acyclovir and Skin-Diseases--Viral

Neonatal herpes simplex virus (HSV) is an uncommon but devastating infection in the newborn, associated with significant morbidity and mortality. The use of PCR for identification of infected infants and acyclovir for treatment has significantly improved the prognosis for affected infants. The subsequent use of suppressive therapy with oral acyclovir following completion of parenteral treatment of acute disease has further enhanced the long-term prognosis for these infants. This review article will discuss the epidemiology, risk factors and routes of acquisition, clinical presentation, and evaluation of an infant suspected to have the infection, and treatment of proven neonatal HSV disease.

Topics: Acyclovir; Antiviral Agents; Cesarean Section; Delivery, Obstetric; Disseminated Intravascular Coagulation; Encephalitis, Herpes Simplex; Extraction, Obstetrical; Extraembryonic Membranes; Female; Herpes Genitalis; Herpes Simplex; Herpesvirus 1, Human; Herpesvirus 2, Human; Humans; Infant, Newborn; Infectious Disease Transmission, Vertical; Keratitis, Herpetic; Labor, Obstetric; Liver Failure; Pregnancy; Pregnancy Complications, Infectious; Prognosis; Respiratory Insufficiency; Risk Factors; Skin Diseases, Viral; Time Factors

Childhood infectious diseases are not usually serious. The symptoms (fever, conjunctivitis, itching) diminish with the administration of antipyretic drugs. Cutaneous lesions leave no scarring. Sometimes complications may appear.

Topics: Acyclovir; Administration, Cutaneous; Antiviral Agents; Chickenpox; Child; Chorioretinitis; Conjunctivitis, Viral; Drug Therapy, Combination; Eye Infections, Viral; Glucocorticoids; Humans; Measles; Mumps; Pruritus; Rubella; Skin Diseases, Viral; Treatment Outcome

Viral skin infections are common findings in organ transplant recipients. The most important etiological agents are the group of human herpesviruses (HHV), human papillomaviruses (HPV), and molluscum contagiosum virus. HHV that are important in this group of patients are herpes simplex virus (HSV) types 1 and 2, varicella-zoster virus (VZV), cytomegalovirus (CMV), Epstein-Barr virus (EBV), HHV-6 and -7, and HHV-8, which causes Kaposi sarcoma (KS). HSV infections are characterized by their ability to establish latency and then reactivate at a later date. The most common manifestations of HSV infection in organ transplant recipients are mucocutaneous lesions of the oropharynx or genital regions. Treatment is usually with acyclovir, valaciclovir, or famciclovir. Acyclovir resistance may arise although the majority of acyclovir-resistant strains have been isolated from AIDS patients and not organ transplant recipients. In such cases, alternatives such as foscarnet, cidofovir, or trifluridine may have to be considered. VZV causes chickenpox as well as herpes zoster. In organ transplant recipients, recurrent herpes zoster can occur. Acute chickenpox in organ transplant patients should be treated with intravenous acyclovir. CMV infection occurs in 20-60% of all transplant recipients. Cutaneous manifestations, which include nonspecific macular rashes, ulcers, purpuric eruptions, and vesiculobullous lesions, are seen in 10-20% of patients with systemic infection and signify a poor prognosis. The present gold standard for treatment is ganciclovir, but newer drugs such as valganciclovir appear promising. EBV is responsible for some cases of post-transplant lymphoproliferative disorder, which represents the greatest risk of serious EBV disease in transplant recipients. HHV-6 and HHV-7 are two relatively newly discovered viruses and, at present, the body of information concerning these two agents is still fairly limited. KS is caused by HHV-8, which is the most recently discovered lymphotrophic HHV. Iatrogenic KS is seen in solid-organ transplant recipients, with a prevalence of 0.5-5% depending on the patient's country of origin. HPV is ubiquitous, and organ transplant recipients may never totally clear HPV infections, which are the most frequently recurring infections in renal transplant recipients. HPV infection in transplant recipients is important because of its link to the development of certain skin cancers, in particular, squamous cell carcinoma. Regular surve

Topics: 2-Aminopurine; Acyclovir; Antiviral Agents; Cidofovir; Cytomegalovirus Infections; Cytosine; Drug Administration Schedule; Epstein-Barr Virus Infections; Famciclovir; Foscarnet; Herpes Zoster; Herpesviridae Infections; Humans; Immunocompromised Host; Molluscum Contagiosum; Organ Transplantation; Organophosphonates; Papillomavirus Infections; Skin Diseases, Viral; Trifluridine; Valacyclovir; Valine

Topics: Acyclovir; Follow-Up Studies; Herpes Zoster; Humans; Infant; Lower Extremity; Male; Rare Diseases; Risk Assessment; Skin Diseases, Viral; Treatment Outcome

The current arsenal of antiviral agents available to the practitioner is expanding rapidly, such that by the time this article goes to press, new drugs may have already been added. Although the majority of approved drugs have been developed for use in only a few viral infections (eg, HIV, herpesviruses, and papillomavirus), discoveries made in the development of these drugs may lead to antiviral agents effective against other viruses. In addition, new uses for the currently available drugs are under evaluation. This review of antiviral agents discusses the treatments available for viral infections such as herpes simplex virus, varicella zoster virus, cytomegalovirus, human papillomavirus, chronic viral hepatitis, and others.

Topics: 2-Aminopurine; Acyclovir; Antiviral Agents; Chickenpox; Cytomegalovirus Infections; Famciclovir; Foscarnet; Guanine; Hepatitis B; Hepatitis C; Herpes Genitalis; Herpes Simplex; Herpesvirus 3, Human; Herpesvirus 8, Human; Humans; Papillomavirus Infections; Sarcoma, Kaposi; Skin Diseases, Viral; Valacyclovir; Valine

Herpes zoster (HZ) is a cutaneous viral infection of the skin that presents in a dermatomal distribution. It represents reactivation of herpes varicella zoster virus that has continued to exist in a latent form in the neurons of the posterior root ganglia. Although it is rare to see HZ in children, cases have been reported after exposure to varicella zoster in utero or during the first months of life. We present a case of HZ in a healthy 7-month-old girl who had had chickenpox at age 4 months.

Topics: Acyclovir; Antiviral Agents; Back; Female; Herpes Zoster; Humans; Infant; Skin Diseases, Viral

Noncontiguous multidermatomal herpes zoster is very rare in both immunocompetent and immunocompromised persons. Most of the reported cases have been limited to 2 noncontiguous dermatomes. This unique presentation has been referred to as zoster duplex unilateralis or bilateralis, depending on whether one or both halves of the body are involved. Granulomatous dermatitis at sites of herpes zoster scars, a rare isotopic response, has only been reported in persons with contiguous dermatomes of zoster. We describe an immunocompromised patient who developed herpes zoster in 7 disparate dermatomes. Three months after resolution of the zoster, the patient developed a granulomatous dermatitis in a zosteriform distribution at the sites of previous infection.

Topics: 2-Aminopurine; Acyclovir; Aged; Antiviral Agents; Dermatitis; Famciclovir; Granuloma; Herpes Zoster; Humans; Immunocompromised Host; Kidney Transplantation; Male; Prodrugs; Skin Diseases, Viral

The outbreak of HIV infection introduced a new phenomenon in varicella zoster virus (VZV) pathology, namely the long-standing wart-like skin lesions that are frequently associated with resistance to thymidine kinase (TK)-dependent antiviral agents. This paper reviews the clinical, histological, and molecular aspects and the therapeutic management of these verrucous lesions. The majority of lesions are characterized by chronically evolving, unique or multiple wart-like cutaneous lesions. The main histopathological features include hyperkeratosis, verruciform acanthosis and VZV-induced cytopathic changes with scant or absent cytolysis of infected keratinocytes. The mechanism that establishes the chronic nature of the lesions appears to be associated with a particular pattern of VZV gene expression exhibiting reduced or nondetectable gE and gB synthesis. Drug resistance to TK-dependent antiviral agents is a result of nonfunctional or deficient viral TK. This necessitates alternative therapeutic management using antiviral agents that target the viral DNA polymerase.

Topics: Acyclovir; Antiviral Agents; Drug Resistance, Microbial; Foscarnet; Herpesvirus 3, Human; HIV Infections; Humans; Skin Diseases, Viral

Neonatal herpes simplex virus (HSV) infections limited to the skin, eyes and mouth (SEM) can result in neurologic impairment. A direct correlation exists between the development of neurologic deficits and the frequency of cutaneous HSV recurrences. Thus, the National Institutes of Allergy and Infectious Diseases Collaborative Antiviral Study Group conducted a Phase I/II trial of oral acyclovir therapy for the suppression of cutaneous recurrences after SEM disease in 26 neonates.. Infants < or = 1 month of age with virologically confirmed HSV-2 SEM disease were eligible for enrollment. Suppressive oral acyclovir therapy (300 mg/m2/dose given either twice daily or three times per day) was administered for 6 months.. Twelve (46%) of the 26 infants developed neutropenia (< 1000 cells/mm3) while receiving acyclovir. Thirteen (81%) of the 16 infants who received drug 3 times per day experienced no recurrences of skin lesions while receiving therapy. In comparison, a previous Collaborative Antiviral Study Group study found that only 54% of infants have no cutaneous recurrences in the 6 months after resolution of neonatal HSV disease if oral acyclovir suppressive therapy is not initiated. In one infant, HSV DNA was detected in the cerebrospinal fluid during a cutaneous recurrence, and an acyclovir-resistant HSV mutant was isolated from another patient during the course of the study.. Administration of oral acyclovir can prevent cutaneous recurrences of HSV after neonatal SEM disease. The effect of such therapy on neurologic outcome must be assessed in a larger, Phase III study. As such, additional investigation is necessary before routine use of suppressive therapy in this population can be recommended.

Topics: Acyclovir; Administration, Oral; Antiviral Agents; Drug Resistance; Eye Infections, Viral; Female; Herpes Genitalis; Herpesvirus 2, Human; Humans; Infant, Newborn; Male; Mouth Diseases; Recurrence; Retrospective Studies; Skin Diseases, Viral

Topics: Acyclovir; Administration, Oral; Aged; Antiviral Agents; Diagnosis, Differential; Foot; Herpes Zoster; Herpesvirus 3, Human; Humans; Leg; Male; Skin; Skin Diseases, Vascular; Skin Diseases, Viral; Treatment Outcome; Vasculitis, Leukocytoclastic, Cutaneous

The aim of the study was the evaluation of the several immunological indices in HIV/AIDS-infected patients with viral skin lesions. 38 HIV/AIDS patients 18-53 years of age (20 men and 18 women) with skin pathology have been enrolled in the study. The skin pathology included 20 cases with recurrent herpes simplex and 18 with chronic ulcerative herpes simplex virus infections. There were 25 patients with HIV infection stage 2, and 13 with stage 3. Immunological studies were carried out before the treatment and 2 months after it. Together with ART, the treatment in cases of chronic ulcerative herpes and recurrent herpes simplex included acyclovir, 400 mg 5 times a day, and Cidipol solution externally. Group 1 received ART according to the standard antiviral therapy protocol, Group 2 received ART, antiviral medicines and Cidipol solution externally. The study showed that after 2 months of the complex therapy with Cidipol, patients from the treatment group demonstrated a reliable increase in the count of CD3+, CD16+ and CD56+ cells and phagocytic activity of neutrophils. There was also a significant decrease (approaching to the normal values) of the levels of immune globulins and heterophil haemolysins. The present study of the immune responses in the cases of skin viral lesions in HIV/AIDS-infected patients contributes to the better understanding of the cellular and cytokine responses, thereby enabling us to increase the efficacy of the therapy and prevention of viral dermatoses in immunocompromised patients.

Topics: Acyclovir; Adolescent; Adult; Antiviral Agents; Female; Herpes Simplex; HIV; HIV Infections; Humans; Male; Middle Aged; Skin Diseases, Viral; Young Adult

Topics: Acyclovir; Antiviral Agents; Blister; Diagnosis, Differential; Female; Herpes Zoster; Humans; Infant; Pantothenic Acid; Skin Diseases, Viral; Treatment Outcome

Topics: Acyclovir; Antiviral Agents; Female; Herpes Zoster; Humans; Immunocompetence; Middle Aged; Pain; Skin Diseases, Viral

Chronic cutaneous varicella zoster virus (VZV) infection has not been previously reported or characterized as a complication of dermatomyositis. Two patients with non-malignancy-associated dermatomyositis, treated with long-term prednisone and methotrexate, developed persistent, painless ulcers ultimately established to be secondary to chronic VZV. The absence of pain or a history suggestive of acute VZV, and the lack of characteristic histopathology, resulted in a lengthy delay in diagnosis. Polymerase chain reaction and tissue immunohistochemistry were positive for VZV, and treatment with valacyclovir resulted in complete clearance. Diagnostic testing for VZV should thus be considered in the evaluation of ulcerative lesions in patients with dermatomyositis. The increased incidence of acute VZV in combination with the nature and duration of immunosuppressive treatment in this patient population may be contributory.

Topics: Acyclovir; Aged; Antiviral Agents; Chronic Disease; Dermatomyositis; Female; Herpesviridae Infections; Herpesvirus 3, Human; Humans; Immunosuppressive Agents; Skin Diseases, Viral; Valacyclovir; Valine

Acyclovir-resistant herpes simplex virus (HSV) infection is common in immunocompromised patients, but the course of such infection is little known. We describe the long-term follow-up of HIV-infected patients diagnosed once with acyclovir-resistant HSV infections. We retrospectively studied all HIV-infected patients between 2000 and 2010 diagnosed with virologically confirmed acyclovir-resistant HSV infection. Patients' socio-demographic and immunovirological characteristics were described. Response to foscarnet or cidofovir and recurrences were reported. Among 5295 HIV-infected patients, 13 (0.2%) were once diagnosed with an acyclovir-resistant HSV infection. Twelve patients were men, nine patients were of African origin. All patients reported previous acyclovir exposure and median CD4 count was 183 cells/mm(3) Ten patients presented exclusively with cutaneous lesions. Initially, 11 patients were treated with foscarnet and two with cidofovir. The median follow-up was 67 months (6-145). All patients recurred, 10 presenting at least one acyclovir-resistant HSV recurrence. The median number of acyclovir-resistant HSV recurrences per patient was 2 (0 - 5). Regarding the first and second recurrences, 7/13 (54%) and 5/11 (45%) HSV clinical isolates exhibited resistance to acyclovir, respectively. Acyclovir-resistant HSV infection prevalence was low in our cohort. The rate of acyclovir-resistant HSV episodes averaged 50% during the two first recurrences.

Topics: Acyclovir; Adult; AIDS-Related Opportunistic Infections; Antiviral Agents; Cidofovir; Cytosine; Drug Resistance, Viral; Female; Follow-Up Studies; Foscarnet; Herpes Simplex; HIV Infections; Humans; Immunocompromised Host; Male; Middle Aged; Organophosphonates; Retrospective Studies; Skin Diseases, Viral; Skin Ulcer; Socioeconomic Factors; Thymidine Kinase; Treatment Outcome

We reviewed the characteristics of infants <3 months of age with central nervous system herpes simplex virus infection at our institution. Twenty-six cases were identified. The age range was 4-73 days. Most infants presented with fever, seizure activity and skin lesions. The blood herpes simplex virus polymerase chain reaction was positive in 91% of patients tested. Suppressive oral acyclovir therapy was likely helpful in preventing disease recurrence.

Topics: Acyclovir; Antiviral Agents; Cerebrospinal Fluid; Fever; Herpes Simplex; Humans; Infant; Infant, Newborn; Magnetic Resonance Imaging; Meningoencephalitis; Retrospective Studies; Seizures; Skin Diseases, Viral

Topics: Acyclovir; Antibodies, Viral; Antiviral Agents; Black or African American; Blood Coagulation Disorders; Diagnosis, Differential; DNA, Viral; Hepatitis; Herpes Simplex; Herpesvirus 2, Human; Humans; Male; Polymerase Chain Reaction; Skin Diseases, Viral; Young Adult

Topics: Acyclovir; Antiviral Agents; Herpes Simplex; Herpesvirus 2, Human; Humans; Infant, Newborn; Male; Recurrence; Skin Diseases, Viral; Valacyclovir; Valine

Although varicella zoster virus latency has been demonstrated in several sensory ganglia, herpes zoster usually effects only one single, either left or right, dermatome in half of the body. In immunocompromised patients, more than one contiguous unilateral dermatome may be involved. Bilateral non-contiguous herpes zoster, also termed herpes zoster duplex, is rarely reported. Chronic varicella zoster virus skin infection is another rare entity encountered in HIV-infected and immunocompromised patients, often associated with aciclovir resistance. We describe here a patient with chronic lymphocytic leukaemia, who presented simultaneously non-contiguous bilateral and chronic herpes zoster lasting for more than 2 months, with resistance to aciclovir. To our knowledge, this is the first report of chronic herpes zoster duplex bilateralis. Physicians should be aware of and recognize these atypical manifestations of varicella zoster virus.

Topics: Acyclovir; Aged; Antiviral Agents; Bronchopneumonia; Chronic Disease; Drug Resistance, Viral; Fatal Outcome; Herpes Zoster; Humans; Immunocompromised Host; Leukemia, Lymphocytic, Chronic, B-Cell; Male; Skin Diseases, Viral

The physicochemical properties of the optimized microemulsion and the permeating ability of oxyresveratrol in microemulsion were evaluated, and the efficacy of oxyresveratrol microemulsion in cutaneous herpes simplex virus type 1 (HSV-1) infection in mice was examined. The optimized microemulsion was composed of 10% w/w of isopropyl myristate, 35% w/w of Tween 80, 35% w/w of isopropyl alcohol, and 20% w/w of water. The mean particle diameter was 9.67 ± 0.58 nm, and the solubility of oxyresveratrol in the microemulsion was 196.34 ± 0.80 mg/ml. After accelerated and long-term stability testing, the microemulsion base and oxyresveratrol-loaded microemulsion were stable. The cumulative amount of oxyresveratrol permeating through shed snake skin from microemulsion at 6 h was 93.04 times compared to that of oxyresveratrol from Vaseline, determined at 20% w/w concentration. In cutaneous HSV-1 infection in mice, oxyresveratrol microemulsion at 20%, 25%, and 30% w/w, topically applied five times daily for 7 days after infection, was significantly effective in delaying the development of skin lesions and protecting from death (p < 0.05) compared with the untreated control. Oxyresveratrol microemulsion at 25% and 30% w/w was significantly more effective than that of 30% w/w of oxyresveratrol in Vaseline (p < 0.05) and was as effective as 5% w/w of acyclovir cream, topically applied five times daily (p > 0.05). These results demonstrated that topical oxyresveratrol microemulsion at 20-30% w/w was suitable for cutaneous HSV-1 mouse infection.

Topics: Acyclovir; Administration, Topical; Animals; Antiviral Agents; Chlorocebus aethiops; Drug Stability; Emulsions; Female; Herpes Simplex; Herpesvirus 1, Human; Mice; Mice, Inbred BALB C; Particle Size; Permeability; Petrolatum; Plant Extracts; Skin; Skin Cream; Skin Diseases, Viral; Snakes; Solubility; Stilbenes; Vero Cells

Topics: Acyclovir; Animals; Antiviral Agents; Bovine papillomavirus 1; Horse Diseases; Papillomavirus Infections; Sarcoidosis; Skin Diseases, Viral

X-linked lymphoproliferative disorder typically presents as an Epstein-Barr virus-specific immune defect with a poor prognosis. Herein we present the clinical and pathologic findings for the first known case of X-linked lymphoproliferative disorder with visual symptoms at initial presentation.. Retrospective chart review, clinicopathologic correlation (brain biopsy and postmortem brain and eye tissue), and literature review.. An 18-year-old boy had a unique presentation of X-linked lymphoproliferative disorder with visual symptoms and retinal findings. He subsequently developed central nervous system vasculitis. He never had evidence of Epstein-Barr virus infection during his clinical course, but in situ hybridization was positive in scattered cells in the brain postmortem. Eye pathologic examination at autopsy showed ischemic changes, but no inflammation.. When a young patient presents with cotton wool spots, a thorough workup must be done, and immunologic disorders should be considered in the differential diagnosis. X-linked lymphoproliferative disorder-associated eye findings may not always be associated with Epstein-Barr virus infection and, as demonstrated by this case, can be indicative of an underlying vasculitic process.

Topics: Acyclovir; Adolescent; Antiviral Agents; Diagnosis, Differential; Epstein-Barr Virus Infections; Fatal Outcome; Herpesvirus 4, Human; Humans; In Situ Hybridization; Ischemia; Lymphoproliferative Disorders; Male; Meningococcal Vaccines; Real-Time Polymerase Chain Reaction; Retinal Diseases; Retinal Vessels; Retrospective Studies; Skin Diseases, Viral; Vasculitis, Central Nervous System

Based on the anecdotally reported eradication of a sarcoid using aciclovir cream, the curative potential of this ointment was investigated in 22 sarcoid-affected horses referred to the Equine Clinic Tillysburg, Austria, between 2006 and 2009. Sarcoid disease was diagnosed by clinical examination and bovine papillomavirus types 1 and 2 from intact skin and tumour tissue. As nine horses had more than one lesion, a total of 47 sarcoids were treated by daily topical application of aciclovir 5 per cent cream for a period of two to six months; in four horses, surgical tumour ablation was performed before treatment. Disease parameters, including the tumour type, number, location and size, were recorded before and after aciclovir therapy. All 47 (100 per cent) of the sarcoids responded to treatment, with complete tumour regression observed for 32 (68 per cent) lesions and no recurrences reported thus far. Incomplete resolution was observed for 15 (32 per cent) lesions, probably due to their thickness. Aciclovir is proposed to be routinely used for the treatment of mild-type sarcoids and as an adjuvant therapeutic agent in combination with surgery.

Topics: Acyclovir; Administration, Topical; Animals; Antiviral Agents; Bovine papillomavirus 1; Horse Diseases; Horses; Papillomavirus Infections; Sarcoidosis; Skin Diseases, Viral; Treatment Outcome

Topics: Acyclovir; Adult; Antiviral Agents; Diagnosis, Differential; Herpes Genitalis; Herpesvirus 2, Human; Humans; Male; Penile Diseases; Skin Diseases, Viral

The present investigation aims at developing microemulsion-based formulations for topical delivery of acyclovir. Various microemulsions were developed using isopropyl myristate/Captex 355/Labrafac as an oil phase, Tween 20 as surfactant, Span 20 as cosurfactant, and water/dimethylsulfoxide (1:3) as an aqueous phase. Transcutol, eucalyptus oil, and peppermint oil were used as permeation enhancers. In vitro permeation studies through laca mice skin were performed using Franz diffusion cells. The optimum formulation containing 2.5% Transcutol as the penetration enhancer showed 1.7-fold enhancement in flux and permeation coefficient as compared to marketed cream and ointment formulation. In vivo antiviral studies were performed in female Balb/c mice against induced herpes simplex virus I infection. A single application of microemulsion formulation containing 2.5% Transcutol given 24 h post-injection resulted in complete suppression of development of herpetic skin lesions.

Topics: Acyclovir; Administration, Cutaneous; Adult; Animals; Antiviral Agents; Chemistry, Pharmaceutical; Emulsions; Female; Herpes Simplex; Herpesvirus 1, Human; Humans; Mice; Mice, Inbred BALB C; Permeability; Skin; Skin Diseases, Viral; Solubility

Only a few reports have focused on ocular motor paralysis in herpes zoster ophthalmicus. We report a case of ocular motor paralysis resulting from herpes zoster. The patient, an 80-yr-old woman, presented with grouped vesicles, papules, and crusting in the left temporal area and scalp, with diplopia, impaired gaze, and severe pain. Her cerebrospinal fluid analysis was positive for varicellar zoster virus IgM. Magnetic resonance imaging was performed to rule out other diseases causing diplopia; there were no specific findings other than old infarctions in the pons and basal ganglia. Therefore, she was diagnosed of abducens nerve palsy caused by herpes zoster ophthalmicus. After 5 days of systemic antiviral therapy, the skin lesions improved markedly, and the paralysis was cleared 7 weeks later without extra treatment.

Topics: Abducens Nerve Diseases; Acyclovir; Aged, 80 and over; Antiviral Agents; Female; Herpes Zoster; Herpes Zoster Ophthalmicus; Humans; Skin Diseases, Viral; Treatment Outcome

Varicella-zoster virus (VZV) infection of the central nervous system (CNS) is rare after hematopoietic stem cell transplantation (SCT). Here, we describe the first patient who developed VZV encephalitis after cord blood transplantation (CBT). A 35-year-old man with myelodysplastic syndrome-overt leukemia underwent CBT. On day +23, a neutrophil count consistently greater than 0.5 x 10(9)/L was achieved. On day +42, 1 mg/kg per day of prednisolone therapy was initiated for grade III acute graft-versus-host disease (GVHD). Then, the dose of prednisolone was slowly reduced. For exacerbation of chronic GVHD, the dose of prednisolone was again increased to 1 mg/kg per day on day +231. On day +265, localized cutaneous zoster in the left thoracic region occurred, but soon resolved after acyclovir therapy. On day +309, he suddenly developed diplopia. Subsequently, right facial palsy and hearing impairment occurred. No skin rash was observed. Magnetic resonance imaging (MRI) scans revealed multifocal abnormal high-signal intensity in the CNS. A high level of VZV DNA was detected in a cerebrospinal fluid specimen. He was diagnosed with VZV encephalitis. Acyclovir was given intravenously for 40 days. Four months after the onset, the neurologic symptoms had incompletely resolved. MRI scans showed substantial resolution but with mild residual lesions. The present report indicates that VZV should be considered as a possible causative agent in patients who develop multifocal neurologic symptoms of the CNS after SCT.

Topics: Acyclovir; Adult; Anti-Inflammatory Agents; Antiviral Agents; Cord Blood Stem Cell Transplantation; DNA, Viral; Encephalitis, Varicella Zoster; Graft vs Host Disease; Herpes Zoster; Herpesvirus 3, Human; Humans; Leukemia; Male; Myelodysplastic Syndromes; Prednisolone; Radiography; Remission Induction; Skin Diseases, Viral

Autoinoculation and dissemination (or Kaposi's varicelliform eruption or eczema herpeticum) of herpetic lesions are two forms of viral spread, and it is essential to differentiate between the two. Presented are typical examples of the two forms of viral spread.

Topics: Acyclovir; Adult; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Antiviral Agents; Chin; Diagnosis, Differential; Drug Therapy, Combination; Female; Herpes Simplex; Humans; Infant; Kaposi Varicelliform Eruption; Lip; Male; Skin Diseases, Viral; Thumb

The objective of this research was to investigate the effect of the topical application of honey on recurrent attacks of herpes lesions, labial and genital, as compared to acyclovir cream.. Sixteen adult patients with a history of recurrent attacks of herpetic lesions, 8 labial and 8 genital, were treated by topical application of honey for one attack and acyclovir cream for another attack.. For labial herpes, the mean duration of attacks and pain, occurrence of crusting, and mean healing time with honey treatment were 35%, 39%, 28% and 43% better, respectively, than with acyclovir treatment. For genital herpes, the mean duration of attacks and pain, occurrence of crusting, and mean healing time with honey treatment were 53%, 50%, 49% and 59% better, respectively, than with acyclovir. Two cases of labial herpes and one case of genital herpes remitted completely with the use of honey. The lesions crusted in 3 patients with labial herpes and in 4 patients with genital herpes. With acyclovir treatment, none of the attacks remitted, and all the lesions, labial and genital, developed crust. No side effects were observed with repeated applications of honey, whereas 3 patients developed local itching with acyclovir.. Topical honey application is safe and effective in the management of the signs and symptoms of recurrent lesions from labial and genital herpes.

Topics: Acyclovir; Adult; Antiviral Agents; Herpes Genitalis; Herpes Labialis; Honey; Humans; Middle Aged; Skin Diseases, Viral

To determine the prognostic value of nasociliary skin lesions (Hutchinson's sign) for ocular inflammation and corneal sensory denervation in acute herpes zoster ophthalmicus.. A longitudinal observational study with a 2-month follow-up was performed involving 83 non-immunocompromised adults with acute herpes zoster ophthalmicus, with a skin rash duration of less than 7 days, referred by their general practitioner. All skin lesions at the tip, the side and the root of the nose, representing the dermatomes of the external nasal and infratrochlear branches of the nasociliary nerve, were documented by taking photographs and marking anatomical drawings. Ocular inflammatory signs were observed by slit-lamp biomicroscopy, and corneal sensitivity was measured with the Cochet-Bonnet esthesiometer at 2-month follow-up.. Hutchinson's sign was a powerful predictor of ocular inflammation and corneal denervation in herpes zoster ophthalmicus [relative risks: 3.35 (CI 95%: 1.82-6.15) and 4.02 (CI 95%:1.55-10.42), respectively]. The manifestation of herpes zoster skin lesions at the dermatomes of both nasociliary branches was invariably associated with the development of ocular inflammation.. Clinicians should be alert for early skin lesions within the complete nasociliary dermatome, because they are a reliable prognostic sign of sight-threatening ocular complications in acute herpes zoster ophthalmicus.

Topics: Acute Disease; Acyclovir; Aged; Antiviral Agents; Cornea; Cranial Nerve Diseases; Female; Herpes Zoster Ophthalmicus; Humans; Hypesthesia; Male; Neuralgia; Neurons, Afferent; Ophthalmic Nerve; Prognosis; Skin; Skin Diseases, Viral

A 7-year-old girl presented with large soft masses rising from the nostril and from behind the ear. She had previously been diagnosed as suffering from hyper-IgE syndrome. The presence of herpes simplex virus infection within these lesions was confirmed by biopsy and immunohistochemical studies. The mass lesions did not respond to antibacterial therapy with cefazolin, but improved promptly under antiviral therapy with acyclovir. Immunological studies revealed a mild decrease in the CD4 cell population. Based on our results and on the relevant literature we propose an immunological mechanism for this unique manifestation of herpes simplex virus infection in hyper-IgE syndrome.

Topics: Acyclovir; Antiviral Agents; CD4 Lymphocyte Count; Child; Female; Herpes Simplex; Humans; Job Syndrome; Simplexvirus; Skin Diseases, Viral; Treatment Outcome

Topics: Acyclovir; Antiviral Agents; Herpes Simplex; Herpesvirus 2, Human; Humans; Male; Middle Aged; Secondary Prevention; Skin Diseases, Viral; Valacyclovir; Valine

In 1983, varicella zoster virus (VZV) disease was first recognized in the context of infection with the human immunodeficiency virus (HIV). Since that time, there have been many reports discussing the occurrence and clinical manifestations of hepes zoster in HIV-infected patients. We describe the development of prolonged herpes zoster in a patient with acquired immunodeficiency syndrome (AIDS) over the course of 104 days. Viral isolates at the three different clinical stages of the skin lesions were sensitive in vitro to acyclovir, and supposed to be a same strain by polymerase chain reaction (PCR) analysis. We also discuss an effective treatment for prolonged cases of zoster.

Topics: Acyclovir; Adult; AIDS-Related Opportunistic Infections; Antiviral Agents; Back; Chronic Disease; DNA, Viral; Herpes Zoster; Humans; Male; Polymerase Chain Reaction; Skin Diseases, Viral

The topical efficacies of foscarnet and acyclovir incorporated into a polyoxypropylene-polyoxyethylene polymer were evaluated and compared to that of 5% acyclovir ointment (Zovirax) by use of a murine model of cutaneous herpes simplex virus type 1 infection. All three treatments given three times daily for 4 days and initiated 24 h after infection prevented the development of the zosteriform rash in mice. The acyclovir formulation and the acyclovir ointment reduced the virus titers below detectable levels in skin samples from the majority of mice, whereas the foscarnet formulation has less of an antiviral effect. Reducing the number of treatments to a single application given 24 h postinfection resulted in a significantly higher efficacy of the formulation of acyclovir than of the acyclovir ointment. Acyclovir incorporated within the polymer was also significantly more effective than the acyclovir ointment when treatment was initiated on day 5 postinfection. The higher efficacy of the acyclovir formulation than of the acyclovir ointment is attributed to the semiviscous character of the polymer, which allows better penetration of the drug into the skin.

Topics: Acyclovir; Administration, Topical; Animals; Drug Administration Schedule; Female; Foscarnet; Herpes Simplex; Mice; Mice, Hairless; Ointments; Pharmaceutical Vehicles; Polymers; Skin Diseases, Viral; Time Factors

In recent studies we found that the topical effectiveness of acyclovir (ACV) formulations was a single-valued function of C-the target site free drug concentration. The topical efficacy was the same when the therapy was initiated 0, 1, or 2 days after intracutaneous herpes simplex virus type-1 (HSV-1) inoculation in hairless mice. The purpose of the present study was to examine the hypothesis that the topical effectiveness of cidofovir (HPMPC) would not be a single valued function of C and that it would be dependent upon when the therapy was initiated relative to the time of viral infection. Formulations of HPMPC and ACV in 95% DMSO as a vehicle were used. Hairless mice intracutaneously infected with HSV-1 were used, and 20 microL of the test formulation was topically applied twice a day. In protocol A, the treatment was continued until the fourth day after virus inoculation, whereas in protocol B the treatment was terminated on the day of virus inoculation. Treatment was initiated on various days ranging from day -6 to day 4, and the lesions were scored on day 5. Treatment of ACV according to protocol A proved efficacious whether started as early as 6 days before virus inoculation or later, whereas the efficacy of ACV was annihilated if applied following protocol B. For HPMPC, on the other hand, the in vivo efficacies were found to be strongly dependent on how early the therapy was initiated, and significant efficacy was observed even when the treatment was terminated on the day of virus inoculation. This difference was attributed to the virus-independent intracellular phosphorylation of HPMPC and slow clearance of its metabolites from the cell. It was also noted that, similar to ACV, for HPMPC the topical efficacy is likely to be a function of C for a fixed protocol. However, unlike for ACV, for HPMPC the efficacy was not a single-valued function of C.

Topics: Acyclovir; Administration, Topical; Animals; Antiviral Agents; Cidofovir; Cytosine; Female; Herpes Simplex; Mice; Mice, Hairless; Organophosphonates; Organophosphorus Compounds; Skin Diseases, Viral

This study aimed to describe a recently recognized and rare presentation of varicella zoster virus (VZV) retrobulbar optic neuritis preceding retinitis in patients with acquired immune deficiency syndrome and to identify factors that may relate to improved visual outcome.. Diagnosis, treatment, and clinical course are described for three eyes of two patients with this viral infection.. Patients had decreased vision, headache, and recent zoster dermatitis. Varicella zoster virus retrobulbar optic neuritis was diagnosed on the bases of clinical, laboratory, and electrophysiologic examination results. Profound vision loss and peripheral retinitis ensued despite intravenous antiviral treatment. Combination intravenous and intravitreous antiviral injections were administered with dramatic visual recovery.. Varicella zoster virus retrobulbar optic neuritis should be considered in immunocompromised patients with visual loss. Early diagnosis and aggressive combination therapy via systemic and intravitreous routes may enable return of useful vision.

Topics: Acyclovir; Adult; AIDS-Related Opportunistic Infections; Antiviral Agents; Cerebrospinal Fluid; Female; Foscarnet; Fundus Oculi; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Male; Meningitis, Viral; Optic Neuritis; Orbital Diseases; Retinitis; Skin Diseases, Viral; Visual Acuity

Topics: Acne Vulgaris; Acyclovir; Adult; Aged; Antiviral Agents; Epithelium; Female; Follow-Up Studies; Hair Follicle; Herpes Zoster; Humans; Keratins; Lymphocytes; Male; Middle Aged; Skin Diseases, Viral

Topics: Acyclovir; Adult; Antiviral Agents; Brain Diseases; Herpes Zoster; Humans; Kidney Failure, Chronic; Male; Renal Dialysis; Skin Diseases, Viral

To study the complication rate of varicella zoster virus (VZV) reactivation and the relationship between complications, presentation and localization of zoster and immune function in HIV disease.. A total of 142 episodes of VZV reactivation in 113 out of 544 HIV-1-infected participants in the Amsterdam Cohort Study of homosexual men were studied. Persistent hyperkeratotic or necrotic skin lesions, post-herpetic neuralgia, other neurological events, ocular events and pneumonitis occurring within 6 months of the onset of the last episode of VZV reactivation were defined as complications, provided that other possible diagnoses were excluded and the event had been previously described in the literature as related to VZV reactivation.. Twenty-four complications occurred in 15 (11%) of these 142 episodes. Complications occurred exclusively in the 40 episodes with either multidermatomal or disseminated presentation, or a trigeminal localization, or both. In the group of episodes of unidermatomal zoster at a non-trigeminal localization no complications occurred. Twenty-one episodes of herpes zoster were localized in the trigeminal area. Localization was not significantly associated with the level of immune function. Compared to unidermatomal presentation (n = 120), multidermatomal (n = 15) and disseminated presentation (n = 7) occurred at lower median CD4+ cell counts (330, 240 and 50 x 10(6)/l, respectively; P = 0.003) and significantly lower levels of CD3 monoclonal antibodies or phytohaemagglutinin-induced T-cell reactivity in vitro. Complications were related to CD4+ cell counts, but in the cases of disseminated, multidermatomal or trigeminal zoster a CD4+ cell measurement provided no additional information on the risk of complications.. In HIV-infected individuals the extent of the clinical presentation and the occurrence of complications of VZV reactivation are related to the degree of immunodeficiency. In episodes of VZV reactivation with either multidermatomal or disseminated presentation or a trigeminal localization, or both the complication rate was high. CD4+ cell counts provided no additional information on the complication risk. Oral acyclovir appears to be sufficient as therapy for unidermatomal zoster at a non-trigeminal localization.

Topics: Acyclovir; Adult; Antiviral Agents; CD4 Lymphocyte Count; Cohort Studies; Herpes Zoster; Herpesvirus 3, Human; HIV Infections; HIV-1; Homosexuality, Male; Humans; Male; Middle Aged; Skin Diseases, Viral; Virus Activation

Cutaneous lesions related to chronic active Epstein-Barr virus (EBV) infection have been rarely documented in immunocompetent patients. A 30-year-old woman, fulfilling the diagnostic criteria for the chronic fatigue syndrome, had a 10-year history of pruritic brownish macules and papules on her chest and back. Her EBV serology was abnormal; the EBV genome was present in the epidermis of lesions, in oral secretions, and in peripheral mononuclear cells (PMC). Her blood lymphocytes spontaneously outgrew in culture. Histology revealed deposits of amyloid in the papillary dermis. Treatment with acyclovir and interferon-alpha rapidly improved her condition, stopped the lymphocyte outgrowth in culture, and reduced the EBV DNA content in oral secretions and in PMC. These data support an endogenous reactivation of EBV infection and suggest a causal relationship with primary amyloidosis.

Topics: Acyclovir; Adult; Amyloidosis; Antiviral Agents; Female; Herpesviridae Infections; Herpesvirus 4, Human; Humans; In Situ Hybridization; Interferon-alpha; Skin Diseases, Viral; Tumor Virus Infections

The purpose of this study was to describe the clinical characteristics and course of peripheral ulcerative keratitis (PUK) secondary to herpes varicella-zoster virus in patients with the acquired immunodeficiency syndrome (AIDS). Three AIDS patients with ocular herpes zoster infection (mean age at onset, 33.0 years; range, 30-42) developed PUK. The three patients had skin involvement, and two of them had bilateral keratouveitis. All were treated with high-dose oral acyclovir (4 g/day) with or without topical antiviral therapy. Two of the patients responded well to oral acyclovir, but one of them stopped the treatment, and bilateral progressive outer retinal necrosis and lethal encephalitis developed. The third patient had a recurrent episode of inflammation with PUK, extensive stromal scarring, and deep neovascularization. AIDS patients with herpes varicella-zoster virus infection may have severe and protracted corneal manifestations, including PUK. The correct diagnosis and aggressive early long-term systemic antiviral treatment must be instituted to control inflammation, ulcer progression, and complications.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Administration, Oral; Adult; Anti-Inflammatory Agents; Antiviral Agents; Corneal Ulcer; Herpes Zoster Ophthalmicus; Humans; Male; Ophthalmic Solutions; Prednisolone; Recurrence; Skin Diseases, Viral; Uveitis

To describe the clinical course of varicella-zoster optic neuropathy preceding acute retinal necrosis in patients with acquired immunodeficiency syndrome.. Case series.. Two tertiary care centers in San Diego, Calif, and London, England.. Three human immunodeficiency virus-positive men with previous cutaneous zoster infection, optic neuropathy, and necrotizing retinitis.. All patients had an episode of zoster dermatitis treated with acyclovir. Visual loss consistent with an optic neuropathy ensued, followed by typical herpetic retinitis. The cause of visual loss was not suspected to be varicella-zoster until after the retinitis occurred. Despite aggressive medical treatment, 4 of 6 eyes progressed to retinal detachment.. Varicella-zoster may cause an optic neuropathy in patients with acquired immunodeficiency syndrome, especially in those with previous shingles. A high index of suspicion is necessary to establish the diagnosis and begin early antizoster treatment.

Topics: Acyclovir; Adult; AIDS-Related Opportunistic Infections; Antigens, Viral; Antiviral Agents; Dermatitis; Fluorescein Angiography; Fundus Oculi; Herpes Zoster; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Immunohistochemistry; Male; Middle Aged; Optic Nerve Diseases; Retina; Retinal Necrosis Syndrome, Acute; Skin Diseases, Viral; Visual Acuity; Vitreous Body

Topics: Acyclovir; Aged; Aged, 80 and over; Female; Herpes Simplex; Humans; Pemphigoid, Bullous; Skin Diseases, Viral

Topics: Acyclovir; Administration, Topical; Combined Modality Therapy; Drug Resistance, Microbial; Herpes Zoster; Humans; Injections, Intralesional; Interferon alpha-2; Interferon-alpha; Male; Middle Aged; Recombinant Proteins; Skin Diseases, Viral; Treatment Outcome; Trifluridine

The prevalence of mucocutaneous herpetic infection is especially high in patients with the acquired immunodeficiency syndrome (AIDS). In these patients, 8 p. 100 of the chronic or recurrent herpetic lesions are due to a mutant strain.. A case of very large (900 cm2) genital chronic herpetic infection is reported in a patient with AIDS (stade C3-CDC/WHO 1993). It was characterised by an acyclovir resistant strain which emerged after several anterior treatment with acyclovir. A treatment with foscarnet was administered and clinical improvement was observed as early as the fourth day, with complete reepithelialization 50 days later.. We discussed essentially the pathogenicity of the herpetic infections due to mutant strains in immunocompromised patients and on the therapeutic modalities. At the present time, foscarnet is the treatment of choice for acyclovir-resistant mucocutaneous herpes simplex.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; Buttocks; Chronic Disease; Drug Resistance; Foscarnet; Herpesviridae Infections; Humans; Male; Skin Diseases, Viral

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Child, Preschool; Female; Herpes Simplex; Herpesvirus 1, Human; Humans; Infectious Disease Transmission, Vertical; Skin Diseases, Viral

The acyclic nucleoside phosphonate (S)-1-(3-hydroxy-2-phosphonylmethoxypropyl)cytosine (HPMPC) was used topically for the treatment of persistent mucocutaneous infections in two cases. One patient with AIDS suffered from a perineal lesion due to infection with herpes simplex virus type 2 (HSV-2) and did not respond to acyclovir and was intolerant of foscarnet. A bone marrow transplant recipient developed orofacial lesions due to infection with herpes simplex virus type 1 (HSV-1) that failed to respond to therapy with both acyclovir and foscarnet. After topical application of HPMPC, the HSV-2 lesions completely resolved. However, the lesions recurred 3 weeks later, and, upon subsequent treatment with HPMPC, regressed. On recurrence, the virus was found to be sensitive to acyclovir, which the patient was given. Again HSV-2, which was resistant to acyclovir, emerged; similar observations were made after another cycle of HPMPC therapy. The HSV-1 isolates were resistant to acyclovir and foscarnet. Following local HPMPC treatment, the lesions regressed, but after 1 week, a second course of topical HPMPC therapy had to be instituted for recurrent infection. The lesions again regressed, and as the recurrent virus was sensitive to acyclovir, the patient was successfully treated with the drug. The results of this study point to the potential usefulness of topical HPMPC in the treatment of immunocompromised patients with HSV-related mucocutaneous infections that are refractory to therapy with acyclovir and/or foscarnet.

Topics: Acyclovir; Administration, Topical; Adult; AIDS-Related Opportunistic Infections; Antiviral Agents; Cidofovir; Cytosine; DNA Restriction Enzymes; DNA, Viral; Drug Resistance, Microbial; Foscarnet; Herpes Genitalis; Herpes Simplex; Herpesvirus 1, Human; Herpesvirus 2, Human; Humans; Leukemia, Myelogenous, Chronic, BCR-ABL Positive; Male; Opportunistic Infections; Organophosphonates; Organophosphorus Compounds; Skin Diseases, Viral; Thymidine Kinase

A case of atypical varicella zoster in a 33-year-old AIDS patient is reported. The patient had had two attacks of herpes zoster within a year and was given high-dose acyclovir several times. Thereafter he developed small keratotic pellucid papules on fingers, wrists and face, which were found to contain varicella-zoster antigen by the ELISA test. Skin biopsy showed acanthosis and lack of vesication, as is usually seen in herpes infections. The atypical varicella-like lesions persisted despite repeated doses of acyclovir but cleared temporarily when the patient was given foscarnet. We believe that the prolonged therapy may have allowed selection of acyclovir-resistant varicella-zoster strains, resulting in the atypical clinical course.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; Biopsy; Herpes Zoster; Humans; Male; Skin; Skin Diseases, Viral; Treatment Failure

The efficacy of a therapeutic agent must be evaluated by objective criteria. However, in herpes zoster (HZ) studies there has been no generally accepted objective clinical criterion.. Our purpose was to establish a clinical method for determining objectively the point in time at which the eruptive phase of HZ is completed (no new vesicle formation). This point is said to be a clinical criterion for the end of viral replication in the skin and thus for measuring the efficacy of a virustatic agent.. Newly formed vesicles were marked with differently colored permanent marker pens each day. This method was evaluated by comparing the results of acyclovir therapy in two groups of patients with HZ. (Group A, no underlying malignancy; n = 9. Group B, underlying malignancy; 64% of these patients were undergoing cytostatic polychemotherapy or had immunodeficiency; n = 22).. In both groups, acyclovir stopped the eruption of new vesicles within 1.8 and 2.8 days, respectively (not statistically significant). Group B showed a tendency toward more protracted hematogenous dissemination and a longer duration of therapy. The total duration of the eruptive phase depended solely on the length of the interval between the onset of the HZ and the beginning of therapy.. The method of marking new vesicles is independent of laboratory facilities, simple, and cost effective; in addition, this method is suitable for statistical evaluation. It is thus superior to other clinical methods for objective assessment of the progression of HZ.

Topics: Acyclovir; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunocompromised Host; Male; Middle Aged; Skin Diseases, Viral; Skin Neoplasms; Time Factors; Virus Replication

Patients with herpes simplex or zoster infections are common in most medical practices. These infections are also very important in HIV medicine, often presenting in an otherwise well person. Knowledge of the effects of immune deficiency on herpes simplex and zoster infection assists in determining when to consider HIV.

Topics: Acyclovir; Aged; Female; Herpes Simplex; Herpes Zoster; HIV Infections; Humans; Skin Diseases, Viral

Hyperkeratotic lesions caused by varicella-zoster, herpes simplex, or cytomegalovirus occur in patients infected with human immunodeficiency virus type 1 (HIV-1). We have also observed this type of lesion with molluscum contagiosum.. These cases were studied to determine whether there are any pathologic changes unique to these lesions.. The cases were studied by routine microscopic examination and immunohistochemistry.. Each case showed changes diagnostic of the viral infection, which was confirmed by immunohistochemical stains for herpes simplex and cytomegalovirus. In the dermis there were fewer inflammatory cells than expected, but there was an increase in factor XIIIa-positive dendritic cells.. Varicella-zoster, herpes simplex virus, cytomegalovirus, and molluscum contagiosum can cause verrucous lesions in HIV-1-infected patients. These lesions may be related to an increase in factor XIIIa-positive dendritic cells.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; Cytomegalovirus Infections; Dendritic Cells; Herpes Simplex; HIV-1; Humans; Interleukins; Keratinocytes; Male; Skin Diseases, Viral; Transglutaminases; Tumor Necrosis Factor-alpha; Warts