acyclovir and Sepsis

Septic thrombophlebitis of the facial vein (STFN) commonly presents with facial erythema, tenderness, and swelling above the involved vessel. Due to its rarity, diagnosis and treatment remain a challenge. Lemierre syndrome (LS), which consists of a triad of internal jugular vein thrombophlebitis, septicemia, and distant septic emboli, is a more common entity of which physicians are more familiar. Whether tonsillitis-related STFN is actually LS in a different anatomical area and shares the same characteristics is still left to be answered. We present a case of STFN with a review of all cases reported in the literature.

Topics: Acyclovir; Adult; Anti-Bacterial Agents; Antiviral Agents; Face; Herpes Simplex; Humans; Jugular Veins; Lemierre Syndrome; Male; Sepsis; Tomography, X-Ray Computed

Acute liver failure is a life threatening disease mostly triggered by drug-induced or toxic liver damage or viral hepatitis. Herpes Simplex virus (HSV) hepatitis is rare and accounts for only 1% of all acute liver failures. The importance of HSV-induced acute liver failure is based on its extremely severe clinical course with lethality rates of almost 75%. HSV hepatitis is just one of several clinical manifestations of HSV sepsis leading more frequently to encephalitis, pneumonia and esophagitis. Local herpes infection or recurrence of dermal lesions (herpes labialis, herpes genitalis), however, is common and account for the high prevalence of HSV-1 or HSV-2 infection in adults. Another rare entity is visual dissemination, which mostly affects immunocompromised patients. Compromised cellular immunity is a major risk factor for HSV sepsis because of either primary infection or reactivation of occult chronic HSV infection. Delayed diagnosis without antiviral therapy significantly contributes to the unfavorable outcome. Typically, anicteric hepatitis is seen in patients with HSV hepatitis. Because of its low incidence, however, and the lack of dermal manifestations, HSV hepatitis is rarely considered in the context of acute liver failure. In addition, diagnostic tests might not always be available. Therefore, it is a generally accepted consensus to begin antiviral therapy pre-emptively with acyclovir in cases of acute liver failure of unknown origin, in which high urgency (HU) liver transplantation remains the only therapeutical option. Even in the case of early specific therapy, sepsis may prevail and the indication for HU transplantation must be evaluated carefully. The outcome after liver transplantation for HSV-induced liver failure with reported survival rates of more than 40% is good. Because of the risk of recurrence, lifelong prophylaxis with acyclovir is recommended.

Topics: Acyclovir; Antiviral Agents; Herpes Simplex; Humans; Liver Failure, Acute; Polymerase Chain Reaction; Sepsis

Concomitant herpetic and candidal esophagitis is a very rare disease that had not been reported in uremic patients. A 57-year-old woman receiving continuous ambulatory peritoneal dialysis (CAPD) therapy for 3 years was admitted due to CAPD-related peritonitis. Endoscopic examination was performed due to severe epigastralgia and upper gastrointestinal bleeding, and combined herpetic and candidal esophagitis was diagnosed. Intravenous acyclovir and fluconazole were prescribed and symptoms improved. The patient subsequently died due to progressive sepsis and respiratory failure. This is the first report of a dual infectious esophagitis in a uremic patient. Since infectious esophagitis may cause severe complications, early diagnosis and aggressive treatment are important.

Topics: Acyclovir; Antifungal Agents; Antiviral Agents; Candidiasis; Esophagitis; Fatal Outcome; Female; Fluconazole; Herpes Simplex; Humans; Middle Aged; Peritoneal Dialysis, Continuous Ambulatory; Sepsis; Uremia

In this multicenter, randomized study, cytomegalovirus (CMV)-seropositive patients who received an allogeneic bone marrow transplant were provided high-dose intravenous acyclovir (500 mg/m(2) q8h) from the day of transplantation until engraftment. The patients were then randomly assigned to receive either oral valacyclovir, 2 g q.i.d. (n=83), or intravenous ganciclovir, 5 mg/kg q12h for 1 week, then 6 mg/kg once daily for 5 days per week (n=85), until day 100 after transplantation. CMV infection occurred in 12% of the patients who received valacyclovir and in 19% of the patients who received ganciclovir (hazard ratio [HR], 1.042; 95% confidence interval [CI], 0.391-2.778; P=.934). CMV disease developed in only 2 patients who received valacyclovir and in 1 patient who received ganciclovir (HR, 1.943; 95% CI, 0.176-21.44; P=.588). Oral valacyclovir can be an effective alternative to intravenous ganciclovir for prophylaxis of CMV disease after bone marrow transplantation.

Topics: Acyclovir; Administration, Oral; Adolescent; Adult; Aged; Antiviral Agents; Bacterial Infections; Bone Marrow Transplantation; Cytomegalovirus; Cytomegalovirus Infections; Female; Ganciclovir; Humans; Injections, Intravenous; Male; Microbial Sensitivity Tests; Middle Aged; Mycoses; Sepsis; Survival Analysis; Transplantation, Homologous; Valacyclovir; Valine

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

Neonatal herpes simplex virus (HSV) infections can be challenging to diagnose and often occur without maternal history of infection. Routine initial pharmacologic management when a neonate presents with signs of sepsis in the first weeks of life typically targets antibiotic therapies. This case illustrates the importance of the addition of antiviral coverage, especially when a neonate demonstrates temperature instability and neurologic changes.. This case report describes the unique presentation of a 9-day old neonate with clinical findings significant for sepsis. This neonate was diagnosed with methicillin-sensitive Staphylococcus aureus (MSSA) bacteremia with concomitant disseminated HSV-2 infection after presenting with temperature instability, lethargy, and signs of multisystem organ impairment.. This neonate was diagnosed with disseminated HSV infection, which occurs in 25% of neonatal HSV disease.. Treatment was initiated with high-dose intravenous acyclovir at 20 mg/kg/dose every 8 hours along with broad-spectrum antibiotics. Management should include anticipating and monitoring for progressive multisystem organ failure in bacterial or viral infection.. This patient did not survive despite maximal intervention from the neonatal intensive care unit team. Disseminated HSV neonatal infections are associated with high mortality rates when they are present alone, and mortality is higher with concurrent bacteremia.. Providers should have a high index of suspicion for HSV infection in neonates presenting in the first 1 to 3 weeks of life with signs of sepsis. Prophylactic treatment with high-dose acyclovir as an adjunct to broad-spectrum antibiotics while awaiting laboratory confirmation can be lifesaving.

Topics: Acyclovir; Anti-Bacterial Agents; Antiviral Agents; Bacteremia; Female; Herpes Simplex; Humans; Infant, Newborn; Methicillin; Pregnancy; Pregnancy Complications, Infectious; Sepsis; Simplexvirus; Staphylococcus aureus

A middle-aged man with decompensated cirrhosis and a dimorphic multisite skin rash is diagnosed with rare atypical herpes simplex infection, manifesting Sweet's syndrome (SS) in the absence of other described associations. SS, an acute febrile neutrophilic dermatosis, has three common forms-classical or idiopathic, malignancy associated and drug induced. Systemic autoimmune, connective tissue diseases and infections are also strong associations. The latter is commonly described in Gram-positive bacteria, salmonellosis and

Topics: Acyclovir; Antiviral Agents; Fatal Outcome; Herpes Simplex; Humans; Liver Cirrhosis; Male; Middle Aged; Multiple Organ Failure; Sepsis; Skin Diseases, Vesiculobullous; Sweet Syndrome

We describe a death in a 15-mo-old girl who developed a varicella-like rash 20 d after varicella vaccination that lasted for 2 mo despite acyclovir treatment. The rash was confirmed to be due to vaccine-strain varicella-zoster virus (VZV). This is the first case of fatal varicella due to vaccine-strain VZV reported from the United States. The patient developed severe respiratory complications that worsened with each new crop of varicella lesions; vaccine-strain VZV was detected in the bronchial lavage specimen. Sepsis and multi-organ failure led to death. The patient did not have a previously diagnosed primary immune deficiency, but her failure to thrive and repeated hospitalizations early in life (starting at 5 mo) for presumed infections and respiratory compromise treated with corticosteroids were suggestive of a primary or acquired immune deficiency. Providers should monitor for adverse reactions after varicella vaccination. If severe adverse events develop, acyclovir should be administered as soon as possible. The possibility of acyclovir resistance and use of foscarnet should be considered if lesions do not improve after 10 d of treatment (or if they become atypical [e.g., verrucous]). Experience with use of varicella vaccine indicates that the vaccine has an excellent safety profile and that serious adverse events are very rare and mostly described in immunocompromised patients. The benefit of vaccination in preventing severe disease and mortality outweigh the low risk of severe events occurring after vaccination.

Topics: Acyclovir; Antiviral Agents; Chickenpox; Chickenpox Vaccine; Fatal Outcome; Female; Herpesvirus 3, Human; Humans; Infant; Multiple Organ Failure; Sepsis; Treatment Failure; United States

A previously well 11-month-old infant presented with lethargy, a blanching rash, vomiting and diarrhoea. She was diagnosed with suspected gastroenteritis and discharged. The patient deteriorated and re-presented 24 h later with lumbar puncture (LP) confirming Neisseria meningitidis. Following an initial good response to ceftriaxone, the patient then developed a blistering facial rash on day 3 for which topical aciclovir was started with no improvement. She subsequently developed fever and redeveloped a rising C reactive protein (CRP). A CT of the head on day 6 was normal, however a repeat LP on day 7 showed persistently raised cerebrospinal fluid (CSF), white cell count (WCC), high proteins and low CSF glucose. A CSF viral PCR confirmed concurrent herpes simplex virus (HSV) type 1 for which parenteral aciclovir was started. The patient responded well to bacterial and viral anti-infective treatments and was subsequently discharged on day 16 with no neurological sequelae.

Topics: Acyclovir; Anti-Bacterial Agents; Antiviral Agents; Ceftriaxone; Diagnosis, Differential; Drug Therapy, Combination; Female; Herpes Simplex; Humans; Immunocompetence; Infant; Meningitis, Meningococcal; Meningitis, Viral; Neisseria meningitidis; Sepsis; Simplexvirus

Varicella usually is a self-limited disease but sometimes can result in severe complications and death. Although infants, adults, and immunocompromised persons are at increased risk for severe disease, before varicella vaccine was introduced in 1995, the majority of hospitalizations and deaths from varicella occurred among healthy persons aged <20 years. Introduction of varicella vaccine has substantially decreased varicella incidence, hospitalizations, and deaths in the United States. This report describes a varicella death in an unvaccinated, previously healthy adolescent aged 15 years. In April 2012, as part of the routine review of vital statistics records, the Ohio Department of Health identified a 2009 death with the International Classification of Diseases, 10th Revision code for varicella as the underlying cause. Because varicella deaths are nationally reportable, the Ohio Department of Health conducted an investigation to validate that the coding was accurate. Investigators learned that, on March 12, 2009, the adolescent girl was admitted to a hospital with a 3-day history of a rash consistent with varicella and a 1-day history of fever and shortness of breath. The patient was started on intravenous acyclovir (on day 4 of illness) and broad-spectrum antibiotics and antifungals, but she died 3 weeks later. The case underscores the importance of varicella vaccination, including catch-up vaccination of older children and adolescents, to prevent varicella and its serious complications.

Topics: Acyclovir; Adolescent; Anti-Bacterial Agents; Antiviral Agents; Chickenpox; Chickenpox Vaccine; Fatal Outcome; Female; Humans; International Classification of Diseases; Lung; Ohio; Pneumonia; Respiratory Distress Syndrome; Sepsis

Herpes simplex virus (HSV)-induced sepsis affects immunocompromised patients. We report here the case of an immunocompetent adult with sepsis, hepatitis, renal failure and esophagitis. The possibility of HSV should be considered in cases of sepsis without any evident cause, even in immunocompetent patients. The characteristic endoscopic and histological findings of the associated esophagitis may assist the etiology of sepsis.

Topics: Acyclovir; Antiviral Agents; Endoscopy, Digestive System; Esophagitis; Hepatitis, Viral, Human; Herpes Simplex; Humans; Immunocompetence; Male; Middle Aged; Sepsis; Ulcer

Topics: Acyclovir; Chlamydia trachomatis; Chlamydiaceae Infections; Female; Herpes Simplex; Herpesvirus 1, Human; Humans; Infant, Newborn; Infectious Disease Transmission, Vertical; Liver Failure, Acute; Pregnancy; Pregnancy Complications, Infectious; Sepsis

Human parechovirus-3 (HPeV-3) is an emerging pathogen that has been described as a cause of neonatal sepsis. Human parechoviruses are a family of viruses closely related to enteroviruses; however, enteroviral PCR will not detect HPeVs. We present clinical details of neonatal meningoencephalitis and hepatitis-coagulopathy syndrome caused by HPeV-3 infection.

Topics: Acyclovir; Antiviral Agents; Cerebrospinal Fluid; Humans; Infant, Newborn; Male; Meningoencephalitis; Parechovirus; Picornaviridae Infections; Polymerase Chain Reaction; Sepsis

Topics: Acyclovir; Antiviral Agents; Diagnosis, Differential; Herpes Simplex; Humans; Infant, Newborn; Sepsis

Twenty-eight patients with upper extremity infections and positive for the human immunodeficiency virus (HIV) were identified. The risk factor for HIV infection was intravenous drug injection in 24 patients, homosexual contact in 3, and heterosexual contact in 1. Eight of the patients had the acquired immunodeficiency syndrome. Two of the cases were prolonged herpetic infections of more than 6 months' duration that did not respond to oral acyclovir. The other 26 cases were bacterial in origin. Twenty-six of 28 cases responded to therapy with resolution of the infection. One patient refused surgical treatment and one died of systemic illness before resolution of the hand infection.

Topics: Abscess; Acquired Immunodeficiency Syndrome; Acyclovir; Adult; AIDS-Related Opportunistic Infections; Antiviral Agents; Arm; Cause of Death; Cohort Studies; Drug Resistance, Microbial; Female; Hand; Herpes Simplex; Heterosexuality; HIV Infections; Homosexuality, Male; Humans; Male; Middle Aged; Retrospective Studies; Risk Factors; Sepsis; Soft Tissue Infections; Staphylococcal Infections; Streptococcal Infections; Substance Abuse, Intravenous

The emergency department (ED) evaluation of the neonate with sepsis or symptoms suggesting sepsis usually includes a complete blood count, catheterized urinalysis with culture, blood cultures, cerebrospinal fluid analysis and culture, and possibly a chest radiograph. Admission for observation for neonates at high risk for sepsis is universal. Depending on the patient's presentation and the preference of the admitting physician, intravenous antibiotics are started. Typically, ampicillin and either an aminoglycoside or cefotaxime are chosen because they cover the likely pathogens in this age group, ie, group B streptococci, Escherichia coli and other gram-negative enterics, and Listeria monocytogenes. Coverage for viral infection, most notably herpes simplex virus (HSV), is only rarely instituted in the ED and is usually considered if the patient has obvious ulcerative lesions or if the mother has known HSV infection. Unfortunately, antiviral therapy with acyclovir or vidaribine has to be started in the early stages of infection to be effective. If antiviral therapy is started after viral entry into cells, morbidity is severe and mortality approaches 80%. Neonates who survive are usually severely disabled. Broadening the indications for initiating antiviral therapy to include the neonate whose mother has any history of a sexually transmitted disease may prevent the sequelae of untreated or inadequately treated HSV infection. A case is reported of an 8-day-old girl who developed disseminated HSV infection and died as a result of hepatic failure.

Topics: Acyclovir; Antiviral Agents; Disseminated Intravascular Coagulation; Emergency Treatment; Fatal Outcome; Female; Herpes Simplex; Humans; Infant, Newborn; Liver Failure; Patient Selection; Sepsis

A fatal case of fulminant hepatic failure that occurred in the neonatal period is reported in a premature infant born after 27 4/7-weeks' gestation. Immediately after birth the infant had severe hypoxia and hypotension resulting from birth asphyxia, hypovolemic shock, and septicemia. At autopsy, histological appearance of the liver showed virtually total hepatocellular necrosis without features of fibrosis. Although the exact cause of hepatocellular injury cannot be fully ascertained, it is assumed that hypoxia and hypotension must have been the predominant factors leading to massive hepatic necrosis.

Topics: Acyclovir; Alanine Transaminase; Aspartate Aminotransferases; Bicarbonates; Cloxacillin; Dopamine; Female; Fetal Hypoxia; Fetal Membranes, Premature Rupture; Humans; Infant, Newborn; Infant, Premature, Diseases; Liver; Male; Necrosis; Netilmicin; Pancuronium; Partial Thromboplastin Time; Penicillins; Pregnancy; Prothrombin Time; Sepsis; Shock; Sodium; Sodium Bicarbonate

Chickenpox (varicella) is generally considered a childhood disease. Although adults account for only 1.5 percent of patients affected, they account for 27.6 percent of total deaths. We report on a 25-year-old white man who died of varicella. We hope that this report will alert the physician to the serious nature of primary varicella infection in adults.

Topics: Acyclovir; Adult; Chickenpox; Humans; Male; Sepsis; Staphylococcal Infections

Topics: Acyclovir; Anti-Bacterial Agents; Diagnosis, Differential; Female; Herpes Genitalis; Herpes Simplex; Humans; Infant, Newborn; Male; Obstetric Labor Complications; Pemphigoid Gestationis; Pregnancy; Pregnancy Complications; Sepsis; Streptococcal Infections; Streptococcus agalactiae