acyclovir and Postoperative-Complications

The aim of this study was to define the typical pattern for varicella zoster virus (VZV) reactivation in delayed facial palsy (DFP) after stapedectomy for otosclerosis.. Review of the relevant literature, personal casistics, and case-report.. In total, 48 cases of DFP after stapes surgery have been described so far, including the reported case with exclusive manifestation of atypical Ramsay Hunt syndrome (RH); in the personal series of 1253 stapedectomies, DFP occurred in only one case (0.08%). Complete DFP (House-Brackmann grade VI) rapidly developed 12 days after surgery; RH appeared 2 days later, confirming the role of VZV. The DFP started improving after 8 weeks and completely recovered 6 months later.. Acute otalgia prior to DFP should raise the suspicion of VZV reactivation. Atypical RH is the most frequent pattern that occurs in DFP after stapedectomy.

Topics: Acyclovir; Antiviral Agents; Facial Nerve; Facial Paralysis; Female; Herpes Zoster Oticus; Herpesvirus 3, Human; Humans; Incidence; Middle Aged; Otosclerosis; Postoperative Complications; Retrospective Studies; Stapes Surgery; Time Factors; Treatment Outcome; Virus Activation; Zoster Sine Herpete

A 25-year-old woman presented with redness, pain, and diminution of vision that occurred 2 weeks after microkeratome-assisted laser in situ keratomileusis (LASIK). On presentation, corneal edema, Descemet membrane folds, keratic precipitates, stromal infiltrates, and flap necrosis were observed. Delayed post-LASIK microbial keratitis was diagnosed. The patient had no history of ocular herpes. Culture and scraping showed no organisms. Immunofluorescence stain was positive for the herpes simplex virus antigen. The patient was started on oral valacyclovir, and progress was monitored through serial clinical photographs and anterior segment optical coherence tomography. Resolution began within 3 days of initiating treatment and was complete in 4 weeks.

Topics: Acyclovir; Administration, Oral; Adult; Antigens, Viral; Antiviral Agents; Corneal Stroma; Female; Humans; Keratitis, Herpetic; Keratomileusis, Laser In Situ; Myopia; Necrosis; Postoperative Complications; Simplexvirus; Surgical Flaps; Tomography, Optical Coherence; Uveitis, Anterior; Valacyclovir; Valine

Herpes simplex virus (HSV) prophylaxis may be underutilized in cosmetic surgery at a time when cosmetic procedures are increasing. Our goal is to review the data regarding HSV prophylaxis in order to remind cosmetic surgeons when to consider adding this regimen to their patient perioperative care.

Topics: Acyclovir; Antiviral Agents; Dermabrasion; Drug Utilization; Herpes Labialis; Herpes Simplex; Humans; Postoperative Complications; Simplexvirus; Surgery, Plastic

Cytomegalovirus infection is a major cause of morbidity and mortality in solid-organ transplant recipients, in terms of cytomegalovirus disease itself and the associated outcomes of organ rejection and death. This review focuses on recent literature concerning prevention and treatment of cytomegalovirus disease in this population.. Two major strategies for the prevention of cytomegalovirus infection in solid-organ transplant recipients - preemptive and prophylactic treatment - are reviewed. Both strategies result in a lower incidence of cytomegalovirus disease when compared to a 'wait and treat' approach, and are generally considered cost-effective. Neither prophylaxis nor preemption has yet been shown to be superior. Newer trials are also reviewed, which are beginning to evaluate protocols of preemption or prophylaxis representative of current practice, as well as to explore alternative dosing strategies, the benefits of cytomegalovirus immune globulin, and the potential benefit of a longer course of prophylaxis. Concerns for the selection of ganciclovir-resistant strains of cytomegalovirus are also addressed.. The consensus is that there is benefit for the treatment of solid-organ transplant patients with an antiviral agent before clinical evidence of cytomegalovirus disease. So far, there has been no demonstration of the superiority of prophylactic or preemptive regimens, nor has the exact nature and dosing of the oral antiviral agent of choice been established.

Topics: Acyclovir; Antiviral Agents; Clinical Trials as Topic; Cytomegalovirus; Cytomegalovirus Infections; Drug Resistance, Viral; Ganciclovir; Humans; Immunoglobulins; Organ Transplantation; Postoperative Complications

Cytomegalovirus (CMV) has major consequences after allogeneic stem cell and solid organ transplantation. CMV may cause significant morbidity and mortality, and monitoring to detect reactivation to reduce disease or management of end organ disease is associated with increased resource utilization. Two other members of the beta-herpesvirus family, human herpesvirus (HHV) type 6 and HHV-7, are increasingly recognized as important pathogens in transplant recipients, either by direct infection (e.g., encephalitis, hepatitis, or pneumonitis) or via interaction with CMV. In addition to direct effects of CMV infection, such indirect effects as an increased risk for bacterial and fungal infections or impaired graft acceptance and function are important research topics. Diagnosis and treatment of CMV infection is currently more advanced than for HHV-6 and HHV-7.

Topics: Acyclovir; Antiviral Agents; Betaherpesvirinae; Clinical Trials as Topic; Cytomegalovirus Infections; Hematopoietic Stem Cell Transplantation; Herpesviridae Infections; Herpesvirus 6, Human; Herpesvirus 7, Human; Humans; Organ Transplantation; Postoperative Complications; Treatment Outcome; Valacyclovir; Valine

Cytomegalovirus (CMV) infection and disease, with its extensive direct and indirect consequences, adds considerably to the cost of patient management in both solid organ and bone marrow transplantation. Antiviral prophylaxis for CMV infection can offer cost advantages over preemptive therapy and "wait-and-treat" approaches. Valacyclovir has demonstrated efficacy for CMV prophylaxis in renal, heart, and bone marrow transplantation and is cost-effective when compared with placebo in renal transplant recipients at high risk of CMV infection. In reducing CMV infection and disease, valacyclovir prophylaxis appears to be associated with reductions in indirect effects of CMV (acute graft rejection, other opportunistic infections) and, if these effects are considered, the potential exists for even greater savings to be made with valacyclovir therapy. Benefits of valacyclovir in transplantation extend beyond CMV to other herpesviruses and may be increased in some clinical situations by prolonging prophylaxis beyond 3 months.

Topics: Acyclovir; Administration, Oral; Antiviral Agents; Bone Marrow Transplantation; Cost-Benefit Analysis; Cytomegalovirus Infections; Graft Rejection; Health Care Costs; Heart Transplantation; Humans; Kidney Transplantation; Opportunistic Infections; Postoperative Complications; Prodrugs; Time Factors; Valacyclovir; Valine

A meta-analysis of 12 randomized trials (1574 patients) examined herpesvirus and related outcomes following organ transplantation over a range of acyclovir exposures (including valacyclovir). Overall, cytomegalovirus (CMV) infection (odds ratio [OR], 0.44; 95% confidence interval [CI], 0.34-0.57; P<.001), CMV disease (OR, 0.41; 95% CI, 0.31-0.54; P<.001), death (OR, 0.60; 95% CI, 0.40-0.90; P=.01), opportunistic infection (OR, 0.70; 95% CI, 0.53-0.91; P=.009), acute graft rejection (OR, 0.67; 95% CI, 0.52-0.86; P<.001), herpes simplex virus disease (OR, 0.17; 95% CI, 0.12-0.24; P<.001), and varicella-zoster virus disease (OR, 0.06; 95% CI, 0.01-0.25; P<.001) were significantly reduced. Increased acyclovir exposure influenced more end points: Maximum efficacy resulted from valacyclovir (8 g/day). Increasing acyclovir exposure to that achieved with valacyclovir extends benefits of prophylaxis to include impact on graft rejection and opportunistic infections.

Topics: Acyclovir; Antiviral Agents; Cytomegalovirus Infections; Dose-Response Relationship, Drug; Graft Rejection; Herpes Simplex; Humans; Odds Ratio; Opportunistic Infections; Organ Transplantation; Postoperative Complications; Prodrugs; Randomized Controlled Trials as Topic; Treatment Outcome; Valacyclovir; Valine

Controlled trials suggest that acyclovir/valacyclovir can provide significant clinical benefits when used for prophylaxis in the immunocompromised host. These findings implicate herpesvirus(es) in the pathogenesis of complex medical conditions, including graft rejection and death. However, it is not known which of the 8 herpesviruses are important under particular circumstances. Prime candidates for triggering adverse outcomes are cytomegalovirus (CMV) in solid organ transplant recipients (causing rejection), CMV and human herpesvirus type 6 (HHV-6) in bone marrow transplant patients (causing marrow suppression), and herpes simplex virus, HHV-6, and CMV in AIDS patients (accelerating the rate of human immunodeficiency virus disease progression and death). Other diseases that may have a herpesvirus component or trigger susceptible antiviral agents include atherosclerosis and multiple sclerosis. In the future, clinicians should be alert to novel findings of randomized trials that may provide insight into the pathogenesis of these diseases and the contributions made by clinically silent herpesvirus infections.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Antiviral Agents; Arteriosclerosis; Bone Marrow Transplantation; Clinical Trials as Topic; Disease Progression; Herpesviridae; Herpesviridae Infections; Humans; Multiple Sclerosis; Organ Transplantation; Postoperative Complications; Valacyclovir; Valine

Treatment options for peripheral facial palsy (PFP) are an often discussed problem in neurologic practice. Following a short description of the complex anatomy of the seventh cranial nerve we therefore review possible etiologies in the context of leading clinical signs, with idiopathic PFP or Bell's palsy (BP) being most frequent. A rather typical clinical course of BP allows to focus differential diagnostic workup predominantly on the rapid identification of treatable infections such as with Herpes zoster or Borrelia burgdorferi. Neuroimaging studies are needed only in case of trauma, with slowly developing PFP or in the presence of associated signs and symptoms. As BP is characterized by an overall high rate of spontaneous recovery, major emphasis has to be put on avoiding complications by protecting the eye. Meta-analysis of four randomized controlled studies suggests a marginal benefit of steroids concerning eventual achievement of complete recovery. Beneficial effects of a combination of acyclovir and prednisone have also been claimed. While such therapies may be considered in patients with a presumptive bad prognosis, more general recommendations on medical treatment of BP will have to await further trials.

Topics: Acyclovir; Adrenal Cortex Hormones; Anti-Inflammatory Agents; Antiviral Agents; Clinical Trials as Topic; Diabetic Neuropathies; Diagnosis, Differential; Diagnostic Imaging; Eye Injuries; Facial Nerve; Facial Nerve Injuries; Facial Paralysis; Herpes Simplex; Humans; Neoplasms; Pons; Postoperative Complications; Prednisone; Prognosis; Virus Diseases

Topics: Acyclovir; Antiviral Agents; Clinical Trials as Topic; Cytomegalovirus Infections; Ganciclovir; Humans; Kidney Transplantation; Postoperative Complications; Valacyclovir; Valine

Despite advances in prophylaxis and treatment, cytomegalovirus (CMV) infection remains a significant problem in the solid-organ transplant recipient. In addition to the clinical manifestations of CMV infection, there is also the immunosuppressive effect of CMV, which confers increased risk for fungal and other opportunistic infections. In reference to heart transplant recipients, the possible connection between CMV infection and rejection or CMV infection and allograft vasculopathy are areas of active research. Recent diagnostic advances, such as the CMV antigenemia assay and CMV-DNA detection by polymerase chain reaction or direct hybrid capture, have enabled early detection and monitoring of CMV infection and have raised the question of the implications of asymptomatic viremia. A wide variety of prophylactic strategies have been evaluated in heart and other solid-organ transplant recipients, including antiviral agents, globulin preparations, combinations of these therapies, and pre-emptive treatment strategies based on early detection or identification of a high-risk subset of patients. Many of these regimens have demonstrated efficacy in certain groups of patients, but a consensus has yet to emerge in terms of a single preferable strategy. Future advances on the horizon include the development of newer antiviral agents and a vaccine.

Topics: Acyclovir; Antiviral Agents; Cytomegalovirus Infections; Ganciclovir; Graft Rejection; Heart Transplantation; Humans; Immunization, Passive; Immunoglobulins; Immunoglobulins, Intravenous; Opportunistic Infections; Postoperative Complications

Topics: Acyclovir; Antilymphocyte Serum; Antiviral Agents; Communicable Diseases; Cytomegalovirus Infections; Humans; Immunosuppression Therapy; Immunosuppressive Agents; Muromonab-CD3; Postoperative Complications; Syndrome; Transplantation Immunology

Topics: Acyclovir; Cytomegalovirus; Cytomegalovirus Infections; Ganciclovir; Humans; Liver Transplantation; Postoperative Complications; Virus Replication

The epidemiology of infections associated with orthotopic liver transplantation is summarized herein, and approaches to prophylaxis are outlined. Infection is a major complication following orthotopic liver transplantation, and more than half of transplant recipients develop at least one infection. The risk of infection is highest in the first month after transplantation, and the most common pathogens are bacteria and cytomegalovirus (CMV). Bacterial infections usually occur in the first month, arise in the abdomen, and are caused by aerobes. The peak incidence of CMV infection is late in the first month and early in the second month after transplantation. CMV syndromes include fever and neutropenia, hepatitis, pneumonitis, gut ulceration, and disseminated infection. Other significant problems are Candida intraabdominal infection, Herpes simplex mucocutaneous infection or hepatitis, adenovirus hepatitis, and Pneumocystis carinii pneumonia. Prophylaxis of infection in liver transplant recipients has not been well-studied. Several different regimens of parenteral, oral absorbable, and/or oral non-absorbable antibiotics active against bacteria and yeast have been used at various centers, but no randomized controlled trials have been conducted. Selective bowel decontamination appears to be a promising approach to the prevention of bacterial and Candida infections, while oral acyclovir may be a relatively convenient and effective agent for CMV prophylaxis.

Topics: Acyclovir; Anti-Bacterial Agents; Bacterial Infections; Cytomegalovirus Infections; Humans; Infections; Liver Transplantation; Mycoses; Parasitic Diseases; Pneumonia, Pneumocystis; Postoperative Complications; Premedication; Risk Factors; Time Factors; Virus Diseases

Although infection with cytomegalovirus (CMV) continue to be recognized relatively frequently after organ transplantation, a decrease in their severity has been described with the use of newer immunosuppressive regimens. In particular whereas antithymocyte globulin was associated with an increase in morbidity and mortality, the use of cyclosporin A has resulted in a decrease in the frequency of symptomatic infections. Several sources of CMV infection in transplant recipients are: immunosuppression secondary to drug therapy can result in reactivation of the latent infection present before transplantation; blood transfusion, either pretransplant red blood cell transfusion or blood required at the time of surgery can also result in transmission of CMV and primary infection; the transplanted kidney or heart, particularly in situations in which seropositive organs are transmitted into seronegatives can serve as the vehicle for transmission. Recent data suggest that transmission of organ donor CMV can occur even in seropositive recipients. The clinical manifestations of CMV infection in transplant recipients range from asymptomatic or mild mononucleosis syndromes to severe infection. It is generally accepted that primary infections in patients who were seronegative before transplantation are more severe than reactivated infections. Involvement of multiple organ systems has been common, with retinitis, pneumonitis and gastrointestinal manifestations occurring most commonly. A specific CMV infection of the kidney has also been described but its manifestations are variable. The association of CMV infections with rejection remains controversial in human transplantation.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Acyclovir; Antiviral Agents; Cytomegalovirus Infections; Ganciclovir; Heart Transplantation; Heart-Lung Transplantation; Humans; Immunosuppression Therapy; Interferons; Kidney Transplantation; Liver Transplantation; Lung Transplantation; Postoperative Complications; Recurrence; Vaccination

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

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

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

Topics: Acyclovir; Bone Marrow Transplantation; Cytomegalovirus; Cytomegalovirus Infections; Heart Transplantation; Humans; Infant, Newborn; Interferon Inducers; Interferon Type I; Kidney Transplantation; Postoperative Complications; Vidarabine

Corneal transplantation is a common surgical intervention for restoring vision loss due to corneal damages. However, for cultural reasons, there is a huge shortage of donor corneas in China. Acellular porcine corneal stromas (APCSs) can be used as corneal substitutes in lamellar keratoplasty for corneal ulcers. This study was conducted to analyze the results of APCS use for herpes simplex keratitis (HSK).. The study involved HSK patients who underwent keratoplasty with APCSs from February 2016 to October 2017 in the second affiliated hospital of Zhejiang University. Patient data were collected at 7 days, 1 month, 3 months, 6 months, and at the last follow-up (7-25 months) postoperative. The corneal transparency, neovascularization, visual acuity, and graft stability were observed.. Thirteen patients with HSK including five patients with corneal perforation were included in this study, nine patients underwent deep anterior lamellar keratoplasty (DALK) and five perforation patients underwent double lamellar keratoplasty. There were nine men and four women with an average age of 62.5 ± 5.6 years old (ranging from 52 to 70 years old). The mean postoperative follow-up duration was 15.1 ± 5.8 months (ranging from 7 to 25 months). At the last visit, visual acuity improved in nine patients (69.2%) compared with preoperative (P = 0.008).The grafts of seven individuals (53.8%) were completely transparent or slightly opaque; their corneal transparency score had improved significantly compared with before the surgery (P = 0.010). Various degrees of neovascularization were present in 11 of the 13 patients (84.6%), most neovascularization gradually stabilized. Graft dissolution occurred in three eyes (23.1%) during the observation period, two underwent regrafting, the other one became stable after treatment. Three patients underwent second allograft transplantation, two of which encountered APCS graft dissolution and one of the patients requested a human donor allograft transplantation due to transparency issues despite the absence of adverse issues.. Acellular porcine corneal stroma seems to be effective in the treatment of HSK and can be used in HSK with corneal perforation by using double lamellar keratoplasty in an emergency.

Topics: Acyclovir; Aged; Animals; Antiviral Agents; Corneal Neovascularization; Corneal Opacity; Corneal Perforation; Corneal Stroma; Corneal Transplantation; Female; Humans; Keratitis, Herpetic; Male; Middle Aged; Ophthalmic Solutions; Postoperative Complications; Swine; Transplantation, Heterologous; Treatment Outcome

The aim of this study was to determine the cost impact of four different strategies for prevention of cytomegalovirus (CMV) disease after renal transplantation.. Hospitalization data and medical resource utilization data were prospectively collected alongside two randomized trials. In the first trial, the patients were randomized to 3-month prophylaxis with either oral ganciclovir (1 g t.i.d., n = 36) or valacyclovir (2 g q.i.d., n = 35), and to the control group (n = 12) managed by deferred therapy. In the second trial, the patients were randomly assigned to 3-month valacyclovir prophylaxis (n = 34) or preemptive therapy with valganciclovir (900 mg b.i.d. for a minimum of 14 days, n = 36) for significant CMV DNAemia. The cost analysis involved all real costs directly related to CMV during the first year after renal transplantation.. The mean CMV-associated costs per patient were EUR 4,581, 2,577, 4,968, and 8,050 in patients in the ganciclovir, valacyclovir, preemptive, and deferred therapy groups, respectively (p < 0.001). Valacyclovir prophylaxis was significantly less expensive than any other regimen. The cost of one episode of CMV disease was EUR 7,510 per patient. Due to excessive incidence of CMV disease, deferred therapy was the most expensive strategy (p < 0.001).. Valacyclovir prophylaxis is less expensive strategy compared with any other regimen.

Topics: Acyclovir; Adult; Antiviral Agents; Cytomegalovirus Infections; Economics, Pharmaceutical; Female; Ganciclovir; Graft Survival; Humans; Kidney Transplantation; Male; Middle Aged; Postoperative Complications; Prospective Studies; Valacyclovir; Valine

Maribavir is an oral benzimidazole riboside with potent in vitro activity against cytomegalovirus (CMV), including some CMV strains resistant to ganciclovir. In a randomized, double-blind, multicenter trial, the efficacy and safety of prophylactic oral maribavir (100 mg twice daily) for prevention of CMV disease were compared with oral ganciclovir (1000 mg three times daily) in 303 CMV-seronegative liver transplant recipients with CMV-seropositive donors (147 maribavir; 156 ganciclovir). Patients received study drug for up to 14 weeks and were monitored for CMV infection by blood surveillance tests and also for the development of CMV disease. The primary endpoint was Endpoint Committee (EC)-confirmed CMV disease within 6 months of transplantation. In a modified intent-to-treat analysis, the noninferiority of maribavir compared to oral ganciclovir for prevention of CMV disease was not established (12% with maribavir vs. 8% with ganciclovir: event rate difference of 0.041; 95% CI: -0.038, 0.119). Furthermore, significantly fewer ganciclovir patients had EC-confirmed CMV disease or CMV infection by pp65 antigenemia or CMV DNA PCR compared to maribavir patients at both 100 days (20% vs. 60%; p < 0.0001) and at 6 months (53% vs. 72%; p = 0.0053) after transplantation. Graft rejection, patient survival, and non-CMV infections were similar for maribavir and ganciclovir patients. Maribavir was well-tolerated and associated with fewer hematological adverse events than oral ganciclovir. At a dose of 100 mg twice daily, maribavir is safe but not adequate for prevention of CMV disease in liver transplant recipients at high risk for CMV disease.

Topics: Acyclovir; Administration, Oral; Antiviral Agents; Benzimidazoles; Cytomegalovirus Infections; Dose-Response Relationship, Drug; Double-Blind Method; Drug Administration Schedule; Female; Follow-Up Studies; Ganciclovir; Graft Rejection; Graft Survival; Humans; Liver Transplantation; Male; Postoperative Complications; Prospective Studies; Ribonucleosides; Risk Assessment; Treatment Outcome

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

In a randomized study, we observed a higher incidence of biopsy-proven acute rejection with pre-emptive valganciclovir therapy as compared with valacyclovir prophylaxis for prevention of cytomegalovirus (CMV) disease after renal transplantation (RTx). Persistence of the virus within the allograft could stimulate the alloimmune response. The aim of our study was to evaluate intragraft CMV infection in patients randomized to the trial.. RTx recipients at risk of CMV were randomized to pre-emptive therapy with valganciclovir (n=36) for significant CMV viraemia (> or =2,000 copies/ml by quantitative PCR in whole blood samples) or 3-month prophylaxis with valacyclovir (n=34). Renal biopsies performed during 12 months post-RTx were analysed for the presence of CMV by real-time PCR and immunohistochemical staining.. A total of 35 patients (59 biopsies) in the pre-emptive group and 31 patients (57 biopsies) with valacyclovir prophylaxis had > or =1 biopsy specimen with sufficient material for intragraft CMV determination. Cumulative incidence of intragraft CMV infection was 14% and 7% (P=0.315) with pre-emptive therapy and prophylaxis, respectively. Patients at risk for primary CMV infection (CMV serological donor-positive and recipient-negative) were at higher risk for intragraft CMV infection (40% versus 5%; P=0.008). CMV viraemia at the time of biopsy was associated with the presence of CMV within the allograft (P<0.001).. During the first year after RTx, the incidence of intragraft CMV infection was relatively low with comparable rates in patients managed by pre-emptive valganciclovir therapy and valacyclovir prophylaxis.

Topics: Acyclovir; Antiviral Agents; Cytomegalovirus; Cytomegalovirus Infections; Double-Blind Method; Ganciclovir; Graft Rejection; Humans; Kidney Transplantation; Postoperative Complications; Premedication; Risk Factors; Transplantation, Homologous; Treatment Outcome; Valacyclovir; Valganciclovir; Valine; Viremia

To investigate the long-term effect of oral acyclovir administered during the first 6 months after penetrating keratoplasty (PK) for herpetic eye disease (HED).. A 5-year follow-up was undertaken for a patient population from a placebo-controlled, randomized trial on acyclovir prophylaxis after keratoplasty. In this former study the effectiveness of oral acyclovir prophylaxis was significant during the first 2 years after keratoplasty. Prospective data such as graft survival, graft clarity, vascularization, infective events, and rejection episodes were obtained from the national keratoplasty follow-up registry. Additional clinical data were derived from the medical charts.. For 47 of the original 63 enrolled patients, the 5-year follow-up was completed. Comparing the acyclovir group with the placebo group, we found that with regard to the cumulative clinically evident recurrences, there was a statistically significant lower monthly event rate in the acyclovir group (P = 0.037). There were no statistically significant differences in visual acuity or in the use of oral aciclovir between the two treatment groups. The incidences of graft failure, vascularization, and medication or surgery for glaucoma were too low to analyze differences between the two groups.. The results of our study suggest that oral acyclovir prescribed during the first 6 months after PK for HED protects against clinically evident HED recurrences during the first 5 years following PK.

Topics: Acyclovir; Administration, Oral; Antiviral Agents; Drug Administration Schedule; Follow-Up Studies; Graft Rejection; Graft Survival; Humans; Kaplan-Meier Estimate; Keratitis, Herpetic; Keratoplasty, Penetrating; Postoperative Care; Postoperative Complications; Postoperative Period; Secondary Prevention; Treatment Outcome; Visual Acuity

Several interventions can cure posttransplant lymphoproliferative disease (PTLD); a sequential approach is usual, starting with reduction in immunosuppressives (RI). The efficacy of RI remains poorly defined, particularly in adults. We assessed an algorithm starting with a defined course of RI in all patients, escalating to interferon (IFN) alpha2b, and finally to chemotherapy, in a prospective multicenter phase II study of adult solid organ transplant recipients. The design predated rituximab.. Reduction in immunosuppressives: cyclosporine or tacrolimus reduction by 50% for 2 weeks; a further 50% reduction for 1 week if not in complete remission (CR). Intravenous acyclovir was given for the duration of all RI. Patients with less than CR, or any rejection, resumed immunosuppressives and proceeded to IFN 3 MIU/m(2)/day for up to 3 months; if less than CR, ProMACE-CytaBOM chemotherapy.. Twenty patients were registered over 60 months; 16 patients with biopsy-proven PTLD were eligible (13 heart, 3 kidney recipients). Median age was 47 (24-75) years. Reduction in immunosuppressives resulted in only 1 of 16 partial responses (12.5%), no CR. Progressive disease occurred in 8 of 16 (50%) and 6 of 16 (38%) experienced rejection. Only 1 of 13 (7%) patients achieved durable CR with IFN. Seven eligible patients received ProMACE-CytaBOM chemotherapy, five of seven (67%) achieving CR, four of five durable beyond 2 years.. Reduction in immunosuppressives produced no CR, progressive disease and rejection were frequent; response to IFN was rare. A strong case can be made for adding rituximab to RI as initial therapy. Chemotherapy resulted in 57% durable CR, data that are relevant for the up to two thirds of PTLD patients who are refractory to rituximab.

Topics: Acyclovir; Adult; Aged; Antineoplastic Agents; Cyclosporine; Female; Heart Transplantation; Humans; Immunosuppressive Agents; Interferon alpha-2; Interferon-alpha; Kidney Transplantation; Lymphoproliferative Disorders; Male; Middle Aged; Postoperative Complications; Recombinant Proteins; Remission Induction; Tacrolimus

Cytomegalovirus (CMV) disease is a risk factor for allograft rejection in renal transplant (RTx) recipients. However, the role of asymptomatic CMV infection remains controversial.. To determine the impact of CMV disease and asymptomatic infection on biopsy-proven acute rejection (BPAR) during 12 months post-RTx.. A total of 106 consecutive RTx recipients at risk for CMV (donor and/or recipient CMV seropositive) were followed prospectively for 12 months post-RTx. CMV activity was monitored using nested PCR from whole blood. Three-month prophylaxis with valacyclovir or ganciclovir was given to 94 patients. BPAR episodes were classified according to the Banff 97 criteria. Multivariate Cox proportional hazards model was used to estimate the effect of CMV disease, asymptomatic infection, and other covariates on BPAR.. Asymptomatic CMV infection occurred in 23% of the patients and 10% developed CMV disease. The incidence of BPAR was 29%. CMV disease was an independent risk factor for BPAR (HR=3.0, P=0.014), while asymptomatic CMV infection was not (P=0.987). In addition to CMV disease, expanded criteria donor and donor age were independent predictors for BPAR. In univariate analysis, valacyclovir (HR=0.26, P=0.008) decreased the risk of BPAR. A similar trend was observed with ganciclovir (HR=0.42, P=0.058). Only valacyclovir remained significant in multivariate analysis (HR=0.18, P=0.044).. CMV disease, but not asymptomatic infection, is an independent risk factor for BPAR during the first 12 months post-RTx.

Topics: Acute Disease; Acyclovir; Antiviral Agents; Carrier State; Cytomegalovirus; Cytomegalovirus Infections; Female; Ganciclovir; Graft Rejection; Humans; Incidence; Kidney Transplantation; Male; Middle Aged; Multivariate Analysis; Postoperative Complications; Prospective Studies; Risk Factors; Treatment Outcome; Valacyclovir; Valine

To compare the efficacy, costs and safety of oral ganciclovir and valacyclovir in the prophylaxis of cytomegalovirus (CMV) disease in renal transplant (RTx) recipients at high risk of CMV disease.. A total of 83 patients were prospectively randomized to 3-month treatment with either oral ganciclovir (3 g/day) or oral valacyclovir (8 g/day). A 3rd group received no prophylaxis. Forty-nine patients were considered to be at high risk of CMV disease due to D+R- serologic status, OKT3/ATG treatment and/or acute rejection within 12 months after RTx. Twenty-three high-risk patients were treated with ganciclovir (GAN group), 17 patients with valacyclovir (VAL group), and 9 patients received no prophylaxis (C group).. No significant differences were found among the groups in their demographic characteristics, immunosuppressive protocols, D/R CMV serology, or CMV risk factors. The 12-month incidence of CMV disease was 89% in the C group compared with 9% in the GAN group and 6% in the VAL group (p < 0.001, GAN or VAL vs. C; p = 0.713, GAN vs. VAL). Treatment failure (death, graft loss, CMV disease or withdrawal from study) occurred in 17, 6, and 89% in the GAN, VAL, and C groups, respectively (p < 0.001, GAN or VAL vs. C; p = 0.285, GAN vs. VAL). The average CMV-associated costs per patient were EUR 3,161, 3,757, and 7,247 in the GAN, VAL, and C groups, respectively (p = 0.027).. Valacyclovir and oral ganciclovir are equally effective in the prophylaxis of CMV disease in high-risk RTx patients. Both regimens are cost-effective and help reduce CMV-associated costs by nearly 50% compared with patients without prophylaxis.

Topics: Acyclovir; Administration, Oral; Adult; Antiviral Agents; Cytomegalovirus Infections; Female; Ganciclovir; Graft Rejection; Graft Survival; Health Care Costs; Humans; Immunosuppressive Agents; Kidney Transplantation; Male; Middle Aged; Postoperative Complications; Prospective Studies; Risk Factors; Valacyclovir; Valine; Viremia

An open, prospective, randomised study was conducted to compare the safety and efficacy of valacyclovir vs. oral ganciclovir for cytomegalovirus (CMV) prophylaxis in renal transplant recipients. Eighty-three renal transplant recipients were assigned randomly to receive valacyclovir (n=43) or oral ganciclovir (n=40) for the first 3 months after transplantation. Both groups were similar in terms of demographics, primary renal disease, graft source, HLA matching, immunosuppressive therapy and donor-recipient CMV antibody status. CMV infection was diagnosed by detection of virus DNA in plasma with the Amplicor CMV Test. CMV disease was observed in only one patient belonging to the ganciclovir group, who developed enterocolitis 6 months post-transplantation. No difference was observed between the two treatment groups with respect to detection of CMV DNA, virus infections other than CMV, acute rejection episodes, and serum creatinine levels at 3 and 6 months following transplantation. An increased number of bacterial infections was noted in the ganciclovir group (p 0.003). No adverse reactions with either treatment were reported. The estimated cost of valacyclovir treatment was 20% higher than that of ganciclovir treatment. Overall, both valacyclovir and oral ganciclovir were found to be effective and safe for CMV prophylaxis in renal transplant recipients. Decisions regarding prophylactic regimens should include additional criteria, such as cost or possible development of resistance.

Topics: Acyclovir; Administration, Oral; Adult; Antiviral Agents; Costs and Cost Analysis; Cytomegalovirus Infections; Female; Ganciclovir; Greece; Humans; Kidney Transplantation; Male; Postoperative Complications; Valacyclovir; Valine

Given its association with Epstein-Barr virus (EBV), there is considerable interest in assessing the impact of prophylactic anti-viral therapy on post-transplant lymphoproliferative disorder (PTLD). A recently completed multi center case-control study assessed the impact of immunosuppressive therapy on PTLD risk among renal transplant patients and collected information on the use of anti-viral therapy. Biopsy-confirmed PTLD cases (n = 100) were matched to 375 controls by center, date of transplant, and age. Data were collected on immunosuppression and rejection therapies, demographics, pre-transplant viral status, number of rejections, and anti-viral use. With adjustment for known risk factors, prophylactic anti-viral use was associated with up to 83% reduction in the risk of PTLD, depending on the anti-viral agent. These results were stronger for the first year post-transplant. For every 30 days of ganciclovir treatment, risk of PTLD during the first year was lower by 38% (Odds Ratio [OR]= 0.62; 95% confidence interval [CI]= 0.38-1.0); acyclovir effects were less striking (OR = 0.83; 95% CI = 0.59-1.16). Anti-viral therapy appears to play a role in reducing the risk of PTLD in renal transplant patients. Ganciclovir may be more potent than acyclovir.

Topics: Acyclovir; Adolescent; Adult; Antiviral Agents; Case-Control Studies; Ganciclovir; Humans; Kidney Transplantation; Lymphoproliferative Disorders; Postoperative Complications; Risk Factors

The main reasons for graft failure following penetrating keratoplasty in patients with herpetic eye disease are recurrence of herpetic disease and allograft rejection. In a randomised trial the effect of systemic acyclovir and mycophenolate mofetil (MMF) on these post-keratoplasty complications was evaluated.. Patients with typical clinical findings of recurrent herpetic keratitis were enrolled in this single-centre study after contraindications to systemic immunosuppression were ruled out. In a prospective randomised trial 30 patients were treated in three groups. In group A patients received acyclovir 200 mg five times/day for 3 weeks. In group B patients were treated with acyclovir 200 mg five times/day for 1 year, and patients in group C received acyclovir 200 mg five times/day in combination with MMF 1 g twice daily for 1 year.. In group A 3 patients experienced seven herpes recurrences. One patient had a moderate and one further patient a severe allograft rejection. In group B three severe allograft rejections were observed. Herpes recurrences did not occur while receiving acyclovir prophylaxis, but only once after the prophylaxis had been stopped. In group C no herpes recurrence was observed, and only two mild allograft rejections occurred while being under combined acyclovir-MMF therapy. Another mild and one moderate allograft rejection were observed after cessation of MMF.. These results demonstrate that systemic acyclovir protects the grafts from recurrences of herpetic disease as long as it is administered at efficient doses. Simultaneously administered mycophenolate mofetil does not trigger herpes recurrences and protects the graft from severe allograft rejections, but mild, less dangerous immune reactions may still occur while receiving MMF. The combination of systemic acyclovir and mycophenolate mofetil therefore is recommended for patients at high risk for herpes recurrence and allograft rejections.

Topics: Acyclovir; Aged; Antiviral Agents; Drug Synergism; Drug Therapy, Combination; Female; Graft Rejection; Herpesvirus 1, Human; Humans; Immunosuppressive Agents; Keratitis, Herpetic; Keratoplasty, Penetrating; Male; Middle Aged; Mycophenolic Acid; Pilot Projects; Postoperative Complications; Prospective Studies; Recurrence; Virus Activation

To determine the prophylactic effect of oral acyclovir on the recurrence rate of herpetic eye disease after penetrating keratoplasty.. A randomized, double-masked, placebo-controlled multicenter trial.. Sixty-eight consecutive patients (68 eyes) with corneal opacities due to herpetic eye disease who underwent penetrating keratoplasty.. Oral acyclovir 400 mg twice daily or placebo tablets for 6 months.. The recurrence rate of herpetic eye disease-related events and rejection episodes, proven by viral cell culture or polymerase chain reaction.. During the 2-year follow-up period, there were 3 culture-proven herpetic eye disease recurrences in the acyclovir group and 9 in the placebo group. Lifetime survival analysis of the probability of remaining free from recurrence revealed a significantly reduced risk of recurrent herpetic disease in the acyclovir-treated group.. This study suggests that oral acyclovir effectively prevents herpes-related recurrences after penetrating keratoplasty in herpetic eye disease.

Topics: Acyclovir; Administration, Oral; Adolescent; Adult; Aged; Antiviral Agents; Corneal Opacity; Double-Blind Method; Female; Graft Rejection; Humans; Keratitis, Herpetic; Keratoplasty, Penetrating; Male; Middle Aged; Postoperative Complications; Secondary Prevention

Oral ganciclovir and valacyclovir reduce the incidence of cytomegalovirus (CMV) disease after renal transplantation (RTx). Our study was designed to compare the efficacy, costs, and safety of oral ganciclovir and valacyclovir in the prophylaxis of CMV disease over the first 6 months after RTx. A total of 38 patients was randomized to 3-month treatment with either oral ganciclovir (1 g t.i.d., n=14, GAN group) or oral valacyclovir (2 g q.i.d., n=12, VAL group). A third group (C, n=12) received no prophylaxis. The patients were monitored by CMV-nested PCR in whole blood. No differences were found between the groups in their demographic characteristics, immunosuppressive protocols, or donor and recipient CMV serology. Thirty-six out of 38 (94.7%) recipients were CMV-seropositive. Over the 6-month post-RTx period, there were 13 episodes of CMV disease in eight (66.7%) patients of the C group compared with none in the GAN and VAL groups ( P=0.0005, GAN vs C; P=0.001, VAL vs C). The incidence of CMV viremia was 30.8%, 50.0%, and 91.7% in the GAN, VAL, and C groups, respectively ( P=0.004, GAN vs C; P=0.07, VAL vs C; P=NS, GAN vs VAL). Treatment failure (death, graft loss, CMV disease, or withdrawal from study) occurred in 14.3%, 0% and 66.7% in the GAN, VAL, and C groups, respectively ( P=0.014, GAN vs C; P=0.001, VAL vs C; P=NS, GAN vs VAL). The average CMV-associated costs per patient (in 2001 euros) were 2,449+/-1,178, 2,485+/-581, and 4,259+/-4,616 in the GAN, VAL, and C groups, respectively. Ganciclovir and valacyclovir were well tolerated, with ganciclovir having had to be withdrawn shortly in one patient only because of thrombocytopenia. In conclusion, oral ganciclovir and valacyclovir are equally safe and effective in the prophylaxis of CMV disease after RTx. Both are cost-effective and help reduce CMV-associated costs by some 40% compared with patients without prophylaxis.

Topics: Acyclovir; Administration, Oral; Adult; Antiviral Agents; Cadaver; Cytomegalovirus Infections; Dose-Response Relationship, Drug; Female; Ganciclovir; Humans; Kidney Diseases; Kidney Transplantation; Living Donors; Male; Middle Aged; Postoperative Complications; Prospective Studies; Renal Insufficiency; Tissue Donors; Valacyclovir; Valine

Reactivation of herpes simplex virus-1 (HSV-1) after facial resurfacing has led to severe outbreaks, delayed reepitheliazation, and scarring. Current recommendations regarding the dosing of antivirals used prophylactically are based mostly on anecdotal experience. No studies have addressed the question of when such antiviral prophylaxis should begin.. The purpose of this study was to compare the efficacy of valacyclovir used as an antiviral prophylaxis when started the morning before versus the morning of facial resurfacing procedures.. Eighty-four patients who presented for facial resurfacing were enrolled. Resurfacing was performed using laser (CO2, Er:YAG), chemical peeling, dermabrasion/dermasanding, or some combination of these techniques. Patients were randomly assigned to start valacyclovir 500 mg twice daily either the morning before or the morning of the procedure. Viral cultures were performed at baseline on all patients, at any sign of infection, and at the end of the 14-day treatment period. All patients were followed for 21 days postoperatively.. Valacyclovir was 100% effective in the prevention of HSV reactivation in both regimens with no adverse effects reported.. This study demonstrates the efficacy of valacyclovir as a preventive agent against HSV outbreaks following facial resurfacing whether started the day before or the day of surgery.

Topics: Acyclovir; Antiviral Agents; Chemexfoliation; Dermabrasion; Drug Administration Schedule; Female; Herpes Simplex; Herpesvirus 1, Human; Humans; Laser Therapy; Male; Middle Aged; Postoperative Complications; Premedication; Recurrence; Rhytidoplasty; Valacyclovir; Valine; Virus Activation

Although the primary treatment of symptomatic cytomegalovirus (CMV) disease in organ transplant recipients is successful in >90% of individuals, relapsing disease, particularly in those with primary infection, remains an important problem. Previously, we had observed that the rate of symptomatic recurrence was >60% in those with primary disease (seronegative for CMV prior to transplant), and approximately 20% in those who were seropositive prior to transplant. The present study was undertaken to determine whether a maintenance regimen of oral ganciclovir for 2-3 months added to the routine 14-21 days of intravenous ganciclovir would further prevent symptomatic CMV recurrence.. From May 1995 until June 1998, all kidney and liver transplant recipients with confirmed tissue-invasive CMV disease or CMV syndrome were treated with 14-21 days of intravenous ganciclovir (5 mg/kg b.i.d. with dose adjusted for renal dysfunction) followed by 2-3 months of oral ganciclovir (2 g daily). The incidence of recurrence of CMV disease and/or viremia during and after oral therapy was then determined over a mean follow-up of 530.6 days.. Thirty-seven patients, 19 kidney and 18 liver transplant recipients, were studied; 5 had biopsy-proven tissue-invasive disease (13.5) and 32 suffered a CMV syndrome (86.5). Twenty-one of these patients (58.6) were seronegative for CMV prior to transplant and received an allograft from a seropositive donor (D+/R-). Overall, 10 patients (27.0) developed CMV recurrence. Eight of 21 patients who were D+/R- for CMV (38.1) developed recurrence as opposed to 2 of 16 patients with other serologic status (12.5) (P=0.14). Patients with recurrent CMV disease and/or viremia had a peak antigenemia assay titer during their initial CMV event of 319.2 positive cells/2 slides compared with 109.8 positive cells/2 slides for patients without recurrent CMV infection (P=0.14); the trend of having a higher peak antigenemia assay titer among patients who recurred occurred both in patients who were at risk of primary CMV infection (D+/R- for CMV) and in those who were not. Two patients developed recurrent infection with strains of CMV that were resistant to ganciclovir.. This new therapeutic regimen of oral ganciclovir following intravenous ganciclovir slightly reduced the overall rate of recurrent CMV disease and/or viremia, but it still did not adequately prevent CMV recurrence in patients who are at risk of primary infection prior to transplant. Of particular concern, 2 patients with primary infection treated with this regimen developed ganciclovir-resistant recurrent disease.

Topics: Acyclovir; Administration, Oral; Adolescent; Adult; Aged; Antiviral Agents; Child; Child, Preschool; Cytomegalovirus Infections; Disease-Free Survival; Female; Follow-Up Studies; Ganciclovir; Humans; Immunoglobulins, Intravenous; Injections, Intravenous; Kidney Transplantation; Liver Transplantation; Male; Middle Aged; Postoperative Complications; Time Factors

Optimal prophylaxis against cytomegalovirus (CMV) disease for organ transplant patients at risk for primary infection (donor seropositive, recipient seronegative, D+R-) remains to be determined. We hypothesized that prolonged oral ganciclovir therapy following intravenous therapy would provide increased protection.. A total of 155 evaluable D+R- organ transplant recipients from 13 transplant centers were entered into the study: all received intravenous ganciclovir (5 mg/kg/day) for 5-10 days and then either oral acyclovir (400 mg tid) or oral ganciclovir (1 g tid) for an additional 12 weeks. Patients were assigned to their treatment groups at a central randomization site, with a separate randomization scheme for each of the organs transplanted (kidney, heart, or liver). In the case of kidney transplants, the patients were stratified according to source of the kidney (living related vs. cadaveric donor). The primary endpoint was the incidence of CMV disease in the first six months post-transplant.. Treatment with oral ganciclovir was associated with a significant decrease in the incidence of symptomatic disease or viremia when compared with the oral acyclovir group (32% vs. 50%, P<0.05). This difference was most marked in terms of tissue invasive disease: only 3 of 15 symptomatic patients in the ganciclovir group vs. 10 of 21 in the acyclovir group developed tissue-invasive infection (P<0.05). There was a significant difference in the time to CMV disease or viremia in the two groups: mean time 212+/-17 days post-transplant for the acyclovir group vs. 291+/-13 days for the ganciclovir group (P<0.001). The incidence of allograft rejection was 34% in the ganciclovir group and 46% in the acyclovir group (P=NS). Leukopenia was more common in the ganciclovir group (P<0.05), but in no case did it require drug discontinuation. Ganciclovir resistance did not develop in this study.. Prophylaxis with oral ganciclovir following a brief course of intravenous ganciclovir provides useful protection against primary CMV disease.

Topics: Acyclovir; Administration, Oral; Adolescent; Adult; Aged; Antiviral Agents; Child; Cytomegalovirus Infections; Drug Therapy, Combination; Female; Ganciclovir; Heart Transplantation; Humans; Immunosuppression Therapy; Injections, Intravenous; Kidney Transplantation; Liver Transplantation; Male; Middle Aged; Postoperative Complications

To determine the efficacy of systemic acyclovir in decreasing complications and improving the outcome of penetrating keratoplasty for herpes simplex virus (HSV) keratitis.. Retrospective study of 53 primary penetrating keratoplasties for HSV keratitis at an eye hospital from January 1, 1989, through December 31, 1996. Medical records were analyzed for history of HSV keratitis, preoperative neovascularization, and disease activity. Postoperative use of acyclovir, recurrence of HSV keratitis, rejection, uveitis or edema, and graft failure were evaluated.. Twenty-four patients (mean +/- SD follow-up, 44.7 +/- 32.6 months) received no acyclovir and were compared with 20 patients, (mean +/- SD follow-up, 28.8 +/- 16.7 months), who received 400 mg acyclovir twice a day for at least 1 year. No patient in the acyclovir group had a recurrence of dendritic keratitis in the first year compared with 5 (21%) of the patients who did not receive acyclovir (P = .03). No patient had graft failure in the acyclovir group compared with 4 (17%) in the group without acyclovir after 1 year of follow-up (P = .06).. Postoperative systemic acyclovir therapy after penetrating keratoplasty for HSV keratitis is associated with a reduced rate of recurrent HSV dendritic keratitis and possible graft failure at 1 year of follow-up.

Topics: Acyclovir; Administration, Oral; Antiviral Agents; Corneal Edema; Drug Evaluation; Female; Follow-Up Studies; Graft Rejection; Herpesvirus 1, Human; Humans; Keratitis, Dendritic; Keratoplasty, Penetrating; Male; Middle Aged; Postoperative Complications; Recurrence; Retrospective Studies; Uveitis, Anterior; Visual Acuity

Cytomegalovirus (CMV) disease is a major complication of organ transplantation. We hypothesized that prophylactic treatment with valacyclovir would reduce the risk of CMV disease.. A total of 208 CMV-negative recipients of a kidney from a seropositive donor and 408 CMV-positive recipients were randomly assigned to receive either 2 g of valacyclovir or placebo orally four times daily for 90 days after transplantation, with the dose adjusted according to renal function. The primary end point was laboratory-confirmed CMV disease in the first six months after transplantation.. Treatment with valacyclovir reduced the incidence or delayed the onset of CMV disease in both the seronegative patients (P<0.001) and the seropositive patients (P=0.03). Among the seronegative patients, the incidence of CMV disease 90 days after transplantation was 45 percent among placebo recipients and 3 percent among valacyclovir recipients. Among the seropositive patients, the respective values were 6 percent and 0 percent. At six months, the incidence of CMV disease was 45 percent among seronegative recipients of placebo and 16 percent among seronegative recipients of valacyclovir; it was 6 percent among seropositive placebo recipients and 1 percent among seropositive valacyclovir recipients. At six months, the rate of biopsy-confirmed acute graft rejection in the seronegative group was 52 percent among placebo recipients and 26 percent among valacyclovir recipients (P=0.001). Treatment with valacyclovir also decreased the rates of CMV viremia and viruria, herpes simplex virus disease, and the use of inpatient medical resources. Hallucinations and confusion were more common with valacyclovir treatment, but these events were not severe or treatment-limiting. The rates of other adverse events were similar among the groups.. Prophylactic treatment with valacyclovir is a safe and effective way to prevent CMV disease after renal transplantation.

Topics: Acyclovir; Adult; Antiviral Agents; Cadaver; Cytomegalovirus; Cytomegalovirus Infections; Double-Blind Method; Female; Graft Rejection; Health Resources; Humans; Incidence; Kidney Transplantation; Male; Middle Aged; Postoperative Complications; Prodrugs; Serologic Tests; Valacyclovir; Valine

To evaluate the efficacy of long-term and low-dose prophylactic oral acyclovir therapy in preventing the recurrence of herpetic infection and increasing graft survival in patients who undergo penetrating keratoplasty (PK) for herpes simplex keratitis (HSK).. Nineteen patients were included in the study, who underwent PK for herpes keratitis from July 1993 to November 1995, received oral acyclovir, and were followed at least 12 months. Group 1 included 12 patients with corneal scarring without perforation. These patients were free of inflammation for a mean of 4.1+/-2.2 months preoperatively, and received oral acyclovir 400 mg/day postoperatively for one year. Seven patients (Group 2) who developed corneal perforation due to necrotizing keratitis were treated with tissue adhesives, therapeutic contact lenses, and topical antiviral and oral acyclovir therapy for the resolution of active inflammation followed by PK after a mean of 3.8+/-2.1 months follow-up. They received oral acyclovir 400 mg/day postoperatively for one year in addition to standard postoperative therapy. The control group consisted of 16 patients (Groups 3 and 4) who underwent PK for herpes simplex keratitis and did not receive oral acyclovir. The indication for PK was corneal opacity and impaired visual acuity in 12 patients (Group 3) and corneal perforation in four (Group 4).. After an average of 25 months follow-up, there was only one recurrence (8.3%) in Group 1 and two cases (28.6%) of herpetic recurrence in Group 2. Recurrence occurred at two months in one patient while he was taking oral acyclovir. Two of these recurrences followed the withdrawal of oral acyclovir therapy after one year of therapy. In contrast, in control groups there were four cases of herpetic recurrence (33.3%) in Group 3 and two (50%) in Group 4 after a mean of 30.5 months postoperative follow-up. In the study groups, a rejection episode was seen in three patients (15.8%) which was successfully treated with medical therapy. One patient from Group 2 developed bacterial keratitis which subsequently resulted in graft failure. All grafts remained clear in the other patients (94.7%). In the control groups, rejection developed in seven patients. Three rejection episodes were treated successfully. The other four developed graft failure in spite of intensive medical therapy.. Our results suggest that postoperative oral acyclovir therapy is effective in preventing the recurrence of herpetic infection. However, the recurrence may develop after cessation of oral acyclovir therapy, especially in patients who underwent PK for corneal perforation due necrotizing HSK.

Topics: Acyclovir; Administration, Oral; Adolescent; Adult; Aged; Antiviral Agents; Female; Follow-Up Studies; Graft Survival; Humans; Keratitis, Herpetic; Keratoplasty, Penetrating; Male; Middle Aged; Postoperative Complications; Recurrence; Retrospective Studies

Cytomegalovirus (CMV) is still a major pathogen in liver transplantation (LTX). The clinical efficacy of prophylactic high-dose acyclovir therapy (800 mg qid) was assessed for the prevention of CMV infection and disease in liver recipients. Fifty-five patients were enrolled in a prospective, randomised, double-blind and placebo-controlled trial; 28 on acyclovir vs. 27 on placebo. The therapy was given for 12 weeks. The patients were followed for 24 weeks. CMV infection was diagnosed in 60% (16 on acyclovir, 17 on placebo) and CMV disease developed in 38% (7 on acyclovir, 14 on placebo) of the patients. The total mortality was 27% (6 on acyclovir, 10 on placebo). Acyclovir delayed 32% of the CMV infections and prevented 59% of the CMV disease cases which occurred in the placebo cohort. The time to CMV disease was significantly prolonged in patients on acyclovir as compared to patients on placebo (P=0.013). Adverse events included neurotoxicity which occurred in 5 cases in the acyclovir, but none in the placebo arm, and nephrotoxicity which was detected in 6 patients in the acyclovir and 5 in the placebo arm, respectively. We conclude that acyclovir prophylaxis significantly reduced the incidence of CMV disease, and delayed the onset of CMV infection in liver transplant patients.

Topics: Acyclovir; Administration, Oral; Adult; Aged; Antiviral Agents; Creatinine; Cytomegalovirus Infections; Double-Blind Method; Female; Graft Survival; Herpes Simplex; Humans; Injections, Intravenous; Liver Transplantation; Male; Middle Aged; Monitoring, Physiologic; Placebos; Postoperative Complications; Proportional Hazards Models; Time Factors

In this prospective randomized study including 28 patients, we show that, in cytomegalovirus (CMV)-seronegative renal transplant recipients (R-) receiving a CMV-seropositive graft (D+), high doses of acyclovir (ACV, i.e. 3,200 mg/day) during the first 3 months after transplantation were as efficient as hyperimmune CMV immunoglobulins (CMV Igs) plus high doses of ACV regarding the prophylaxis of CMV primoinfection. Fifty-four percent of the patients in the ACV arm and 50% in the other arm presented at least one episode of viremia (n.s.). The incidence of CMV disease was 31% in the ACV group and 20% in the ACV + CMV Ig group (n.s.). By comparison with historical controls (no prophylaxis), we found that ACV with or without CMV Ig significantly delayed and significantly decreased the rate of CMV disease, although the severity score was not statistically different. Moreover, high doses of ACV were far less expensive than their combination with hyperimmune CMV Igs. Thus, until oral ganciclovir is available for the prophylaxis of primary CMV infection in renal transplant patients, we recommend the use of high doses of ACV for the first 3 months after transplantation in high-risk renal transplant patients, i.e. D+/R-.

Topics: Acyclovir; Combined Modality Therapy; Cytomegalovirus; Cytomegalovirus Infections; Humans; Immunoglobulins; Kidney Transplantation; Postoperative Complications; Prospective Studies; Treatment Outcome

A randomized trial was performed to compare the sequential use of 2 weeks of intravenous ganciclovir (10 mg/[kg.d]) followed by 50 weeks of high-dose oral acyclovir (800 mg/m2 four times daily) with 2 weeks of intravenous ganciclovir alone as prophylaxis for cytomegalovirus (CMV) and Epstein-Barr virus (EBV) disease after pediatric liver transplantation. CMV disease was diagnosed for seven of 24 patients treated with ganciclovir followed by high-dose oral acyclovir compared with two of 24 children treated with ganciclovir alone (P = .048). Similarly, the rate of CMV disease among high-risk patients (CMV-positive donor/CMV-negative recipient) treated with the combination regimen was higher than that among high-risk patients treated with ganciclovir alone (four [57%] of seven vs. zero of five, respectively; vs P < .05). The rate of EBV disease among patients treated with the combination regimen (eight [33%] of 24) was similar to that among patients treated with ganciclovir alone (five [21%] of 24; P = not significant). We conclude that sequential prophylaxis with 2 weeks of intravenous ganciclovir followed by 50 weeks of high-dose oral acyclovir did not decrease the frequency of CMV or EBV disease after pediatric liver transplantation when compared with 2 weeks of intravenous ganciclovir alone.

Topics: Acyclovir; Administration, Oral; Adolescent; Antiviral Agents; Child; Child, Preschool; Cytomegalovirus; Cytomegalovirus Infections; Double-Blind Method; Ganciclovir; Herpesviridae Infections; Herpesvirus 4, Human; Humans; Injections, Intravenous; Liver Transplantation; Opportunistic Infections; Postoperative Complications; Tumor Virus Infections

In an attempt to decrease the prevalence and severity of cytomegalovirus (CMV) disease, preemptive therapy with ganciclovir was administered to all renal transplant patients treated with OKT3 between February 1993 and December 1994 (26 patients). The results were compared with those of a historical group treated with OKT3 but not with ganciclovir (29 patients). Both groups were similar in age, sex, number of previous transplants, number of rejections, serological status of donor and recipient and OKT3 dose. Ganciclovir was administered during the period of treatment with OKT3. Only 2 (7.7%) treated patients developed CMV disease versus 11 (37.9%) of the control group (p = 0.01). In the control group the intensity of the disease was severe in 7 (63.6%) cases, whereas in the treated patients it was always of slight intensity (p = 0.01). In conclusion, preemptive therapy with ganciclovir during treatment with OKT3 decreases the prevalence and severity of CMV disease.

Topics: Acyclovir; Adult; Aged; Antibodies, Viral; Antiviral Agents; Cytomegalovirus Infections; Female; Humans; Immunoglobulin M; Immunosuppressive Agents; Kidney Transplantation; Male; Middle Aged; Muromonab-CD3; Postoperative Complications; Prevalence

Topics: Acyclovir; Antiviral Agents; Cytomegalovirus Infections; Follow-Up Studies; Ganciclovir; Graft Rejection; Graft Survival; Humans; Incidence; Kidney Transplantation; Placebos; Postoperative Complications; Probability

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; Adolescent; Adult; Aged; Child; Child, Preschool; Cytomegalovirus; Cytomegalovirus Infections; Female; Follow-Up Studies; Humans; Immunoglobulins; Immunosuppressive Agents; Infant; Kidney Transplantation; Male; Middle Aged; Postoperative Complications; Reoperation; Risk Factors; Time Factors; Transplantation, Homologous

Cytomegalovirus disease is an important cause of morbidity following liver transplantation. To date there has not been an effective prophylaxis for CMV disease after liver transplantation. One hundred forty-three patients were randomized to receive either high dose oral acyclovir (800 mg 4 times a day) alone for 3 months after transplantation (acyclovir group) or intravenous ganciclovir (5 mg/kg twice a day) for 14 days followed by high dose oral acyclovir to complete a 3-month regimen (ganciclovir group). Of 139 patients available for evaluation, 43 of 71 (61%) patients from the acyclovir group developed CMV infection compared with 16 of 68 (24%) from the ganciclovir group (relative risk, 3.69; 95% confidence interval, 2.07-6.56; P < 0.00001). Of those randomized, CMV disease was seen in 20 (28%) of the acyclovir group compared with 6 (9%) of the ganciclovir group (relative risk, 5.11; 95% confidence interval, 2.05-12.75; P = 0.0001). The median time to onset of CMV infection was 45 days in the acyclovir group compared with 78 days in the ganciclovir group (P = 0.004). The median time to onset of CMV disease was 40 days in the acyclovir group compared with 78 days in the ganciclovir patients (P = 0.02). With respect to primary CMV infection, there was no difference in the rates in the 2 groups, but tissue invasive disease and recurrent CMV disease were less frequent in the ganciclovir group. It is concluded that a course of 2 weeks of ganciclovir immediately after transplantation followed by high dose oral acyclovir for 10 weeks is superior to a 12-week course of high dose oral acyclovir alone for prevention of both CMV infection and CMV disease after liver transplantation. However, the lack of significant effect in seronegative recipients who received grafts from seropositive donors suggests that other strategies are needed to prevent CMV infection in this high risk population.

Topics: Acyclovir; Cytomegalovirus Infections; Drug Therapy, Combination; Female; Ganciclovir; Humans; Incidence; Liver Transplantation; Male; Middle Aged; Postoperative Complications; Prospective Studies; Recurrence; Risk Factors; Survival Rate; Viremia

To assess the efficacy of high-dose oral acyclovir therapy compared with preemptive, short-course ganciclovir therapy (administered only if cytomegalovirus [CMV] shedding occurred) to prevent CMV disease in liver transplant recipients.. A randomized controlled trial.. Liver transplant center at a university-affiliated Veterans Affairs Medical Center.. 47 consecutive patients having liver transplantation.. Patients were stratified by their CMV antibody status and the CMV antibody status of the donor and were randomly assigned to one of two treatment groups. Surveillance cultures for CMV (buffy coat and urine) were done every 2 to 4 weeks for 24 weeks in all patients. One group received high-dose oral acyclovir (800 mg four times daily). The experimental group received no acyclovir, but if surveillance cultures were positive, ganciclovir (5 mg/kg intravenously twice daily) was administered for 7 days.. Cytomegalovirus shedding and CMV disease were measured in the two groups.. Cytomegalovirus shedding before the onset of CMV disease occurred in 25% (6 of 24) of patients in the acyclovir group compared with 22% (5 of 23) in the experimental group. Cytomegalovirus disease developed in 29% (7 of 24) of the acyclovir group and in 4% (1 of 23) of the experimental group (P < 0.05). No hematologic toxicity occurred with ganciclovir.. Oral acyclovir is ineffective prophylaxis against CMV in liver transplant recipients. Preemptive, short-course ganciclovir therapy in patients with CMV shedding was well tolerated and provided effective prophylaxis against subsequent CMV disease; this protocol targets the patients at risk for CMV disease and minimizes toxicity and expense.

Topics: Acyclovir; Adult; Aged; Cytomegalovirus Infections; Drug Administration Schedule; Ganciclovir; Graft Survival; Herpes Simplex; Humans; Liver Transplantation; Male; Middle Aged; Postoperative Complications; Simplexvirus; Time Factors; Virus Shedding

Topics: Actuarial Analysis; Acyclovir; Adult; Cytomegalovirus Infections; Fever; gamma-Globulins; Ganciclovir; Graft Rejection; Humans; Immunosuppressive Agents; Liver Function Tests; Liver Transplantation; Postoperative Complications; Survival Analysis; Virus Diseases

To study the effect of cytomegalovirus immune globulin (CMVIG) on prevention of cytomegalovirus (CMV) disease and its complications in patients receiving liver transplants.. Randomized, multicenter, placebo-controlled, double-blind trial.. Four university-affiliated transplant centers in Boston (Boston Center for Liver Transplantation).. One hundred forty-one liver transplant recipients completed the study.. CMVIG or placebo (1% albumin) given in a dose of 150 mg/kg body weight within 72 hours of the transplant, then at weeks 2, 4, 6, and 8, and at 100 mg/kg at weeks 12 and 16.. Patients were observed for 1 year after transplantation for the development of CMV infection, disease, pneumonia, as well as for opportunistic fungal infections, graft survival, and mortality. Weekly cultures were taken of urine, buffy coat, and throat wash for CMV for 2 months, then monthly, and at any clinical illness.. Using a Cox proportional hazards model, CMVIG was shown to reduce severe CMV-associated disease (multi-organ CMV disease, CMV pneumonia, or invasive fungal disease associated with CMV infection) from 26% to 12% (relative risk, 0.39; 95% CI, 0.17 to 0.89). When we controlled for the use of monoclonal antibodies to T cells (OKT3), CMVIG use was still protective (relative risk, 0.39; CI, 0.17 to 0.90). Rates of CMV disease were reduced from 31% to 19% (relative risk, 0.56; CI, 0.3 to 1.1) in CMVIG recipients although no effect on rates of CMV infection, graft survival, or patient survival at 1 year were shown. When we controlled for the urgency of transplantation and OKT3 use, a reduction in CMV disease (relative risk, 0.22; CI, 0.06 to 0.81) was shown for globulin recipients for all serologic groups except for the highest risk group (the CMV-seropositive donor, CMV-seronegative group).. CMVIG reduced the rate of severe CMV-associated disease in patients undergoing orthotopic liver transplantation. No effect of CMVIG on CMV donor-positive, recipient-negative liver transplant recipients was shown, suggesting a need for additional prophylactic strategies.

Topics: Acyclovir; Adult; Analysis of Variance; Cytomegalovirus Infections; Drug Therapy, Combination; Female; Humans; Immunoglobulins, Intravenous; Liver Transplantation; Male; Middle Aged; Multivariate Analysis; Opportunistic Infections; Postoperative Complications; Proportional Hazards Models; Risk Factors; Treatment Outcome

Topics: Acyclovir; Cytomegalovirus Infections; Drug Administration Schedule; Drug Therapy, Combination; Humans; Immunosuppressive Agents; Liver Transplantation; Postoperative Complications; Time Factors

The occurrence of cytomegalovirus infection after solid organ transplantation has been correlated with decrease patient and allograft survival. The disease has not been conquered for two majors reasons: the length of time to establish the diagnosis of CMV has been excessive, and suitable, nontoxic antiviral agents have not been available for use. The purpose of this study was to examine the current incidence and impact of tissue-invasive cytomegalovirus (TI-CMV) disease that developed in 93 patients who underwent solid organ transplantation at University of Minnesota Hospitals (3/1/87 and 6/30/89) and who were treated with antiviral agent ganciclovir ( [9-(1,3-dihydroxy-2-2-propoxymethyl)-guanine [DHPG]). During this same period of time 323 patients received kidney transplants and 71 received kidney-pancreas transplants. Three patient groups were defined: (1) no CMV; (2) CMV infection (cultural or serologic evidence of noninvasive CMV infection); and (3) evidence of TI-CMV disease based upon initial complaints of fever, malaise, dyspnea, or abdominal pain, leukopenia (WBC less than 3000/ml), and evidence of a positive CMV rapid antigen test, CMV culture, or the presence of characteristic CMV inclusion bodies upon examination of material obtained by means of bronchoscopy, upper-gastrointestinal endoscopy, colonoscopy, or liver or renal biopsy. Patients with solely fever, leukopenia, but without a rising CMV serum titer, or positive CMV urine or blood cultures were excluded from the study. A multivariate analysis revealed that rejection therapy, age greater than 50 years, and receiving an organ from a seropositive donor were all significant variables that predisposed to TI-CMV. Analysis of patient and kidney allograft survival indicated that asymptomatic CMV infection had little current impact upon patient or allograft survival, while patients who developed TI-CMV exhibited higher rates of allograft loss and mortality, despite DHPG therapy. Comparison with historical group of patients indicated that TI-CMV DHPG-treated patients exhibited a trend toward improved allograft survival that may be relevant because the historical group of patients included patients with mild CMV infection. DHPG therapy was well tolerated and produced minimal toxicity, and excellent 30-day cure rates (89.2%), although 21.2% of patients required retreatment subsequently. We are currently conducting a trial to compare the ability of DHPG administered plus an anti-CMV immune globulin

Topics: Acyclovir; Adult; Aged; Cytomegalovirus Infections; Ganciclovir; Graft Survival; Humans; Immunization, Passive; Kidney Transplantation; Middle Aged; Organ Transplantation; Postoperative Complications; Transplantation, Homologous

Topics: Acyclovir; Azepines; Cytomegalovirus Infections; Heart Transplantation; Humans; Immune Sera; Immunization, Passive; Immunoglobulins; Immunoglobulins, Intravenous; Postoperative Complications

Topics: Acyclovir; Adolescent; Adult; Antiviral Agents; Bone Marrow Transplantation; Child; Clinical Trials as Topic; Cytomegalovirus Infections; Female; Ganciclovir; Humans; Male; Postoperative Complications; Pulmonary Fibrosis

Cytomegalovirus is a major viral pathogen in patients who undergo renal transplantation, and cytomegalovirus disease is difficult to treat. We therefore conducted a randomized, placebo-controlled, double-blind trial of acyclovir for the prevention of cytomegalovirus disease in recipients of renal allografts from cadavers. Acyclovir was given orally in doses of 800 to 3200 mg per day, according to the patients' estimated level of renal function. Patients took the first dose of either acyclovir or placebo six hours before transplantation and continued to take the assigned medication for 12 weeks. Of 118 patients enrolled in the study, 104 completed at least 30 days on the study medication and were included in our analysis of the results. During the first year after transplantation, 4 of 53 patients (7.5 percent) in the acyclovir group had symptomatic cytomegalovirus disease, as compared with 15 of 51 (29 percent) in the placebo group (P = 0.002). There was a single case of cytomegalovirus pneumonia in the acyclovir group, as compared with nine in the placebo group. The greatest prophylactic benefit of acyclovir was observed among seronegative patients who had received a kidney from a seropositive donor; only one of six such patients in the acyclovir group had cytomegalovirus disease, as compared with all seven in the placebo group. Acyclovir decreased the incidence of documented cytomegalovirus infection (with or without symptomatic disease) to 36 percent from 61 percent among the patients who received the placebo (P = 0.011). Among the patients who received acyclovir, the rates of recovery of virus from the blood and urine were significantly reduced, but the rate of viral shedding from the pharynx was not significantly different from that in the placebo group. There were no differences between the groups in the frequency of adverse events or in the rate of survival of either grafts or patients. We conclude that the oral administration of acyclovir, beginning before the transplantation of a renal allograft from a cadaver, reduces the rate of cytomegalovirus infection and disease without affecting the survival rate of either grafts or patients.

Topics: Acyclovir; Administration, Oral; Adolescent; Adult; Aged; Clinical Trials as Topic; Cytomegalovirus Infections; Double-Blind Method; Drug Administration Schedule; Female; Graft Survival; Herpes Simplex; Humans; Kidney Transplantation; Male; Middle Aged; Postoperative Complications; Random Allocation

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

Acyclovir was shown to limit herpes simplex reactivation in a controlled trial to prevent herpes labialis after surgical intervention for trigeminal neuralgia. Of 14 patients receiving acyclovir, unambiguous herpes labialis developed in only one, compared with 12 of 16 in the placebo group.

Topics: Acyclovir; Adult; Aged; Clinical Trials as Topic; Female; Herpes Labialis; Humans; Male; Middle Aged; Placebos; Postoperative Complications; Premedication; Random Allocation; Trigeminal Neuralgia

Forty patients with serum antibody against herpes simplex virus (HSV) were enrolled in a randomized, placebo-controlled, double-blind investigation of acyclovir given orally in a low dosage as prophylaxis against recurrent HSV infection after renal transplantation. During 30 postoperative days of medication, 14 of 21 placebo-treated and one of 19 acyclovir-treated patient(s) developed reactivation of HSV infection. Eleven of the former, but not the latter, had herpetic lesions. The protection against active infection with HSV during the period of prophylaxis with acyclovir is statistically highly significant. From 30 to 90 days after transplantation when no antiviral medicine was given, 60% (3/5) of the remaining placebo recipients and 44% (7/16) of the acyclovir patients developed active HSV infections. Herpetic lesions occurred in two of three and two of seven of infected people in the respective groups. No adverse effects of the drug were observed. The results show that HSV infections in immunosuppressed renal allograft recipients can be safely prevented, deferred, and ameliorated by an initial period of prophylaxis with a low dose of oral acyclovir.

Topics: Acyclovir; Adult; Antibodies, Viral; Clinical Trials as Topic; Double-Blind Method; Female; Graft Survival; Herpes Simplex; Humans; Kidney Transplantation; Male; Middle Aged; Postoperative Complications; Prospective Studies; Random Allocation; Recurrence; Simplexvirus

Forty-two patients undergoing bone marrow transplantation were included in a randomised, double-blind and placebo controlled trial of prolonged acyclovir prophylaxis against infections with viruses of the herpes group. Twenty patients were allocated to receive acyclovir and 22 to receive placebo. Acyclovir or placebo was administered i.v. at a dose of 250 mg/m2 twice daily, starting 5 days before transplantation. At 5 weeks after transplantation, administration was changed to tablets, 400 mg three times daily (children less than 6 years, 200 mg three times daily) and continued until 6 months after transplantation. In the placebo group, 10 acute herpes simplex virus (HSV) infections occurred in 7 patients (5 HSV-1 and 2 HSV-2), and another patient repeatedly shed HSV in throat washings. Five patients developed herpes zoster. Among patients receiving acyclovir only one episode of HSV infection occurred and no herpes zoster. The difference in the number of infection episodes and the number of infected patients was strongly significant (p = 0.0002 and 0.0017, respectively). The only acyclovir patient who reactivated HSV was terminally ill, and it is highly likely that she did not absorb a sufficient amount of the orally administered drug to control infection. All HSV and varicella zoster virus (VZV) infections were reactivations, and 9 of 10 patients who developed HSV infections or shed virus had a pre-transplantation HSV IgG titer of greater than 10 000 (ELISA). Acyclovir had no effect on cytomegalovirus (CMV), time of engraftment, or graft versus host disease (GVHD). Apart from a possible allergic reaction (skin rash) to acyclovir tablets, no adverse reactions were seen during this long prophylaxis with acyclovir.

Topics: Acyclovir; Bone Marrow Transplantation; Clinical Trials as Topic; Double-Blind Method; Female; Graft vs Host Disease; Herpesviridae Infections; Humans; Male; Postoperative Complications; Premedication; Prospective Studies; Random Allocation; Virus Activation

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

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

Topics: Acyclovir; Bone Marrow Transplantation; Clinical Trials as Topic; Double-Blind Method; Humans; Postoperative Complications; Random Allocation; Sepsis; Streptococcal Infections

Oral acyclovir was found to be safe and effective for the prevention of herpes simplex virus reactivation after marrow transplantation in a double-blind, placebo-controlled trial. Acyclovir or placebo was administered to 49 patients for 5 weeks beginning 1 week before transplantation: 5 of 24 patients receiving acyclovir developed herpes simplex virus infection during prophylaxis, compared to 17 of 25 patients receiving placebo (p less than 0.01). The median time to first virus reactivation was significantly longer among patients receiving acyclovir (78 days versus 9 days after transplant, p = 0.006). The effect was even more pronounced when the analysis was adjusted for drug compliance: Among patients taking a minimum of 40% of their prescribed drug, acyclovir was 96% virologically effective and 100% clinically effective during the period of administration. Acyclovir use was also associated with significantly more rapid marrow engraftment in patients receiving methotrexate. No virus resistant to acyclovir was isolated. Oral acyclovir provides effective prophylaxis against reactivation of herpes simplex virus among severely immunosuppressed patients able to take orally administered drugs.

Topics: Acyclovir; Adolescent; Adult; Bone Marrow Transplantation; Child; Clinical Trials as Topic; Double-Blind Method; Female; Herpes Simplex; Humans; Immunosuppression Therapy; Lymphocyte Activation; Male; Middle Aged; Patient Compliance; Postoperative Complications; Prospective Studies; Random Allocation; Simplexvirus

Topics: Acyclovir; Bone Marrow Transplantation; Clinical Trials as Topic; Cytomegalovirus Infections; Humans; Postoperative Complications

In a double-blind controlled study, oral acyclovir was compared with placebo in 39 consecutive patients undergoing bone-marrow transplantation. Acyclovir was given at a dose of 200 mg every 6 h from 8 days before to 35 days after bone-marrow transplantation. Pharmacokinetic studies showed good absorption of the drug, despite intestinal damage related to chemoradiotherapy or gut graft-versus-host disease. There was no sign of toxicity. The protection against herpes simplex virus (HSV) infection was complete in the treated group compared with the placebo group even in patients with high anti-HSV antibody titres before transplantation. The same protection was observed against cytomegalovirus (CMV) infection. The frequencies of HSV and CMV infections were the same in both groups after the cessation of treatment.

Topics: Acyclovir; Administration, Oral; Adolescent; Adult; Bone Marrow Transplantation; Child; Child, Preschool; Clinical Trials as Topic; Cytomegalovirus Infections; Double-Blind Method; Herpes Simplex; Humans; Postoperative Complications

Acyclovir, a new antiviral agent, was compared to a placebo in a randomized double-blind trial of treatment for culture-proven herpes simplex virus infection after marrow transplantation. Patients received either intravenous acyclovir at 750 mg/m2 body surface area per day or a placebo for 7 days. Thirteen of 17 patients given acyclovir had a beneficial response as compared with two of 17 given the placebo (p less than 0.01). The duration of positive cultures was shorter among acyclovir recipients (3 versus 17 days, p less than 0.00005). Also shorter were the median days to resolution of pain (10 versus 16 days, p = 0.03), to crusting of lesions (7 versus 14 days, p = 0.01), and to total healing (14 versus 28 days, p = 0.03). No acyclovir toxicity was observed. Recurrent infection was common. Acyclovir provided significant antiviral and clinical efficacy without toxicity in highly immunosuppressed patients but had no effect on virus latency.

Topics: Acyclovir; Adolescent; Adult; Antiviral Agents; Bone Marrow Transplantation; Child; Child, Preschool; Clinical Trials as Topic; Double-Blind Method; Female; Guanine; Herpes Simplex; Humans; Immunosuppressive Agents; Infusions, Parenteral; Male; Mucous Membrane; Placebos; Postoperative Complications; Random Allocation; Recurrence

Topics: Acyclovir; Clinical Trials as Topic; Corneal Transplantation; Corneal Ulcer; Humans; Keratitis, Dendritic; Middle Aged; Postoperative Complications; Vidarabine

Topics: Acyclovir; Aged; Drug Therapy, Combination; Facial Paralysis; Humans; Male; Methylprednisolone; Microvascular Decompression Surgery; Nimodipine; Postoperative Complications; Treatment Outcome; Trigeminal Nerve; Trigeminal Neuralgia

To review the long-term outcomes of penetrating keratoplasty (PKP) for corneal complications of herpes zoster ophthalmicus (HZO).. We reviewed the medical records of 53 eyes of 53 patients who underwent PKP due to corneal complications of HZO at the Kellogg Eye Center.. The mean age of patients at the time of PKP was 68.0±16.4 years, with a follow-up of 4.0±3.8 years and quiescent period of 6.5±5.3 years from active HZO to PKP. Preoperatively, 25 (47.2%) eyes were completely anaesthetic, while 16 (30.2%) had deep corneal neovascularisation in four quadrants. Comorbid ocular disease, including cataract, glaucoma and macular disease, was present in 25 (47.2%) eyes. Twenty patients (37.8%) received acyclovir for the entire postoperative period. There were no recurrences of zoster keratitis in any eye. The most common complications were difficulty healing the ocular surface (12/53, 22.6%) and glaucoma (14/53, 26.4%). Thirty per cent of the eyes required one or more additional postoperative procedures, most commonly tarsorrhaphy (10/53, 18.9%) and amniotic membrane graft (6/53, 11.3%). At 1, 2-4 and ≥5 years, 94%, 82% and 70% grafts remained clear, respectively. Visual acuity improved at 1 year postoperatively (p<0.0001), but this improvement was not sustained. There was no significant benefit of long-term acyclovir on visual acuity (p=0.2132) or graft survival (p=0.241).. Even in eyes with significant preoperative risk factors, PKP for the corneal complications of HZO can achieve favourable tectonic and visual results. Although most grafts remained clear, long-term visual potential may be limited by comorbid ocular diseases. Prophylactic postoperative oral acyclovir did not improve outcomes.

Topics: Acyclovir; Adolescent; Adult; Aged; Aged, 80 and over; Antiviral Agents; Corneal Diseases; Eye Infections, Viral; Female; Follow-Up Studies; Graft Survival; Herpes Zoster Ophthalmicus; Humans; Keratoplasty, Penetrating; Male; Middle Aged; Postoperative Complications; Retrospective Studies; Treatment Outcome; Visual Acuity

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

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

Antiviral-resistant herpes simplex virus type 1 (HSV-1) has been recognized as an emerging clinical problem among patients undergoing hematopoietic stem cell transplantation (HSCT).. A prospective observational study was conducted at a hematological center over a 2-year period. Oropharyngeal swab samples were serially collected each week from 1 week before and up to 100 days after HSCT and were tested for virus isolation. The HSV-1 isolates were tested for sensitivity to acyclovir (ACV). The prognosis of patients with ACV-resistant (ACVr) HSV-1 and the genetic background of the ACVr HSV-1 isolates were assessed.. Herpes simplex virus type 1 was isolated in 39 of 268 (15%) HSCT patients within 100 days after transplantation. Acyclovir-resistant HSV-1 emerged in 11 of these 39 patients (28%). The 100-day death rates of HSCT patients without HSV-1 shedding, those with only ACV-sensitive HSV-1 shedding, and those with ACVr HSV-1 shedding were 31%, 39%, and 64%, respectively. Patients with HSV-1, including ACVr HSV-1, shedding showed a significantly higher mortality rate. Relapsed malignancies were a significant risk factor for the emergence of ACVr HSV-1. Acyclovir resistance was attributable to viral thymidine kinase and DNA polymerase mutations in 6 and 5 patients, respectively.. Herpes simplex virus type 1, including ACVr HSV-1, shedding was associated with poorer outcome in HSCT patients, even if HSV disease did not always occur. Patients with relapsed malignancies were at especially high risk for the emergence of ACVr HSV-1.

Topics: Acyclovir; Adolescent; Adult; Aged; Antiviral Agents; DNA-Directed DNA Polymerase; Drug Resistance, Viral; Female; Hematopoietic Stem Cell Transplantation; Herpes Simplex; Herpesvirus 1, Human; Humans; Japan; Male; Microbial Sensitivity Tests; Middle Aged; Multivariate Analysis; Postoperative Complications; Prognosis; Proportional Hazards Models; Prospective Studies; Recurrence; Survival Rate; Thymidine Kinase; Young Adult

To report a case of bilateral herpetic epithelial keratitis after bilateral intravitreal bevacizumab injections for the treatment of exudative age-related macular degeneration.. A 66-year-old man with diabetes and an extensive history of bilateral anti-vascular endothelial growth factor treatments for exudative age-related macular degeneration received an intravitreal bevacizumab injection in the right eye and triple therapy (bevacizumab, photodynamic therapy, and triamcinolone acetonide) in the left eye. After 4 days, he presented with pain, photophobia, tearing, and decreased vision in both eyes. Slit-lamp examination revealed bilateral dendritic epithelial lesions with terminal bulbs, and he was diagnosed with bilateral herpes simplex epithelial keratitis.. The patient was treated with ganciclovir ophthalmic ointment and oral acyclovir with resolution of signs and symptoms.. To our knowledge, this is the first documented account of bilateral herpetic epithelial keratitis after bilateral intravitreal bevacizumab injections.

Topics: Acyclovir; Aged; Angiogenesis Inhibitors; Antiviral Agents; Bevacizumab; Eye Infections, Viral; Ganciclovir; Humans; Intravitreal Injections; Keratitis, Herpetic; Male; Ointments; Ophthalmic Solutions; Postoperative Complications; Vascular Endothelial Growth Factor A; Wet Macular Degeneration

Prognosis of hepatitis-associated aplastic anaemia (HAAA) was improved with haematopoietic stem cell transplantation (HSCT) and immunosuppression, but the long-term outcome remains undefined. Case 1: a girl aged 3 years with acute liver failure (ALF) submitted to orthotopic liver transplantation (OLT) subsequently developed aplastic anaemia and HSCT from a compatible sibling was performed. Post-HSCT, the patient developed post-transplant lymphoproliferative disorder and rituximab was administered with good response. Fifteen years later, both grafts show good outcome. Case 2: a girl aged 10 years submitted to OLT due to ALF, developed pancytopenia 2 months later. Due to the absence of a human leucocyte antigen compatible donor, she was treated with ciclosporin and antithymocyte globulin with very good long-term outcome. These clinical cases suggest that, for patients with HAAA that underwent OLT, aggressive therapy with HSCT or immunosuppression may provide a benign long-term outcome.

Topics: Acyclovir; Anemia, Aplastic; Antiviral Agents; Child; Child, Preschool; Diagnosis, Differential; Female; Follow-Up Studies; Hematopoietic Stem Cell Transplantation; Hepatitis; Humans; Liver Failure, Acute; Liver Transplantation; Postoperative Complications

Topics: Acyclovir; Administration, Intravenous; Antacids; Antiviral Agents; Coronary Artery Bypass; Critical Illness; Endoscopy, Digestive System; Esophagitis; Esophagogastric Junction; Esophagus; Female; Herpes Simplex; Herpesvirus 1, Human; Humans; Immunohistochemistry; Middle Aged; Peptic Ulcer Hemorrhage; Postoperative Complications; Proton Pump Inhibitors; Treatment Outcome

Over 26 years, we found 46 infectious episodes in 350 kidney transplant recipients. Fifteen were urinary tract infections, recurrent in 4 patients. There were 8 cytomegalovirus infections, three of them fatal when intravenous (IV) ganciclovir was not available. Seven patients had a reactivation of tuberculosis (TB) in the pleura, cervical spine, lumbar spine, knee, ankle, skin and peritoneum, respectively, and were all resolved satisfactorily with conventional anti-TB therapy. Three patients transplanted before routine prophylaxis with the use of acyclovir developed an extensive herpes zoster infection in the 1st 6 months after transplantation, which was resolved with the use of oral acyclovir, and 1 had a disseminated herpes simplex infection resolved with the use of IV acyclovir. Three patients transplanted before routine prophylaxis with trimethoprim sulfa developed Pneumocystis carinii pneumonia in the 1st 6 months after transplantation, which was fatal in one of them. In 2 patients, we found a Nocardia infection, confined to the lung, which was cured in one of the cases and systemic and fatal in the other. Two patients transplanted before routine prophylaxis with the use of nystatin developed esophageal candidiasis in the 1st 6 months after transplantation. One patient developed infective endocarditis in a stenotic bicuspid aortic valve and died 10 years later after another incident of infective endocarditis at the prosthetic aortic valve. Two patients developed an extensive condyloma at the penis, perianal region, and perineum owing to human papillomavirus, requiring extensive surgical resection and podophyllin applications. Another patient developed fatal post-transplantation lymphoproliferative disease due to Epstein-Barr virus infection 15 years after transplantation. One patient developed a severe and fatal mucocutaneous leishmaniasis with no response to conventional antimonial therapy. It is interesting to note that despite Chagas disease being endemic in Bolivia, we had no patients with reactivation or transmission through the graft even though many of the patients and donors were serologically positive for Chagas disease.

Topics: Acyclovir; Adolescent; Adult; Aged; Bolivia; Child; Cytomegalovirus Infections; Epstein-Barr Virus Infections; Female; Ganciclovir; Herpes Simplex; Herpes Zoster; Humans; Kidney Transplantation; Male; Middle Aged; Opportunistic Infections; Pneumonia, Pneumocystis; Postoperative Complications; Retrospective Studies; Tuberculosis; Young Adult

Valganciclovir (vGCV) and valacyclovir (vACV) are used in cytomegalovirus (CMV) prophylaxis in renal transplant recipients. The aim of this study was to compare the economic impact of both regimens during 1-year follow-up.. A total of 117 renal transplant recipients at risk for CMV were randomized to 3-month prophylaxis either with vGCV (900 mg/day, n = 60) or vACV (8 g/day, n = 57) and their data used in a pharmacoeconomic analysis. The pharmacoeconomic evaluation involved all direct CMV-related expenses in the first year after transplantation. Sensitivity analysis was employed to examine the effects of various prices of antiviral drugs and diagnostic procedures on overall CMV-related costs. Simulation of the more expensive US healthcare perspective was performed, and a scenario involving costs of acute rejection (AR) was examined.. Overall CMV-related costs were significantly lower in the vACV arm; median United States dollars (USD) 3473 (3108-3745) vs. USD 5810 (4409-6757; P < 0.001) per patient, respectively. Our data showed that the critical determinant of the major disparity between the prophylactic regimens was the prophylaxis price. Median cost of prophylaxis in the vACV group was USD 1729 (1527-2173) compared to USD 3968 (2683-4857) in the vGCV group (P < 0.001). In sensitivity analysis of the overall CMV-related costs, the least and the most expensive pharmacotherapy and diagnostic scenarios were used; nevertheless, the vACV arm remained markedly less expensive. Simulation considering the higher physician/nurse and hospitalization fees of the US healthcare system and the scenario including expenditure associated with AR episodes also favored vACV.. VACV prophylaxis for CMV is associated with a significant 44% lower cost than vGCV at the first year after renal transplantation.

Topics: Acyclovir; Adult; Antiviral Agents; Cytomegalovirus; Cytomegalovirus Infections; Female; Follow-Up Studies; Ganciclovir; Humans; Kidney Transplantation; Male; Middle Aged; Postoperative Complications; Valacyclovir; Valganciclovir; Valine

Pretreatment with antiherpetic medications and steroids decreases likelihood of development of delayed facial paralysis (DFP) after otologic surgery.. Heat-induced reactivation of herpes simplex virus type 1 (HSV1) in geniculate ganglion neurons (GGNs) is thought to cause of DFP after otologic surgery. Antiherpetic medications and dexamethasone are used to treat DFP. Pretreatment with these medications has been proposed to prevent development of DFP.. Rat GGN cultures were latently infected with HSV1 expressing a lytic protein-GFP chimera. Cultures were divided into pretreatment groups receiving acyclovir (ACV), acyclovir-plus-dexamethasone (ACV + DEX), dexamethasone alone (DEX), or untreated media (control). After pretreatment, all cultures were heated 43°C for 2 hours. Cultures were monitored daily for reactivation with fluorescent microscopy. Viral titers were determined from culture media.. Heating cultures to 43°C for 2 hours leads to HSV1 reactivation and production of infectious virus particles (59 ± 6.8%); heating cultures to 41°C showed a more variable frequency of reactivation (60 ± 40%), compared with baseline rates of 14.4 ± 5%. Cultures pretreated with ACV showed lower reactivation rates (ACV = 3.7%, ACV + DEX = 1.04%) compared with 44% for DEX alone. Viral titers were lowest for cultures treated with ACV or ACV + DEX.. GGN cultures harboring latent HSV1 infection reactivate when exposed to increased temperatures that can occur during otologic surgery. Pretreatment with ACV before heat provides prophylaxis against heat-induced HSV reactivation, whereas DEX alone is associated with higher viral reactivation rates. This study provides evidence supporting the use of prophylactic antivirals for otologic surgeries associated with high rates of DFP.

Topics: Acyclovir; Animals; Anti-Inflammatory Agents; Antiviral Agents; Cells, Cultured; Dexamethasone; Facial Paralysis; Geniculate Ganglion; Hot Temperature; Neurons; Otologic Surgical Procedures; Polymerase Chain Reaction; Postoperative Complications; Rats; Rats, Sprague-Dawley; Viral Load; Virus Activation; Virus Latency

Topics: Acyclovir; Adult; Antiviral Agents; Humans; Keratitis, Herpetic; Lasers, Excimer; Male; Photorefractive Keratectomy; Postoperative Complications; Simplexvirus; Treatment Outcome

Collagen crosslinking (CXL) has been proposed as a treatment for infectious keratitis. Given the insurgence of antibiotic-resistant microorganisms and frequent toxicity of topical medications, CXL may be a potential treatment for corneal infections. However, corneal infection is itself a possible complication of this treatment. We describe a case of severe corneal thinning and melting in a woman who had a CXL procedure as a treatment for herpetic keratitis.

Topics: Acyclovir; Antiviral Agents; Collagen; Combined Modality Therapy; Cornea; Corneal Perforation; Corneal Stroma; Cross-Linking Reagents; Female; Humans; Keratitis, Herpetic; Keratoplasty, Penetrating; Middle Aged; Photochemotherapy; Photosensitizing Agents; Postoperative Complications; Riboflavin; Ultraviolet Rays

Topics: Acyclovir; Adult; Allografts; Antiviral Agents; Cytomegalovirus; Cytomegalovirus Infections; Female; Ganciclovir; Humans; Kidney Transplantation; Male; Middle Aged; Postoperative Complications; Valacyclovir; Valine

Varicella zoster virus (VZV) infections are a relevant cause of morbidity and mortality in hematological patients and especially in hematopoietic stem cell transplant (HSCT) recipients. The present study aimed to investigate the prevalence and clinical significance of viral persistence and antiviral resistance by systematically analyzing all episodes of VZV diagnosed in our laboratory in pediatric and adult hematological patients between 2007 and 2010.. Patient charts were reviewed to document patient and disease characteristics. VZV loads were determined in all available clinical samples from the day of diagnosis and thereafter. Persistent VZV infection was defined as a VZV infection that lasted at least 7 days. Analysis of resistance was performed in all patients with persistent VZV infection by sequence analysis of viral thymidine kinase and DNA polymerase genes.. In total, 89 episodes occurred in 87 patients, of whom 65 were recipients of an allogeneic HSCT. Follow-up samples were available in 54 episodes. Persistent VZV was demonstrated in 32 of these episodes (59%). Complications occurred in 16 of the persistent episodes (50%) vs 2 of 22 nonpersistent episodes (9%). Mutations possibly associated with resistance were found in 27% of patients with persistent VZV, including patients with treatment-unresponsive dermatomal zoster that progressed to severe retinal or cerebral infection.. In hematological patients, VZV-related complications occur frequently, especially in persistent infections. Antiviral resistance is a relevant factor in persistent infections and needs to be investigated in various affected body sites, especially when clinical suspicion of treatment failure arises.

Topics: Acyclovir; Adolescent; Adult; Antibodies, Viral; Antineoplastic Agents; Antiviral Agents; Blood; Child; Combined Modality Therapy; Drug Resistance, Viral; Female; Hematologic Diseases; Hematopoietic Stem Cell Transplantation; Herpes Zoster; Herpesvirus 3, Human; Humans; Male; Polymerase Chain Reaction; Postoperative Complications; Viral Load; Virus Activation; Virus Replication; Young Adult

Cytomegalovirus (CMV) remains an important pathogen in transplant patients, and valacyclovir (VACV) prophylaxis 8 g/day has been used in high-risk CMV-seromismatched [D+/R-] renal transplant patients to decrease CMV disease. Neurotoxic adverse effects have limited its use, and the aim of the present study was to retrospectively evaluate low-dose VACV prophylaxis, 3 g/day for 90 days after transplantation, in 102 D+/R- renal transplant patients.. We compared patient and graft survival rates up to 5 years after transplantation with the data from the Collaborative Transplant Study Group (CTS) database. The incidence of CMV disease, rejection and neurotoxic adverse effects was analyzed up to 1 year after transplantation.. The patient and graft survival rates up to 5 years were comparable with those derived from the CTS. CMV disease was diagnosed in 25% of the patients and 2% developed tissue-invasive CMV disease. The rejection frequency was 22% and neurotoxic adverse effects were seen in 2% of the patients.. Low-dose VACV prophylaxis (3 g/day) for 90 days post-transplantation results in high patient and graft survival rates and reduces the incidence of CMV disease. Neurotoxic adverse effects are minimal. We believe that low-dose VACV prophylaxis should be considered to form one of the arms in future prospective comparison studies for the prevention of CMV disease in the high-risk D+/R- population of renal transplant patients.

Topics: Acyclovir; Adult; Antibiotic Prophylaxis; Antiviral Agents; Cytomegalovirus; Cytomegalovirus Infections; Female; Follow-Up Studies; Glomerular Filtration Rate; Graft Rejection; Graft Survival; Humans; Kidney Transplantation; Male; Middle Aged; Postoperative Complications; Prognosis; Renal Insufficiency, Chronic; Retrospective Studies; Survival Rate; Time Factors; Valacyclovir; Valine

A 64 year-old female with Parkinson disease treated with amantadine for two years who suddenly suffered bilateral corneal oedema. It was initially treated as herpetic endotheliitis without improvement as we lacked information on her chronic treatment. The corneal oedema finally resolved after withdrawing the drug.. Amantadine hydrochloride may produce endothelial dysfunction. Once the amantadine treatment is stopped, the corneal oedema may be reversible but endothelial density remains low. An ophthalmologist examination should be performed before the initiation of amantadine treatment in order to establish a risk: benefit ratio, especially in those patients with low endothelial density or any endothelial anomaly.

Topics: Acyclovir; Amantadine; Antiparkinson Agents; Aqueous Humor; Cataract Extraction; Ceftazidime; Corneal Edema; Corneal Endothelial Cell Loss; Corneal Opacity; Diagnostic Errors; Female; Humans; Keratitis; Middle Aged; Parkinson Disease; Postoperative Complications; Prednisolone; Saline Solution, Hypertonic; Vancomycin

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

Ramsay Hunt syndrome develops upon reactivation of a latent virus within the geniculate ganglion. The patient presents with acute facial paralysis, severe ear pain, and a vesicular eruption of the external auditory canal and concha. Varicella zoster virus seropositivity occurs among approximately 90% of members of society. In these persons, virus reactivation may occur especially with advancing age and immunosuppression. We present a case of Ramsay Hunt syndrome that developed in a 35-year-old male patient, who had undergone a renal transplantation 8 months prior and had received maintenance immunosuppression.

Topics: Acyclovir; Adult; Antiviral Agents; Dose-Response Relationship, Drug; Herpes Zoster Oticus; Humans; Immunosuppressive Agents; Kidney Failure, Chronic; Kidney Transplantation; Male; Methylprednisolone; Mycophenolic Acid; Postoperative Complications; Treatment Outcome

Discussion of a rare case of angioleiomyoma of the internal auditory canal.. Thirteen-year-old female patient with a 1-year history of progressive hearing loss.. Middle cranial fossa approach providing complete surgical extirpation.. Surgical pathology.. Radiography and history suggestive of vestibular schwannoma; pathology revealed angioleiomyoma.. Angioleiomyoma is a rare lesion of the internal auditory canal that has many similar clinical and radiographic features of a vestibular schwannoma. There are no previous reports of this tumor occurring within the internal auditory canal in this age group.

Topics: Acyclovir; Adolescent; Angiomyoma; Anti-Inflammatory Agents; Antiviral Agents; Cranial Fossa, Middle; Ear Neoplasms; Ear, Inner; Facial Nerve; Facial Nerve Diseases; Female; Hearing Loss, Sudden; Humans; Magnetic Resonance Imaging; Postoperative Complications; Prednisone; Tomography, X-Ray Computed; Valacyclovir; Valine; Vertigo; Vestibular Nerve

We report the case of a 34-year-old man who had uncomplicated cataract surgery in his left eye. Medical history was significant for atopic dermatitis, requiring oral immunosuppressive medications. Two days after the surgery, the patient presented with pain, photophobia, decreased vision, and a small corneal abrasion. On postoperative day 5, the patient returned with left upper lid vesicular lesions and 2 corneal dendrites. Corrected vision was 20/100 OS, with intraocular pressure of 18 mm Hg and 1+ pigmented cells in the anterior chamber. Cultures of the lid lesions revealed herpes simplex virus (HSV) type 1. The patient was placed on oral acyclovir 800 mg 5 times a day. By day 8, the dendrites had resolved, and by day 15, the lid lesions healed over. HSV keratitis is an uncommon complication after cataract surgery. Ophthalmologists should be aware of the possibility of developing HSV keratitis even after the most routine cataract extraction.

Topics: Acyclovir; Administration, Oral; Adult; Anti-Inflammatory Agents; Antifungal Agents; Antiviral Agents; Cataract Extraction; Drug Administration Schedule; Drug Therapy, Combination; Eyelid Diseases; Herpes Simplex; Humans; Keratitis, Herpetic; Male; Postoperative Complications; Prednisolone; Treatment Outcome; Wound Healing

Topics: Acyclovir; Antibodies, Monoclonal; Antibodies, Monoclonal, Murine-Derived; Antineoplastic Combined Chemotherapy Protocols; Antiviral Agents; Carmustine; Cisplatin; Colitis; Combined Modality Therapy; Cyclophosphamide; Cytarabine; Dexamethasone; Doxorubicin; Etoposide; Hematopoietic Stem Cell Transplantation; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunocompromised Host; Immunoglobulins, Intravenous; Intestinal Pseudo-Obstruction; Lymphoma, Large B-Cell, Diffuse; Male; Melphalan; Middle Aged; Postoperative Complications; Prednisolone; Rituximab; Transplantation, Autologous; Vincristine; Virus Activation

To assess the incidence of and risk factors associated with postherpetic neuralgia (PHN) after hematopoietic cell transplantation (HCT) varicella zoster virus (VZV) infection, we conducted a retrospective chart review of 418 consecutive patients who underwent HCT between April 2005 and March 2007. The male/female ratio was 221/197, median age at HCT was 47 years (range: 0-69 years), and autologous/allogeneic/syngeneic HCT ratio was 154/263/1. Seventy-eight patients developed VZV infection after HCT. Sixty-two patients had localized zoster, 11 patients had disseminated zoster (rash like chicken pox), and 4 patients had visceral zoster. All cases were treated with acyclovir (ACV) or valacyclovir (VACV), and there was no VZV infection-related death. Twenty-seven (35%) of the 78 patients with VZV infection suffered PHN after resolution of VZV infection. Multivariate analysis showed that advanced age is the only risk factor in autologous HCT (P = .0075; odds ratio [OR] = 1.14; 95% confidence interval [CI], 0.97-1.33). On the other hand, advanced age (P = .0097; OR = 1.06; 95% CI, 1.01-1.12), male gender (P = .0055; OR = 12.7; 95% CI, 1.61-100.1), and graft-versus-host disease (GVHD) prophylaxis with a tacrolimus-based regimen (P = .0092; OR = 9.56; 95% CI, 1.44-63.3) were associated with increased risk of PHN in allogeneic HCT. This study for the first time clarified the risk of PHN in HCT recipients.

Topics: Acyclovir; Adolescent; Adult; Aged; Chickenpox; Child; Child, Preschool; Female; Genetic Diseases, Inborn; Hematopoietic Stem Cell Transplantation; Herpes Zoster; Humans; Incidence; Infant; Infant, Newborn; Japan; Male; Middle Aged; Neoplasms; Neuralgia, Postherpetic; Postoperative Complications; Retrospective Studies; Risk; Transplantation, Autologous; Transplantation, Homologous; Valacyclovir; Valine; Virus Activation; Young Adult

Topics: Acyclovir; Adolescent; Adult; Antibodies, Viral; Antigens, Viral; Antiviral Agents; Child; Child, Preschool; Cytomegalovirus; Cytomegalovirus Infections; Disease-Free Survival; Ethnicity; Female; Foscarnet; Ganciclovir; Graft vs Host Disease; Hematopoietic Stem Cell Transplantation; Humans; Infant; Infant, Newborn; Living Donors; Male; Middle Aged; Myeloablative Agonists; Postoperative Complications; Premedication; Proportional Hazards Models; Recurrence; Tissue Donors; Transplantation Conditioning; Transplantation, Homologous; Virus Activation; Young Adult

Cytomegalovirus (CMV) disease represents an important cause of morbidity in renal transplant recipients. We report our preliminary evaluation of the efficacy and security of preemptive therapy to manage renal transplant recipients with evidence of active CMV replication.. Preemptive therapy with gancyclovir and/or valgancyclovir (VGCV) was recently substituted for CMV antiviral prophylaxis at our institution. Between May 2006 and December 2007, all patients undergoing renal transplantation were included in a CMV infection surveillance program. Blood samples to determine CMV viral load were obtained weekly during the first 4 months. Asymptomatic patients, with a viral load determined using polymerase chain reaction (PCR) with CMV DNA >100,000 copies/mL, were treated with VGCV for 3 months or until resolution of viral replication. Until April 2006, patients undergoing renal transplantation received CMV prophylaxis with oral acyclovir and pp65 antigenemia was the test for CMV infection surveillance. The group on preemptive therapy was compared with a historical group on prophylaxis therapy: 100 renal patients who underwent transplantation between April 2004 and 2006.. Among 96 recipients, quantitative determination of viral DNA in blood was elevated in 14 asymptomatic patients, who were treated with oral VGCV for 3 months. The patients were followed up for a median time of 13.3 months. None of the 14 patients who received VGCV developed CMV disease.. VGCV administered as preemptive therapy was safe and efficacious to prevent CMV disease.

Topics: Acyclovir; Adolescent; Adult; Aged; Antiviral Agents; Cytomegalovirus Infections; DNA, Viral; Female; Ganciclovir; Humans; Kidney Transplantation; Male; Middle Aged; Postoperative Complications; Transplant Recipients; Valganciclovir; Viral Load; Young Adult

EBV-associated post-transplant lymphoproliferative disorder (PTLD) is a well-recognized complication following solid organ transplantation and hematopoietic stem cell transplantation (HSCT) using bone marrow or peripheral blood as stem cell sources, but rarely reported in umbilical cord blood transplantation (UCBT). We report two cases in unrelated UCBT setting and added the following new information to the literature: (i) EBV-related PTLD can be presented late in recipients of unrelated UCBT; (ii) in contrast to reported literatures that PTLD is a serious complication with unfavorable outcome, especially in monomorphic form, our cases showed that the clinical course may be relatively benign if treatment is initiated promptly.

Topics: Acyclovir; Adrenoleukodystrophy; Antibodies, Monoclonal; Antibodies, Monoclonal, Murine-Derived; Antiviral Agents; Child; Child, Preschool; Combined Modality Therapy; Cord Blood Stem Cell Transplantation; Cyclosporine; Epstein-Barr Virus Infections; Graft vs Host Disease; Herpesvirus 4, Human; Humans; Immunoglobulins, Intravenous; Immunologic Factors; Immunosuppressive Agents; Lymphoproliferative Disorders; Male; Postoperative Complications; Prednisolone; Remission Induction; Rituximab; Tumor Virus Infections; Virus Activation

Epstein-Barr virus (EBV) infection occurring in the postoperative period represents a significant risk for pediatric transplant recipients. It presents in various manners, including a mononucleosis-like syndrome, hepatitis, encephalopathy, or posttransplant lymphoproliferative disease (PTLD). Valacyclovir has in vitro activity against EBV. We sought to review our experience with valacyclovir on peripheral blood EBV viral loads among a group of EBV-infected patients after liver transplantation (OLT).. Twelve children of ages 6-36 months (median, 12 months), underwent OLT. Eight (66%) were EBV immunoglobulin (Ig)G seronegative at the time of the operation. Eight patients developed primary infection and 4 patients developed reactivation of a post primary infection. Valacyclovir was prescribed immediately to 3 patients when we detected an acute-primary EBV infection. Valacyclovir was prescribed for 2 patients who had primary EBV infections followed by PTLD. Three patients who had primary EBV infection were administered valacyclovir after they became chronically EBV PCR positive for more than 1 year. Four out of 12 cases (33%) were EBV seropositive at the time of OLT, and underwent postprimary EBV reactivation displaying chronic EBV carrier state for 8-10 months before valacyclovir treatment. Peripheral blood EBV viral loads were tested every 2 months. The primary outcome was the proportion of subjects with EBV viremia who had a >or=2 log 10 decrease in EBV copies/mL after valacyclovir treatment. The duration of valacyclovir treatment was a median of 10 months (range, 8-11 months). At the beginning of the treatment period the median level of EBV viral load was 1.1 x 10(4) (range, 1 x 10(4) to 1 x 10(7)). EBV virus was cleared in only 1 patient with primary acute EBV infection. EBV viral loads did not change in 7 of 12 patients and decreased only 1 log 10 (n = 2) or 2 log 10 (n = 2).. In this small, non-placebo-controlled study, valacyclovir treatment was not effective to decrease peripheral blood EBV viral loads.

Topics: Acute Disease; Acyclovir; Antiviral Agents; Body Weight; Child, Preschool; Chronic Disease; Epstein-Barr Virus Infections; Humans; Infant; Liver Function Tests; Liver Transplantation; Postoperative Complications; Recurrence; Retrospective Studies; Valacyclovir; Valine; Viral Load; Virus Activation

Topics: Acyclovir; Antiviral Agents; Chickenpox; Herpesvirus 3, Human; Humans; Kidney Transplantation; Male; Postoperative Complications; Treatment Outcome

We report on three cases of severe disseminated Herpes simplex type-2 (HSV-2) infection that occurred in two orthotopic liver-transplant (OLT) and one renal-transplant patients. In two cases, i.e., in the OLT patients, this was associated with HSV-2-related acute hepatitis. The rapid onset of IV acyclovir (ACV) therapy led to recovery within 8-12 days. Although rare, HSV-2-disseminated infection, in the context of organ transplantation may be life-threatening, but can be cured if ACV therapy is initiated early in the course of this disease.

Topics: Acyclovir; Adult; Antiviral Agents; Female; Herpes Simplex; Herpesvirus 2, Human; Humans; Kidney Transplantation; Liver Transplantation; Male; Middle Aged; Postoperative Complications

To determine the effect of routine use of prophylactic oral acyclovir after penetrating keratoplasty (PK) for herpes simplex virus (HSV) keratitis on recurrence, rejection, and graft failure rates.. Records from 70 consecutive patients who underwent PK for HSV keratitis at the W.K. Kellogg Eye Center between August 1, 1990, and December 31, 2000, were reviewed. Data collected included preoperative disease activity, duration, host vascularity, pre- and postoperative vision, and antiviral use. Particular attention was given to all episodes of HSV recurrence, graft rejection, and failure.. Fifty-six patients (80%) were treated with prophylactic oral acyclovir after surgery. This cohort experienced fewer episodes of rejection (P = 0.006) and better overall graft survival (P = 0.04) than those who were not treated with prophylactic oral antivirals. There was no statistically significant difference in recurrence-free survival between the 2 groups (P = 0.22). Cox regression analysis failed to identify any single variable as a statistically significant predictor of recurrence, rejection, or graft failure.. Prophylactic oral acyclovir use after PK for HSV keratitis is associated with decreased episodes of rejection and improved graft survival.

Topics: Acyclovir; Administration, Oral; Adolescent; Adult; Aged; Aged, 80 and over; Antiviral Agents; Child; Child, Preschool; Female; Graft Rejection; Graft Survival; Herpesvirus 1, Human; Humans; Keratitis, Herpetic; Keratoplasty, Penetrating; Male; Middle Aged; Postoperative Complications; Virus Activation

Herpes simplex virus (HSV) infection usually occurs in immunocompromised or severely debilitated patients. It is not so common in patients with renal transplants. The diagnosis can only be made histologically. It usually occurs during or shortly after treatment of graft rejection with high-dose steroids. We have recently experienced a case of HSV esophagitis and nephropathy in the renal allograft biopsy, which was identified by histology, immunostaining, and electron microscopy. A 43-year-old woman underwent cadaveric renal transplantation with cyclosporine and prednisolone treatment. Twelve months later, she developed renal insufficiency and proteinuria. Allograft renal biopsy showed some evidence of acute rejection. She was treated with 3 successive days of methylprednisolone (1.0 g/d) intravenously and continued tapering of steroids. Three weeks after steroid pulse therapy, she had throat pain, oral cavity ulcer, dysphagia, and febrile sensation. Esophagoscopy revealed multiple confluent ulcers in the whole esophagus, and biopsy showed enlarged epithelial cells with prominent nuclei. Immunohistochemically, the epithelial cells were positive with a monoclonal antibody to HSV type 1. She was started on acyclovir intravenously, which was continued for a week. After a week, her symptoms began to improve and repeat endoscopy showed no residual esophagitis. A renal allograft infection with HSV can persist in heavily immunosuppressed patients with recurrent rejection episodes. HSV mainly affects tubular cells causing necrosis, a major reason for functional deterioration. A biopsy is required for diagnosis.

Topics: Acyclovir; Adult; Antiviral Agents; Cadaver; Esophagitis; Female; Graft Rejection; Herpes Simplex; Humans; Kidney Transplantation; Necrosis; Postoperative Complications; Tissue Donors

Topics: Acyclovir; Adult; Antibodies, Viral; Antiviral Agents; Chickenpox Vaccine; Child; Child, Preschool; Contraindications; Disease Transmission, Infectious; Environmental Exposure; Hematopoietic Stem Cell Transplantation; Herpes Zoster; Herpesvirus 3, Human; Humans; Immune Sera; Immunization, Passive; Infant; National Institutes of Health (U.S.); Postoperative Complications; Practice Guidelines as Topic; Premedication; Sensitivity and Specificity; United States; Valacyclovir; Valine

Cytomegalovirus (CMV) prophylaxis is recommended for high-risk patients, while preemptive therapy is considered acceptable for patients at moderate/low risk. After reviewing kidney transplant patients from 1992-1995 and 1996-1999, we decided to replace prophylaxis by preemptive therapy. Herein we have presented our data. From 1996-1999 we treated 129 patients with ganciclovir prophylaxis for 3 months if D+/R- or if they received depleting antibodies. The incidence of CMV was 13.2% versus 3.7% in the 1992-1995 cohort. The increase was associated with mycophenolate mofetil (MMF) use (P = .002). Forty-two percent of the D+/R- developed an infection with 89% of bouts occurring in the first month after cessation of prophylaxis. From 2002-2004, we never gave prophylaxis to 129 patients except when they received thymoglobulin. High-risk D+/R- patients were monitored by polymerase chain reaction (PCR) CMV for 3 months. The incidence of CMV was 17.1% with 54% of the D+/R- developing CMV. CMV infection occurred mostly during the first trimester posttransplantation. Creatinine at 1 year posttransplantation was worse in the presence of CMV infection (154.3 mumol/L-1.75 mg % versus 130.2 mumol/L-1.47 mg %, P = .03). Time to cure CMV infection was longer when MMF was discontinued: 36.7 days versus 69.9 days (P = .026). Our results indicated that CMV incidence is increasing: 3.7% (1992-1995) --> 13.2% (1996-1999) -->17.1% (2002-2004) and that it impairs 1 year graft function. Recovery was faster among patients still receiving MMF compared with those discontinuing MMF. Although MMF inhibits synthesis of anti-CMV IgM, it increases the anti-herpes virus effect of ganciclovir and may protect against chronic allograft nephropathy. Based on our experience, we plan to reintroduce prophylaxis in high-risk patients and to continue MMF when treating CMV infection.

Topics: Acyclovir; Antiviral Agents; Cytomegalovirus Infections; Follow-Up Studies; Ganciclovir; Humans; Incidence; Kidney Transplantation; Postoperative Complications; Retrospective Studies; Time Factors

Patients undergoing haemopoietic stem cell transplants (HSCT) are at high risk of varicella zoster virus (VZV) reactivation, with a significant incidence of dissemination. This study reports a retrospective analysis of 247 allogeneic HSCT recipients receiving anti-viral prophylaxis with low-dose oral aciclovir 400 mg/day, administered until immunosuppression was discontinued and the CD4(+) cell count exceeded 200/mm(3). Viral reactivation was successfully suppressed by aciclovir prophylaxis, with only one case of breakthrough infection. The cumulative incidence of zoster infection at 1 year post transplant was 2% and at 5 years 34%. In all, 64 patients discontinued prophylaxis. Zoster developed in 26 of these, giving a cumulative incidence of infection at 1 year after stopping aciclovir of 39% and at 3 years 44%. Infection occurred in a localised dermatomal distribution in 93% of cases. This supports previous findings that aciclovir prophylaxis prevents early VZV reactivation, although the long-term incidence is not affected as infection occurs once prophylaxis is discontinued. Such infection, however, is mild and localised. This study does not support the idea that use of such low-dose aciclovir regimens reduces the zoster incidence by permitting subclinical reactivation during prophylaxis, and therefore the re-establishment of protective anti-viral immunity.

Topics: Acyclovir; Adult; Antiviral Agents; CD4-Positive T-Lymphocytes; Chickenpox; Cohort Studies; Hematopoietic Stem Cell Transplantation; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunosuppressive Agents; Leukemia; Middle Aged; Postoperative Complications; Retrospective Studies; Risk Factors; T-Lymphocytes; Time Factors; Transplantation Conditioning; Transplantation, Homologous

The aim of this paper is to present a patient suffering from acoustic neuroma and operated on with immediate postoperative hearing and facial function preservation who developed delayed Ramsay-Hunt syndrome. To our knowledge, this is the first case in whom a postoperative delayed facial palsy and hearing loss occurred. The patient gave an history of previously diagnosed herpes zoster reactivation limited to chest one-year before. This is undoubtdetly a predisposing factor for development of delayed facial palsy. It must not be underestimated and it obliges to consider a prophylaxis. Theoretically, the prophylactic antiviral therapy might prevent the evolution towards the herpes zoster oticus or reduce the severity of the symptoms allowing the preservation of the hearing function. It would be pointed out that the delayed facial plasy has favourable prognosis, while the hearing impairment may recover with a greater difficulty even after an antiviral treatment as in our case.

Topics: Acyclovir; Antiviral Agents; Female; Hearing Loss, Sensorineural; Herpes Zoster Oticus; Herpesvirus 3, Human; Humans; Middle Aged; Neuroma, Acoustic; Postoperative Care; Postoperative Complications; Preoperative Care; Time Factors

Topics: Acyclovir; Brain; Brain Edema; Craniotomy; Decompression, Surgical; Encephalitis, Herpes Simplex; Female; Herpesvirus 1, Human; Humans; Immunocompromised Host; Immunosuppressive Agents; Magnetic Resonance Imaging; Meningioma; Middle Aged; Postoperative Complications; Steroids; Stress, Physiological; Treatment Outcome; Unconsciousness

We report on a chronic asymptomatic hepatitis B surface antigen (HBsAg) carrier who developed an increase in aminotransferase and HBsAg levels 1 year after lung transplantation. During treatment for cutaneous herpes simplex virus (HSV) infection with oral valaciclovir there was a marked decrease in replicating hepatitis B virus (HBV)-DNA and aminotransferase levels, which was sustained for 9 months by continuing low-dose valaciclovir. A second rise in aminotransferase levels again responded to a valaciclovir dose increase and the HBV-DNA levels declined further. Although we cannot exclude a spontaneous variation of the serologic parameters, our observation suggests that valaciclovir may represent a valuable therapeutic option in the treatment of chronic hepatitis B after lung transplantation.

Topics: Acyclovir; Bronchiectasis; Carrier State; Chronic Disease; Female; Follow-Up Studies; Graft Survival; Hepatitis B Surface Antigens; Hepatitis B, Chronic; Humans; Lung Transplantation; Middle Aged; Postoperative Complications; Preoperative Care; Risk Assessment; Serologic Tests; Treatment Outcome; Valacyclovir; Valine

Reactivation of herpes simplex virus resulting in oral infection is common after cardiac transplantation and usually occurs within the first month posttransplant. The clinical presentation, however, may be atypical. We present a case of a 48-year-old female who presented with a large tongue mass 1 year after cardiac transplantation. Outpatient biopsies and viral stains were nondiagnostic. Because of the high suspicion for malignancy, an excisional biopsy was performed in the operating room. Pathologic analysis was consistent with herpes simplex virus type 1 infection. The patient received antiviral therapy with resolution of infection at follow-up.

Topics: Acyclovir; Antiviral Agents; Female; Follow-Up Studies; Heart Transplantation; Humans; Middle Aged; Postoperative Complications; Recurrence; Stomatitis, Herpetic; Tongue Diseases; Virus Activation

A woman with a history of recurrent herpes simplex keratitis in the left eye developed endothelial and stromal keratitis after cataract extraction. Because of the resultant corneal distortion a high regular astigmatism appeared. An arcuate keratotomy was performed to improve her visual acuity.. Corneal astigmatism can appear after herpetic keratitis. An arcuate keratotomy was effective in this case to decrease astigmatism and improve her vision. Keratitis reactivation is possible so antiviral prophylaxis is advisable. Our good results show that arcuate keratotomy can be a useful technique for these patients.

Topics: Acyclovir; Antiviral Agents; Astigmatism; Dexamethasone; Drug Therapy, Combination; Female; Humans; Keratitis, Herpetic; Lens Implantation, Intraocular; Middle Aged; Ophthalmologic Surgical Procedures; Phacoemulsification; Postoperative Complications; Tobramycin; Valacyclovir; Valine; Virus Activation

A 40-year-old woman underwent bilateral Laser In Situ Keratomileusis (LASIK) for the correction of myopia and astigmatism. The day after, four dendritic ulcers appeared in her left eye. She was treated with topical antiviral agents until complete recovery. She had a history of recurrent labial herpetic infection.. Reactivation of herpes simplex virus type 1 can occur, even without any previous history of corneal infection. Although this does not contraindicate surgery, all patients with a history of herpetic infection should be made aware of the complications related to this technique.

Topics: Acyclovir; Adrenal Cortex Hormones; Adult; Antiviral Agents; Astigmatism; Female; Herpes Labialis; Humans; Keratitis, Herpetic; Keratomileusis, Laser In Situ; Myopia; Postoperative Complications

To study the role of herpes virus reactivation in the onset of more than three days-delayed facial paralysis (FP) following vestibular schwannoma (VS) surgery and advocate a specific medical management.. Retrospective study on 8 cases from a series of 348 patients operated on of a VS between 1996 and 2002. Seven of the eight patients were given intravenously acyclovir (30 mg x kg(-1) x d(-1) for 5 days) and methyl-prednisolone (2 mg x kg(-1) x d(-1) for 7 days). A serologic testing looking for specific anti-herpes simplex viruses type 1 and 2 (HSV-2) and varicella-zoster virus (VZV) antibodies at the onset of the FP and 2 weeks later could be done in only 3 cases.. Mean delay of FP onset was 8.75 days. Mean time for recovery with intravenous treatment was 90 days. All treated patients had a House and Brackmann grade 1 recovery. The last one had only a grade 3 after 400 days of evolution: he could not be treated because of postoperative transient psychiatric problems. Serologic testing revealed in those patients in whom it could be done either a high level of anti-HSV or -VZV antibodies at the time of onset or a dramatic increase in anti-HSV or anti-VZV antibodies between the two samples, strongly suggesting a HSV or VZV reactivation.. HSV or VZV reactivation can be evocated in most cases of delayed FPs arising in the postoperative course of VSs, suggesting usefulness of emergency-given steroid and acyclovir intravenous regimen to block virus replication and fight secondary oedema and inflammation causative of nerve lesions. Evoked reactivation mechanism is comparable to that already suspected in delayed FP arising with the same delay in middle ear surgical procedures.

Topics: Acyclovir; Adult; Anti-Inflammatory Agents; Antibodies, Viral; Antiviral Agents; Facial Paralysis; Female; Herpesviridae Infections; Herpesvirus 1, Human; Herpesvirus 2, Human; Humans; Male; Methylprednisolone; Middle Aged; Neuroma, Acoustic; Postoperative Complications; Retrospective Studies

Cytomegalovirus (CMV) following orthotopic liver transplantation can result in significant morbidity and mortality. Prophylaxis with oral aciclovir (ACV) or ganciclovir (GCV) for all transplant recipients (universal prophylaxis) may be beneficial, but which agent is more cost-effective is unknown.. A single centre, retrospective study of all patients who had OLT at the Western Australian Liver Transplantation Service was performed. Patients received ACV from 1992 to 1998, and GCV from 1999 to 2001. A comparative cost-effectiveness analysis for the two groups was performed based on the mean total cost of the number of cases of CMV infection and disease as the clinical end-point.. The ACV group comprised of 55 patients and there were 24 in the GCV group. The incidence of CMV disease was 7% and 4% for the ACV and GCV groups, respectively (P > 0.05). For CMV infection it was 16% and 8%, respectively (P > 0.05). GCV prevented more cases of CMV infection and disease than ACV but at an incremental cost of dollars A20,000 (dollars US10,172) per case prevented. Overall, ACV was more cost-effective than GCV by dollars A2200 (dollars US1119) per person. The cost benefit of ACV was derived principally through a reduced pharmaceutical cost. Both agents were well tolerated without development of antiviral resistance.. Universal prophylaxis of CMV infection-following liver transplantation with aciclovir is more cost-effective than with ganciclovir.

Topics: Acyclovir; Adult; Age Distribution; Antiviral Agents; Australia; Cost-Benefit Analysis; Cytomegalovirus Infections; Drug Costs; Female; Ganciclovir; Graft Rejection; Health Care Costs; Humans; Incidence; Liver Transplantation; Male; Middle Aged; Postoperative Complications; Primary Prevention; Probability; Retrospective Studies; Sex Distribution; Statistics, Nonparametric; Treatment Outcome

The objectives of this study were to study the role of herpes virus reactivation in the onset of delayed facial paralysis (DFP) occurring more than 72 hours after vestibular schwannoma (VS) surgery and to advocate specific medical management.. We conducted a retrospective case review.. University-based, tertiary care center.. Eight patients managed for DFP in a series of 348 patients operated for a VS.. Patients were evaluated and graded according to the House and Brackmann grading system and followed up for 1 year. A serologic search for specific antiherpes simplex viruses type 1 and 2 (HSV-2) and varicella zoster virus (VZV) antibodies at the onset of DFP and 2 weeks later was possible in three cases. Seven of the eight patients were given intravenous acyclovir (30 mg/kg/ for 5 days) and methylprednisolone (2 mg.kg/ for 7 days).. Mean delay of DFP onset was 8.75 days. All treated patients had a House and Brackmann Grade 1 recovery: mean time to recovery was 40.4 days. The last one had only a Grade 3 recovery because he could not be treated because of postoperative transient psychiatric problems. Serologic testing in those patients in whom it could be done revealed either a high level of anti HSV or VZV antibodies at the time of onset or a dramatic increase in anti-HSV or anti-VZV antibodies between the two samples, strongly suggesting an HSV or VZV reactivation.. HSV or VZV reactivation might be responsible for most cases of DFPs, thus suggesting the usefulness of immediate steroid and acyclovir administration to obtain total recovery. The viral reactivation mechanism is comparable to that already suspected in DFP occurring with the same delay in middle ear surgical procedures.

Topics: Acyclovir; Adult; Aged; Antiviral Agents; Bell Palsy; Facial Paralysis; Female; Herpesvirus 1, Human; Herpesvirus 2, Human; Herpesvirus 3, Human; Humans; Male; Methylprednisolone; Middle Aged; Neuroma, Acoustic; Postoperative Complications; Retrospective Studies; Virus Activation

Topics: Acyclovir; Bell Palsy; Ear, Middle; Humans; Otosclerosis; Postoperative Complications; Preoperative Care

Thirty-one herpes simplex virus type one (HSV-1) isolates from 12 haematopoietic stem cell transplant recipients with persistent HSV infections despite acyclovir (ACV) prophylaxis or treatment, were genotypically and phenotypically characterized. The relationship between drug susceptibility of the isolates and mutations in thymidine kinase (TK) and DNA polymerase (DNA pol) genes was examined. In all 12 patients, HSV infections were due to ACV-resistant, foscarnet-sensitive viruses. Out of 31 isolates examined, 23 were resistant and eight were sensitive to ACV; eight patients carried viruses with frameshift mutations in the TK gene (due to addition or deletion of single nucleotides in homopolymeric repeats). These mutations were found at codon 61 (G deletion, one patient), 146 (G insertion, five patients) and 153 or 185 (C deletion, one patient each). In four patients, viruses were selected during ACV therapy that contained novel amino acid substitutions in the TK gene (H58R, G129D, A189V, R216H, R220C). Their possible role in ACV resistance was further confirmed phenotypically and by the absence of any resistance-associated mutations in the DNA pol gene. These substitutions were located in ATP- or nucleoside-binding sites or in conserved regions of the TK gene. In addition, a single mutation, Q570R, in the delta-region C of the DNA pol gene, was identified in an isolate from a single patient with resistance to ACV. Our study confirms and expands previous data on genotypic changes associated with ACV resistance of HSV-1 clinical isolates.

Topics: Acyclovir; Adolescent; Adult; Antibiotic Prophylaxis; Antiviral Agents; Child; Codon; DNA-Directed DNA Polymerase; Drug Resistance, Viral; Female; Genotype; Hematopoietic Stem Cell Transplantation; Herpes Simplex; Herpesvirus 1, Human; Humans; Male; Middle Aged; Molecular Sequence Data; Mutation; Phenotype; Postoperative Complications; Thymidine Kinase

The purpose of this study was to evaluate patients who contracted the varicella zoster virus infection (VZV) following their allogeneic stem cell transplants. We retrospectively reviewed the incidence and the timing of varicella zoster virus (VZV) infections, including the clinical course, complications, and associated clinical risk factors. Between January 1998 and April 2003, a total of 71 patients received allogeneic stem cell transplants in our hospital. For prophylaxis of the herpes virus infection, all patients were given a daily oral 1000 mg dose of acyclovir from day -7 to day +35. Among the 71 patients, 28 of them (39.4%) developed VZV infection between day 77 and day 980 (median 182 days) following their allogeneic stem cell transplants. In 21 of these infected patients (75%) the occurrence was within the first 300 days after the transplant. Twenty-two patients (78.5%) were under treatment with immunosuppressive agents. Twenty-six patients developed only one episode of the VZV infection after their transplants, but two other patients developed two episodes. Twenty one patients (75%) stricken with the VZV infections had cutaneous reactivation infections of a single dermatome, and in one patient two dermatomes were affected. Five patients (17.8%) developed disseminated cutaneous zoster, and one patient (3.6%) developed a visceral infection. Treatment with acyclovir (oral or drip infusion) was successful in 25 patients. Two patients improved with vidarabine treatment, however the patient with the visceral infection died despite the use of acyclovir. The incidence of visceral infection was low, but the one case was fatal.

Topics: Acyclovir; Adolescent; Adult; Antiviral Agents; Female; Herpes Simplex; Herpes Zoster; Humans; Immunosuppressive Agents; Incidence; Male; Middle Aged; Postoperative Complications; Prognosis; Retrospective Studies; Stem Cell Transplantation; Time Factors; Transplantation, Homologous; Vidarabine

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

High-dose valaciclovir at up to 8 g/day has been shown to be effective in prophylaxis against cytomegalovirus (CMV) disease in renal transplant recipients. We report our experience with low-dose valaciclovir prophylaxis of up to 3 g/day, adjusted to creatinine clearance. A group of patients at high risk of developing CMV disease who received prophylaxis were selected as the study group. This included all CMV-positive patients who received antilymphocyte therapy (R+, n=20) and all CMV-negative recipients of CMV-positive organs (D+R-, n=15). D+R- patients receiving antilymphocyte therapy were excluded, as most of the patients in the control group had received ganciclovir prophylaxis. A historical control group was used, which consisted of patients who did not receive prophylaxis. Low-dose valaciclovir prophylaxis resulted in a statistically significant decrease (8.5 vs 37%, P=0.004) in CMV disease in the study group at 6 months. On subgroup analysis the decrease was statistically significant only in the R+ group (5 vs 45%, P=0.003), not in the D+R- group (13.3 vs 26.6%, P=0.651). Low-dose valaciclovir prophylaxis seems to be adequate for R+ patients receiving antilymphocyte therapy. The role of low-dose valaciclovir prophylaxis needs to be assessed further in a prospective trial.

Topics: Acyclovir; Adult; Antiviral Agents; Cytomegalovirus Infections; Dose-Response Relationship, Drug; Drug Therapy, Combination; Female; Humans; Immunosuppressive Agents; Kidney Transplantation; Living Donors; Male; Postoperative Complications; Prodrugs; Reoperation; Retrospective Studies; Tissue Donors; Valacyclovir; Valine

In corneal recipients with herpes infection, acyclovir given for 1 year postoperatively prevents viral reactivation and improves graft outcome. The indication for prophylactic antiviral therapy relies on the preoperative diagnosis of herpes. However, many patients present with corneal scars featuring sequelae of herpes without a proven history of herpes. Here we report the results of a prospective study of anti-herpes simplex virus (anti-HSV) and varicella zoster virus (VZV) antibody testing in the aqueous humor at the time of corneal transplantation to refine the indication of the antiviral treatment.. The study involved 33 keratitis corneal graft recipients, 21 of whom had documented herpes keratitis. A control group was made with 11 cataract patients. An anterior chamber puncture was performed just before surgery. The micro-ELISA test was done on both aqueous humor and serum, and local anti-HSV or VZV antibody synthesis was acknowledged if the ratio of antibody concentrations was above 4.. Local antibody synthesis to HSV was detected in 22 cases, to VZV in 9 cases, to both HSV and VZV in 6 cases, and no synthesis in 8 cases. The sensitivity of the test was 65% in patients with a documented history of herpes (14 cases out of 21). Among non-herpetic patients, the test was positive in 9 patients, who thus benefited from postoperative antiviral therapy. No viral reactivation was encountered after a minimum follow-up of 1 year.. Antibody testing in the aqueous humor at the time of keratoplasty is a convenient, inexpensive diagnostic tool in corneal recipients. It provides useful information before prescribing a long and expensive postoperative antiviral therapy.

Topics: Acyclovir; Adult; Aged; Aged, 80 and over; Antibodies, Viral; Antiviral Agents; Aqueous Humor; Corneal Transplantation; Enzyme-Linked Immunosorbent Assay; Female; Herpesvirus 3, Human; Humans; Keratitis, Herpetic; Male; Middle Aged; Postoperative Complications; Simplexvirus; Virus Activation

Varicella is a common childhood disease that can cause morbidity and mortality among immunosuppressed patients. There have been few previous studies monitoring the course of pediatric liver transplant patients with acute varicella. The aim of this study was to evaluate the treatment, outcomes, and complications of pediatric liver transplant patients admitted with acute varicella infection.. A retrospective chart review was carried out based on discharge diagnoses of orthotopic liver transplant and varicella among pediatric patients (age range, birth-18 years) admitted to the UCLA Medical Center between 1985 and 2001.. Five hundred fifty-six pediatric patients received liver transplantations between 1985 and 2001. Twenty-two of these patients were admitted to the UCLA Medical Center with varicella (11 females, 11 males). No patients were treated on an outpatient basis. Mean age of the patients was 6 years (range, 1-16 years). None of these patients received the varicella vaccine before hospitalization. On admission, 5 of 22 patients (23%) had received varicella zoster immunoglobulin within 96 hours of exposure. The mean length of hospitalization was 6 days (range, 2-11 days). All immunosuppression dosages were reduced during the admissions. None of the patients had been treated with high-dose corticosteroids for acute rejection before the onset of the varicella infection. Patients were treated until defervescence with intravenous acyclovir and until their varicella lesions crusted. Patients were discharged with oral acyclovir to complete a 10-day course (including the intravenous treatment). No patients had complications from the varicella infection. A complication of an elevated serum creatinine for one patient was noted with the intravenous acyclovir treatment. This patient had associated headache and nausea that resolved when the creatinine level returned to normal.. There were no complications or dissemination of varicella infection among our pediatric liver transplant patients. Further prospective randomized trials are required to evaluate the management of pediatric liver transplant patients infected with varicella.

Topics: Acyclovir; Adolescent; Antiviral Agents; Chickenpox; Chickenpox Vaccine; Child; Child, Preschool; Female; Herpesvirus 3, Human; Hospitalization; Humans; Immunocompromised Host; Immunosuppressive Agents; Infant; Liver Transplantation; Male; Postoperative Complications; Retrospective Studies; Safety; Treatment Outcome

Generally, the need for information about varicella-zoster virus (VVZ) infection in cardiac transplantation (CT) is greater than that for other organ transplants. All cases of VVZ infection among the 175 CT patients included herpes zoster as the clinical syndrome in all 11 cases (men, 90.9%; mean age, 50.3+/-5 years; incidence, 6.3%). The infection was limited to one dermatome in seven patients (63.6%: thoracic, 6%; ophthalmic, 1), or two contiguous dermatomes in four patients (36.4%). The infection onset was after the first semester in seven patients (63.6%). All patients received three drug immunosuppressive therapy. Cardiac rejection during the three previous months occurred in one patient (3A grade). Previous CMV disease was observed in three patients (27.3%: range, 7-14 months). Intravenous acyclovir was administered to five patients (ophthalmic and several dermatome forms), and oral therapy for the rest. All the patients recovered; there were no complications or postherpetic neuralgia (mean follow-up: 16.5 months). VVZ infection, a frequent late infection among CT recipients, presents as a clinical syndrome of herpes zoster, frequently in patients with previous CMV infection. In CT, herpes zoster frequently affects two dermatomes, but the clinical courses and responses to treatment are favorable. There was no postherpetic neuralgia.

Topics: Acyclovir; Antiviral Agents; Female; Heart Transplantation; Herpes Zoster; Humans; Incidence; Male; Middle Aged; Postoperative Complications; Retrospective Studies; Treatment Outcome

If not promptly recognized and treated, herpes simplex virus (HSV) hepatitis is associated with a high mortality. A patient transplanted for primary sclerosing cholangitis required, 4 years later, a colectomy for a steroid-resistant flare of ulcerative colitis. He subsequently developed fever, with genital and oral ulcerations. He was hospitalized for diabetic decompensation with massive elevation of serum aminotransferases. Examination revealed vesicles on the hands. Liver biopsy showed Cowdry type B inclusions. Therapy with acyclovir was immediately initiated and the patient recovered. This case illustrates the diagnostic importance of mucocutaneous lesions in the assessment of complications after liver transplantation.

Topics: Acyclovir; Adult; Antiviral Agents; Cholangitis, Sclerosing; Colectomy; Colitis, Ulcerative; Hepatitis; Herpes Simplex; Humans; Liver Transplantation; Male; Postoperative Complications; Reoperation; Simplexvirus

The object of the present study was to review a series of surgically removed vestibular schwannoma tumours to establish the incidence of delayed facial palsy and to evaluate the course of recovery according to the possible etiology (surgical postoperative edema or viral reactivation) with reference to the time of onset.. The study group was composed of 98 patients with vestibular schwannoma. Sex, age, location, and extent of tumour and postoperative complications were all taken into consideration in the final evaluation. The course of each patient's postoperative facial function was graded according to House and Brackmann's six-grade scale. The incidence and the time of onset of the delayed facial palsy were also evaluated.. The deterioration in the facial function was found to be delayed in 25 of the 98 patients (26%); of these, it occurred in the first 5 days after surgery in 11 cases, between 6 and 13 days in 10 cases, and after 15 days in 14 patients. The incidence rate of the delayed facial dysfunction was not influenced by age, sex, or the size of the tumour. The prognosis of the facial dysfunction was favourable in the majority of cases, and, in fact, there were only five grade III to IV cases 1 year later. Facial dysfunction was over grade III in the majority of the latter five cases, and the period of recovery was long.. Eighty percent of our patients with delayed facial palsy following vestibular schwannoma resection were classified as having excellent or good function. In the remaining patients who had a less favourable recovery, the palsy was more severe, and the onset occurred after some time. This seems to agree with those who are of the opinion that the complication is due to viral reactivation. In these patients, it is advisable to start aggressive medical therapy with antiviral agents such as acyclovir as soon as possible.

Topics: Acyclovir; Adult; Aged; Antiviral Agents; Edema; Facial Nerve; Facial Paralysis; Female; Humans; Incidence; Male; Middle Aged; Neuroma, Acoustic; Neurosurgical Procedures; Postoperative Complications; Prognosis; Recovery of Function; Retrospective Studies; Steroids; Time Factors; Treatment Outcome; Virus Activation

The impact of transfusion of leucodepleted platelet concentrates (PCs) on cytomegalovirus (CMV) disease was assessed in 215 allogeneic (145 unrelated and 70 related donor) transplants over 3 years. In 43%, both donor and patient were CMV seronegative (CMV-/-). All received CMV-seronegative red cells and random leucodepleted PCs. No CMV disease occurred in any CMV-/- (low risk) transplant. CMV infection occurred in 31 seropositive patients (26%); 13 died and five deaths were attributable to CMV disease. When compared with historical controls, who received CMV-seronegative PCs, we found no difference in transfusion-acquired CMV in the current cohort.

Topics: Acyclovir; Adolescent; Adult; Antiviral Agents; Child; Child, Preschool; Cytomegalovirus Infections; Female; Foscarnet; Ganciclovir; Humans; Infant; Lymphocyte Depletion; Male; Middle Aged; Platelet Transfusion; Postoperative Complications; Retrospective Studies; Stem Cell Transplantation; Transplantation, Homologous

Prevention of cytomegalovirus (CMV) infection after hematopoietic stem cell transplantation (HSCT) generally involves preemptive treatment of recognized infection before the onset of overt CMV-associated disease. The success of this method depends on efficient recognition of infection and intervention before the disease progresses. Reliable tests for such diagnosis include blood culture, antigenemia assays, polymerase chain reaction assays, and other DNA sequence- or RNA sequence-based assays. For selected high-risk patients, such as patients receiving T cell-depleted hematopoietic stem cell transplants, prophylactic use of antiviral agents before the onset of CMV infection is recommended. The ability to monitor the immunological status of the patient relative to CMV-specific immunity is increasing in importance. Ultimately, the solution to the problem of efficient prevention of CMV infection in this population will require combined antiviral chemotherapy and improved reconstitution of CMV immunity.

Topics: Acyclovir; Antiviral Agents; Chemoprevention; Cidofovir; Cytomegalovirus; Cytomegalovirus Infections; Cytosine; Ganciclovir; Hematopoietic Stem Cell Transplantation; Humans; Organophosphonates; Organophosphorus Compounds; Postoperative Complications; Risk Factors; Transplantation, Autologous; Transplantation, Homologous; Valacyclovir; Valganciclovir; Valine

New antiviral agents and practice guidelines have been implemented to address cytomegalovirus (CMV) infection in organ transplantation. We hypothesized that such measures would reduce rates of symptomatic CMV infection, CMV disease, and CMV seroconversion and associated complications in renal transplant and simultaneous pancreas-kidney transplant recipients. We analyzed the impact of CMV in 1,424 renal transplant and simultaneous pancreas-kidney transplant recipients, transplanted at our center between January 1, 1994 and June 30, 1999. Most patients received quadruple sequential immunosuppression with high-dose acyclovir (800 mg four times daily) for 12 weeks as prophylaxis. High-risk patients (donor CMV-positive/recipient CMV-negative) received ganciclovir (500 to 1,000 mg three times daily) beginning in 1998, again for 12 weeks. One hundred and one renal transplant (9.0%) and 40 simultaneous pancreas-kidney transplant (13.4%) recipients experienced symptomatic CMV infection or CMV disease. Donor CMV-positive/recipient CMV-negative patients had the greatest rates of CMV infection or CMV disease (25.2%; P = 0.0001 versus all other categories). The impact of CMV on outcomes was evaluated in a proportional hazards model. Symptomatic CMV infection or CMV disease increased the risk for subsequent rejection (relative risk, 2.11; P = 0.003) and non-CMV infection (relative risk, 2.24; P = 0.001). To determine if the effects of ganciclovir were masked by pre-1998 data, CMV infection and CMV disease rates for ganciclovir-treated patients (n = 62) were censored at 1 year and compared with acyclovir-treated patients (n = 287). Ganciclovir was associated with trends toward lower rates of infection and disease. It also delayed the time to infection or disease. Serologic testing in high-risk patients also showed late seroconversion, with 20% of patients seroconverting by 6 months, 12 weeks after the prophylaxis period. These data suggest that despite better prophylaxis strategies, CMV remains an important pathogen in renal transplant and simultaneous pancreas-kidney transplant recipients. This finding may require reassessment of prophylaxis strategies and the development of alternative or novel anti-CMV regimens.

Topics: Acyclovir; Adult; Antiviral Agents; Cytomegalovirus; Cytomegalovirus Infections; Drug Administration Schedule; Female; Ganciclovir; Graft Rejection; Humans; Immunosuppressive Agents; IMP Dehydrogenase; Kidney Transplantation; Living Donors; Male; Mycophenolic Acid; Pancreas Transplantation; Postoperative Complications; Proportional Hazards Models; Retrospective Studies; Transplantation Conditioning

Herpes simplex virus (HSV) can cause postpartum endometritis. The clinical diagnosis of HSV endometritis has been reported previously. The disease is responsive to acyclovir intravenously.. A 22-year-old woman, gravida 2, para 1, status post primary cesarean section for a double footling breech presentation, developed a persistent postpartum fever. Simulating the febrile course of septic pelvic thrombophlebitis, the patient's condition was unresponsive to broad-spectrum antimicrobials and heparin therapy. Active herpetic lesions and a positive cervical culture for herpes simplex prompted the use of intravenous acyclovir. Rapid resolution of the fever and the similarity to previous case reports suggested the clinical diagnosis of herpes simplex endometritis.. The diagnosis of postpartum herpes simplex endometritis should be considered when managing a persistent postpartum fever unresponsive to aggressive antimicrobial and heparin therapy. Immediate resolution of the fever should occur with the use of acyclovir.

Topics: Acyclovir; Adult; Antiviral Agents; Breech Presentation; Cesarean Section; Diagnosis, Differential; Endometritis; Female; Fever; Herpes Simplex; Humans; Infusions, Intravenous; Postoperative Complications; Postpartum Period; Pregnancy

Valaciclovir (VACV) 2 g q.i.d. for 3 months after kidney transplantation has been shown, (Lowance et al., NEJM 1999; 340: 1462-70), to reduce CMV disease from 45 to 16% and rejection from 52 to 26% in CMV-negative (D+R-) recipients. Neurotoxic side effects, however, were frequent, and 5% of the patients experienced hallucinations. We hypothesised that a lower dosage of VACV would prevent CMV disease with fewer CNS side effects.. Since September 1998 all CMV-mismatched renal transplant recipients received VACV 1 g t.i.d. for 3 months posttransplantation (PT). The incidence of CMV disease, rejection and neurotoxic side effects during 6 months PT was studied retrospectively in, up to now, 25 patients.. 24% (6/25) of the patients developed CMV disease. The mean time for onset of symptoms was 145 days (92-191). Five of the patients had mild-moderate symptoms and recovered after ganciclovir therapy for 3 weeks. One patient was diagnosed with a CMV-associated retinitis on day 191 PT. The rate of biopsy-confirmed acute graft rejection was 32% (8/25). 20% (5/25) of the patients had a serum creatinine of >200 micromol/l after 6 months, including one patient on hemodialysis. CNS adverse effects were not observed. None out of nine patients with basiliximab induction and VACV developed CMV disease. One patient with basiliximab that did not receive VACV, developed a symptomatic CMV-infection.. The incidence of CMV disease was lower than in historical controls at our centre, and the time to onset of symptoms was prolonged. Compared to the 8 g VACV/day study, CMV disease and graft rejection was more frequent, but no neurotoxic side effects were observed. A combination with basiliximab induction and VACV 3 g/day shows promising results, but randomised studies are needed for confirmation.

Topics: Acyclovir; Adult; Aged; Antiviral Agents; Cytomegalovirus Infections; Female; Graft Survival; Humans; Incidence; Kidney Transplantation; Male; Middle Aged; Postoperative Complications; Retrospective Studies; Valacyclovir; Valine

Topics: Acyclovir; Antiviral Agents; Cytomegalovirus Infections; Dose-Response Relationship, Drug; Humans; Kidney; Kidney Transplantation; Postoperative Complications; Safety; Valacyclovir; Valine

Topics: Acyclovir; Antiviral Agents; Cytomegalovirus; Cytomegalovirus Infections; Drug Resistance, Microbial; Ganciclovir; Humans; Organ Transplantation; Postoperative Complications; Valacyclovir; Valine

In the period 1973-1998, among 2139 allograft recipients treated with standard immunosuppression, posttransplant lymphoproliferative disorders (PTLD) developed in 19 patients (0.9%): one plasmacytic hyperplasia, two polymorphic PTLD, one myeloma, and 15 lymphomas. PTLD developed 1 year after transplantation (tx) in 14 patients. Five patients were diagnosed at autopsy, 2 were lost to follow up, 3 died before therapy could be instituted, and 1 patient has just started chemotherapy. Of the 8 evaluable patients, 2 received acyclovir and are alive in complete remission (CR) and 6 received chemotherapy +/- surgery. Of these 6, 4 died of lymphoma and/or infection, 1 died of unrelated causes in CR, and 1 is alive in CR. PTLD is a severe complication of tx, usually running an aggressive course which may preclude prompt diagnosis and treatment. Nevertheless, therapy is feasible and must be tailored on the histologic subtype. Seventy-four percent of patients were diagnosed with late-onset PTLD stressing the need for long-term follow up.

Topics: Acyclovir; Adult; Aged; Antiviral Agents; Bone Marrow Transplantation; Drug Therapy, Combination; Humans; Immunophenotyping; Immunosuppressive Agents; Incidence; Italy; Kidney Transplantation; Lymphoproliferative Disorders; Middle Aged; Organ Transplantation; Postoperative Complications; Retrospective Studies; Time Factors; Transplantation, Homologous

Topics: Acyclovir; Adult; Anticoagulants; Antiviral Agents; Blood Component Transfusion; Drug Therapy, Combination; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunoglobulins, Intravenous; Immunosuppressive Agents; Kidney Transplantation; Male; Postoperative Complications

Cytomegalovirus (CMV) disease may occur following renal transplantation and has been shown to have health and cost consequences in this setting.. To compare the cost effectiveness of different CMV management strategies for renal transplant patients: prophylaxis with (i) oral valaciclovir or (ii) intravenous ganciclovir; viral testing for CMV followed by (iii) pre-emptive therapy with intravenous ganciclovir or (iv) adjustment of immunosuppression and intensive monitoring; or (v) waiting to treat when CMV disease develops.. A decision-tree model was constructed that included the different management strategies for the donor seropositive/recipient seronegative (D+R-) population. Clinical outcomes for the D+R- population came from clinical trials. Treatment algorithms and costs for CMV syndrome and tissue invasive disease were developed from published literature and UK physician interviews. One- and 2-way sensitivity analyses were performed.. UK National Health Service.. Prophylaxis with either oral valaciclovir or intravenous ganciclovir dominated (lower costs and fewer cases of CMV disease) the pre-emptive treatment and wait-and-treat strategies. The cost per patient was from 157 Pounds to 438 Pounds higher with oral valaciclovir prophylaxis compared with intravenous ganciclovir prophylaxis and the incremental cost per case of CMV disease avoided with valaciclovir prophylaxis ranged from 2243 Pounds to 8111 Pounds (1996 values). These results are sensitive to the efficacy of intravenous ganciclovir prophylaxis and CMV management costs.. For D+R- renal transplant patients, prophylaxis is the dominant (more effective and less costly) management strategy compared with pre-emptive and wait-and-treat strategies. The cost per patient with oral valaciclovir prophylaxis compared with intravenous ganciclovir prophylaxis is slightly higher in our base case scenario, but may be lower under reasonable alternative assumptions.

Topics: Acyclovir; Administration, Oral; Algorithms; Antiviral Agents; Cost-Benefit Analysis; Cytomegalovirus Infections; Decision Trees; Drug Costs; Ganciclovir; Humans; Injections, Intravenous; Kidney Transplantation; Postoperative Complications; Premedication; Valacyclovir; Valine; Virus Shedding

Topics: Acute Disease; Acyclovir; Antineoplastic Combined Chemotherapy Protocols; Antiviral Agents; Cytarabine; Etoposide; Female; Humans; Idarubicin; Imipenem; Kidney Transplantation; Leukemia, Myeloid; Middle Aged; Myelodysplastic Syndromes; Postoperative Complications; Thienamycins

This case report is presented to raise the awareness of the potential risk of reactivation of herpes simplex virus (HSV) encephalitis after intracranial surgery.. The case of an 8-year-old male patient who suffered a reactivation of HSV encephalitis after undergoing amygdalohippocampectomy for complex partial seizures is reported. This patient had previously contracted HSV 1 meningoencephalitis at the age of 16 months. Six years later, a left amygdalohippocampectomy was proposed after the development of intractable partial epilepsy associated with left mesial temporal lesions. During the postoperative period, the patient suffered severe clinical deterioration with partial status epilepticus, aphasia, and hyperthermia, which resolved after intensive antiepileptic treatment supported by acyclovir.. We advise prophylactic pre-, peri-, and postoperative treatment with acyclovir for patients with known histories of HSV encephalitis who undergo intracranial procedures.

Topics: Acyclovir; Antiviral Agents; Child; Encephalitis, Viral; Epilepsies, Partial; Herpesvirus 1, Human; Humans; Magnetic Resonance Imaging; Male; Postoperative Complications; Recurrence; Sclerosis; Temporal Bone

Topics: Acyclovir; Adolescent; Adult; Aged; Antiviral Agents; Cytomegalovirus Infections; Female; Humans; Incidence; Kidney Transplantation; Male; Middle Aged; Postoperative Complications; Retrospective Studies

Topics: Acyclovir; Adult; Aged; Antiviral Agents; Chickenpox; Female; Humans; Kidney Transplantation; Male; Middle Aged; Postoperative Complications; Retrospective Studies

Topics: Acyclovir; Antiviral Agents; Heart Transplantation; Herpesviridae Infections; Humans; Postoperative Complications; Retrospective Studies; Tissue Donors

Topics: Acyclovir; Administration, Oral; Adult; Antiviral Agents; Cytomegalovirus Infections; Female; Humans; Kidney Transplantation; Middle Aged; Postoperative Complications; Valacyclovir; Valine

Topics: Acyclovir; Antiviral Agents; Cadaver; Costs and Cost Analysis; Cytomegalovirus Infections; Graft Survival; Hospitals, Community; Humans; Kidney Transplantation; Living Donors; Postoperative Complications; Survival Rate; Texas; Tissue Donors

Topics: Acyclovir; Administration, Oral; Adult; Antiviral Agents; Costs and Cost Analysis; Cross-Sectional Studies; Cytomegalovirus Infections; Ganciclovir; Humans; Incidence; Kidney Transplantation; Pancreas Transplantation; Postoperative Complications; Retrospective Studies; Tennessee; Time Factors

Topics: Acyclovir; Administration, Oral; Antiviral Agents; Cytomegalovirus Infections; Female; Graft Rejection; Humans; Incidence; Kidney Transplantation; Male; Postoperative Complications; Prevalence; Retrospective Studies

Topics: Acyclovir; Adult; Analysis of Variance; Antilymphocyte Serum; Antiviral Agents; Azathioprine; Cyclosporine; Cytomegalovirus Infections; Graft Survival; Humans; Immunosuppression Therapy; Immunosuppressive Agents; Incidence; Kidney Transplantation; Postoperative Complications; Prednisone; Prevalence; Retrospective Studies

Topics: 2-Aminopurine; Acyclovir; Antiviral Agents; Chemexfoliation; Chemoprevention; Dermabrasion; Dermatitis, Perioral; Elective Surgical Procedures; Famciclovir; Female; France; Herpes Simplex; Humans; Postoperative Complications; Recurrence; Stomatitis, Herpetic; Valacyclovir; Valine

Systemic viral disease after renal transplantation, especially after treatment with OKT3 or antithymocyte globulin, has usually been attributed to cytomegalovirus (CMV) infection. Identification of human herpesvirus 6 (HHV6) has raised the possibility that infection or reactivation of this virus may also occur in the same setting.. We thus examined the incidence of CMV and HHV6 infection in a prospective blinded consecutive series of 30 renal and renal/pancreas transplant patients, 22 of whom received OKT3, antithymocyte globulin, or both.. Clinical diagnosis of a viral syndrome was made in 15 patients. Three patients with only HHV6 DNA in urine or serum had fever and abnormal liver function but not neutropenia. All five CMV-seronegative patients who received positive kidneys developed moderate to severe disease with fever and neutropenia but also had HHV6 DNA in urine or serum. Seven CMV-seropositive patients developed disease, mostly after OKT3/antithymocyte globulin, but six shed both CMV and HHV6 in urine or serum. The simultaneous detection of both HHV6 and CMV DNA in either urine or serum was the strongest predictor of disease (and also the severity of disease), with an odds ratio of 99.0 (95% confidence intervals 5.4-1814, P<0.002).. Most systemic viral disease after renal transplantation may be due to either coinfection or reactivation of CMV and HHV6 together. A wider understanding of risk factors for severe viral disease in this setting may come from testing for both viruses in all donors and patients in both clinical practice and clinical trials.

Topics: Acyclovir; Antiviral Agents; Cytomegalovirus; Cytomegalovirus Infections; DNA, Viral; Forecasting; Herpesviridae Infections; Herpesvirus 6, Human; Humans; Kidney Transplantation; Postoperative Complications; Prospective Studies; Serologic Tests; Virus Shedding

Cytomegalovirus remains a significant source of morbidity and mortality in immunocompromised hosts. The increased sensitivity of molecular diagnostic techniques (PCR, antigenemia) has resulted in our ability to detect viral replication earlier in the posttransplant period, before the onset of symptoms. With the advent of effective antiviral therapy, "preemptive therapy," guided by sensitive, early and specific predictors of CMV disease, has become a realistic objective. Although multiple studies have analyzed the sensitivity and specificity of these tests, their predictive value for the development of disease has not been defined. The purpose of this study was to evaluate the predictive value of a positive CMV PCR in the setting of solid abdominal organ transplantation. A total of 476 PCR assays were performed on 134 transplant recipients (102 kidney, 19 kidney/pancreas, 11 liver, 2 other) either as protocol serial samples or as dictated by clinical events. All samples were concomitantly analyzed using standard virological assays for CMV including culture, shell vial, and serology. Patients with any CMV seropositive donor/recipient (D/R) combination received ganciclovir prophylaxis in conjunction with antilymphocyte induction for 14 days. No subsequent CMV prophylaxis was used. The positive predictive value was 55% in all seropositive donor/recipient combinations. The highest risk group (seronegative recipient of seropositive donor) showed the highest positive predictive value, whereas seropositive recipients of either seropositive or seronegative donors showed positive predictive values of 45% and 25%, respectively. Negative predictive value was 100% for all groups. Early detection of CMV infection has important implications for patient management, including preemptive therapy, which can be guided by PCR, especially in high risk (D+/R-) patients.

Topics: Acyclovir; Antiviral Agents; Cytomegalovirus; Cytomegalovirus Infections; Ganciclovir; Humans; Kidney Transplantation; Liver Transplantation; Pancreas Transplantation; Polymerase Chain Reaction; Postoperative Complications; Predictive Value of Tests; Retrospective Studies; Transplantation

Sixty-four consecutive liver transplant patients receiving 76 organs have been monitored for human cytomegalovirus (HCMV) in blood and urine posttransplantation using a polymerase chain reaction (PCR) assay that amplifies a 149 base pair fragment of the glycoprotein B gene. Six hundred and twenty-six blood and 310 urine samples were analysed during surveillance. Thirty-two patients had CMV infection (50%), 12 of whim progressed to HCMV disease. Detection of HCMV in either blood or urine was significantly associated with the presence or development of HCMV disease (blood, P < 0.00001; urine, P = 0.0033). All cases of HCMV disease were detected as PCR-positive in blood, although due to sampling only 50% of these patients were PCR-positive prior to disease onset. HCMV infection and disease were more likely in patients who suffered rejection (P < 0.001). In addition, the median amounts of augmented prednisolone were higher in patients with HCMV infection and disease. In all cases, augmented prednisolone preceded HCMV infection/disease. There was no statistical association between CMV infection and death. Overall, the results show that routine use of PCR for HCMV in surveillance samples of blood and urine of liver transplant recipients can provide diagnostic and prognostic information. However, its ability to provide prognostic information is directly related to the availability of appropriate surveillance samples, emphasising the importance of the routine acquisition of such samples in patient management to allow preemptive anti-HCMV therapy.

Topics: Acyclovir; Antibodies, Viral; Antiviral Agents; Blood; Cause of Death; Cytomegalovirus; Cytomegalovirus Infections; Follow-Up Studies; Graft Rejection; Humans; Immunosuppression Therapy; Liver Transplantation; Polymerase Chain Reaction; Postoperative Complications; Prognosis; Survival Rate; Time Factors; Tissue Donors; Urine

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

Posttransplantation lymphoproliferative disorders (PTLDs) represent an important complication of solid organ transplantation. The main causative factor of PTLDs seems to be the intensity and type of immunosuppressive therapy and the frequent occurrence of Epstein-Barr virus infection. PTLDs that are disseminated at diagnosis or present late after transplantation generally share an unfavorable prognosis and are unlikely to regress in response to reduction in immunosuppressive therapy. We describe a case of cutaneous B-cell lymphoma occurring 4 years after heart transplantation in which molecular analysis revealed a monoclonal pattern of Epstein-Barr virus infection and immunoglobulin gene rearrangement. In spite of its monoclonal nature and late occurrence, the lymphomatous lesions regressed completely after antiviral treatment and a reduction in immunosuppressive therapy.

Topics: Acyclovir; Antiviral Agents; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Therapy, Combination; Heart Transplantation; Herpesviridae Infections; Herpesvirus 4, Human; Humans; Immunosuppressive Agents; Lymphoma, B-Cell; Male; Middle Aged; Opportunistic Infections; Postoperative Complications; Prognosis; Skin Neoplasms; Tumor Virus Infections

Posttransplant lymphoproliferative disorder (PTLD) has been observed with increasing frequency consequent to the availability of more effective and potent immunosuppression. Prior work suggested that a peripheral blood monitoring strategy detecting peripheral B lymphoproliferation was effective in the early diagnosis of PTLD among 7 of 179 (3.9%) consecutive transplant recipients. Each of those seven patients received at least one course of antithymocyte globulin, Minnesota antilymphocyte globulin, or OKT3 before developing PTLD.. To determine whether antiviral prophylaxis might reduce the incidence of PTLD, a subsequent group of 198 consecutive recipients received either ganciclovir or acyclovir during antilymphocyte antibody administration. When the donor or recipient were cytomegalovirus-seropositive, ganciclovir was given; acyclovir was used when both were cytomegalovirus-seronegative. Baseline and protocol posttransplant cell surface profiles were obtained using immunofluorescence and flow cytometry to detect T cells, lymphocyte activation markers, and the CD19 B cell antigen.. Demographic factors, including the incidence of recipients more than 50 years of age, non-Caucasians, previous transplantation, and diabetes mellitus, were similar in both groups. Additionally, the number of patients receiving antilymphocyte preparations was similar. However, only one patient (0.5%) from the latter group who received preemptive antiviral therapy developed PTLD. Although elevations in CD19+ B cells preceded clinical PTLD among each of the seven earlier patients, evidence of peripheral B cell proliferation was not demonstrated for the sole patient from the latter group, which suggests a possible effect of antiviral therapy.. Prophylactic antiviral therapy may reduce the sensitivity of peripheral monitoring for B lymphoproliferation, but the dramatic reduction in PTLD incidence strongly supports its use among transplant recipients at risk.

Topics: Acyclovir; Adolescent; Adult; Antigens, CD; Antigens, CD19; Antilymphocyte Serum; Antiviral Agents; Ganciclovir; Herpesvirus 4, Human; Humans; Immunophenotyping; Immunosuppressive Agents; Incidence; Kidney Transplantation; Liver Transplantation; Lymphoproliferative Disorders; Middle Aged; Muromonab-CD3; Pancreas Transplantation; Postoperative Complications; Retrospective Studies

The attack rate of cytomegalovirus (CMV) is over 50% in solid organ transplant recipients at risk for primary CMV infection and in those receiving antilymphocyte antibody therapy. Various CMV prophylaxis regimens over the last few years have reduced the attack rate to around 20% overall.. We report our results using high-dose acyclovir for 3 months after transplant, with targeted intravenous ganciclovir for the duration of any antilymphocyte antibody therapy, in our kidney and simultaneous pancreas/kidney transplant recipients. Records of 109 consecutive patients over a 2-year period were reviewed.. Six cases of CMV disease were identified. Five cases occurred in 21 patients at risk for primary CMV disease (24%), whereas only one case occurred in 73 patients at risk for CMV reactivation (1.4%).. We conclude that high-dose acyclovir and targeted ganciclovir is excellent prophylaxis against CMV reactivation in kidney and simultaneous pancreas/kidney transplantation.

Topics: Acyclovir; Administration, Oral; Adolescent; Adult; Aged; Antilymphocyte Serum; Antiviral Agents; Creatinine; Cytomegalovirus Infections; Drug Therapy, Combination; Ganciclovir; Humans; Immunosuppressive Agents; Injections, Intravenous; Kidney Transplantation; Middle Aged; Pancreas Transplantation; Postoperative Complications; Recurrence; Retrospective Studies; Risk Factors

A 5-year-old girl with a kidney transplant developed post-transplant Epstein-Barr virus-induced lymphoproliferative disease. She was treated with acyclovir, alpha-interferon, and gamma globulin. A transplant nephrectomy was performed on day 4 due to acute rejection and she was started on hemodialysis. The acyclovir dose was decreased at this time. However, 6 days following the start of acyclovir she developed progressively worsening neurological symptoms resulting in a coma on day 8. Fourteen days after acyclovir was begun pre- and post-dose serum concentrations were 7.02 microM and 182.5 microM, respectively. Acyclovir was then discontinued and 2 days later the child's neurological status began to improve. We conclude that acyclovir in children with end-stage renal failure may lead to severe and reversible neurotoxicity, despite acyclovir dosage adjustment based on renal impairment.

Topics: Acyclovir; Antiviral Agents; Child, Preschool; Female; Humans; Kidney Transplantation; Lymphoproliferative Disorders; Nervous System Diseases; Postoperative Complications; Renal Dialysis

A proposed clinical strategy is offered for the prevention and treatment of facial herpetic infection associated with phenol chemical peel or dermabrasion of the perioral area. A retrospective evaluation of 181 consecutive patients undergoing perioral chemical peel or dermabrasion from 1983 to 1990 was performed. No patients were excluded and the minimum follow-up was 6 to 24 months. All procedures were done at a private practice ambulatory surgery center. Patients with any history of oral herpetic lesions were pretreated with oral acyclovir. The vast majority of these patients received dosages far exceeding previously described regiments. A subset of patients (n = 12) whose procedures predated acyclovir's commercial availability received no prophylactic treatment and allowed for a comparison group. The incidence of postoperative infection was measured to determine the effectiveness of prophylactic acyclovir treatment. In patients reporting previous herpetic infection, postoperative herpetic outbreaks were far more likely to occur (50 percent infection rate) in the absence of prophylactic acyclovir. An 8.3 percent infection rate was noted in patients with a similar history who received standard acyclovir prophylaxis. Once high dose prophylactic treatment was initiated, no further herpetic outbreaks were observed. Even among patients with a negative history of oral herpes (no treatment), 6.6 percent developed postoperative infections. Pretreatment with high dose acyclovir clinically minimizes the incidence and severity of postoperative herpetic infection in patients undergoing perioral chemical peel or dermabrasion. All patients should be treated preoperatively with acyclovir regardless of past history, because even those patients reporting no previous outbreaks of oral herpes may develop postoperative infections.

Topics: Acyclovir; Adult; Antiviral Agents; Chemexfoliation; Dermabrasion; Face; Herpes Simplex; Humans; Postoperative Complications; Premedication; Retrospective Studies; Treatment Outcome

Topics: Acyclovir; Adolescent; Adult; Aged; Azathioprine; Child; Child, Preschool; Combined Modality Therapy; Cyclosporine; Cytomegalovirus Infections; Drug Therapy, Combination; Female; Ganciclovir; Humans; Immunoglobulins, Intravenous; Infant; Liver Transplantation; Male; Methylprednisolone; Middle Aged; Muromonab-CD3; Postoperative Complications; Prednisone; Retrospective Studies

Topics: Acyclovir; Combined Modality Therapy; Cytomegalovirus Infections; Follow-Up Studies; Graft Rejection; Graft Survival; Humans; Immunoglobulins, Intravenous; Incidence; Kidney Transplantation; Postoperative Complications; Retrospective Studies; Risk Factors; Time Factors

Topics: Acyclovir; Antiviral Agents; Cytomegalovirus Infections; Ganciclovir; Herpes Simplex; Herpes Zoster; Humans; Kidney Transplantation; Postoperative Complications

Two patients with previous corneal transplants developed unusual rejection-like episodes of the grafted cornea. Both had a migrating line of keratic precipitates and stromal edema involving both the donor and recipient corneas. Intensive steroid treatment attained little effect, but oral acyclovir treatment dramatically suppressed the disease process. The facts suggest that a virus-related immune mechanism against both the donor and recipient endothelia, rather than simple allograft rejection, may have been responsible for the clinical presentations. Oral acyclovir therapy might be considered in patients with steroid-nonresponsive corneal endotheliitis mimicking allograft rejection.

Topics: Acyclovir; Administration, Oral; Adult; Corneal Edema; Corneal Stroma; Corneal Transplantation; Endothelium, Corneal; Female; Graft Rejection; Humans; Keratitis; Keratitis, Herpetic; Keratoplasty, Penetrating; Male; Middle Aged; Postoperative Complications

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

Forty-six days after renal transplantation for inborn tubulointerstitial nephropathy, an 18-year-old man was rehospitalized for renal failure with creatinine at 200 mumol/l. There was no sign of infection and ciclosporin level was within therapeutic range. Transplant biopsy showed minor interstitial infiltration with mononucleated cells. Methylprednisolone by 10 mg/kg/d bolus did not improve renal function and OKT3 5 mg/d was substituted for ciclosporin but had to be stopped on day 8 because of a severe infectious syndrome. The patient developed fever (39 degrees C), erythemato-pultaceous pharyngitis followed by major multiple lymph node and spleen enlargement. The diagnosis of primary Epstein-Barr infection was confirmed serologically. Histology of a submaxillary lymph node reported monomorphic immunoblastic lymphoproliferation. Immunologic phenotyping showed CD19, CD20 and CD22 surface antigens characteristic of B cells and in situ Epstein-Barr hybridization was positive in 100% of the cells. Southern Blot showed an oligoclonal pattern. Ciclosporin and azathioprin were stopped and the patient was treated with corticosteroids (15 mg/d) and aciclovir given orally (3.2 g/d) for 3 months. Outcome at six months was favorable with normalization of the renal function and complete regression of the infectious syndrome. This case demonstrated the importance of molecular biology techniques for virologic and genotypic assessment of lymphomatous proliferation allowing positive aetiologic diagnosis.

Topics: Acyclovir; Adolescent; Blotting, Southern; Herpesviridae Infections; Herpesvirus 4, Human; Humans; In Situ Hybridization; Kidney Transplantation; Lymphoproliferative Disorders; Male; Nephritis, Interstitial; Postoperative Complications; Tumor Virus Infections

Epstein Barr virus (EBV) infection has been associated with the post-transplant lymphoproliferative disorder (PTLD) in up to 8% of transplant recipients. Primary EBV infection and the use of antilymphocyte preparations appear to increase the incidence of PTLD. Experimental evidence suggests that the antiviral prophylaxis used by many transplant programs may influence the development of this post-transplant complication. In order to investigate the influence of antiviral prophylaxis (intravenous ganciclovir followed by high-dose oral acyclovir) on the development of PTLD in kidney-pancreas and liver allograft recipients from the University of Washington Medical Center, records were reviewed for pretransplant EBV status, antilymphocyte preparation use and for histologic documentation of PTLD. Two of 83 kidney-pancreas recipients (1 EBV-seronegative, 1 EBV-seropositive) and 1 of 123 liver recipients (EBV-seropositive) has developed PTLD. Six of 83 kidney-pancreas patients were EBV-seronegative prior to transplantation and 4 of these patients received at least two courses of an antilymphocyte preparation. Thirty-eight (49%) of the 77 EBV-seropositive kidney-pancreas recipients received at least two courses of an antilymphocyte globulin without the development of PTLD. Both the EBV-seronegative kidney-pancreas and the liver recipient who developed PTLD had received multiple courses of antilymphocyte globulins. One EBV-seropositive kidney-pancreas recipient had only received one course of OKT3 1 year prior to the development of PTLD. The incidence of PTLD reported here in patients receiving intravenous ganciclovir followed by high-dose oral acyclovir antiviral prophylaxis is lower than previously recorded when consideration is given for patient's EBV status and the use of antilymphocyte preparations.

Topics: Acyclovir; Antilymphocyte Serum; Ganciclovir; Herpesviridae Infections; Herpesvirus 4, Human; Humans; Immunosuppressive Agents; Incidence; Kidney Transplantation; Liver Transplantation; Lymphoproliferative Disorders; Pancreas Transplantation; Postoperative Complications; Time Factors; Tumor Virus Infections

Topics: Acyclovir; Adult; Child; Cytomegalovirus; Cytomegalovirus Infections; Follow-Up Studies; Ganciclovir; Humans; Incidence; Intestines; Postoperative Complications; Retrospective Studies; Survival Rate; Time Factors; Transplantation, Homologous

Topics: Acyclovir; Anti-Bacterial Agents; Bacterial Infections; Humans; Incidence; Liver Transplantation; Pneumonia; Postoperative Complications; Retrospective Studies; Treatment Outcome

Topics: Acute Disease; Acyclovir; Herpes Simplex; Herpesvirus 1, Human; Hospitals, General; Humans; New Jersey; Postoperative Complications; Respiratory Tract Infections; Surgical Procedures, Operative

Topics: Acyclovir; Adolescent; Anti-Bacterial Agents; Bacterial Infections; Child; Child, Preschool; Cytomegalovirus Infections; Drug Therapy, Combination; Follow-Up Studies; Humans; Infant; Intestine, Small; Liver Transplantation; Male; Pneumonia, Pneumocystis; Postoperative Complications; Sulfamethoxazole; Surgical Wound Infection; Time Factors; Trimethoprim; Virus Diseases

Topics: Acyclovir; Adult; Cytomegalovirus; Cytomegalovirus Infections; Humans; Immunoglobulins, Intravenous; Liver Transplantation; Male; Postoperative Complications

Topics: Acyclovir; Cytomegalovirus Infections; Drug Therapy, Combination; Ganciclovir; Humans; Immunization, Passive; Immunoglobulins; Immunoglobulins, Intravenous; Immunosuppressive Agents; Incidence; Liver Transplantation; Postoperative Complications; Retrospective Studies; Risk Factors

Keratoplasties are performed relatively frequently in herpes-afflicted eyes. However, intraocular lenses (IOLs), for eyes with intraocular recurrent herpes simplex virus (HSV) disease remain a verdict in most surgical centers. As most herpetic disease is uniocular and cataract is a frequent complication in the long run, a real need exists for triple procedures in such eyes so as to achieve their full visual rehabilitation. Taking full advantage of systemic aciclovir therapy and prophylaxis, we started with triple procedures in herpes-afflicted eyes in 1987. Up to July 1991, we operated on 29 eyes, and 28 could be optically rehabilitated. One eye was given up and received a conjunctival cover for sociomedical reasons. Three repeat keratoplasties (10%) were necessary, and a considerable number of complications had to be overcome; ten eyes suffered from sustained fibrinous exsudations (35%), ten were threatened by one or more endothelial immune therapy reactions (35%), and ten experienced one or more herpes recurrences (35%), mostly intraocular recurrences. As this study was not performed as a randomized, placebo-controlled, double-blind study, no absolute scientific proof of aciclovir's value in these patients can be presented. Nonetheless, we would conclude from the exceedingly good rehabilitation rate of 96% observed during an average follow-up period of 19 months that in all probability, systemic aciclovir was in the first rank responsible for this success rate. Thus, there is good clinical evidence that systemic aciclovir prophylaxis and therapy is indeed the most important key for successful triple procedures in eyes afflicted with herpetic disease.

Topics: Acyclovir; Adolescent; Adult; Aged; Aged, 80 and over; Cataract Extraction; Female; Follow-Up Studies; Humans; Keratitis, Herpetic; Keratoplasty, Penetrating; Lenses, Intraocular; Male; Middle Aged; Postoperative Complications; Recurrence; Reoperation; Treatment Outcome

Oral infection with Herpes Simplex Virus (HSV) is a frequent and well documented complication in immunosuppressed individuals including patients on immunosuppressive medication. We report the development of severe oral infection with HSV type 1 in a 34 year old woman with type 1 diabetes mellitus and end stage renal disease (ESRD) following cadaveric renal transplantation at the Western General Hospital, Edinburgh. The role of acyclovir in therapy and chemoprophylaxis is discussed.

Topics: Acyclovir; Adult; Diabetes Mellitus, Type 1; Female; Herpes Labialis; Humans; Kidney Failure, Chronic; Kidney Transplantation; Postoperative Complications

A case of acyclovir-resistant herpes simplex virus keratouveitis after penetrating keratoplasty is reported.. Resistance to acyclovir was evident clinically and was confirmed by in vitro susceptibility testing. The susceptibility of the herpes simplex isolates to acyclovir and foscarnet was determined by a dye uptake assay that measured cytopathic effect, and thymidine kinase activity was measured by a plaque autoradiography technique.. The viral isolate from postoperative day 22 was susceptible to acyclovir and foscarnet, and showed normal thymidine kinase activity. Isolates from postoperative days 29 and 32 (coinciding with deterioration in clinical appearance) were resistant to acyclovir, susceptible to foscarnet, and deficient in thymidine kinase activity.. Practitioners should be aware of the potential for the emergence of resistance in this setting; prophylaxis and rational alternate therapies are discussed.

Topics: Acyclovir; Administration, Oral; Animals; Drug Resistance, Microbial; Foscarnet; Humans; Keratitis, Herpetic; Keratoplasty, Penetrating; Male; Microbial Sensitivity Tests; Middle Aged; Ophthalmic Solutions; Postoperative Complications; Simplexvirus; Uveitis; Vero Cells; Visual Acuity

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

Infection with herpes simplex virus is common among immunosuppressed patients. In an attempt to prevent such infection, 58 patients (group 1) who underwent cardiac transplantation between 1987 and 1990 were given acyclovir (200 mg orally three times a day) prophylactically throughout their postoperative hospital stay (mean 22 days +/- 1 day). The patients' immunosuppressive protocol included cyclosporine, azathioprine and prednisone. The course of these patients was compared to that of 24 patients (group 2) who underwent cardiac transplantation between 1983 and 1986 but were not given prophylactic antiviral treatment postoperatively. The immunosuppressive protocol in these patients consisted of cyclosporine and prednisone. Herpes infection developed during the 1st year in 5 patients (9%) in group 1 and in 11 patients (46%) in group 2 (p < 0.05). The actuarial rates of freedom from herpes infection at 1, 6 and 12 months after transplantation were 100%, 98% +/- 2% and 95% +/- 3%, respectively, in group 1 and 82% +/- 7%, 58% +/- 11%, 53% +/- 11% in group 2. All viral infections were cutaneous or mucosal, except for one, which developed in a patient with pneumonia. All infections responded well to treatment, although one patient with an infected cornea was left with a permanent visual deficit. The authors conclude that prophylaxis of herpes simplex virus infection with acyclovir administered orally in the early postoperative period is effective in preventing viral infections during the 1st year after cardiac transplantation.

Topics: Acyclovir; Administration, Oral; Adult; Female; Heart Transplantation; Herpes Simplex; Humans; Immunocompromised Host; Immunosuppressive Agents; Male; Middle Aged; Postoperative Complications; Retrospective Studies

Topics: Acyclovir; Antilymphocyte Serum; Cause of Death; Clotrimazole; Combined Modality Therapy; Dose-Response Relationship, Drug; Drug Administration Schedule; Follow-Up Studies; Graft Rejection; Humans; Immunosuppressive Agents; Kidney Function Tests; Kidney Transplantation; Muromonab-CD3; Opportunistic Infections; Pentamidine; Postoperative Complications; Survival Analysis; Survival Rate; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Acyclovir; Cytomegalovirus Infections; Humans; Kidney Transplantation; Postoperative Complications

Five out of 430 patients (1.16%) undergoing kidney transplantation developed an atypical clinical picture of herpetic dendritic keratitis within four weeks after surgery. It was manifested by multiple dendrites, located mainly in the corneal periphery or the limbus, developing in relatively uninflamed eyes. The response to acyclovir therapy was prolonged and took at least three weeks. Additionally, subepithelial infiltrates with ultimate scarring developed in all patients. Disciform keratopathy was not found. This clinical course is ascribed to the patients' immunosuppressed state.

Topics: Acyclovir; Adult; Humans; Immunosuppression Therapy; Keratitis, Dendritic; Kidney Transplantation; Postoperative Complications; Retrospective Studies

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

Over three years 81 consecutive bone marrow transplant recipients (32 allogeneic and 49 autologous) who received prophylaxis with acyclovir, were studied for symptomatic virus infection. Thirty nine infections were documented in a total of 28 patients. Thirty two infections were mild, five were moderately severe, and two were severe. Cytomegalovirus infection occurred in only six allogeneic recipients. Herpes simplex virus and varicella zoster virus infections occurred infrequently. Seven patients who were considered at the time of death to have died due to an infectious cause were studied virologically at necropsy. In only one patient was a virus infection thought to have been the cause of death. Prophylaxis with acyclovir may have influenced the rate and clinical prominence of herpes virus infections. In this study viruses were considered to have had a relatively minor role in causing morbidity and mortality.

Topics: Acyclovir; Adolescent; Adult; Bone Marrow Transplantation; Child; Child, Preschool; Graft vs Host Disease; Humans; Middle Aged; Postoperative Complications; Prospective Studies; Virus Diseases

From May 1981 to May 1984, 90 pediatric patients underwent liver transplantation and 65 patients survived as of May 1986. Two of the nonsurvivors died with complications related to clinical varicella. Of these 67 patients (65 survivors and two nonsurvivors who died of varicella-related causes), 51 patients were determined to be varicella susceptible. Clinical disease developed in no patients with serologic evidence or clinical history of varicella prior to transplantation. Eighteen susceptible patients were exposed and received zoster immune globulin and varicella did not develop. Clinical disease developed in eight patients despite zoster immune globulin, although one patient received it 96 hours after exposure. Six patients received no zoster immune globulin and clinical varicella developed. In all, varicella developed in 14 patients. Thirteen were admitted to the hospital and treated with intravenous acyclovir. Of those treated, two died of causes related to complications of varicella. The remaining patients treated with acyclovir had mild disease. The one patient not treated with acyclovir also had mild disease. We conclude that patients contracting varicella after liver transplantation while receiving maintenance immunosuppressive agents should be treated with intravenous acyclovir. Generally, when treated with acyclovir while receiving maintenance immunosuppressive drugs, these patients have mild clinical disease. Patients recently treated with high-dose prednisone and cyclosporine may have severe clinical disease resulting in death.

Topics: Acyclovir; Chickenpox; Child; Child, Preschool; Cyclosporins; Female; Herpesvirus 3, Human; Humans; Immunization, Passive; Liver Transplantation; Male; Postoperative Complications; Prednisone

Topics: Acyclovir; Adult; Antiviral Agents; Female; Ganciclovir; Herpesviridae Infections; Herpesvirus 4, Human; Humans; Kidney Transplantation; Lymphoproliferative Disorders; Male; Middle Aged; Pancreas Transplantation; Postoperative Complications

Topics: Acyclovir; Adult; Antiviral Agents; Bone Marrow Transplantation; Cytomegalovirus; Cytomegalovirus Infections; Female; Ganciclovir; Humans; Immunosuppression Therapy; Male; Middle Aged; Postoperative Complications; Pulmonary Fibrosis

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

To determine if acyclovir sodium prevents postoperative herpes simplex virus type 1 (HSV-1) recurrences, 21 rabbits harboring latent HSV-1 underwent uniocular autograft penetrating keratoplasty. All operated-on eyes were treated with topical and subconjunctival dexamethasone sodium phosphate. Ten of the 21 rabbits also received oral acyclovir (intravenous acyclovir was given at the time of surgery). Postoperatively, 9 (82%) of 11 operated-on eyes in rabbits not treated with acyclovir had positive HSV-1 ocular cultures. In acyclovir-treated rabbits, however, none of the 10 operated-on eyes had positive ocular cultures. In addition, 9 (82%) of 11 of the operated-on eyes had geographic ulcers develop in the non-acyclovir-treated rabbits, compared with 1 (10%) of 10 in the acyclovir-treated rabbits. Finally, stromal keratitis appeared in 5 (56%) of 9 of the operated-on eyes in non-acyclovir-treated rabbits and 1 (12%) of 8 of the operated-on eyes in acyclovir-treated rabbits. The results of this study indicate that acyclovir significantly lowered the incidence of HSV-1 ocular shedding, geographic ulceration, and stromal keratitis in a rabbit autograft penetrating keratoplasty model.

Topics: Acyclovir; Administration, Oral; Animals; Corneal Stroma; Corneal Transplantation; Corneal Ulcer; Female; Injections, Intravenous; Keratitis; Keratitis, Dendritic; Postoperative Complications; Rabbits; Recurrence; Simplexvirus; Tears

Topics: Acyclovir; Cytomegalovirus Infections; Humans; Kidney Transplantation; Postoperative Complications; Premedication

Topics: Acyclovir; Antiviral Agents; Cytomegalovirus Infections; Drug Administration Schedule; Ganciclovir; Humans; Kidney Transplantation; Postoperative Complications

Patients undergoing allogeneic bone marrow transplantation who are seropositive for cytomegalovirus are vulnerable to serious cytomegalovirus infection, presumably because of reactivation of latent endogenous virus and severe immunosuppression. We administered intravenous acyclovir from 5 days before to 30 days after allogeneic marrow transplantation for hematologic neoplasms in an effort to prevent cytomegalovirus infection and disease in patients seropositive for cytomegalovirus before transplantation. Eighty-six patients seropositive for both cytomegalovirus and herpes simplex virus before transplantation received acyclovir, whereas 65 patients seropositive only for cytomegalovirus served as controls (acyclovir is the standard prophylactic agent against herpes simplex virus in this setting). The probability that cytomegalovirus infection would develop within the first 100 days after transplantation was 0.70 among acyclovir recipients and 0.87 among control patients at medians of 62 and 40 days after transplantation, respectively (P = 0.0001 by log-rank test). Invasive cytomegalovirus disease developed in 19 acyclovir recipients (22 percent) and 25 control patients (38 percent) (P = 0.008). Survival within the first 100 days after transplantation was better among acyclovir recipients (P = 0.002). Acyclovir prophylaxis was associated with a relative risk of 0.5 or less for the development of cytomegalovirus infection or disease or for death within the first 100 days after transplantation (P less than or equal to 0.04), in proportional-hazards regression analysis. We conclude that prophylaxis with intravenous acyclovir significantly reduced the risk of both cytomegalovirus infection and cytomegalovirus disease in seropositive patients after allogeneic bone marrow transplantation and that it was also associated with significantly improved survival.

Topics: Acyclovir; Adolescent; Adult; Analysis of Variance; Antibodies, Viral; Bone Marrow Transplantation; Child; Child, Preschool; Cytomegalovirus; Cytomegalovirus Infections; Drug Evaluation; Female; Graft vs Host Disease; Herpes Simplex; Humans; Injections, Intravenous; Leukemia; Male; Middle Aged; Postoperative Complications; Pulmonary Fibrosis; Risk Factors

Topics: Acyclovir; Antibodies, Viral; Antiviral Agents; Cytomegalovirus; Cytomegalovirus Infections; Drug Evaluation; Ganciclovir; Humans; Immunosuppression Therapy; Liver Transplantation; Postoperative Complications; Virus Activation

Disseminated cytomegalovirus (CMV) infection in a liver transplant recipient was treated successfully by administration of ganciclovir (BW B759U) at a dosage of 7.5 mg/kg/day for 2 wk in the face of continuation of chemical immunosuppression. The spectrum of illness included symptomatic esophagitis and hepatic dysfunction associated with the appearance of CMV inclusion bodies, retinal lesions, and bone marrow suppression. Clinical improvement during therapy with ganciclovir was prompt and was paralleled by reversal of histological abnormalities. CMV was recovered from none of the cultured tissues after the start of therapy. Ten months after discontinuation of ganciclovir, the patient had no evidence of further CMV disease. The observation suggests that replicative CMV infection in organ-transplanted patients may be suppressed by relatively low dose ganciclovir, even when the patients are maintained on immunosuppressive regimens designed to prevent graft rejection.

Topics: Acyclovir; Adult; Antiviral Agents; Cytomegalovirus Infections; Esophagus; Female; Ganciclovir; Humans; Immune Tolerance; Liver Transplantation; Postoperative Complications

Cytomegalovirus (CMV) infection is relatively frequent and severe in immunosuppressed patients giving rise to diagnostic and therapeutic problems. We describe a series of 7 patients, six with acute lymphoblastic leukemia and one with aplastic anemia. All patients had CMV infection at the moment of maximum immunodepression. Two patients had undergone recent bone-marrow transplant. Six had been transfused in the two months prior to the onset of infection. Diagnosis was established through isolation of CMV from blood or serological methods. Symptoms ranged from prolonged fever to multi-organic involvement. Two cases had pulmonary involvement as well as fever, hepatitis and petechial rash. Two other cases presented with fever and hepatosplenomegaly and in the remaining, 3, fever was the only sign. Clinical course was favourable in all cases including the two with pneumonitis; of these two the first received acyclovir and anti-CMV Ig and the other received no specific therapy. One of the remaining cases was also given acyclovir and specific anti CMV Ig was administered to the 3 patients with isolated fever. In conclusion, CMV infection should be suspected in immunosuppressed patients with prolonged fever.

Topics: Acyclovir; Anemia, Aplastic; Antineoplastic Agents; Bone Marrow Transplantation; Child; Child, Preschool; Combined Modality Therapy; Cytomegalovirus Infections; Female; Fever; Humans; Immunization, Passive; Immunologic Deficiency Syndromes; Infant; Leukemia, Lymphoid; Male; Postoperative Complications

Topics: Acyclovir; Adult; Antiviral Agents; Cytomegalovirus Infections; Female; Ganciclovir; Humans; Kidney Transplantation; Male; Middle Aged; Postoperative Complications

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

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

On the 4th day of acyclovir treatment for Herpes simplex pneumonia, a 28 month-old girl who had received allogenic marrow transplant for stage IV neuroblastoma presented with severe neurologic disorders including coma and choreic movements. These symptoms disappeared 9 days after acyclovir was stopped. The disturbance in acyclovir kinetics because of acute renal failure and/or a cerebral cortex atrophy might explain the poor neurologic tolerance of acyclovir. This reversible neurologic involvement on a prone patient should be known as a differential diagnosis of Herpes simplex encephalitis.

Topics: Acyclovir; Bone Marrow Transplantation; Child, Preschool; Chorea; Coma; Herpesviridae Infections; Humans; Postoperative Complications; Transplantation, Homologous

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

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

The effect of prophylactic intravenous administration of a cytomegalovirus (CMV) hyperimmune globulin with a high titer of neutralizing antibodies plus oral acyclovir was studied in 93 consecutive bone marrow transplant recipients. In spite of receiving blood products unscreened for CMV only six patients developed CMV infections during the time they received passive immunization. Five patients reactivated virus after hyperimmune globulin infusions were stopped; four of them suffered from chronic graft-versus-host disease (GVHD) Among the patients suffering from acute GVHD grade III/IV and/or chronic GVHD the incidence of CMV infection (10/38) was significantly higher than among those with no or milder forms of GVHD (1/55) (p less than 0.01). Only three patients suffered from symptomatic CMV infections; two with gastrointestinal manifestations and one with fatal CMV pneumonia. Thus CMV prophylaxis as used here proved highly effective in combating one of the major difficulties encountered in BMT.

Topics: Acyclovir; Administration, Oral; Adolescent; Adult; Antibodies, Viral; Bone Marrow Transplantation; Child; Child, Preschool; Cytomegalovirus Infections; Dose-Response Relationship, Immunologic; Female; Humans; Immunization, Passive; Infant; Male; Middle Aged; Postoperative Complications

Herpes simplex virus (HSV) hepatitis in adults is a rare and severe disease usually occurring in immunocompromised patients or pregnant women. We report on a case of primary HSV type I hepatitis in a 48-year-old male renal transplant recipient with successful outcome after acyclovir treatment.

Topics: Acyclovir; Hepatitis, Viral, Human; Herpes Simplex; Humans; Kidney Transplantation; Male; Middle Aged; Postoperative Complications

Topics: Acyclovir; Adult; Female; Herpes Genitalis; Humans; Ileum; Intestinal Absorption; Malabsorption Syndromes; Postoperative Complications

Topics: Acyclovir; Esophagitis; Female; Herpes Simplex; Humans; Kidney Transplantation; Middle Aged; Postoperative Complications

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

Cytomegalovirus (CMV) infection is the most frequent cause of lethal infection after bone marrow transplantation. Viremia occurs in 50% of patients seropositive for CMV before transplantation. Interstitial pneumonitis due to CMV occurs in 10% to 20% of patients with 85% mortality. It is known that CMV infection is due to host reactivation of latent CMV infection or to the transmission of the virus by the marrow donor or by blood transfusions. Treatment of CMV infection has been disappointing in the past. All attempts to treat CMV pneumonia with available agents have failed. Recent studies have indicated the usefulness of prophylactic measures and the early treatment of CMV infections. The use of hyperimmune gammaglobulins has given contradictory results. The selection of seronegative marrow donors or blood donors is useful only if the recipient is seronegative. New antiviral drugs have been used recently in preliminary clinical trials. In preliminary studies a guanosine analogue similar to Acyclovir (DHPG Synthex or BWB 759 U Wellcome) has given reasonable hope of disease cure if it is used early before the occurrence of pneumonia. Phosphonoformate (Foscarnet) has also been shown to be active against CMV infection. Both drugs have good antiviral and clinical action in immunosuppressed patients but the results have been disappointing in cases of pneumonia. Relapse occurs frequently after cessation of the treatment and attempts are being made to use maintenance therapy.

Topics: Acyclovir; Antiviral Agents; Bone Marrow Transplantation; Cytomegalovirus Infections; Foscarnet; Ganciclovir; Humans; Immunization, Passive; Phosphonoacetic Acid; Postoperative Complications

Topics: Acute Disease; Acyclovir; Adult; Antiviral Agents; Cytomegalovirus Infections; Female; Forced Expiratory Flow Rates; Ganciclovir; Humans; Kidney Transplantation; Postoperative Complications

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

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

Varicella-zoster virus (VZV) infection is a late complication of bone marrow transplantation in almost half of the long-term survivors. We have reported the clinical relapse of VZV infection in two marrow transplant recipients treated with standard regimens of acyclovir, a new antiviral agent with activity against VZV. Since most VZV infections occur after discharge from a transplant center, primary care physicians must be alert to the possibility of relapse of VZV infection after acyclovir therapy.

Topics: Acyclovir; Adolescent; Bone Marrow Transplantation; Herpes Zoster; Humans; Immune Tolerance; Leukemia, Myeloid; Male; Postoperative Complications; Recurrence

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

Topics: Acyclovir; Adult; Cytomegalovirus Infections; Herpes Simplex; Humans; Kidney Transplantation; Middle Aged; Postoperative Complications; Renal Dialysis

Forty-four heart and five heart-lung transplant recipients with cytomegalovirus (CMV) infection were investigated for risk factors associated with symptomatic CMV infection (17 patients) and CMV pneumonia (eight patients). Symptomatic infection was associated with primary rather than reactivated infection (P less than .005), younger age (P less than .005), heart-lung transplantation (P less than .001), and significant rises in titer of antibody to the early antigen of Epstein-Barr virus (P less than .001). Among recipients of heart transplants, patients with cardiomyopathy more often had symptomatic disease due to CMV (P less than .05). CMV pneumonia was associated with heart-lung transplantation and, in patients with primary CMV infection, earlier positive cultures for CMV after transplantation (P less than .02). CMV viremia was found in all patients with symptomatic infection, including the eight patients with CMV pneumonia, and the frequency of positive buffy coat cultures for CMV was significantly higher in patients with symptoms than in patients without symptoms (P less than .001). Neither symptomatic CMV infection nor CMV pneumonia was significantly associated with the use of antithymocyte globulin, restricted to therapy for rejection, and the use of high doses of acyclovir in 11 patients had no demonstrable impact on CMV culture positivity.

Topics: Acyclovir; Adult; Age Factors; Antibodies, Viral; Antilymphocyte Serum; Cyclosporins; Cytomegalovirus Infections; Female; Heart Transplantation; Heart-Lung Transplantation; Herpesviridae Infections; Humans; Infectious Mononucleosis; Lung Transplantation; Male; Pneumonia; Postoperative Complications; Risk; Sex Factors; Syndrome; Time Factors

Topics: Acyclovir; Bone Marrow Transplantation; Humans; Immunosuppression Therapy; Lymphoma; Lymphoproliferative Disorders; Postoperative Complications; Premedication

Topics: Acyclovir; Bacterial Infections; Cryptococcosis; Cytomegalovirus Infections; Drug Combinations; Humans; Infection Control; Infections; Kidney Transplantation; Pneumonia, Pneumocystis; Postoperative Complications; Prognosis; Sulfamethoxazole; Toxoplasmosis; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Virus Diseases

Three patients who had received cadaveric renal transplants developed fevers within three months of transplantation. Concurrent cytomegalovirus infection was confirmed by virological studies. In all three patients there was both a clinical and virological response to a five day course of intravenous acyclovir. In one patient the dose required to produce this response was 5 mg/kg/day; however two patients required 10 mg/kg/day. All three patients remain well after 8-12 months follow-up.

Topics: Acyclovir; Adult; Cytomegalovirus Infections; Follow-Up Studies; Humans; Infusions, Parenteral; Kidney Transplantation; Male; Middle Aged; Postoperative Complications

Late cytomegalovirus (CMV) infection in renal allograft recipients is uncommon. The treatment of CMV infection is controversial, with numerous claims of successful treatment with different drugs. We report the successful use of acyclovir in a serious case of CMV infection occurring in a young woman 3 1/2 years after a renal transplant. This result is encouraging and supports the future use of acyclovir in the treatment of CMV infection in this and other settings.

Topics: Acyclovir; Adult; Cytomegalovirus Infections; Female; Humans; Kidney Transplantation; Postoperative Complications; Time Factors

Forty marrow transplant patients were treated with acyclovir for varicella-zoster virus infection. Median duration of virus positivity and of new lesion formation was 2.1 and 2.2 days, and pustulation , crusting, and healing occurred at medians of 3.5, 8, and 28 days, respectively. Acute pain ceased at a median of 7 days, though seven patients had later recurrence of pain and eight had pain that persisted for more than 28 days. Three patients had recurrence of infection within 4 days after the end of treatment and were successfully treated in each case with a second course of acyclovir. Side effects were minimal. These data compare favorably with published data both from the treatment of normal persons with acyclovir and treatment of normal persons with acyclovir and treatment of immunocompromised patients with vidarabine, and they indicate that acyclovir is safe and effective for the treatment of varicella-zoster virus infection in the severely immunocompromised host.

Topics: Acyclovir; Adolescent; Adult; Bone Marrow Transplantation; Child; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunosuppression Therapy; Male; Postoperative Complications; Recurrence

A monoclonal diffuse histiocytic lymphoma developed during the course of a serologically documented primary Epstein-Barr virus infection in a 22-year-old cardiac transplant recipient taking cyclosporine and prednisone. Throat washings revealed the virus at tumor presentation, and the tumor was shown to contain Epstein-Barr nuclear antigen-positive cells and the viral genome. Prolonged inversion of the T cell helper/suppressor ratio was demonstrated. A brief course of acyclovir appeared to halt viral shedding in the throat but had no apparent effect on the tumor.

Topics: Acyclovir; Adult; Burkitt Lymphoma; Cyclosporins; Heart Transplantation; Herpesvirus 4, Human; Humans; Immunosuppression Therapy; Male; Postoperative Complications; Prednisone

High-dosage Acyclovir therapy with intravenous applications of 3 X 15 mg/kg/day is discussed with reference to 2 patients with herpetic keratouveitis. The inflammations resolved after 7 days of treatment.

Topics: Acyclovir; Adult; Corneal Transplantation; Corneal Ulcer; Female; Humans; Infusions, Parenteral; Keratitis, Dendritic; Postoperative Complications; Recurrence; Uveitis; Visual Acuity

Six marrow transplant recipients receiving acyclovir at various dosages for herpesvirus infections developed neurologic symptoms during treatment. Three were receiving concomitant human alpha interferon, and all six had received previous intrathecal methotrexate. Symptoms developed a median of 8 days (range, 2 to 18 days) after initiation of therapy and consisted of lethargy or agitation in five patients, tremor in five, and disorientation or transient hemiparesthesias in one patient each. The only consistent laboratory finding was an abnormal electroencephalogram. Five patients had an increased myelin basic protein level in cerebrospinal fluid. Improvement or resolution of symptoms occurred a median of 13 days (range, 4 to 15 days) after cessation of acyclovir therapy. Acyclovir used at a wide range of dosages may be associated with reversible neurologic symptoms in patients after marrow transplantation. The contribution of previous prophylaxis for central nervous system leukemia, herpesvirus infections, marrow transplantation, or the concomitant use of interferon is unknown.

Topics: Acyclovir; Adolescent; Adult; Akathisia, Drug-Induced; Bone Marrow Transplantation; Child; Electroencephalography; Female; Herpesviridae Infections; Humans; Male; Nervous System Diseases; Paresthesia; Postoperative Complications; Tremor

Three patients in whom herpes zoster infections developed following bone marrow transplantation were treated with acyclovir. The patients experienced pain relief within 24 hours of starting treatment. The progression of their skin lesions halted within 1, 2, and 4 days of therapy, respectively, and healed completely within two weeks of therapy. Pharmacokinetic studies indicated that acyclovir plasma concentration-time profiles approximated biexponential equations. The drug half-lives were 3.91, 3.83, and 3.40 hours, respectively. Acyclovir was not myelotoxic and may be helpful in aborting varicella-zoster virus infections in bone marrow transplant recipients.

Topics: Acyclovir; Adolescent; Antiviral Agents; Bone Marrow Transplantation; Child; Female; Guanine; Half-Life; Herpes Zoster; Humans; Kinetics; Leukemia, Lymphoid; Male; Pain; Postoperative Complications

Herpes simplex virus was demonstrated in rapidly progressing cutaneous lesions 7 days after allogeneic bone marrow transplantation in a 14-year-old girl. Extension of the eruption was not controlled by hyperimmune plasma and transfer factor. In contrast, prompt and complete resolution followed administration of acyclovir. The absence of renal insufficiency or damage to the new graft emphasizes the value of this agent in managing progressive herpes simplex infections in immunocompromised patients.

Topics: Acyclovir; Adolescent; Antiviral Agents; Bone Marrow Transplantation; Female; Guanine; Herpes Simplex; Humans; Immunosuppression Therapy; Postoperative Complications