Pneumonia, Viral; Pregnancy; Pregnancy Complications, Infectious

Topics: Acyclovir; Female; Humans; Infant, Newborn; Male; Pneumonia, Viral; Pregnancy; Pregnancy Complications, Infectious; Simplexvirus; Vidarabine

Three marrow transplant patients developed pneumonia due to acyclovir-resistant thymidine-kinase-deficient herpes simplex virus (HSV) type 1. In all three, pneumonia was evident at autopsy by both standard and immunohistology, and virus was recovered from culture of lung tissue. Two patients also had other pulmonary infections at death; one had only HSV pneumonia. All had received prophylaxis and repeated treatment courses with acyclovir, and all initially had acyclovir-sensitive virus. The acyclovir-resistant HSV strains were sensitive to foscarnet, and in at least one case to vidarabine, but as expected were resistant to ganciclovir. These cases represent potentially severe visceral infection in which acyclovir-resistant virus strains were primary or important copathogens. Although acyclovir-resistant HSV is generally considered less virulent, these cases illustrate the potential importance of infection due to acyclovir-resistant HSV in severely immunocompromised patients. They also highlight the need to test HSV strains for antiviral sensitivity and to consider alternative therapies to acyclovir in appropriate clinical situations.

Topics: Acyclovir; Adult; Animals; Antiviral Agents; Bone Marrow Transplantation; Cells, Cultured; Drug Resistance, Microbial; Female; Foscarnet; Ganciclovir; Graft vs Host Disease; Herpes Simplex; Humans; Male; Middle Aged; Phosphonoacetic Acid; Pneumonia, Viral; Simplexvirus; Thymidine Kinase; Vero Cells; Vidarabine

We report our experience of herpes simplex virus infection in a series of 51 recipients of heart lung transplantation (HLT). Nine patients, all of whom were seropositive for the virus preoperatively, developed HSV infection. Seven episodes of culture-proved mucocutaneous HSV infection without evidence of pulmonary involvement occurred in four patients. Six episodes of HSV pneumonia were seen in a further five patients, one of whom died. Diagnosis of HSV pneumonia was by histological appearances on transbronchial biopsy, together with culture of lung tissue or bronchoalveolar lavage. Concomitant cytomegalovirus infection occurred in four patients. All patients who developed HSV pneumonia did so within the first two postoperative months; in four patients following augmented immunosuppression. We now suggest that HLT recipients who are HSV antibody-positive should receive prophylactic acyclovir for the first two months after surgery and at times of augmented immunosuppression.

Topics: Acyclovir; Adolescent; Adult; Child; Female; Heart-Lung Transplantation; Herpes Simplex; Humans; Immunosuppression Therapy; Male; Middle Aged; Pneumonia, Viral; Postoperative Complications

Topics: Acyclovir; Blood Transfusion; Bone Marrow Transplantation; Cytomegalovirus Infections; gamma-Globulins; Humans; Immune Tolerance; Pneumonia, Viral

Topics: Acyclovir; Combined Modality Therapy; Cytomegalovirus Infections; Ganciclovir; Humans; Immunization, Passive; Pneumonia, Viral; Research Design

We studied the effect of cytomegalovirus immunoglobulin alone, or combined with ganciclovir, on the outcome of biopsy proven cytomegalovirus pneumonia after bone marrow transplantation. Treatment with cytomegalovirus immunoglobulin alone had no effect on the cytomegalovirus nor on clinical outcome. The combined treatment of cytomegalovirus immunoglobulin with ganciclovir suppressed the cytomegalovirus but all patients died because of ongoing pulmonary deterioration. These results may suggest that this combined treatment has limited value on the outcome of an established cytomegalovirus pneumonia after marrow transplantation.

Topics: Acyclovir; Adult; Antiviral Agents; Bone Marrow Transplantation; Cytomegalovirus; Cytomegalovirus Infections; Drug Therapy, Combination; Female; Ganciclovir; Humans; Immunization, Passive; Immunoglobulins; Immunoglobulins, Intravenous; Male; Middle Aged; Pneumonia, Viral; Postoperative Complications

Topics: Acyclovir; Antiviral Agents; Cytomegalovirus; Cytomegalovirus Infections; Ganciclovir; Humans; Kidney Transplantation; Liver Transplantation; Pneumonia, Viral

A study of ganciclovir used on compassionate grounds in the treatment of severe cytomegalovirus disease in iatrogenically immunosuppressed and AIDS patients in Europe, commenced in June 1985. The results of 120 iatrogenically immunosuppressed patients treated between May 1986 and February 1988 are reported. Patients presented with systemic infection (58), pneumonia (58), retinitis (9) and infection of other organs (9). There was a favourable clinical response (as rated by the local physician) in 40 of 57 (70%) evaluable patients with systemic infection, 38/58 (65%) with pneumonia, 6/8 (75%) with retinitis, and 4/9 (44%) of those with CMV infection of other organs. Of particular note was the relatively high rate of short term survival (up to 12 days post therapy) in bone marrow transplant patients with CMV pneumonia, 10/19 (52%), compared to the 10% survival reported by Shepp et al., (1985). Adverse events were frequent (26%) and haematological effects necessitated discontinuation of treatment in 13/120 (11%) patients. The use of ganciclovir should be confined, therefore, to the treatment of severe cytomegalovirus disease.

Topics: Acyclovir; Antiviral Agents; Cytomegalovirus Infections; Drug Therapy, Combination; Ganciclovir; Humans; Immunosuppression Therapy; Pneumonia, Viral

Chickenpox pneumonia can occur in as many as half of the varicella-zoster infections in adults. Although it usually exhibits a benign course, this complication can cause considerable morbidity and mortality in predisposed groups, including pregnant women and immunosuppressed patients. In these patients, the use of antiviral drugs, most notably acyclovir, has been shown to lessen the morbidity of varicella-zoster infections. Early diagnosis of lung involvement from the chest x-ray or arterial blood gas measurements, even in the absence of symptoms, is essential for optimum efficacy of drug therapy. The use of acyclovir in normal hosts continues to be debated, especially for prophylaxis, because of its potential for nephrotoxicity. Judicious use of acyclovir will reduce the overall mortality from this potentially fatal complication of varicella zoster virus infection.

Topics: Acyclovir; Adult; Chickenpox; Humans; Male; Pneumonia, Viral; Pulmonary Diffusing Capacity

Primary varicella-zoster (VZ) infection in eight children with perinatally acquired human immunodeficiency virus infection tended to be severe, prolonged, complicated by bacterial infections and in one case fatal. Depletion of CD4-lymphocytes was associated with chronic and recurrent VZ infection. In some patients convalescent VZ antibody titers were low and did not correlate with recurrence of VZ lesions. Administration of acyclovir appeared to be beneficial in suppressing VZ in human immunodeficiency virus-infected children with primary or recurrent VZ infection.

Topics: Acyclovir; Bacterial Infections; Chickenpox; Child; Child, Preschool; Female; Hepatitis, Viral, Human; HIV Infections; Humans; Infant; Male; Pneumonia, Viral; Recurrence

Topics: Acyclovir; Adult; Drug Utilization; Female; gamma-Globulins; Herpes Zoster; Humans; Male; Pneumonia, Viral; Surveys and Questionnaires

Cytomegalovirus (CMV) pneumonia causes significant morbidity and mortality in bone marrow transplant recipients and in patients with AIDS. 9-(1,3-Dihydroxy-2-propoxymethyl) guanine (ganciclovir) and phosphonoformic acid (PFA) demonstrate activity against CMV in human infections, although recurrent CMV and systemic drug toxicity frequently develop. We examined the efficacy of aerosol administration of antiviral agents against murine CMV (MCMV) infection. Animals were inoculated with MCMV intranasally and were treated with oral ganciclovir; with aerosolized ganciclovir, PFA, or ribavirin; or with buffer. MCMV in lung and salivary gland homogenates was quantified by plaque assay. Oral ganciclovir (200 mg/kg per day) reduced titers of MCMV in both tissues by greater than 95%. Aerosolized ganciclovir, 100 and 200 mg/kg per day, reduced lung titers of MCMV by 93% and 97%, respectively. Aerosolized PFA, 20 and 200 mg/kg per day, reduced lung titers of MCMV by 60% and 68%, respectively. Aerosolized ganciclovir and PFA inhibited replication of MCMV in salivary glands substantially less than did oral administration of either agent. Our results suggest that aerosol administration of antiviral agents can potently and selectively inhibit replication of MCMV in the lung.

Topics: Acyclovir; Administration, Oral; Aerosols; Animals; Antiviral Agents; Cytomegalovirus Infections; Disease Models, Animal; Female; Foscarnet; Ganciclovir; Mice; Mice, Inbred BALB C; Phosphonoacetic Acid; Pneumonia, Viral; Pregnancy; Pregnancy Complications, Infectious; Ribavirin

Topics: Acyclovir; Antiviral Agents; Cytomegalovirus Infections; Ganciclovir; Humans; Kidney Transplantation; Male; Middle Aged; Myocarditis; Pneumonia, Viral; Postoperative Complications

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adrenal Gland Diseases; Antiviral Agents; Chorioretinitis; Cytomegalovirus Infections; Encephalitis; Ganciclovir; Gastrointestinal Diseases; Humans; Pneumonia, Viral

Topics: Acyclovir; Antiviral Agents; Bone Marrow Transplantation; Combined Modality Therapy; Cytomegalovirus; Cytomegalovirus Infections; Ganciclovir; Humans; Immunization, Passive; Pneumonia, Viral; Postoperative Complications

To assess the efficacy of the combination of the antiviral agent ganciclovir (9-1,3 dihydroxy-2-propoxymethylguanine) and high-dose intravenous immune globulin for treating cytomegalovirus interstitial pneumonitis after allogeneic bone marrow transplantation.. Nonrandomized prospective trial of combined treatment with two drugs; findings in these patients were compared with those in control patients treated with either of the two drugs alone.. Medical, pediatric, and intensive care units of a tertiary-care cancer treatment center.. Consecutive cases of 10 patients in the study group and of 11 patients in a historical control group with evidence of cytomegalovirus pneumonia after bone marrow transplantation for treatment of leukemia or congenital immune deficiency.. Study Group (10 patients): ganciclovir, 2.5 mg/kg body weight, three times daily for 20 days, plus intravenous immune globulin, 500 mg/kg every other day for ten doses. Patients were then given ganciclovir, 5 mg/kg.d three to five times a week for 20 more doses, and intravenous immune globulin, 500 mg/kg twice a week for 8 more doses. Control Group (11 patients): ganciclovir alone (2 patients), 5 mg/kg twice a day for 14 to 21 days; cytomegalovirus hyperimmune globulin (5 patients), 400 mg/kg.d for 10 days; and intravenous immune globulin (4 patients), 400 mg/kg.d for 10 days.. Responses were observed in all patients treated with combination therapy; 7 of 10 patients were alive and well, and had no recurrence of disease at a median of 10 months after therapy. No therapeutic benefit was observed, and none of the 11 patients treated with either ganciclovir or intravenous immune globulin alone survived (P = 0.001 by Fisher exact test).. Ganciclovir, when combined with high-dose intravenous immune globulin, appears to have significantly altered the outcome of patients with cytomegalovirus pneumonia after allogeneic bone marrow transplantation.

Topics: Acyclovir; Adult; Bone Marrow Transplantation; Bronchoalveolar Lavage Fluid; Child; Combined Modality Therapy; Cytomegalovirus; Cytomegalovirus Infections; Female; Ganciclovir; Hematologic Diseases; Humans; Immunization, Passive; Infant; Macrophages; Male; Pneumonia, Viral; Postoperative Complications; Prospective Studies; Pulmonary Fibrosis

To determine if the combination of ganciclovir and intravenous cytomegalovirus immunoglobulin is effective in patients with cytomegalovirus pneumonia after bone marrow transplant.. Consecutive entry trial with treatment for a minimum of 14 days.. Consecutive sample of 25 patients with bone marrow transplants and cytomegalovirus pneumonia after transplant proven by open lung biopsy or bronchoalveolar lavage. Patients with abnormal renal function or concomitant infectious causes of pneumonia, or who were respirator-dependent at diagnosis, were not eligible.. Induction treatment consisted of ganciclovir, 2.5 mg/kg body weight every 8 hours for 14 days, and cytomegalovirus immunoglobulin, 400 mg/kg on days 1, 2, and 7 and 200 mg/kg on day 14. Ganciclovir dosage was adjusted for renal function. Patients who were improved but still symptomatic after 14 days were given maintenance treatment consisting of ganciclovir, 5 mg/kg once daily for an additional 14 days, and immunoglobulin, 200 mg/kg on day 21. Patients with clinical deterioration continued to receive induction doses. Ganciclovir therapy was discontinued if the neutrophil count fell below 500 X 10(6)/L for 2 consecutive days.. Serial tests of renal and liver function, blood counts, and viral cultures of blood, throat, and urine were obtained 3 times a week. Thirteen of twenty-five (52%) patients (95% CI, 31 to 72) survived the initial episode of pneumonia. Viral excretion ceased in 17 of 23 (74%) patients treated more than 96 hours. Proven recurrences of pneumonia occurred in 3 patients and possible recurrences in 2 after treatment was stopped. Three patients developed neutropenia during induction therapy and 6 patients during maintenance therapy.. Survival of 13 (52%) of 25 patients from the initial episode of cytomegalovirus pneumonia with the regimen of ganciclovir and cytomegalovirus immunoglobulin is significantly better (P less than 0.001) than the survival of 13 of 89 (15%) patients using previous antiviral regimens.

Topics: Acyclovir; Adolescent; Adult; Antibodies, Viral; Bone Marrow Transplantation; Child; Child, Preschool; Combined Modality Therapy; Cytomegalovirus; Cytomegalovirus Infections; Female; Ganciclovir; Humans; Immunization, Passive; Male; Middle Aged; Neutropenia; Pneumonia, Viral; Postoperative Complications; Prospective Studies; Pulmonary Fibrosis

Ganciclovir, also called DHPG, was administered intravenously to eight renal transplant recipients with life-threatening cytomegalovirus (CMV) pneumonitis. One patient died of pulmonary failure; a favorable clinical response was observed in the seven others. In one patient, CMV pneumonitis recurred but responded well to a second course of the drug. At no time was the immunosuppressive regimen completely stopped in the seven surviving patients. Six of them maintained a good renal function 1-11 months after treatment with ganciclovir. No toxic effect was detected during therapy. We conclude that ganciclovir appears to be a promising and effective treatment for CMV pneumonitis after renal transplantation.

Topics: Acyclovir; Adolescent; Adult; Antiviral Agents; Cytomegalovirus Infections; Female; Ganciclovir; Humans; Immunosuppressive Agents; Kidney Transplantation; Male; Middle Aged; Pneumonia, Viral

Of 13 patients with chickenpox pneumonia (12 of them adults) treated during 1979-87, 10 received antiviral drugs--nine acyclovir and one vidarabine. Three died despite intensive treatment. Serious secondary infections occurred in six cases. There were no clear indications that antiviral treatment altered the natural history of the condition. Acyclovir may at present be used too late in the course of chickenpox pneumonia to alter its outcome.

Topics: Acyclovir; Adolescent; Adult; Bacterial Infections; Chickenpox; Female; Humans; Lung; Male; Middle Aged; Pneumonia, Viral; Radiography; Vidarabine

Pneumonia is a rare but serious complication of varicella during pregnancy. Maternal mortality has been reported to be 41% with fetal and neonatal mortality at 65%. Treatment has included respiratory support and prophylactic antibiotics. Acyclovir has been prescribed with the intent to decrease the impact of the infection. It was added to the treatment protocol of two cases of varicella pneumonia in pregnancy. Despite the high maternal and perinatal mortality both pairs of patients and infants survived. Acyclovir did not appear to adversely influence the fetus, and may have contributed to the survival of mother and child.

Topics: Acyclovir; Adolescent; Adult; Chickenpox; Combined Modality Therapy; Drug Therapy, Combination; Female; Humans; Infant, Newborn; Pneumonia, Viral; Positive-Pressure Respiration; Pregnancy; Pregnancy Complications, Infectious

Six normal adults with varicella pneumonia were treated successfully with acyclovir sodium. All patients showed resolution of roentgenographic and arterial blood gas abnormalities. In addition, five of the six patients demonstrated thrombocytopenia that resolved with therapy. Intravenous acyclovir therapy should be instituted as early as possible in patients who may have varicella pneumonia.

Topics: Acyclovir; Adult; Aged; Aged, 80 and over; Chickenpox; Female; Humans; Injections, Intravenous; Male; Pneumonia, Viral

Topics: Acyclovir; Adolescent; Adult; Antiviral Agents; Child, Preschool; Cytomegalovirus Infections; Female; Ganciclovir; Heart Transplantation; Humans; Immunosuppression Therapy; Lung Transplantation; Male; Middle Aged; Opportunistic Infections; Ovarian Neoplasms; Pneumonia, Viral; Teratoma

Thirty-one immunocompromised patients with severe cytomegalovirus (CMV) disease were treated with intravenous ganciclovir. Twenty-one patients had received transplants--15 bone marrow recipients, five renal allograft recipients, and one liver transplant recipient--while the other ten were immunocompromised due to acquired immunodeficiency syndrome (six), hematologic malignancies (three), and systemic lupus erythematosus (one). They presented with one or more of the following syndromes: CMV pneumonitis (19), CMV of the gastrointestinal tract (six), CMV retinitis (seven), and CMV hepatitis (three). Seventeen (55%) of 31 patients demonstrated clinical improvement during ganciclovir therapy, with the best response seen in the transplant recipients. Viremia ceased in 14 (93.3%) of 15 patients after a mean of 4.7 days of therapy; viruria ceased in eight (53.3%) of 15 patients after a mean of 11 days of therapy. Ganciclovir plasma concentrations at a dosage of 2.5 mg/kg/three times a day were as follows: mean peak, 16.04 mumol/L; mean trough, 2.38 mumol/L. Neutropenia occurred in 11 (35%) of 31 patients and in nine (60%) of 15 bone marrow transplant recipients. We conclude that ganciclovir exerted an antiviral effect against CMV and may play a role in the treatment of CMV disease in patients with depressed immunity, especially bone marrow and organ transplant recipients.

Topics: Acyclovir; Adolescent; Adult; Antiviral Agents; Bone Marrow Transplantation; Child, Preschool; Cytomegalovirus Infections; Female; Ganciclovir; Humans; Immune System Diseases; Infant; Kidney Transplantation; Liver Transplantation; Male; Middle Aged; Pneumonia, Viral; Postoperative Complications

Topics: Acyclovir; Adult; Chickenpox; Humans; Middle Aged; Pneumonia, Viral

Topics: Acyclovir; Adult; Chickenpox; Humans; Male; Pneumonia, Viral

Topics: Acyclovir; Adult; Chickenpox; Female; Humans; Pneumonia, Viral; Pregnancy; Pregnancy Complications, Infectious

Topics: Acyclovir; Antiviral Agents; Bone Marrow Transplantation; Cytomegalovirus Infections; Ganciclovir; Humans; Pneumonia, Viral; Postoperative Complications

Topics: Acyclovir; Adult; Cytomegalovirus Infections; Female; Humans; Interferon Type I; Pneumonia, Viral

Eight immunosuppressed homosexual men with cytomegalovirus viremia--seven with serious bilateral retinitis, one with colitis in addition to retinitis, and one with pneumonitis only--were treated with a new acyclovir derivative, 9-(1,3-dihydroxy-2-propoxymethyl) guanine, which has excellent in-vitro activity against cytomegalovirus. All patients had virologic and clinical improvement, but substantial leukopenia developed in three patients. Both clinical relapses and viral relapses occurred frequently, usually within 30 days after cessation of treatment. 9-(1,3-Dihydroxy-2-propoxymethyl) guanine represents the first clinically and virologically effective agent for the treatment of cytomegalovirus disease, but more effective and less toxic therapeutic regimens for both acute and chronic use must be developed.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; Agranulocytosis; Antiviral Agents; Colitis; Cytomegalovirus Infections; Ganciclovir; Hodgkin Disease; Homosexuality; Humans; Male; Pneumonia, Viral; Retinitis

The drug 9-(1,3-dihydroxy-2-propoxymethyl)-guanine (DHPG) was used to treat serious cytomegalovirus infections in 26 patients with underlying immunodeficiency (including 22 with the acquired immunodeficiency syndrome). In 17 of 22 patients in whom cytomegalovirus was virologically confirmed, clinical status improved or stabilized, although in 4 of them the status of some affected organs deteriorated or did not improve. Fourteen of 18 patients with adequate viral-culture data had clearing of cytomegalovirus from all cultured sites. Patients with cytomegalovirus pneumonia often responded poorly; four of seven died before completing 14 days of DHPG therapy. The condition of 11 of 13 patients with cytomegalovirus retinitis and 5 of 8 with gastrointestinal disease stabilized or improved. However, clinical and virologic relapses occurred in 11 of 14 patients (79 percent) when DHPG was discontinued. Neutropenia was the most frequent adverse reaction. We conclude that DHPG offers promise for the therapy of severe cytomegalovirus infections in some immunodeficient patients, but further study will be necessary to establish its efficacy and safety.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; Antiviral Agents; Child, Preschool; Cytomegalovirus; Cytomegalovirus Infections; Drug Evaluation; Female; Ganciclovir; Gastrointestinal Diseases; Humans; Immune Tolerance; Immunologic Deficiency Syndromes; Infant; Male; Middle Aged; Pneumonia, Viral; Recurrence; Retinitis

Bone marrow transplantation was performed between IV/82 and X/85 in 64 patients with acute leukemia (n = 36), chronic myelogenous leukemia (CML; n = 13), severe aplastic anemia (n = 12), and neuroblastoma stage IV (n = 3). Of these patients 57 received allogeneic marrow from HLA-ABCDR identical, MLC-negative sibling donors. Six transplants were performed with syngenic marrow and one with autologous marrow. Of the 64 patients 48 survived 40-1,250 days after transplantation, resulting in a survival rate (SR) of 75% and a survival probability (SP) of 71%. Of the 36 patients suffering from acute leukemia (SR = 64%, SP = 51%), patients with acute myelogenous leukemia (AML) in first complete remission (n = 11; SR = 81%, SP = 76%), as well as patients with acute lymphatic leukemia (ALL) in 1st to 4th complete remission at the time of transplantation (n = 14; SR = 81%, SP = 76%) show a favorable prognosis. A poor survival rate was seen for patients with AML when transplanted in second or partial remission (1/5; SR = 20%), as well as for patients suffering from ALL and transplanted during relapse or partial remission (1/6; SR = 16%). Of 13 patients suffering from CML 12 survived the transplantation free of relapse (SR = 93%, SP = 92%), and one patient died from varicella zoster pneumonia. Of the transplanted patients with severe aplastic anemia, 12 of 13 are surviving with complete hematologic reconstitution; one patient, however, died on day 10 from a sepsis. In our patient group, the SR as well as the SP has been improved through changes in the irradiation protocol concomitant with prophylactic application of anti-CMV hypergammaglobulin, as well as through additional oral medication of Azyklovir. The 41 patients (BMT No. 7-47) with total body irradiation at one time show an SR of 44% and an SP of 41%. The following 46 patients (BMT No. 48-93) have reached an SR of 83% and an SP of 74% under the regimen of fractionated total body irradiation, plus prophylaxis with anti-CMV hypergammaglobulin and Azyklovir. Within this group, no fatal CMV pneumonia was encountered as opposed to six patients lost from CMV pneumonia in the first group.

Topics: Acyclovir; Adolescent; Adult; Anemia, Aplastic; Bone Marrow Transplantation; Child; Child, Preschool; Combined Modality Therapy; Cytomegalovirus Infections; Graft vs Host Disease; Humans; Immunization, Passive; Leukemia; Leukemia, Lymphoid; Leukemia, Myeloid; Leukemia, Myeloid, Acute; Middle Aged; Neoplasm Staging; Neuroblastoma; Pneumonia, Viral; Postoperative Complications

Topics: Acyclovir; Adolescent; Adult; Antiviral Agents; Bone Marrow Transplantation; Cytomegalovirus Infections; Drug Therapy, Combination; Female; Ganciclovir; Humans; Male; Methylprednisolone; Neutropenia; Pneumonia, Viral; Postoperative Complications

Ten marrow transplant recipients with biopsy-proven cytomegalovirus pneumonia were treated with the acyclic nucleoside analog 9-[2-hydroxy-1-(hydroxymethyl) ethoxymethyl]guanine (BW B759U). Viruria and viremia ceased after 4 days of treatment in all patients with cultures initially positive from these sites. Cytomegalovirus was eliminated from respiratory secretions after a median of 8 days. Despite this antiviral effect, only one patient survived the pneumonia. Quantitative cultures of lung tissue before and after treatment confirmed that therapy with BW B759U was associated with substantial antiviral activity, with a mean decrease in viral titers of more than 99.99% after treatment. Neutropenia developed in three patients when mean peak and trough plasma levels exceeded 50 and 10 mu mol/L, respectively, but no other toxicity was seen. BW B759U is the first antiviral agent showing consistent activity against cytomegalovirus in vivo, and it should be evaluated in the earlier management of cytomegalovirus infections after marrow transplantation and in serious cytomegalovirus infections in other immunocompromised patients.

Topics: Acyclovir; Adolescent; Adult; Antiviral Agents; Bone Marrow Transplantation; Child, Preschool; Cytomegalovirus Infections; Female; Ganciclovir; Humans; Kidney Diseases; Lung; Male; Neutropenia; Pneumonia, Viral; Postoperative Complications; Tissue Distribution

Primary varicella-zoster virus infection (chickenpox) in immunocompromised children is frequently associated with visceral dissemination and attendant high mortality. Eight children with malignant neoplasms and chickenpox with visceral involvement (seven with hepatitis, three with pneumonitis, two with encephalitis, and two with coagulopathy) were initially treated with intravenously (IV) administered vidarabine but demonstrated progressive visceral involvement. After three days of vidarabine treatment (two days for two patients), seven had rising serum SGPT levels, all eight had pneumonitis, seven had deteriorating mental status and/or seizure activity, and six had worsening coagulopathy. Vidarabine was replaced by IV administered acyclovir, with subsequent improvement in all but the most severely ill patient who died. Seven of eight patients recovered completely; no side effects of acyclovir were observed. This clinical experience suggests that acyclovir may be more effective than vidarabine in disseminated varicella infection; however, controlled clinical trials will be necessary to establish this.

Topics: Acyclovir; Blood Coagulation Disorders; Chickenpox; Child; Encephalitis; Female; Hepatitis, Viral, Human; Humans; Leukemia, Lymphoid; Lymphatic Diseases; Male; Pneumonia, Viral; Vidarabine

Topics: Acyclovir; Adult; Chickenpox; Humans; Male; Pneumonia, Viral

Topics: Acyclovir; Adult; Age Factors; Chickenpox; Humans; Injections, Intravenous; Male; Pneumonia, Viral

Topics: Acyclovir; Bone Marrow Transplantation; Combined Modality Therapy; Cytomegalovirus Infections; Humans; Injections, Intravenous; Interferon Type I; Leukemia; Pneumonia, Viral

Topics: Acyclovir; Adult; Chickenpox; Female; Humans; Pneumonia, Viral

A murine model of lethal cytomegalovirus pneumonia following intratracheal inoculation of normal mice was used to study the effects of antiviral therapy with acyclovir (ACV) and interferon (IF), alone and in combination. Five hundred units of fibroblast IF administered intraperitoneally the day prior to infection and 100 mg/kg/day ACV administered intraperitoneally for 7 days beginning within 3 h of infection were both highly effective in preventing mortality. Compared to the condition of untreated animals, each drug reduced viral titers in lung homogenates of the treated animals 7 days after infection. However ACV, unlike IF, diminished viral growth in the lung at 14 days, prevented viral dissemination to spleens and salivary glands in some animals, and significantly protected animals from reactivation of virus during immunosuppression 2 months after infection. The combination of ACV + IF offered no increased antiviral activity compared to ACV alone and failed to protect animals from reactivation. In these experiments the overall antiviral activity of ACV alone was greater than IF and the combination of ACV + IF.

Topics: Acyclovir; Animals; Cytomegalovirus Infections; Female; In Vitro Techniques; Interferons; Mice; Mice, Inbred Strains; Pneumonia, Viral; Rodent Diseases; Virus Activation

A case of neonatal herpes simplex infection is discussed that presented as pneumonia, with subsequent development of skin lesions. The virus was isolated from skin scrapings. In spite of treatment with vidarabine, skin lesions continued to develop, and central nervous system involvement occurred. Acyclovir therapy led to prompt resolution of symptoms.

Topics: Acyclovir; Female; Herpes Simplex; Humans; Infant, Newborn; Pneumonia, Viral; Radiography; Respiratory Distress Syndrome, Newborn; Simplexvirus; Skin

Thirteen recipients of bone marrow transplants were given high-dose acyclovir and alpha-interferon (Cantell interferon) for the treatment of biopsy-proven cytomegaloviral pneumonia. Three patients survived. Doses of acyclovir between 500 and 1,000 mg/m2 of body surface area (peak plasma levels, 7-86 micrograms/ml) and doses of interferon between 2 X 10(4) and 40 X 10(4) units/kg per day (peak serum levels, 5-608 units/ml) were given. No consistent antiviral effect was seen despite the large doses employed. Possible marrow toxicity associated with this regimen occurred in five patients, neurologic symptoms in two, and nephrotoxicity in one. Thus, treatment with high-dose acyclovir plus alpha-interferon was moderately toxic but ineffective against cytomegaloviral pneumonia after bone marrow transplantation.

Topics: Acyclovir; Bone Marrow Transplantation; Combined Modality Therapy; Cytomegalovirus Infections; Humans; Interferon Type I; Kidney Diseases; Nervous System Diseases; Pneumonia, Viral

Topics: Acyclovir; Adult; Chickenpox; Female; Humans; Keratitis, Dendritic; Male; Pneumonia, Viral

Topics: Acyclovir; Cytomegalovirus Infections; Guanine; Heart Transplantation; Humans; Immunosuppression Therapy; Male; Middle Aged; Pneumonia, Viral

Cytomegalovirus pneumonia is a serious complication of marrow transplantation, with a 90 percent fatality rate. Acyclovir, a new antiviral agent with variable in vitro activity against cytomegalovirus, was administered to eight marrow transplant patients with biopsy-proven cytomegalovirus pneumonia; one patient survived. Doses were between 400 and 1200 mg/m2 and peak plasma levels between 47 and 316 microM were attained. Possible marrow toxicity occurred in three patients, and mild neurotoxicity occurred in one. High-dose acyclovir had mild toxicity but was not effective as treatment for cytomegalovirus pneumonia after marrow transplantation.

Topics: Acyclovir; Adolescent; Adult; Antibodies, Viral; Antiviral Agents; Bone Marrow Cells; Bone Marrow Transplantation; Child; Cytomegalovirus; Cytomegalovirus Infections; Drug Evaluation; Female; Guanine; Humans; Lymphocyte Activation; Male; Nervous System; Pneumonia, Viral

Topics: Acyclovir; Adult; Antiviral Agents; Chickenpox; Female; Guanine; Humans; Pneumonia, Viral