acyclovir and Stomatitis--Herpetic

Herpes simplex virus 1 (HSV-1) is the main pathogen responsible for herpes infections. In 13-30% of the cases, primary HSV-1 leads to the primary herpetic gingivostomatitis (PHGS), often a self-limiting infection; however, it can limit the ability to drink/eat with, sometimes, the need for hospitalization. Multiple therapeutic methods have been proposed. This systematic review aims to collect and critically appraise the available evidence about the clinical management of PHGS.. Literature search including three databases (PubMed, Scopus, Embase), study design, and data analysis were performed following PRISMA guidelines, according to the PICO tool (PROSPERO n° CRD42023391386). Risk of bias was assessed with RoB 2 and ROBINS-I.. Five studies on a total of 364 patients (average age: 7.6 years) were identified. The treatment regimens were summarized in acyclovir; acyclovir + honey; fluids and analgesic; maalox + diphenhydramine; lidocaine; chlorhexidine (CHX); CHX + ialuronic acid; CHX + Mucosyte®; antimicrobial photodynamic therapy (aPDT); topical antiviral; topical antiviral + aPDT; and others.. Although PHGS is a disease with a high worldwide prevalence, the lack of consensus about therapeutic management indicates gaps in existing evidence. Most of the proposed treatment consists in symptomatic drugs with empiric regimens which are ineffective for the viral replication. The main limit to realize randomized clinical trial is due to the rapid onset and remission of the disease. In fact, the diagnostic delay, estimated in 72 h, decreases the effectiveness of any antiviral drugs.. Out of the five studies included in this systematic review, only one was able to provide some weak evidence that ACV is an effective treatment, improving healing of oral lesions and reducing duration of symptoms.

Topics: Acyclovir; Antiviral Agents; Child; Delayed Diagnosis; Humans; Lidocaine; Randomized Controlled Trials as Topic; Stomatitis, Herpetic

This review on herpes simplex virus type I and type II (HSV‑I, HSV‑II) summarizes recent developments in clinical manifestations and treatment interventions for primary and recurrent orolabial and genital herpes, as well as those regarding vaccination issues. Among the clinical presentations, the relationship between pyogenic granuloma and chronic HSV‑I infection; HSV-related folliculitis; verrucous HSV‑I and HSV‑II lesions; the role of recurrent HSV‑I infection in burning mouth syndrome; HSV‑I and HSV‑II infection of the periareolar area; zosteriform HSV; the "knife-cut sign"; and the preferential colonization and infection of preexisting dermatoses by HSV‑I or HSV‑II are discussed. The usual antiviral treatment regimens for primary and recurrent orolabial and genital herpes are compared to short-term and one-day treatment options. New anti-HSV‑I and anti-HSV‑II agents include amenavir, pritelivir, brincidofovir, valomaciclovir, and FV-100. Therapeutic or preventive vaccination against HSV‑I and HSV‑II infections still remains a highly desirable treatment aim, which, unfortunately, has no clinically relevant applications to date.

Topics: Acyclovir; Antiviral Agents; Burning Mouth Syndrome; Herpes Genitalis; Herpes Labialis; Herpes Simplex; Herpesvirus 1, Human; Herpesvirus 2, Human; Humans; Randomized Controlled Trials as Topic; Recurrence; Stomatitis, Herpetic; Vaccination; Virulence; Zoster Sine Herpete

Topics: Acyclovir; Antiviral Agents; Child; Child, Preschool; Female; Gingivitis; Humans; Infant; Male; Randomized Controlled Trials as Topic; Stomatitis, Herpetic

Herpes simplex virus (HSV), a member of the Herpesviridae family, is a significant human pathogen that results in mucocutaneous lesions in the oral cavity or genital infections. Acyclovir (ACV) and related nucleoside analogues can successfully treat HSV infections, but the emergence of drug resistance to ACV has created a barrier for the treatment of HSV infections, especially in immunocompromised patients. There is an urgent need to explore new and effective tactics to circumvent drug resistance to HSV. This review summarises the current strategies in the development of new targets (the DNA helicase/primase (H/P) complex), new types of molecules (nature products) and new antiviral mechanisms (lethal mutagenesis of Janus-type nucleosides) to fight the drug resistance of HSV.

Topics: Acyclovir; Antiviral Agents; Drug Resistance; Herpes Labialis; Humans; Immunocompromised Host; Molecular Structure; Mutagenesis; Nucleosides; Plant Extracts; Simplexvirus; Stomatitis, Herpetic

Every year I see preschool children with gingivostomatitis. There seems to be quite a substantial burden of illness with this condition. Because it is caused by herpes simplex virus type 1, should I prescribe antiherpetic therapy with oral acyclovir?. While most children with primary gingivostomatitis will be asymptomatic, some will experience considerable pain and discomfort and are at risk of dehydration. There are no large, well designed studies to clearly determine appropriate therapy for all children. Based on a single randomized study, treatment should be started only within the first 72 hours of symptom onset if substantial pain or dehydration are documented.

Topics: Acyclovir; Antiviral Agents; Child; Dehydration; Humans; Pain; Pediatrics; Practice Guidelines as Topic; Randomized Controlled Trials as Topic; Stomatitis, Herpetic

Oral and perioral herpes simplex virus (HSV) infections in healthy individuals often present with signs and symptoms that are clearly recognized by oral health care providers (OHCPs). Management of these infections is dependent upon a variety of factors and several agents may be used for treatment to accelerate healing and decrease symptoms associated with lesions. This article will review the pertinent aspects of topical and systemic therapies of HSV infections for the OHCP.

Topics: 2-Aminopurine; Acyclovir; Administration, Oral; Administration, Topical; Antiviral Agents; Famciclovir; Humans; Palliative Care; Stomatitis, Herpetic; Valacyclovir; Valine

Topics: Acyclovir; Administration, Oral; Antiviral Agents; Child, Preschool; Evidence-Based Medicine; Humans; Immunocompetence; Male; Stomatitis, Herpetic; Treatment Outcome

Treatment of cancer is increasingly effective, but associated with oral complications such as mucositis, fungal infections, bacterial infections and viral infections such as the herpes simplex virus (HSV).. To examine the effects of interventions for the prevention or treatment or both, of herpes simplex virus in patients receiving treatment for cancer.. We searched the following databases: Cochrane Oral Health Group's Trials Register, CENTRAL, MEDLINE, EMBASE, CINAHL, CANCERLIT, SIGLE and LILACS. The reference list of all related review articles and articles considered to be potentially relevant were checked for further trials. Authors of identified trials and known specialists in the field were also contacted in an attempt to identify any additional published or unpublished trials. Date of most recent search: November 2008.. All randomised controlled trials comparing interventions for the prevention or treatment or both of HSV infection in people being treated for cancer. Outcomes were presence/absence of clinical/culture positive HSV infections (prevention), time to complete healing of lesions (treatment), duration of viral shedding, recurrence of lesions, relief of pain, amount of analgesia, duration of hospital stay, cost of oral care, patient quality of life and adverse effects.. Data were independently extracted, in duplicate, by two review authors. Authors were contacted for details of randomisation, blindness and sample demographics where necessary. Quality assessment was carried out on randomisation, blindness, withdrawals and selective reporting. The Cochrane Collaboration's statistical guidelines were followed and risk ratio (RR) values were calculated using random-effects models.. Seventeen trials satisfied the inclusion criteria. Four trials evaluated preventative interventions for HSV lesions, three trials for viral isolates, and eight trials evaluated both outcome measures. A single trial reported on the cost of prophylaxis for HSV. Two trials evaluating treatment reported on time to healing, duration of viral shedding and relief of pain. No trials reported on duration of hospital stay, amount of analgesia or patient quality of life.In placebo controlled trials, aciclovir was found to be effective for the prevention of HSV infections as measured by oral lesions or viral isolates (RR = 0.16, 95% confidence interval (CI) 0.08 to 0.31 nine trials; RR = 0.17, 95% CI 0.07 to 0.37 nine trials). There is no evidence that valaciclovir is more efficacious than aciclovir, or that higher doses of valaciclovir are more effective than lower doses. Placebo was found to be more effective than prostaglandin E for prevention of viral isolates (RR = 1.87, 95% CI 1.12 to 3.14 one trial).Aciclovir was also found to be effective for the treatment of HSV in terms of duration of viral shedding (median of 2.5 days versus 17.0 days, P = 0.0002; 2 days compared to more than 9, P = 0.0008), time to first decrease in pain (median 3 days compared to 16, P = 0.04), complete resolution of pain (9.9 days compared to 13.6 days, P = 0.01; median of 6 days compared to 16, P = 0.05), 50% healing (median of 6 days compared to 11, P = 0.01) and total healing (median 13.9 days compared to 20.7 days, P = 0.08; median of 8 days compared to 21, P = 0.0).. There is evidence that aciclovir is efficacious in the prevention and treatment of herpes simplex virus infections. There is no evidence that valaciclovir is more efficacious than aciclovir, or that a high dose of valaciclovir is better than a low dose of valaciclovir. There is evidence that as a prophylaxis, placebo is more efficacious than prostaglandin E. However, in all included trials, risk of bias is unclear.

Topics: Acyclovir; Antiviral Agents; Herpes Labialis; Humans; Immunocompromised Host; Neoplasms; Prostaglandins E; Randomized Controlled Trials as Topic; Simplexvirus; Stomatitis, Herpetic; Valacyclovir; Valine

The development of novel strategies to eradicate herpes simplex virus (HSV) is a global public health priority. While acyclovir and related nucleoside analogues provide successful modalities for treatment and suppression, HSV remains highly prevalent worldwide and is a major cofactor fueling the HIV epidemic. HSV is the predominant cause of genital ulcerative disease, and neonatal and sporadic infectious encephalitis. Asymptomatic shedding, which occurs more frequently than previously appreciated, contributes to viral transmission. Acyclovir resistance may be problematic for immunocompromised patients and highlights the need for new safe and effective agents. Ideally, vaccines to prevent infection, drugs to inhibit the establishment of or reactivation from latency, or vaginal microbicides to prevent sexual and perinatal transmission are needed to control the epidemic. This review summarizes current therapeutic options and strategies in development.

Topics: Acyclovir; Anti-Infective Agents; Antiviral Agents; Encephalitis, Herpes Simplex; Female; Herpes Genitalis; Herpes Simplex; HIV Infections; Humans; Infant, Newborn; Keratitis, Herpetic; Male; Pregnancy; Stomatitis, Herpetic; Syndrome; Viral Vaccines

Although epidemiologic data and the potentially serious effects of transmission of genital herpes from mother to infant during birth have been widely reported, published reports on oral herpes disease in pregnancy remain scarce and no clear management guidelines exist. Thus, questions remain about acquisition, transmission and outcome of infection, especially with respect to acute gingivostomatitis in pregnancy. In response to these questions, we summarize previous reports on herpes simplex virus 1 (HSV-1) oral disease in pregnancy and, briefly, present 2 cases of primary gingivostomatitis in the first trimester of pregnancy, resulting in a favourable outcome for both mother and infant. We also point out the most recent data on rare, potentially severe in outcome, but treatable, primary central nervous system HSV-1 infection in later stages of pregnancy. Finally, we emphasize a multidisciplinary approach to oral HSV disease in pregnancy, with dentist participation in the diagnosis and treatment.

Topics: Acyclovir; Adult; Antiviral Agents; Female; Herpes Labialis; Herpesvirus 1, Human; Humans; Infectious Disease Transmission, Vertical; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Outcome; Pregnancy Trimesters; Stomatitis, Herpetic; Treatment Outcome

Primary herpetic gingivostomatitis is a highly contagious infection of the oral cavity which typically affects children but can also occur in adults. Symptoms may vary widely from mild discomfort to life-threatening encephalitis.. The objective of this review was to evaluate the effectiveness of systemic acyclovir for primary herpetic gingivostomatitis.. We searched the following databases: Cochrane Oral Health Group's Trials Register (to 22 May 2008); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2008, Issue 2); MEDLINE (1950 to 22 May 2008); and EMBASE (1980 to 22 May 2008). There were no language restrictions.. Randomised controlled trials comparing acyclovir to placebo in children and young adults < 25 years of age with a diagnosis of primary herpetic gingivostomatitis with or without herpes labialis were considered.. Two review authors independently and in duplicate screened and extracted information from, and assessed the risk of bias in the included clinical trials. The Cochrane Collaboration statistical guidelines were followed for data synthesis.. Only two clinical trials, one with 72 participants and the other with 20 participants were included in this review. The second study failed to report several methodological items and was inconsistent in its reporting of the outcomes measurement.The first trial, with a moderate risk of bias, showed better results in the acyclovir group compared to the placebo group in children < 6 years of age in reducing the number of individuals with oral lesions (risk ratio (RR) 0.10 (95% confidence interval (CI) 0.02 to 0.38)), new extraoral lesions (RR 0.04 (95% CI 0.00 to 0.65)), difficulty in eating (RR 0.14 (95% CI 0.03 to 0.58)), and drinking difficulties (RR 0.11 (95% CI 0.01 to 0.83)) after 8 days of treatment.Following the onset of treatment, three patients from the placebo group were admitted to hospital for rehydration (P = 0.11).Four children (two from the acyclovir, and two from the placebo group) showed mild gastrointestinal symptoms that resolved spontaneously after 24 to 48 hours without a change in the study treatment.. We found two relevant trials in this systematic review, only one of them could provide some weak evidence that acyclovir is an effective treatment in reducing the number of oral lesions, preventing the development of new extraoral lesions, decreasing the number of individuals with difficulties experienced in eating and drinking and reducing hospital admission for children under 6 years of age with primary herpetic gingivostomatitis.

Topics: Acyclovir; Antiviral Agents; Child; Child, Preschool; Female; Gingivitis; Humans; Infant; Male; Randomized Controlled Trials as Topic; Stomatitis, Herpetic

To review the treatment of primary herpetic gingivostomatitis at a children's hospital.. A review of charts from 1999 to 2003.. Forty-eight cases were identified. They ranged in age from 8 months to 12 years, with a median age of 2 years 7 months. All children were treated with fluids and analgesics; 11 children were treated with fluids and analgesics exclusively. Thirty-five children were treated with a mixture of Maalox and diphenhydramine, 8 with acyclovir, and 7 with viscous lidocaine; 11 children were treated with 2 or more of these regimens. Both the Maalox and diphenhydramine mixture and the viscous lidocaine were administered as swish and swallow, swish and spit, or by application with a swab as frequently as every hour or as infrequently as every 8 hours.. Topical therapy with Maalox and diphenhydramine or viscous lidocaine was administered to 73% and 15% of the patients, respectively, whereas acyclovir was administered to only 17%. Dosing and administration of topical agents in the treatment of primary herpetic gingivostomatitis in preschoolers were problematic. Acyclovir was not being used as often as it could have been.

Topics: Acyclovir; Administration, Oral; Aluminum Hydroxide; Analgesics; Anesthetics, Local; Antacids; Antiviral Agents; Child; Child, Preschool; Diphenhydramine; Drug Administration Schedule; Drug Combinations; Drug Therapy, Combination; Female; Fluid Therapy; Humans; Incidence; Infant; Lidocaine; Magnesium Hydroxide; Male; New York; Stomatitis, Herpetic

In immunocompetent patients, HSV is controlled rapidly by the human host's immune system, and recurrent lesions are small and short lived. When treated with antiviral agents, these patients rarely develop resistance to these drugs. In contrast immunocompromised patients might not be able to control HSV infection. Thus, frequent and severe reactivations are often seen and might lead to fatal herpetic encephalitis or disseminated HSV infection. Treatment in these patients is limited because immunocompromised hosts often develop severe herpes disease refractory to antiviral drug therapy. It is therefore imperative that physicians develop regimens to deal with both receptive and refractory HSV disease. The following treatment protocol (modified from Balfour and colleagues) might serve as a guide until further investigation of new drugs is performed. In all patients standard oral ACV therapy should be initiated at a dose of 200 mg orally, five times a day for the first 3 to 5 days. Prior to treatment, cultures the lesions should be obtained to verify HSV etiology. If the response is poor, the dose of oral ACV should be increased to 800 mg five times a day. If no response seen after 5 to 7 days, it is unlikely that the lesion will respond to intravenous ACV (or chemically and structurally related drugs such as VCV or famciclovir), so an alternative regimen must be assigned. First, repeat cultures for vital, fungal, and bacterial pathogens must be performed. In addition, ACV susceptibility studies should be ordered, if available. If the mucocutaneous lesion is accessible for topical treatment, TFT (as ophthalmic solution) should be applied to the area three to four times a day until the lesion is completely healed. If the lesion is inaccessible or if the response to TFT is poor, therapy with intravenous foscarnet should be given for 10 days or until complete resolution of the lesions. The dosage of foscarnet should be 40 milligrams per kilogram three times per day or 60 milligrams per kilogram twice daily. If foscarnet fails to achieve clinical clearing, consideration should be given to use of intravenous cidofovir (or application of compounded 1% to 3% topical cidofovir ointment). Vidarabine is reserved for situations in which all of these therapies fail. If lesions reoccur in the same location following clearing, the patient should started on high-dose oral ACV (800 mg, five times daily) or intravenous foscarnet (40 mg/kg tid or 60 mg/kg bid) as soon as possib

Topics: Acyclovir; Antiviral Agents; Cidofovir; Cytosine; Drug Resistance, Viral; Foscarnet; Herpes Simplex; Humans; Organophosphonates; Organophosphorus Compounds; Stomatitis, Herpetic; Trifluridine; Vidarabine

Herpes is a pandemic infection in the human species. The purpose of this work was to conduct a critical analysis of the literature devoted to the pathophysiology and treatment of orofacial herpes an other localizations (genital herpes and neonatal herpes excluded).. We searched for articles in English and French devoted to orofacial herpes and other herpetic localizations indexed in Medline (1980-July 001), EmBase, and the Cochrane Library (1995-July 2001). Critical analysis was based on level of proof using the ANAES methodology.. More than 700 articles were identified. One hundred four were selected for this report. Primary HSV1 infection usually occurred before adulthood and involved acute gingivo-stomatitis in the majority of the cases. Several primary HIV1 infections were asymptomatic or aspecific and non-recognized. After the primary infection, the virus remains in the ganglion of the trigeminal nerve in a latent state and can be reactivated sporadically. Reactivation is associated with viral excretion and can be symptomatic (herpetic recrudescence) or not (recurrence). Recrudescence of orofacial herpes is typically labial. No currently available vaccine can prevent acquisition of HSV1. Treatment of acute gingivostomatitis has been standardized and is based on aciclovir. Inversely, the effectiveness of aciclovir and other nucleoside analogs with anti-herpes activity has not been clearly established for prevention or cure of recrudescence of orofacial herpes. Other localizations (hand, anus, diffuse skin localizations in contact sports, Kaposi-Juliusberg syndrome) are much more exceptional. Treatment has not been standardized.. Despite the abundance of the literature on orofacial herpes, consistent quality is lacking, particularly concerning therapeutic studies. The quality of these reports is generally inferior to those devoted to genital herpes. There has however been a general trend towards improved methodology over the last years. Very little has been reported on exceptional localizations of orofacial herpes.

Topics: Acyclovir; Administration, Oral; Administration, Topical; Antiviral Agents; Facial Dermatoses; Herpes Simplex; Herpesvirus 1, Human; Herpesvirus 2, Human; Humans; Immunocompetence; Stomatitis, Herpetic; Virus Activation

Herpetic gingivostomatitis (HGS) is the predominant manifestation of cutaneomucosal herpes in children with HSV1 primary infection before the age of 3 years. The infection is self limiting and lasts 10 to 14 days. Pain and dysphagia are particularly important during the first week of infection and may necessitate parenteral rehydratation and administration of antalgesics. HGS in the young child causes substantial morbidity leading to hospital and social costs (work stoppage for parents). The clinical course is generally benign with the exception of forms with important extension, eczema, herpeticum Kaposi-Juliusberg pustulosis observed at this age only in children with atopic dermititis. Other severe forms are observed in the neonate and immunodepressed subject, which can also be caused by HSV1. Forms with little or not clinical manifestation predominate and generally go undiagnosed, explaining the asymptomatic viral excretion observed in the saliva or other secretions (ocular, genital secretions). Despite the sterotypic nature of the clinical expression, HGS is still often undiagnosed both by general practitioners and pediatricians. This lack of diagnosis generally has few consequences due to the benign course in a few days, but the infection can have an important psychological and social leading to significant healthcare costs. Moderate and severe forms require medical care. Aciclovir should be prescribed if the diagnosis is made early (3 days) in combination with symptomatic care. Studies of the medical and economic impact of herpetic gingivostomatis should be conducted.

Topics: Acyclovir; Antiviral Agents; Child, Preschool; Costs and Cost Analysis; Deglutition Disorders; Herpesvirus 1, Human; Humans; Pain; Physical Examination; Stomatitis, Herpetic

General treatments for immunocompetent individuals with herpes simplex infections are based on the use of antiviral agents which constitute the only treatment with proven efficacy. Antivirals were developed in the 1980s with aciclovir (ACV) as the leading compound and have greatly changed management. However, once the virus has penetrated the organism, it cannot be eradicated, neither by the immune system nor by antiviral agents. This viral resistance is basically related to its capacity to maintain itself in a latent form in the sensorial ganglions. ACV is the first line treatment, used since the 1980s; other antiviral agents are also available.

Topics: Acyclovir; Antiviral Agents; Drug Therapy, Combination; Herpes Genitalis; Herpes Labialis; Herpes Simplex Virus Vaccines; Herpesvirus 1, Human; Herpesvirus 2, Human; Humans; Interferon-alpha; Secondary Prevention; Stomatitis, Herpetic; Valacyclovir; Valine

Topics: Acyclovir; Adult; Antibodies, Viral; Antiviral Agents; Child, Preschool; DNA, Viral; Enzyme-Linked Immunosorbent Assay; Female; Fluorescent Antibody Technique; France; Herpes Genitalis; Herpes Labialis; Herpes Simplex; Humans; Infant; Infant, Newborn; Male; Pemphigoid Gestationis; Polymerase Chain Reaction; Pregnancy; Recurrence; Simplexvirus; Stomatitis, Herpetic; Time Factors

Primary symptomatic herpes simplex virus infection in children usually manifests as gingivostomatitis and is prevalent in the 1- to 3-year age group. The disease involves the buccal and gingival mucosa and the tongue, and lasts approximately 2 weeks. Two recent non-blind studies reported a more rapid regression of symptoms after treatment with aciclovir suspension. Three randomised double-blind, placebo-controlled trials have clearly demonstrated that early aciclovir treatment significantly shortens the duration of all clinical manifestations and infectivity of affected children compared with placebo. We conclude that the treatment of herpetic gingivostomatitis with aciclovir is recommended. Treatment should be started within the first 3 days of disease onset. The proposed therapeutic dose is 15 mg/kg, 5 times daily for 5 to 7 days.

Topics: Acyclovir; Antiviral Agents; Child, Preschool; Clinical Trials as Topic; Humans; Infant; Stomatitis, Herpetic

Viral lesions of the mouth in patients with HIV infection are common and these diseases any be a marker for HIV and disease progression. We review the spectrum of oral viral manifestations and discuss treatment modalities. The most common Epstein-Barr virus (EBV)-induced disorder in HIV-infected patients is oral hairy leukoplakia. EBV-related oral B-cell and T-cell lymphoma in AIDS patients has been described repeatedly. Herpes virus type 1 and rarely type 2 may lead to painful and resistant oral ulcers, and systemic treatment with acyclovir, valaciclovir or famciclovir is indicated. In acyclovir-resistant cases foscarnet is the treatment of choice. In recent years it has been documented that Kaposi's sarcoma, which often affects oral mucosa, is probably induced by herpesvirus type 8. Cytomegalovirus was found in 53% of cases with herpesviridae-induced mucosal ulcers as the only ulcerogenic viral agent in AIDS patients. In severe cytomegalovirus infection treatment with ganciclovir is helpful. Viral warts induced by different HPV may occur in the mouth. Several physical treatment modalities are possible in the oral mucosa. In AIDS patients mollusca contagiosa may occur as large and atypical lesions in the face and lips and rarely in the oral cavity. Cryotherapy is a bloodless treatment in such patients.

Topics: 2-Aminopurine; Acyclovir; AIDS-Related Opportunistic Infections; Anti-HIV Agents; Cytomegalovirus Infections; Disease Progression; Famciclovir; Foscarnet; Ganciclovir; Herpesviridae Infections; Herpesvirus 1, Human; Herpesvirus 2, Human; Herpesvirus 4, Human; Herpesvirus 8, Human; Humans; Leukoplakia, Hairy; Lymphoma, B-Cell; Lymphoma, T-Cell; Molluscum Contagiosum; Mouth Diseases; Mouth Neoplasms; Oral Ulcer; Prodrugs; Sarcoma, Kaposi; Stomatitis, Herpetic; Tumor Virus Infections; Valacyclovir; Valine; Virus Diseases; Warts

Herpes viruses are characterized by their ability to establish and maintain latent infections that can be reactivated. Several stimuli can trigger the reactivation of herpes viruses, which are perhaps best recognized in the recurrent blisters and ulcers associated with herpes simplex virus. We present two clinical cases of reactivation of herpes simplex virus during radiation therapy for management of cancers of the head and neck. Although the role of ionizing radiation in the reactivation of herpes simplex virus has not been established, we review the viral and host events associated with the establishment of orofacial herpes simplex virus infection, latency, and reactivation of the virus. We discuss current models of viral reactivation and suggest directions for further clinical research into the reactivation of orolabial herpes simplex virus during radiotherapy.

Topics: Acyclovir; Adult; Antiviral Agents; Carcinoma, Squamous Cell; Cerebellar Neoplasms; Head and Neck Neoplasms; Humans; Immunocompromised Host; Lymphoma, AIDS-Related; Lymphoma, B-Cell; Lymphoma, Large-Cell, Immunoblastic; Male; Middle Aged; Nasopharyngeal Neoplasms; Radiotherapy; Recurrence; Simplexvirus; Stomatitis, Herpetic; Virus Activation; Virus Latency

Topics: Acyclovir; Antiviral Agents; Chronic Disease; Combined Modality Therapy; Female; Humans; Immunocompromised Host; Immunosuppressive Agents; Kidney Transplantation; Middle Aged; Periodontitis; Recurrence; Stomatitis, Herpetic

This paper presents an overview of the clinical conditions associated with a herpetic lesion at the time of the primary infection, as a true primary infection or a first herpetic accident, or during recurrences. The virus responsible, its anatomy and its functioning are detailed. The etiology and transmission of herpetic viral infection, its evolution and complications, as well as diagnostic aids are also discussed. To complete the discussion of this chronic disease which can cause acute annoyances treatment, particularly for children is reviewed, and suggestions are made to prevent it.

Topics: Acyclovir; Child; Child, Preschool; Chronic Disease; Herpesvirus 1, Human; Humans; Infant; Mouthwashes; Recurrence; Stomatitis, Herpetic

Oral and intravenous acyclovir formulations provide effective virostasis against many herpes viruses infections, especially severe herpes simplex or varicella-zoster infections in ambulatory and immunocompromised patients. The therapeutic virostatic efficacy of topical acyclovir formulations requires further development, however, especially for orolabial herpetic infections.

Topics: Acyclovir; Administration, Topical; Herpes Labialis; Herpes Zoster; Humans; Immunocompromised Host; Stomatitis, Herpetic

Topics: Acyclovir; Herpes Labialis; Herpes Zoster; Herpesviridae Infections; HIV Infections; Humans; Mouth Diseases; Stomatitis, Herpetic; Virus Diseases

Reactivation of herpes simplex virus (HSV) appears to play a significant role in oral mucositis resulting from bone marrow transplantation. The acyclic guanosine derivative acyclovir has been shown to be effective in treating and protecting against HSV infection in this group. The purpose of this study was to determine the role of HSV reactivation in oral mucositis in patients undergoing bone marrow transplantation who were seronegative for HSV or who received acyclovir prophylaxis. The results suggest that HSV plays an insignificant role in oral mucositis in these patients.

Topics: Acyclovir; Antibodies, Viral; Bone Marrow Transplantation; Humans; Simplexvirus; Stomatitis, Herpetic; Transplantation Immunology

The treatment of herpes simplex virus (HSV) infections in the past has been largely unsuccessful. Introduction of the drug acyclovir has been a positive development. Acyclovir has been extensively studied in the treatment of a a variety of HSV infections in immunocompromised patients and in otherwise healthy patients. The results have shown it to effectively inhibit HSV replication but to have no effect in preventing or eliminating the latent state of the virus. It has been shown to be very effective in certain instances and not so effective in others.

Topics: Acyclovir; Facial Dermatoses; Herpes Simplex; Humans; Recurrence; Stomatitis, Herpetic

Topics: Acyclovir; Autonomic Nervous System Diseases; Encephalitis; Esophagitis; Facial Dermatoses; Female; Fingers; Hepatitis, Viral, Human; Herpes Genitalis; Herpes Labialis; Herpes Simplex; Humans; Infant, Newborn; Keratitis, Dendritic; Male; Peripheral Nervous System Diseases; Recurrence; Respiratory Tract Infections; Stomatitis, Herpetic; Vaccination; Viral Vaccines

Herpes simplex viruses cause common mucocutaneous infections, but many aspects of their epidemiology and transmission are incompletely defined. Although the incidence of oral herpes remains relatively unchanged, the incidence of genital herpes is increasing significantly. Definitive diagnosis of herpes remains dependent on virus isolation, but techniques involving direct examination of clinical specimens are increasingly sensitive and may simplify and speed diagnosis. With the advent of acyclovir, effective therapy and suppression of infection are feasible for immunodeficient and selected normal patients. Unanswered questions remain regarding the long-term safety of acyclovir and the potential for emergence of clinically significant drug resistance. No effective vaccines are yet available for herpes virus infections. Promising strategies for vaccine development include preparation of immunogenic proteins, engineering of specially attenuated live virus strains, and incorporation of selected herpes genes into live vaccinia virus vectors.

Topics: Acyclovir; Adult; Animals; Antiviral Agents; Child, Preschool; Drug Resistance, Microbial; Female; Herpes Genitalis; Herpes Simplex; Humans; Infant; Interferons; Male; Recurrence; Simplexvirus; Stomatitis, Herpetic; Viral Vaccines; Virus Activation; Virus Cultivation

Topics: Acyclovir; Administration, Oral; Administration, Topical; Antiviral Agents; Child; Encephalitis; Female; Herpes Genitalis; Herpes Labialis; Herpes Simplex; Humans; Idoxuridine; Infant, Newborn; Male; Pregnancy; Stomatitis, Herpetic; Vidarabine

Infections with herpes simplex virus (HSV) are extremely common. HSV infection may be asymptomatic or may cause any one of a wide variety of disease syndromes. In this review, the physical properties and mode of replication of HSV are briefly described, and an outline of the different clinical manifestations associated with HSV infection is presented. Principles of diagnosis, treatment, and prevention of these infections are also discussed.

Topics: Acyclovir; Adult; Animals; Child; Encephalitis; Female; Genes, Viral; Herpes Genitalis; Herpes Simplex; Humans; Infant, Newborn; Male; Meningitis, Viral; Pregnancy; Recurrence; Simplexvirus; Stomatitis, Herpetic; Transcription, Genetic; Vidarabine; Virus Replication

Five per cent acyclovir cream containing propylene glycol was used in a double-blind, placebo controlled, randomized trial of topical acyclovir therapy in 30 patients with recurrent orofacial herpes simplex infections. Several patients re-entered the trial and a total of 60 treated episodes were evaluated. Analysis of the first episodes treated showed a significant reduction in the duration of vesiculation from 2.7 to 1.8 days (P = 0.016) and in the total healing time from 8.3 to 5.7 days (P = 0.022). A decrease in the duration of itching was also observed. Evaluation of all episodes treated showed a significant decrease only in the duration of vesiculation from 2.3 to 1.6 days (P = 0.016); the total healing time was decreased from 6.6 to 5.4 days (P = 0.051). The penetration of acyclovir through the skin and the time of initiation of therapy appear to be the major limiting factors governing efficacy. We hypothesize that repeated treatment with acyclovir may decrease the severity of the herpes simplex infections.

Topics: Acyclovir; Administration, Topical; Adult; Clinical Trials as Topic; Double-Blind Method; Female; Herpes Labialis; Humans; Male; Random Allocation; Recurrence; Stomatitis, Herpetic; Time Factors

In order to determine the anti-pathogenic clinical efficacy of cycloferon liniment in the combined treatment of herpetic stomatitis and periodontitis, medical examination and treatment of these disorders have been carried out in a group of 80 patients. It is established that the use of cycloferon liniment in the combined treatment of herpetic stomatitis and periodontitis decreases the infectious load in parodontal recess, reduces the manifestations of local inflammation, normalizes the immunity indices, and decreases the level of endogenous intoxication, which ensures the acceleration of recuperation processes and lowers the frequency of recurrences.

Topics: Acridines; Acyclovir; Adult; Candida albicans; Chlamydia trachomatis; Female; Humans; Immunoassay; Immunoglobulin A; Inflammation; Interferon Inducers; Interleukin-1beta; Liniments; Male; Mouth; Periodontitis; Recurrence; Severity of Illness Index; Simplexvirus; Stomatitis, Herpetic; Tumor Necrosis Factor-alpha

Oral herpes simplex virus, or HSV, infections recur after trauma and stress. The prevalence of these infections after dental procedures is not known. Also, it is unclear whether antiviral agents are effective in preventing dental procedure-induced HSV recurrences. This study determined the efficacy and safety of oral valacyclovir in suppressing dentally related cold sore outbreak and HSV shedding.. The authors enrolled 125 otherwise healthy HSV-seropositive adults who reported having recurrent herpes labialis (more than one episode per year and at least one episode in the previous year) in a randomized, double-blind, placebo-controlled study and gave them valacyclovir prophylactically (2 grams taken twice on the day of dental treatment and 1 g taken twice the next day) or a matching placebo. To detect the presence of the virus, the authors used clinical examinations, viral cultures and real-time polymerase chain reaction analysis of saliva.. During the one-week observation period after treatment, there were more clinical lesions (20.6 percent versus 11.3 percent), more HSV-1-positive culture specimens (7.9 percent versus 1.6 percent) and more HSV-1-positive saliva specimens (7.9 percent versus 4.0 percent) in placebo than in valacyclovir-treated patients, respectively. The percentage of patients who developed recurrences and shed HSV-1 in saliva 72 hours after dental procedures was significantly smaller in the valacyclovir group than in the placebo group (11.3 percent versus 27 percent; P = .026). The mean time to pain cessation was significantly less in the valacyclovir group (3.2 days) than in the placebo group (6.2 days) (P = .006).. HSV recrudescence after routine dental treatment is suppressed by valacyclovir prophylaxis.. HSV recrudescence is common after routine dental treatment. Clinicians should consider antiviral therapy for patients at risk of experiencing a recurrence, as well as to minimize transmission of the disease.

Topics: Acyclovir; Adolescent; Adult; Aged; Antiviral Agents; Child; Dental Care; Double-Blind Method; Female; Follow-Up Studies; Herpes Labialis; Humans; Male; Middle Aged; Placebos; Premedication; Prodrugs; Prospective Studies; Recurrence; Saliva; Simplexvirus; Stomatitis, Herpetic; Treatment Outcome; Valacyclovir; Valine; Virus Shedding

To examine the efficacy of aciclovir suspension for treating herpetic gingivostomatitis in young children.. Randomised double blind placebo controlled study.. Day care unit of a tertiary paediatric hospital.. 72 children aged 1-6 years with clinical manifestations of gingivostomatitis lasting less than 72 hours; 61 children with cultures positive for herpes simplex virus finished the study.. Duration of oral lesions, fever, eating and drinking difficulties, and viral shedding.. Aciclovir suspension 15 mg/kg five times a day for seven days, or placebo.. Children receiving aciclovir had oral lesions for a shorter period than children receiving placebo (median 4 v 10 days (difference 6 days, 95% confidence interval 4.0 to 8.0)) and earlier disappearance of the following signs and symptoms: fever (1 v 3 days (2 days, 0.8 to 3.2)); extraoral lesions (lesions around the mouth but outside the oral cavity) (0 v 5.5 days (5.5 days, 1.3 to 4.7)); eating difficulties (4 v 7 days (3 days, 1.31 to 4.69)); and drinking difficulties (3 v 6 days (3 days, 1.1 to 4.9)). Viral shedding was significantly shorter in the group treated with aciclovir (1 v 5 days (4 days, 2.9 to 5.1)).. Oral aciclovir treatment for herpetic gingivostomatitis, started within the first three days of onset, shortens the duration of all clinical manifestations and the infectivity of affected children. Further studies are needed to evaluate the ideal dose and length of treatment.

Topics: Acyclovir; Administration, Oral; Antiviral Agents; Child; Child, Preschool; Double-Blind Method; Feeding and Eating Disorders; Fever; Herpesvirus 1, Human; Hospitalization; Humans; Infant; Patient Compliance; Recurrence; Stomatitis, Herpetic; Time Factors; Treatment Outcome

Oropharyngeal shedding of herpes viruses (herpes simplex, cytomegalovirus) was assessed in patients on standard acyclovir prophylaxis during bone marrow transplantation (BMT) to determine the frequency of viral shedding and to assess possible oropharyngeal complications that may be associated with viral reactivation in these patients. We conducted a prospective assessment of 83 patients receiving BMT. Patients were evaluated weekly and oral surveillance cultures were completed. Shedding of herpes simplex virus (HSV) was detected in the oropharynx of 2.9% of seropositive patients on prophylactic acyclovir, and only one case of clinical oral herpetic infection was seen. Cytomegalovirus (CMV) was cultured from the oropharynx in 13.3% of CMV seropositive patients provided with prophylactic acyclovir, but no oropharyngeal lesions were attributed to CMV reactivation. No correlation was seen between HSV and CMV pretransplant serology and severity of oral mucositis and acute graft versus host disease. No effect on time to engraftment was detected. This study supports the continuing use of acyclovir prophylaxis in HSV seropositive patients receiving BMT. Acyclovir prophylaxis was effective in preventing viral shedding in all but 2.9% of patients, and only one case of clinical infection was diagnosed. The frequency of CMV shedding was approximately four times that of HSV; however, no oral lesions were attributed to CMV.

Topics: Acyclovir; Adolescent; Adult; Antibiotic Prophylaxis; Antiviral Agents; Bone Marrow Transplantation; Cytomegalovirus Infections; Drug Administration Schedule; Female; Follow-Up Studies; Humans; Male; Middle Aged; Opportunistic Infections; Prospective Studies; Stomatitis, Herpetic

Topics: Acyclovir; Adolescent; Adult; CD4 Lymphocyte Count; Child; Combined Modality Therapy; Female; Herpes Simplex; Herpesvirus 1, Human; Humans; Immunity, Cellular; Keratitis, Herpetic; Male; Middle Aged; Recurrence; Stomatitis, Herpetic; Vaccines, Inactivated; Viral Vaccines

To evaluate (a) the prophylactic effect of the antiherpetic drug acyclovir on oral ulcers in patients with acute myeloid leukaemia receiving remission induction chemotherapy and thus (b), indirectly, the role of herpes simplex virus in the aetiology of these ulcers.. Randomised, double blind, placebo controlled trial.. 74 herpes simplex virus seropositive patients aged 18-84. Thirty seven patients received acyclovir (800 mg by mouth daily) and 37 placebo. The patients were examined daily for 28 days.. Occurrence of herpes labialis, intraoral ulcers, and acute necrotising ulcerative gingivitis.. The two populations were comparable in age, sex, type of antineoplastic treatment, and history of herpes labialis. Acute oral infections occurred in 25 of the acyclovir treated patients and 36 of the placebo treated patients (relative risk 0.69 (95% confidence interval 0.55 to 0.87)). This difference was due to a reduction in the incidence of herpes labialis (one case versus eight cases; relative risk 0.13 (0.02 to 0.95)), intraoral ulcers excluding the soft palate (one case versus 13 cases; relative risk 0.08 (0.01 to 0.56)), and acute necrotising ulcerative gingivitis (one case versus eight cases; relative risk 0.13 (0.02 to 0.95)). However, ulcers on the soft palate were diagnosed with similar frequency in the two groups. Isolation of herpes simplex virus type 1 in saliva was reduced from 15 cases in the placebo group to one case in the acyclovir group (relative risk 0.07 (0.01 to 0.48)).. Intraoral ulcers excluding the soft palate are most often due to infection with herpes simplex virus, whereas ulcers on the soft palate have a non-herpetic aetiology. The findings suggest that acute necrotising ulcerative gingivitis may also be due to herpes simplex virus. Prophylaxis with acyclovir should be considered for patients with acute myeloid leukaemia during remission induction therapy.

Topics: Acute Disease; Acyclovir; Adolescent; Adult; Aged; Aged, 80 and over; Double-Blind Method; Female; Gingivitis, Necrotizing Ulcerative; Herpes Labialis; Herpes Simplex; Humans; Leukemia, Myeloid; Male; Middle Aged; Mouth Diseases; Opportunistic Infections; Stomatitis, Herpetic; Ulcer

In a double-blind study, 198 patients experiencing recurrent herpes orofacialis were randomly assigned to treatment with either tromantadine hydrochloride (ViruMerz Serol, CAS 53783-83-8) or aciclovir. All patients performed an up to 5-day course of topical treatment beginning on average within 2 h after the first signs of recurrence. The herpes efflorescences and symptoms were assessed daily by the same physician for 14 days, except on weekends, and by the patients each day during the whole observation time. Rapid healing was achieved with both medications. Efficacy was assessed by rating the course of vesicle eruptions, duration until beginning of incrustation and the clinical course of the symptoms (burning, tension, pain). Equivalence between the medication groups was shown by comparative analysis of all evaluation criteria. The global efficacy and tolerability of both medications was rated by the physician as well as by the patients as "good" or "very good" in more than 80% of the cases. The results of this trial show equivalence of both medications in the treatment of recurrent herpes orofacialis, and confirm the good dermal tolerability of the drugs.

Topics: Acyclovir; Administration, Topical; Adolescent; Adult; Amantadine; Antiviral Agents; Double-Blind Method; Female; Humans; Male; Middle Aged; Stomatitis, Herpetic

Most strains of herpes simplex virus that are resistant to acyclovir are susceptible in vitro to both foscarnet and vidarabine. We conducted a randomized trial to compare foscarnet with vidarabine in 14 patients with the acquired immunodeficiency syndrome (AIDS) and mucocutaneous herpetic lesions that had been unresponsive to intravenous therapy with acyclovir for a minimum of 10 days. The patients were randomly assigned to receive either foscarnet (40 mg per kilogram of body weight intravenously every 8 hours) or vidarabine (15 mg per kilogram per day intravenously) for 10 to 42 days. In the isolates of herpes simplex virus we documented in vitro resistance to acyclovir and susceptibility to foscarnet and vidarabine.. The lesions in all eight patients assigned to foscarnet healed completely after 10 to 24 days of therapy. In contrast, vidarabine was discontinued because of failure in all six patients assigned to receive it. The time to complete healing (P = 0.01), time to 50 percent reductions in the size of the lesions (P = 0.01) and the pain score (P = 0.004), and time to the end of viral shedding (P = 0.006) were all significantly shorter in the patients assigned to foscarnet. Three patients had new neurologic abnormalities while receiving vidarabine. No patient discontinued foscarnet because of toxicity. Although initial recurrences of herpes simplex infection after the index lesion had healed tended to be susceptible to acyclovir, acyclovir-resistant infection eventually recurred in every healed patient, a median of 42.5 days (range, 14 to 191) after foscarnet was discontinued.. For the treatment of acyclovir-resistant herpes simplex infection in patients with AIDS, foscarnet has superior efficacy and less frequent serious toxicity than vidarabine. Once the treatment is stopped, however; there is a high frequency of relapse.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; Antiviral Agents; Drug Resistance, Microbial; Female; Foscarnet; Herpes Genitalis; Humans; Male; Phosphonoacetic Acid; Recurrence; Simplexvirus; Stomatitis, Herpetic; Vidarabine

Several chemotherapeutic regimens and radiation therapy, if delivered to the oral mucosa, are associated with a high frequency of mouth lesions. The cause of this side effect is not known for certain, but in past studies it has sometimes been associated with the ability to culture herpes simplex virus type 1 from the mouth. In a double-blind prospective trial, patients with head and neck tumors treated with chemotherapy or radiation therapy were treated with either acyclovir or placebo. Although the frequency of culture-positive herpes simplex virus was low in the untreated group, it was significantly lower, zero, in the acyclovir-treated group. However, there were no differences in the frequency or type of mouth lesions experienced by patients receiving either radiation or chemotherapy who were taking acyclovir or placebo. These results suggest that herpes simplex virus is not a frequent cause or complication of oral lesions afflicting this patient population.

Topics: Acyclovir; Clinical Trials as Topic; Double-Blind Method; Humans; Mouth Mucosa; Prospective Studies; Radiation Injuries; Random Allocation; Stomatitis, Herpetic

The occurrence of HSV infection and the effect of prophylaxis with oral acyclovir were evaluated prospectively in 34 consecutive patients undergoing bone marrow transplantation (BMT). All allogeneic BMT procedures involved T-lymphocyte depletion for prevention of graft-vs.-host disease (GVHD). Five HSV-seronegative patients did not receive acyclovir, and they did not develop HSV infection. Oral acyclovir was administered to 15 HSV-seropositive BMT recipients; 14 untreated HSV-seropositive BMT recipients served as a control group. The adult dose of acyclovir was 400 mg three times a day on Days -6 to +14 and 200 mg three times a day on Days +15 to +90. Children received 500 mg/m2 per day divided into three equal doses on Days -6 to +14 and 250 mg/m2 per day again divided into three on Days +15 to +90. In the group on prophylaxis, only one developed HSV infection during the time prior to engraftment. In the reference group, 12 of 14 (85.7%) developed oral HSV infection within 0 to 16 days (median 11 days) after the transplantation. Time for engraftment (duration of neutropenia) was shorter in patients receiving acyclovir. After engraftment, HSV infection was not observed during administration or following discontinuation of acyclovir on Day 90, but occurred in three patients in whom acyclovir was discontinued on Days 25, 35 and 40 after BMT. In the untreated group, two patients had recurrence of HSV infection on Days 40 to 60, and one had two infectious episodes. GVHD occurred in only two recipients, neither of whom had HSV infection. We conclude that the incidence of HSV infection during the period until engraftment in recipients of T-lymphocyte-depleted BMT is high, similar to that reported by others in recipients of whole BMT. Relatively low-dose oral acyclovir administered for 90 days can effectively prevent HSV infections in previously HSV-seropositive BMT recipients and may also shorten the period until engraftment.

Topics: Acyclovir; Administration, Oral; Adolescent; Adult; Anemia, Aplastic; Bone Marrow Transplantation; Child; Child, Preschool; Clinical Trials as Topic; Drug Administration Schedule; Female; Graft vs Host Disease; Herpes Simplex; Histocompatibility Testing; HLA Antigens; Humans; Leukemia, Lymphoid; Leukemia, Myeloid; Leukemia, Myeloid, Acute; Lymphocyte Depletion; Male; Middle Aged; Stomatitis, Herpetic; T-Lymphocytes; Transplantation, Homologous

Topics: Acyclovir; Child, Preschool; Clinical Trials as Topic; Double-Blind Method; Female; Humans; Male; Placebos; Stomatitis, Herpetic

Orofacial mucocutaneous infections resulting from herpes simplex virus (HSV) were detected in 40% of patients with acute leukemia. Of the 34 separate episodes, oral mucosal sites were involved in 22 cases. Evidence to support dissemination of HSV was found in 3 patients on 4 separate occasions. The relationship of neutrophil levels to the onset and resolution of lesions is examined. The value of acyclovir for treatment of these HSV-induced lesions is reported, and the question of administering this agent for routine prophylaxis against HSV in these patients is addressed.

Topics: Acute Disease; Acyclovir; Adult; Clinical Trials as Topic; Herpes Labialis; Humans; Leukemia, Lymphoid; Leukemia, Myeloid, Acute; Prospective Studies; Stomatitis, Herpetic; Time Factors

Neonatal herpes simplex virus (HSV) infections are recognized to be severe because of their association with significant morbidity and mortality. Through ongoing studies performed by the National Institute of Allergy and Infectious Diseases Collaborative Antiviral Study Group, the presentation, natural history, outcome and value of antiviral chemotherapy have been considered. Infants developing neonatal HSV infections can be classified according to the extent of disease, disseminated or localized. Localized infection can be subdivided into either central nervous system (CNS) disease, occurring in 35% of infected infants, or skin, eye and mouth (SEM) disease, in 41% of infants. Disseminated disease accounts for 24% of neonatal HSV infection. Therapeutic outcome depends upon disease classification. Administration of either 15 or 30 mg/kg/day of vidarabine resulted in significantly decreased mortality for infants with life-threatening disseminated and CNS disease as compared to placebo recipients. Approximately one-third of children developed normally following disseminated disease or CNS infection. When disease was localized to the SEM, no death occurred, and 88% of treated infants developed normally. While these data indicate that therapy is effective for management of infants with neonatal HSV infection, improvements are necessary. Hopefully, a study in progress will demonstrate improved outcome with acyclovir treatment.

Topics: Acyclovir; Central Nervous System Diseases; Clinical Trials as Topic; Female; Herpes Genitalis; Herpes Simplex; Humans; Infant, Newborn; Keratitis, Dendritic; Pregnancy; Pregnancy Complications, Infectious; Recurrence; Risk; Skin Diseases, Infectious; Stomatitis, Herpetic; Vidarabine

Sixty-three immunocompromised patients with infections caused by herpes simplex virus were evaluated in a double-blind, placebo-controlled study of topical acyclovir therapy; 33 patients received acyclovir and 30 received the placebo. The two populations of patients were balanced in terms of age, race, sex, underlying disease, preceding chemotherapy, and site, size, and duration of lesions. Acyclovir recipients experienced an acceleration in the clearance of virus (P = .0006), the resolution of pain (P = .004), and the total healing of lesions (P = .038); median temporal differences between populations averaged six days for each of these three parameters. The surface area of herpetic lesions continued to enlarge in placebo recipients after entry into the trial; in contrast, lesion surface area decreased progressively during therapy in drug recipients. The speed of healing was influenced by lesion size. Patients with lesions of greater than or equal to 50 mm2 benefited most from therapy, particularly in terms of pain resolution and time to total healing (median differences between groups, eight days). Irrespective of underlying disease, sex, preceding chemotherapy, or age, acyclovir therapy was of clinical benefit. No adverse clinical or laboratory reactions were encountered.

Topics: Acyclovir; Administration, Topical; Adolescent; Adult; Aged; Child; Clinical Trials as Topic; Double-Blind Method; Female; Herpes Genitalis; Herpes Labialis; Herpes Simplex; Humans; Immune Tolerance; Male; Middle Aged; Recurrence; Simplexvirus; Stomatitis, Herpetic

Five per cent acyclovir cream containing propylene glycol was used in a double-blind, placebo controlled, randomized trial of topical acyclovir therapy in 30 patients with recurrent orofacial herpes simplex infections. Several patients re-entered the trial and a total of 60 treated episodes were evaluated. Analysis of the first episodes treated showed a significant reduction in the duration of vesiculation from 2.7 to 1.8 days (P = 0.016) and in the total healing time from 8.3 to 5.7 days (P = 0.022). A decrease in the duration of itching was also observed. Evaluation of all episodes treated showed a significant decrease only in the duration of vesiculation from 2.3 to 1.6 days (P = 0.016); the total healing time was decreased from 6.6 to 5.4 days (P = 0.051). The penetration of acyclovir through the skin and the time of initiation of therapy appear to be the major limiting factors governing efficacy. We hypothesize that repeated treatment with acyclovir may decrease the severity of the herpes simplex infections.

Topics: Acyclovir; Administration, Topical; Adult; Clinical Trials as Topic; Double-Blind Method; Female; Herpes Labialis; Humans; Male; Random Allocation; Recurrence; Stomatitis, Herpetic; Time Factors

Intravenous acyclovir was evaluated in the treatment of 97 immunocompromised patients with mucocutaneous herpes simplex virus infection in a randomized, double-blind, placebo-controlled trial. Acyclovir recipients had significantly shorter periods of virus shedding (p less than 0.0002) and lesion pain (p less than 0.01), and more rapid lesion scabbing (p less than 0.004) and lesion healing (p less than 0.04). The most common adverse reaction was a low incidence of peripheral vein irritation; no serious toxicity could be definitely attributed to acyclovir treatment even in these seriously ill patients. Intravenous acyclovir offers both safe and effective treatment for mucocutaneous herpes simplex virus infection in the immunocompromised host.

Topics: Acyclovir; Adolescent; Adult; Aged; Antiviral Agents; Child; Child, Preschool; Clinical Trials as Topic; Double-Blind Method; Female; Guanine; Herpes Genitalis; Humans; Immune Tolerance; Infusions, Parenteral; Male; Middle Aged; Stomatitis, Herpetic

Topics: Acyclovir; Child; Child Health Services; Drug Administration Schedule; Humans; Stomatitis, Herpetic

Topics: Acyclovir; Adolescent; Antiviral Agents; Exanthema; Female; Humans; Immunocompromised Host; Lip Diseases; Stomatitis, Herpetic

Topics: Acyclovir; Aged; Antiviral Agents; Female; Hemodiafiltration; Humans; Kidney Failure, Chronic; Neurotoxicity Syndromes; Recovery of Function; Renal Dialysis; Stomatitis, Herpetic; Treatment Outcome

Herpes labialis remains a common worldwide affliction. Recent advances in understanding the basic pathogenesis have led to new therapeutic intervention, both on-label and off-label. Aside from reducing the duration and symptomatology of acute outbreaks, another goal of treatment is to decrease the frequency of future episodes. Oral and topical acyclovir and its analogues are the mainstay of both chronic suppressive and episodic therapy. A new muco-adhesive formulation of acyclovir provides a decrease in outbreaks, probably due to a diminution of herpesvirus load in all reservoir sites. Acyclovir-resistant strains are rare in immunocompetent hosts; parenteral foscarnet and cidofovir are administered in this situation. Parenteral acyclovir is the drug of choice for eczema herpeticum, which may begin as herpes labialis in an atopic dermatitis patient. Thermotherapy may be beneficial, and a certified device to deliver heat is available outside the United States.

J Drugs Dermatol. 2017;16(3 Suppl):s49-53.

Topics: Acyclovir; Administration, Oral; Administration, Topical; Adult; Antiviral Agents; Chronic Disease; Cidofovir; Cytosine; Drug Resistance, Viral; Foscarnet; Herpes Labialis; Herpesvirus 1, Human; Humans; Hyperthermia, Induced; Infusions, Parenteral; Organophosphonates; Recurrence; Stomatitis, Herpetic; Viral Load

The objective of this work was to develop an oral mucosal drug delivery system to facilitate the local and systemic delivery of acyclovir for the treatment of oral herpes infection caused by the herpes simplex virus (HSV). An in situ gelling system was used to increase the residence time and thus the bioavailability of acyclovir in oral mucosa. Temperature and pH trigged in situ gel formulations were prepared by cold method using polymers like poloxamer 407, carbopol 934, and HPMC. Glycerin and a mixture of tween 80 and ethanol (1 : 2 ratio) were used as the drug dissolving solvent. The pH of carbopol containing formulation was adjusted to pH 5.8 while the pH of poloxamer solution was adjusted to pH 7. These formulations were evaluated for sol-gel transition temperature, gelling capacity, pH, viscosity, spreadability, gel strength, drug content, ex-vitro permeation, and mucoadhesion. The gelation temperatures of all the formulations were within the range of 28-38°C. All the formulations exhibited fairly uniform drug content (98.15-99.75%). Drug release study of all the formulations showed sustained release properties. The release of drug through these in situ gel formulations followed the Higuchi model and Korsmeyer peppas model mechanism.

Topics: Acyclovir; Animals; Antiviral Agents; Chemistry, Pharmaceutical; Gels; Hydrogen-Ion Concentration; Mouth Mucosa; Permeability; Simplexvirus; Solubility; Stomatitis, Herpetic; Swine; Viscosity

Topics: Acyclovir; Antiviral Agents; Child; Female; Humans; Lip; Stomatitis, Herpetic; Tongue

In comparison to the range of antibiotics used in medicine, the spectrum of antifungal and antiviral drugs used in primary dental care is relatively limited. In practical terms, there are only three antifungal agents and two antiviral agents that have a role. This paper will describe the clinical presentation of orofacial candidal and viral infections and the use of antimicrobial drugs in their management.

Topics: Acyclovir; Amphotericin B; Antifungal Agents; Antiviral Agents; Candidiasis, Oral; Cheilitis; Dental Care; Fluconazole; Glossitis; Guanine; Herpes Zoster; Humans; Miconazole; Mouth Diseases; Nystatin; Primary Health Care; Stomatitis, Herpetic

We report a challenging case of an atypical presentation of recrudescent herpes simplex virus infection in a patient with common variable immunodeficiency. Oral infections in immunosuppressed patients may present with unusual clinical features that can mimic non-infectious diseases. This report discusses the diagnostic steps necessary for definitive diagnosis and to guide appropriate and effective management.

Topics: Acyclovir; Antiviral Agents; Common Variable Immunodeficiency; Diagnosis, Differential; Female; Humans; Immunocompromised Host; Lichen Planus, Oral; Middle Aged; Opportunistic Infections; Stomatitis, Herpetic; Valacyclovir; Valine

Infections caused by acyclovir-resistant isolates of herpes simplex virus (HSV) after hematopoietic stem cell transplantation (HSCT) are an emerging concern. An understanding of the evolutionary aspects of HSV infection is crucial to the design of effective therapeutic and control strategies.. Eight sequential HSV-1 isolates were recovered from an HSCT patient who suffered from recurrent herpetic gingivostomatitis and was treated alternatively with acyclovir, ganciclovir, and foscavir. The diverse spectra and temporal changes of HSV drug resistance were determined phenotypically (drug-resistance profiling) and genotypically (sequencing of the viral thymidine kinase and DNA polymerase genes).. Analysis of 60 clones recovered from the different isolates demonstrated that most of these isolates were heterogeneous mixtures of variants, indicating the simultaneous infection with different drug-resistant viruses. The phenotype/genotype of several clones associated with resistance to acyclovir and/or foscavir were identified. Two novel mutations (E798K and I922T) in the viral DNA polymerase could be linked to drug resistance.. The heterogeneity within the viral populations and the temporal changes of drug-resistant viruses found in this HSCT recipient were remarkable, showing a rapid evolution of HSV-1. Drug-resistance surveillance is highly recommended among immunocompromised patients to manage the clinical syndrome and to avoid the emergence of multidrug-resistant isolates.

Topics: Acyclovir; Adult; DNA, Viral; Drug Resistance, Multiple, Viral; Evolution, Molecular; Female; Ganciclovir; Genes, pol; Genetic Heterogeneity; Genotype; Hematopoietic Stem Cell Transplantation; Herpesvirus 1, Human; Humans; Leukemia, Myeloid, Acute; Mutation; Phenotype; Stomatitis, Herpetic; Thymidine Kinase

Topics: Acyclovir; Antiviral Agents; Female; Fingers; Gingivitis; Herpes Simplex; Herpesvirus 1, Human; Humans; Infant; Lymphangitis; Stomatitis, Herpetic

A previously healthy boy aged 9 years and 11 months was admitted due to herpetic gingivostomatitis with poor intake. He also had fever, neutropenia, and elevated serum aminotransferase level (> 1000 IU/mL). Prolonged prothrombin time, mild gastrointestinal hemorrhage and transient decreased conscious level were noted during hospital days 2 and 3. Intravenous acyclovir therapy commenced on hospital day 2 and his serum aminotransferase level peaked (> 4000 IU/mL) on hospital day 3 and then improved gradually. A throat swab was positive for human herpes simplex virus (HSV)-1, serological test was positive for acute primary HSV-1 infection, and a blood specimen was also strongly positive for HSV-1 by polymerase chain reaction. He received a 14-day course of intravenous acyclovir and recovered uneventfully. Herpetic gingivostomatitis, although mostly benign and self-limited, may be complicated with severe hepatitis, even in immunocompetent hosts.

Topics: Acyclovir; Administration, Intravenous; Antiviral Agents; Child; Fever; Hepatitis; Herpesvirus 1, Human; Humans; Male; Neutropenia; Serologic Tests; Specimen Handling; Stomatitis, Herpetic; Transaminases; Treatment Outcome

Topics: Acyclovir; Antiviral Agents; Diagnosis, Differential; Herpes Labialis; Herpesvirus 1, Human; Humans; Patient Education as Topic; Prodrugs; Recurrence; Stomatitis, Herpetic; Virus Activation

Topics: Acyclovir; Adult; Antiviral Agents; Connective Tissue; Follow-Up Studies; Gingiva; Gingival Diseases; Gingival Recession; Graft Survival; Herpesvirus 1, Human; Humans; Male; Necrosis; Recurrence; Stomatitis, Herpetic; Treatment Failure

To describe the clinical presentation of HSV-infected young infants and to seek distinctive features that could permit a targeted approach to empiric use of acyclovir.. Case study of neonatal HSV during a 22-year period of an institutional strategy of consistent use of acyclovir empirically in all infants with onset of an illness at ≤ 21 days of age for which antibiotics were given empirically. Multiple sources were used to optimize HSV case data, and to estimate the rate of HSV infection in empirically treated infants.. A total of 32 infants with perinatally acquired HSV infection were identified. All received acyclovir empirically at admission. At presentation, 50% of infants had only nonspecific complaints, which was fever in 75%. After testing, 75% of infants with HSV had central nervous system (CNS) infection, including 40% who presented with mucocutaneous lesions, 83% with seizures, and 94% with nonspecific complaints. Cerebrospinal fluid (CSF) polymerase chain reaction confirmed CNS infection in 16 of 22 (73%) patients tested. Cultures of mucocutaneous lesion yielded HSV in 8 of 10 cases, but culture of CSF was negative in all 26 cases tested, and screening cultures of unaffected mucosal sites were the only HSV-confirmatory test in a single patient. Laboratory and CSF findings were not distinctive in patients with HSV. Age of ≤ 21 days at onset of symptoms captured 90% of all infants with HSV and 94% of those with nonspecific complaints. An estimated 1.3% of empirically treated patients had HSV infection.. Early manifestations of perinatally acquired HSV are frequently nonspecific, yet CNS infection is common. Empiric acyclovir strategy narrowly restricted to infants with onset of illness at ≤ 21 days of age, who would receive antibiotics empirically, captured 90% of HSV cases and anticipated a rate of HSV CNS infection similar to that of bacterial meningitis.

Topics: Acyclovir; Antiviral Agents; Cerebrospinal Fluid; Female; Herpes Simplex; Humans; Infant; Infant, Newborn; Male; Meningoencephalitis; Mouth Mucosa; Polymerase Chain Reaction; Simplexvirus; Stomatitis, Herpetic; Virus Cultivation

Topics: Acute Disease; Acyclovir; Antiviral Agents; Endoscopy, Digestive System; Esophagitis; Female; Humans; Immunochemistry; Stomatitis, Herpetic; Young Adult

Topics: Acyclovir; Age Factors; Antiviral Agents; Dental Plaque; Dental Scaling; Female; Humans; Middle Aged; Stomatitis, Herpetic

Topics: Acyclovir; Antiviral Agents; Diagnosis, Differential; Female; Herpesvirus 1, Human; Humans; Palate, Hard; Stomatitis, Herpetic; Valacyclovir; Valine; Young Adult

Erythema multiforme is an acute mucocutaneous disorder, characterized by varying degrees of blistering and ulceration. We report a case of recurrent herpes-associated erythema multiforme managed with prophylactic acyclovir. An 11-year-old boy had lesions in the oral cavity and lips, which had been diagnosed as erythema multiforme minor. Four months later, the patient had desquamative gingivitis with erythematous lesions and necrotic areas in the skin. This episode was not related to drug intake, which suggests that the erythema multiforme was a result of herpetic infection. This hypothesis was supported by positive serology for herpes simplex virus. Five months later, the patient returned with new oral, skin and penis mucosal lesions. The diagnosis was confirmed as herpes simplex virus-associated erythema multiforme major. The episode was treated with acyclovir, and acyclovir was used prophylactically for 7 months to control the disease.

Topics: Acyclovir; Antiviral Agents; Child; Erythema Multiforme; Follow-Up Studies; Gingivitis; Herpes Genitalis; Herpes Labialis; Humans; Lip Diseases; Male; Mouth Diseases; Penile Diseases; Recurrence; Simplexvirus; Stomatitis, Herpetic

The tongue is a common location for Horton necrotic injuries. But some herpetic lesions can show similar symptoms to the disease and complicate the diagnosis.. A 67-year-old woman, treated by corticosteroids for Horton disease, presented a central, deep, and very painful ulceration of the tongue. The spreading of necrosis despite treatment was an indication for biopsy, giving the diagnosis of herpetic infection. Valacyclovir was efficient within 15 days.. This necrotic injury looks like herpetic stomatitis presented by severely immunodeficient AIDS patients. No case under corticosteroids had been described so far. The tongue-limited location is exceptional.

Topics: Acyclovir; Aged; Antiviral Agents; Female; Giant Cell Arteritis; Glucocorticoids; Humans; Necrosis; Prednisone; Stomatitis, Herpetic; Tongue Diseases; Valacyclovir; Valine

This is the fourth paper in a series on the prescribing of medicines for children by dentists working in primary dental care. It deals with the prescription of antifungals and antivirals for children.

Topics: Acyclovir; Antifungal Agents; Antiviral Agents; Azoles; Candidiasis, Oral; Child; Drug Prescriptions; Humans; Infant; Infant, Newborn; Mouth Diseases; Polyenes; Stomatitis, Herpetic

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

Tissue-destructive and more selective cytotoxic therapies are the main methods used to treat actinic cheilitis. A topical immune stimulant, 5% imiquimod cream, has recently been used for treatment of cutaneous epithelial malignancies including squamous cell carcinoma in situ and basal cell carcinoma.. Our aim was to review the results in patients who had been treated for actinic cheilitis with imiquimod cream.. A review identified 15 patients with biopsy-proven actinic cheilitis who had been treated with topical imiquimod 3 times weekly for 4 to 6 weeks. All patients with histories consistent with facial herpes simplex or documented prior facial herpes simplex eruptions were treated with oral valcyclovir, 1 g/d, during imiquimod therapy.. All 15 patients showed clinical clearing of their actinic cheilitis at 4 weeks after discontinuation of the topical imiquimod. Sixty percent of the patients experienced a moderate to marked increased local reaction consisting of increased erythema, induration, and erosions or ulcerations, which in some cases continued through the period of therapy.. Imiquimod appears to have a role in the treatment of actinic cheilitis. However, the dose and duration of therapy, as well as the long-term efficacy, need to be established; and local reactions are to be expected and may not improve during therapy.

Topics: Acyclovir; Adjuvants, Immunologic; Adult; Aged; Aged, 80 and over; Aminoquinolines; Antiviral Agents; Cheilitis; Female; Humans; Imiquimod; Male; Middle Aged; Retrospective Studies; Stomatitis, Herpetic; Valacyclovir; Valine

To present to general dentists the typical signs and symptoms associated with adult acute (primary) herpetic gingivostomatitis. The pertinent laboratory tests, management options and current pharmacotherapy are also reviewed. REVIEW DESIGN: The clinical files of 13 adult patients were reviewed. All had no history of herpes simplex virus infection and presented with oral lesions suggestive of primary herpetic infection. The subjects were all patients of one of the investigators, and their workup included Tzanck testing and viral culture.. The patients ranged in age from 18 to 79 (mean 37.2, standard deviation 19.6) years. Nine (69%) were men. Viral culture was confirmed as the gold standard for diagnosis. The sensitivity of Tzanck testing was 77% (10/13), slightly higher than that reported previously (40% to 50%). In this patient group the febrile lymphadenopathic profile was typical of younger patients (18 to 42 years of age), whereas older patients presented with predominantly oral symptoms.. Primary herpetic gingivostomatitis is not limited to children but can affect people of any age. Proper diagnosis and treatment are essential, particularly in elderly and immunocompromised patients. Tzanck testing may serve as a useful adjunct in diagnosis. Antiviral agents such as valacyclovir and famciclovir should be considered part of early management. Dentists are often the first health care professionals to be consulted by patients with this condition, and recognition of the infection is paramount.

Topics: 2-Aminopurine; Acute Disease; Acyclovir; Adolescent; Adult; Age Factors; Aged; Antiviral Agents; Cytodiagnosis; Famciclovir; Female; Fluorescent Antibody Technique, Direct; Humans; Male; Middle Aged; Simplexvirus; Stomatitis, Herpetic; Valacyclovir; Valine; Virus Cultivation

Herpes simplex virus-type I (HSV-1) is responsible for both primary and recurrent infections of the oral mucosa. The aim of this case report is to show how HSV-1 may cause periodontal damage such as gingival recession. A 26-year-old male patient presented in a private office for the treatment of gingival recessions. He reported that the recessions had appeared suddenly with marginal inflammation of the gingiva and vesicle formation; within a few hours, the gingival tissue had been completely destroyed. The lesions were accompanied by pain, fever, and regional lymphadenopathy. Two weeks later, the patient returned complaining of a recurrence accompanied by pain and lymphadenopathy. The following day, the patient's condition had worsened and the depth of the recession had increased. A biopsy was taken for histological examination. A free epithelial-connective tissue graft was performed. Histological and direct immunofluorescence examinations confirmed the herpetic origin of the lesion. Eight months after surgery, a new herpetic lesion was detected in correspondence to the gingival margin of the first lower right premolar; therefore, acyclovir was prescribed. After 1 week, the antiviral therapy was completely successful; the gingival lesion disappeared, and no recession of the soft tissue margin was observed. Based on these clinical features, diagnosis of gingival recession induced by HSV-1 must be carried out at an early stage to establish a successful therapy.

Topics: Acyclovir; Adult; Antiviral Agents; Biopsy; Connective Tissue; Epithelium; Fluorescent Antibody Technique, Direct; Gingiva; Gingival Recession; Gingivitis; Humans; Male; Recurrence; Stomatitis, Herpetic

We present a case of herpetic gingivostomatitis and finger infection. Vesicular hand lesions may result from autoinoculation of oral herpes simplex virus (HSV) infection in children, which may be evident or asymptomatic.

Topics: Acyclovir; Antiviral Agents; Fingers; Hand Dermatoses; Herpes Simplex; Humans; Infant; Male; Stomatitis, Herpetic; Virus Shedding

This study was conducted to compare the survival rates of bone marrow transplantation (BMT) patients who were affected with the survival rates of those who were not affected by oral recrudescent human herpes virus-1 infection (HHV-1) after transplantation.. Fifty-two consecutive patients who underwent BMT were included in the study. The time of death after BMT was displayed, by means of the Kaplan-Meier method, for the following parameters: age and gender of the patient, donor gender, primary disease, stem cells, conditioning regimen, platelet number after day 100, acute and chronic graft-versus-host disease, oral recurrent HHV-1 infection post-BMT, oral lichenoid lesions of graft-versus-host disease, graft-versus-host disease at the salivary glands, parenteral nutrition, and oral mucositis. The data were initially analyzed by means of the log-rank test and then included in the Cox proportional hazards model.. The multivariate analysis demonstrated a significance of 5% for only the platelet numbers and oral recurrent HHV-1 infection.. The present study provides evidence that platelet numbers below 100,000 cells/mm(3) after day 100 and oral recurrent HHV-1 infection are independent negative prognostic variables in BMT patients' 24-month survival rates.

Topics: Acute Disease; Acyclovir; Adolescent; Adult; Age Factors; Anemia, Aplastic; Antiviral Agents; Bone Marrow Transplantation; Chronic Disease; Female; Graft vs Host Disease; Humans; Leukemia; Linear Models; Lymphoma; Male; Middle Aged; Multivariate Analysis; Platelet Count; Prognosis; Proportional Hazards Models; Recurrence; Salivary Gland Diseases; Sex Factors; Stomatitis; Stomatitis, Herpetic; Survival Rate; Tissue Donors; Transplantation Conditioning

Topics: Acyclovir; Antiviral Agents; Fatty Alcohols; Guanine; Herpes Labialis; Humans; Recurrence; Simplexvirus; Stomatitis, Herpetic; Virulence; Virus Activation; Virus Shedding

Erythema multiforme (EM) is a complex disease that may have cutaneous and/or mucosal involvement. The severity may range from mild to severe and potentially life threatening. The literature cites many factors including viruses, infections, and medications as causes. This report documents a patient who developed EM secondary to a herpes simplex viral (HSV) infection.. Two weeks following an eruption of herpes labialis, a 20-year-old white female patient developed acutely painful oral and labial ulcers accompanied by target skin lesions. A diagnosis of erythema multiforme (EM) was made. The patient was treated with antivirals, analgesics, and symptomatic therapy.. Nine days after the onset of symptoms, the oral and cutaneous lesions had started to heal and the patient no longer required pain medication.. Although the etiology of EM is still often unknown, infections with herpes simplex virus have been implicated as a possible precipitating factor. This case illustrates the association of the occurrence of EM with an HSV infection.

Topics: Acyclovir; Adult; Analgesics; Antiviral Agents; Erythema Multiforme; Female; Gingival Diseases; Herpes Labialis; Humans; Lip Diseases; Oral Ulcer; Recurrence; Stomatitis, Herpetic; Wound Healing

A child with acute disseminated encephalomyelitis (ADEM) developed after acute herpetic gingivostomatisis was described. Inspite of the improvement of his gingivostomatitis, his consciousness gradually deteriorated and he was admitted to Nakadori General Hospital. His consciousness level was drowsiness and increased bilateral patellar reflexes were shown. Because magnetic resonance imaging (MRI) T2-weighted scan showed areas of high signal intensity disseminated in superior portion of medulla oblongata, dorsal portion of pons, basal nuclei and thalamus, he was suspected as having ADEM. Anti-herpes simplex virus (HSV) 1 IgG and IgM antibodies elevated in both blood and cerebrospinal fluid. From these results, HSV1 infection was thought to be the preceding infection of ADEM. Methylprednisolone therapy (20 mg/kg daily) for 3 days, followed by prednisolone (2 mg/kg) was started, with an excellent response. In addition, administration of acyclovir was also continued, considering the complication of HSV encephalitis. MRI T2-weighted scan performed at 2 months later after the onset of ADEM revealed disappearance of the lesions. He was discharged without remaining disorders. It is difficult to distinguish between ADEM and HSV encephalitis because both of these diseases show various neurological symptoms. In our case, MRI was the most useful method for correct diagnosis of ADEM. We concluded that ADEM is important as a disease of central nervus system due to HSV1 infection, in addition to encephalitis.

Topics: Acute Disease; Acyclovir; Antiviral Agents; Child, Preschool; DNA, Viral; Electroencephalography; Encephalomyelitis, Acute Disseminated; Humans; Immunoglobulin G; Immunoglobulin M; Magnetic Resonance Imaging; Male; Polymerase Chain Reaction; Stomatitis, Herpetic

Topics: Acyclovir; Adult; Antiviral Agents; Crowns; Diagnosis, Differential; Female; Humans; Mandible; Molar; Post and Core Technique; Recurrence; Stomatitis, Herpetic

A previously healthy 7-year-old girl suffered from oral herpetic gingivostomatitis. After four days, oral administration of acyclovir (ACV), 1,000 mg in five divided doses, was started. She became irritable and intermittently delirious next day. Laboratory tests of blood and cerebrospinal fluid (CSF) were within normal limits and EEG showed no abnormality. Brain CT and MRI demonstrated mild asymmetry of the lateral ventricle. SPECT showed low perfusion area in the bilateral thalamus. The titer of IgG and IgM against herpes simplex virus (HSV) was increased in the serum but not in the CSF. A PCR study of HSV DNA was negative in the CSF. ACV was discontinued after 5 days' administration and she recovered from neurological disorders within 48 hours. ACV neurotoxicity is self-limiting and dose-dependent. It may be distinguished from herpes simplex encephalitis by the lack of fever, headache, focal neurologic signs, and abnormal CSF and neuroradiological findings. However, when the differentiation should be difficult, we believe that the administration of ACV can be carefully continued because the potential fatality of HSE is high while ACV neurotoxicity is reversible.

Topics: Acyclovir; Antiviral Agents; Child; Diagnosis, Differential; Encephalitis, Viral; Female; Herpes Simplex; Humans; Psychoses, Substance-Induced; Stomatitis, Herpetic

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

Over a 3-month period, four patients who had received unrelated donor (UD) bone marrow transplants (BMT) presented with severe mucocutaneous herpes simplex virus (HSV) infection while receiving acyclovir (ACV) prophylaxis. Sensitivity testing of the isolates revealed three to be acyclovir-resistant and in one patient the infection was also characterised by a marked failure to respond to foscarnet (phosphonoformic acid). The emergence of ACV-resistant HSV infections in themselves is a new and challenging problem, and yet a far greater problem will become evident if these infections develop resistance to non thymidine kinase dependent therapy.

Topics: Acyclovir; Adolescent; Adult; Antiviral Agents; Bone Marrow Transplantation; Child; Drug Resistance, Microbial; Female; Foscarnet; Herpesvirus 1, Human; Humans; Male; Microbial Sensitivity Tests; Stomatitis, Herpetic; Transplantation, Homologous

Intraoral herpes simplex virus infection is commonly mistaken for recurrent aphthous stomatitis. The purpose of this study was to describe the clinical features of intraoral herpes simplex virus infection.. Fifty-two immunocompetent patients with culture-positive intraoral herpes simplex virus infection were studied.. The median age of the patients was 42 years. One third of the patients exhibited single ulcers; the remaining patients displayed multiple lesions. In 47 of 52 cases, the ulcers occurred on keratinized surfaces of the oral cavity; however, 5 patients had persistent ulcerations on nonkeratinized mucosa, a typical feature of herpetic ulcers in immunosuppressed patients. Of 27 patients with histories of recurrences, 22 were previously incorrectly diagnosed with recurrent aphthous stomatitis.. Herpes simplex virus infection of the oral cavity can usually be differentiated from other causes of recurrent oral ulcerations on the basis of its clinical appearance and distribution. The recognition of atypical features may prevent unnecessary and costly treatments for unrelated though clinically similar-appearing disorders.

Topics: Acyclovir; Adolescent; Adult; Aged; Antiviral Agents; Diagnosis, Differential; Female; Humans; Immunocompetence; Male; Middle Aged; Mouth Mucosa; Oral Ulcer; Recurrence; Simplexvirus; Stomatitis, Herpetic; Virus Cultivation

Topics: Acyclovir; Antiviral Agents; Child; Female; Humans; Stomatitis, Herpetic; Tic Disorders; Tourette Syndrome

Topics: Acyclovir; Antiviral Agents; Child; Child, Preschool; Humans; Stomatitis, Herpetic

Topics: Acyclovir; Antiviral Agents; Child; Child, Preschool; Folic Acid; Humans; Stomatitis, Aphthous; Stomatitis, Herpetic

Persistent mucocutaneous ulcers in AIDS represent a variety of disease entities. The purpose of this study was to characterize clinicopathologic features of persistent oral ulcers associated with cytomegalovirus and herpes simplex virus in AIDS. Forty-seven persons infected with HIV with persistent ulcers (mean, 2.4 ulcers/person) were included in this study. A biopsy specimen from a representative ulcer was taken from each patient. Hematoxylin-eosin, periodic acid-Schiff, cytomegalovirus, and herpes simplex virus immunocytochemical stains were performed on tissue sections. The most common sites of involvement were the buccal/labial mucosa (27%), tongue (25%), and gingiva (18%). Mean ulcer size was 1.8 cm with a mean duration of 5.6 weeks. The ulcerogenic viral agents were cytomegalovirus alone in 53% of cases, cytomegalovirus and herpes simplex virus coinfection in 28% of cases, and herpes simplex virus alone in 19% of cases. Treatment response to ganciclovir with or without topical steroids resulted in lesion resolution in the cytomegalovirus and cytomegalovirus/herpes simplex virus groups; however, recurrence/resistance was relatively high (23%). Herpes simplex virus/cytomegalovirus ulcers responded to oral acyclovir in combination with systemic ganciclovir. Increasing the oral acyclovir dosage resulted in resolution of herpes simplex virus-only ulcers in all but one case. Cytomegalovirus and herpes simplex virus are associated with persistent mucocutaneous ulcers in AIDS. These lesions responded to systemic antiviral therapy but are difficult to differentiate from other ulcerogenic diseases such as aphthous major, necrotizing stomatitis, and ulcerations not otherwise specified without biopsy and histopathologic examination.

Topics: Acyclovir; Adult; AIDS-Related Opportunistic Infections; Antiviral Agents; Cytomegalovirus Infections; Cytopathogenic Effect, Viral; Diagnosis, Differential; Female; Ganciclovir; Humans; Male; Middle Aged; Mouth Diseases; Recurrence; Stomatitis, Herpetic; Ulcer

A single "stat." 800-mg dose of acyclovir taken at the first sensory signs for either oral or genital herpes simplex regularly prevented lesions from appearing in twenty-six of thirty-two persons known to have recurrent attacks. This dosage schedule is a cost-effective alternative to the long-term daily prophylactic dosing currently recommended.

Topics: Acyclovir; Adult; Aged; Antiviral Agents; Chemoprevention; Cost-Benefit Analysis; Drug Administration Schedule; Female; Herpes Genitalis; Humans; Male; Middle Aged; Recurrence; Stomatitis, Herpetic

Four HIV-positive patients with herpes simplex virus and cytomegalovirus coinfected oral ulcers are presented. All patients had persistent oral pain associated with nonhealing mucosal ulcers. Lesions occurred on the palate, retromolar pad, tongue, and lip, and the clinical appearance of the ulcers was nonspecific. Histologic and immunohistochemical stains showed herpes simples virus alterations in keratinocyte nuclei and cytomegalovirus alterations in mesenchymal/endothelial cell nuclei and cytoplasm. Lesions in one patient responded to ganciclovir therapy. One patient improved with acyclovir, and another healed normally after excisional biopsy. Each virus alone has been described as causing oral ulcerations; their appearance together in the same lesion would suggest a synergistic relationship.

Topics: Acyclovir; Adult; AIDS-Related Opportunistic Infections; Antiviral Agents; Cell Nucleus; Cytomegalovirus; Cytomegalovirus Infections; Cytoplasm; Endothelium, Vascular; Follow-Up Studies; Ganciclovir; Gingival Diseases; HIV Seropositivity; Humans; Immunohistochemistry; Keratinocytes; Lip Diseases; Male; Mesoderm; Middle Aged; Mouth Diseases; Palate; Simplexvirus; Stomatitis, Herpetic; Tongue Diseases; Ulcer

A 36-year-old Japanese man who received an unrelated bone marrow transplant (BMT) developed severe mucocutaneous infection with herpes simplex virus (HSV) type 1 during oral acyclovir prophylaxis. The lesions progressed despite treatment with intravenous acyclovir and vidarabine. The HSV isolates were sensitive acyclovir, vidarabine and foscarnet in vitro, but peripheral CD3- or CD19-positive cells were barely detectable even 4 months after transplant. A 12-day course of treatment with foscarnet led to a rapid improvement. Foscarnet therapy should be considered for all severe HSV infections following BMT, regardless of whether or not the HSV isolates are sensitive to acyclovir.

Topics: Acyclovir; Adult; Antiviral Agents; Bone Marrow Transplantation; Drug Resistance, Microbial; Foscarnet; Herpes Labialis; Humans; Leukemia, Myeloid, Accelerated Phase; Male; Neutropenia; Simplexvirus; Stomatitis, Herpetic; Transplantation Conditioning; Transplantation, Homologous; Vidarabine; Whole-Body Irradiation

Two immunocompromised patients with herpetic geometric glossitis, a clinically distinctive form of lingual herpes simplex virus (HSV) type 1 infection, are described. The significant features of herpetic geometric glossitis are summarized, the clinical differential diagnosis of this form of HSV infection is reviewed, and the possible pathogenesis of these lingual lesions is discussed. Both of our patients, as well as all previously described patients with this condition, had extremely painful cross-hatched, branched, and/or linear fissures on the dorsal aspect of the tongue. Symptoms promptly resolved within 1 to 2 days, and the fissures subsequently healed within 3 to 12 days after systemic acyclovir therapy was initiated. In contrast to tongue lesions of herpetic geometric glossitis, similar-appearing lingual lesions of other conditions are usually asymptomatic. The similar morphology of corneal dendrites in herpetic epithelial keratitis and linear fissures in herpetic geometric glossitis suggest the possibility that these HSV mucosal lesions may have a common pathogenesis.

Topics: Acyclovir; Adult; Antiviral Agents; Female; Glossitis; Humans; Immunocompromised Host; Male; Middle Aged; Stomatitis, Herpetic

We report a case of herpetic gingivostomatitis that was remarkable because it occurred in a 70-year-old man. The patient had multiple small ulcers throughout the mouth that were culture-positive for herpes simplex virus type 1 and responded rapidly to acyclovir. Whether this condition was a case of primary herpes or an unusual presentation of secondary disease was not resolved. Nevertheless the case serves as a reminder that age, although it may make a diagnosis seem implausible, does not alone exclude it.

Topics: Acyclovir; Age Factors; Aged; Humans; Male; Stomatitis, Herpetic

This paper provides a case report and review of the literature of the presentation of multiple herpetic whitlows with primary herpetic gingivostomatitis. The management of the condition is discussed.

Topics: Acyclovir; Adult; Humans; Male; Paronychia; Stomatitis, Herpetic; Virus Shedding

Topics: Acyclovir; Child; Contraindications; Herpes Simplex; Humans; Stomatitis, Herpetic

Herpes simplex virus (HSV) infections causing severe disease are reported frequently in patients suffering from human immunodeficiency virus (HIV) infection. This disease pattern may also be seen in an immunocompromised disease state with other causes, however, as in the case presented in this paper. An 84-year-old woman had hepatic cirrhosis resulting from chronic hepatitis C virus infection. The woman developed ulcerative lesions in and around her mouth and in the genito-anal region, and these persisted for some months. Diagnosis of HSV infection was not obtained until after extensive laboratory investigations. Aciclovir infusion therapy started immediately afterwards led to dramatic improvement of the skin and mucous membrane changes. Complete clearing of lesions was not obtained, however, because the patient died as a result of the immunosuppression.

Topics: Acyclovir; Aged; Aged, 80 and over; Female; Fluorescent Antibody Technique; Hepatitis C; Herpes Genitalis; Herpes Simplex; Humans; Immune Tolerance; Inclusion Bodies, Viral; Liver Cirrhosis; Opportunistic Infections; Skin; Stomatitis, Herpetic

Topics: Acyclovir; Administration, Topical; Anti-Inflammatory Agents; Diagnosis, Differential; Glucocorticoids; Herpesvirus 6, Human; Humans; Stomatitis, Aphthous; Stomatitis, Herpetic

Topics: Acyclovir; Administration, Oral; Chickenpox; Child; Humans; Stomatitis, Herpetic

Topics: Acyclovir; Adult; AIDS-Related Opportunistic Infections; Drug Resistance, Microbial; Female; Foscarnet; Herpes Genitalis; Herpes Simplex; Herpesvirus 1, Human; Herpesvirus 2, Human; HIV Infections; Humans; Male; Middle Aged; Stomatitis, Herpetic; Vidarabine

Recurrent oral herpes simplex virus lesions are common in both immunocompetent and immunocompromised persons. In contrast, cytomegalovirus-associated intraoral lesions are rarely seen, even in the immunocompromised host. We report a case of concurrent oral herpes simplex virus and cytomegalovirus infection, appearing as an ulcerative lesion of the labial mucosa in a patient with acquired immunodeficiency syndrome. Herpes simplex virus type 1 was shown to be present in the lesion by culture tests, histopathologic examination, immunohistochemistry findings and a direct immunofluorescence assay, and cytomegalovirus by histopathologic examination and immunohistochemistry findings. We deduce that the lesion was due to concurrent herpes simplex virus-1 and cytomegalovirus infection. The patient responded well to 2 weeks of treatment with a high dose of acyclovir.

Topics: Acyclovir; Adult; AIDS-Related Opportunistic Infections; Antibodies, Monoclonal; Cytomegalovirus; Cytomegalovirus Infections; Humans; Lip Diseases; Male; Mouth Diseases; Mouth Mucosa; Simplexvirus; Stomatitis, Aphthous; Stomatitis, Herpetic; Superinfection

We describe a 36-year-old man with recurrent Stevens-Johnson syndrome, which became progressively more severe over a 13-year period. His episodes were apparently preceded by herpes simplex virus oral mucosal infections. A management protocol, including immediate therapy with acyclovir and prednisone at the onset of herpes simplex virus oropharyngitis, is outlined. This management strategy has successfully prevented four subsequent episodes of progression to Stevens-Johnson syndrome. Thus, Stevens-Johnson syndrome associated with herpes simplex virus may be prevented by early use of acyclovir and prednisone.

Topics: Acyclovir; Adult; Humans; Male; Prednisone; Recurrence; Stevens-Johnson Syndrome; Stomatitis, Herpetic

Topics: Acyclovir; Adolescent; Adult; Chlorhexidine; Female; Humans; Israel; Lidocaine; Male; Miconazole; Military Personnel; Penicillin V; Stomatitis, Herpetic; Tonsillitis

Topics: Acyclovir; Child; Diagnostic Errors; Humans; Stomatitis, Herpetic

The optimal management of herpes simplex stromal keratitis and uveitis is controversial. Thirty-two patients with presumptive herpetic anterior uveitis without active corneal inflammation received 3% acyclovir ophthalmic ointment five times daily and acyclovir 200mg orally five times a day. Eight of 18 patients (44.4%) who had received corticosteroids deteriorated over the first five days of therapy; one of 14 patients (7.1%) without previous corticosteroid use worsened during this time (P less than .05). The mean healing time was similar in these two groups. These results suggest that antiviral therapy may be first-line treatment in patients with herpetic keratouveitis who have not received corticosteroids.

Topics: Acyclovir; Administration, Oral; Adult; Female; Humans; Iridocyclitis; Male; Ointments; Steroids; Stomatitis, Herpetic; Uveitis, Anterior

Recurrent infections with herpes simplex virus (HSV), occurring in as many as 20% of the population, often interfere with dental treatment. HSV (type 1 and type 2) belongs to the family of DNA viruses. The new generation of antiviral drugs promises to provide more successful management of viral diseases. Acyclovir, an analogue of viral deoxyguanosine, is an inhibitor of viral DNA and viral DNA polymerase. The aim of the present study was to evaluate to efficacy of the Virolex ointment, an acyclovir preparation manufactured by KRKA Novo mesto, in the treatment of labial herpes. The results show that Virolex is a highly effective agent. If started in the initial phase of infection it can prevent the development of herpetic lesions. Compared to other antiviral drugs used in the treatment of labial herpes, the duration of acyclovir therapy is shorter.

Topics: Acyclovir; Humans; Ointments; Stomatitis, Herpetic

Twenty-nine patients with leukemia were observed for the development of and recovery from oral herpes simplex virus (HSV) lesions. In patients with seropositive test results, lymphocyte and monocyte counts may provide a guide to predict the onset of HSV infections and to indicate when to institute acyclovir prophylaxis. When HSV developed, acyclovir was effective in preventing progression of the lesions, which did not resolve until white cell counts had recovered.

Topics: Acyclovir; Adolescent; Adult; Aged; Antibodies, Viral; Female; Humans; Leukemia, Myeloid, Acute; Leukocyte Count; Lymphocytes; Male; Middle Aged; Monocytes; Neutrophils; Simplexvirus; Stomatitis, Herpetic

The effect of acute herpes simplex virus type 1 (HSV-1) infection on the healing process of intraoral wounds and tooth extraction sockets in the rat was studied. A standardized size of the buccal mucosa was excised and molars were extracted and a HSV-1 suspension was topically applied. The virus infected wounds were clinically characterized by erythema and swelling and histologically by heavy inflammation cell infiltrate and abscesses during the first week. The acute HSV-1 infection was found to significantly delay healing of both types of wounds by 3 days. Antiviral treatment with acyclovir (ACV) decreased the degree of inflammation and improved healing of the infected wounds. The present results indicate a delayed and disturbed healing of wounds in the oral cavity in the presence of HSV-1. The findings may have a clinical significance for primary or latent HSV-1 infections in conjunction with surgical intervention in the oral cavity.

Topics: Acyclovir; Alveolar Process; Animals; Biopsy; Dissection; Epithelium; Female; Mouth Mucosa; Rats; Rats, Inbred Strains; Stomatitis; Stomatitis, Herpetic; Tooth Extraction; Wound Healing

Topics: Acyclovir; Antibodies, Viral; Antiviral Agents; Child, Preschool; Herpes Simplex; Herpesvirus 1, Human; Humans; Immunoenzyme Techniques; Infant; Stomatitis, Herpetic

We report the case of an immunocompromised patient with AIDS in whom developed a perioral and several intraoral HSV 2 lesions that persisted for more than 1 year. The virus was resistant to acyclovir but was sensitive to foscarnet. Viral isolates were thymidine kinase negative. The lesions resolved with intravenous foscarnet therapy given over a 15-week period, and when last seen, 8 months after foscarnet was discontinued, the patient had not had a recurrence.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; Antiviral Agents; Candidiasis, Oral; Drug Resistance, Microbial; Facial Dermatoses; Foscarnet; Herpes Simplex; Humans; Male; Organophosphorus Compounds; Phosphonoacetic Acid; Stomatitis, Herpetic

Infection of athymic mice with defined populations of acyclovir-susceptible (thymidine kinase [TK]-positive) and acyclovir-resistant (TK-deficient or TK-altered) herpes simplex virus type 1 strains was used to simulate herpetic skin disease of the immunocompromised host. In vitro characterization of the defined virus mixtures revealed that the dye uptake method was quite sensitive in the detection of small amounts (3 to 9%) of acylovir-resistant virus. Mice infected with homogeneous virus populations exhibited a good correlation between clinical response and the in vitro drug susceptibility of the infecting virus. Animals infected with defined mixtures of viruses exhibited varied patterns of infection and responses to acyclovir treatment. However, disease severity was useful in predicting the TK phenotype of virus recovered from lesions. Pathogenic, TK-altered virus was responsible for progressive disease in animals receiving low-dose (0.25-mg/ml) prophylactic acyclovir or high-dose (1.25-mg/ml) delayed therapy. Although this mutant was recovered infrequently, it was responsible for clinically significant disease in the animals from which it was isolated.

Topics: Acyclovir; Animals; Autoradiography; Drug Resistance, Microbial; Female; Herpes Simplex; Iodine Radioisotopes; Mice; Mice, Inbred BALB C; Mice, Nude; Simplexvirus; Stomatitis, Herpetic; Viral Plaque Assay; Virus Replication

A series of herpes simplex virus isolates were recovered from a bone marrow transplant patient who received prolonged acyclovir therapy for indolent herpes simplex mouth and throat ulceration. Of 14 isolates received 10 were resistant to acyclovir and partially resistant to phosphonoacetic acid. Biochemical characterization revealed that resistance was due to an alteration in the virus DNA polymerase. DNA sequence analysis of the polymerase gene of a plaque-purified resistant virus isolate revealed a single nucleotide change when compared with the sequence of the gene of a plaque-purified sensitive isolate. This single base change resulted in a predicted amino acid substitution of Gly to Ser at residue number 841, a putative functional region of the polymerase.

Topics: Acyclovir; Adult; Base Sequence; Bone Marrow; Bone Marrow Transplantation; DNA-Directed DNA Polymerase; Drug Resistance, Microbial; Female; Genes, Viral; Humans; Immunologic Deficiency Syndromes; Leukemia, Myelogenous, Chronic, BCR-ABL Positive; Mutation; Simplexvirus; Stomatitis, Herpetic

Topics: Acyclovir; Herpes Labialis; Herpes Simplex; Humans; Stomatitis, Herpetic

Topics: Acyclovir; Cytarabine; Humans; Stomatitis, Herpetic; Thiosemicarbazones

Topics: Acyclovir; Adult; Child; Female; Herpes Labialis; Humans; Male; Pilot Projects; Stomatitis, Herpetic

Topics: Acyclovir; Adult; DNA-Directed DNA Polymerase; Drug Resistance, Microbial; Female; Humans; Simplexvirus; Stomatitis, Herpetic

Topics: Acyclovir; Antiviral Agents; Bromodeoxyuridine; Chronic Disease; Foscarnet; Humans; Immunosuppression Therapy; Leukemia, Lymphoid; Male; Middle Aged; Phosphonoacetic Acid; Stomatitis, Herpetic; Vidarabine

The article reports on 41 patients having infections induced by Herpes simplex and Herpes zoster virus. Systemic intravenous administration of acyclovir results in a very rapid reduction of pain and mucosal changes in herpetic stomatitis. In cutaneous lesions of the trigeminal nerve branches induced by Herpes zoster virus there is also a very rapid reduction of pain and efflurescence after 3 days. In 16 patients suffering from Ramsay Hunt syndrome, also known as Herpes zoster oticus, lesions of the facial nerve function were present. 8 Patients demonstrated cochleovestibular signs and symptoms, 2 had flat inner ear hearing loss of 40 dB, 1 reduced unilateral caloric response. Treatment was effected by intravenous administration of acyclovir and simultaneous classical symptomatic therapy consisting of intravenously administered dextrane, cortisone and antiinflammatory drugs. Symptomatic therapy is necessary because acyclovir stops the replication of viruses but does not influence the disturbed nerve function. In 2 cases with a damage of more than 90% of the facial nerve fibres, endaural decompression of the geniculate ganglion was performed. Cochleovestibular deficits improved to normal during one week and all facial lesions within 8 months. Drug-related side effects were seen in one patient who had an exanthema.

Topics: Acyclovir; Adult; Antibodies, Viral; Female; Herpes Labialis; Herpes Simplex; Herpes Zoster; Herpesvirus 3, Human; Humans; Male; Middle Aged; Otorhinolaryngologic Diseases; Simplexvirus; Stomatitis, Herpetic; Trigeminal Neuralgia

Topics: Acyclovir; Herpes Zoster; Humans; Mouth Diseases; Stomatitis, Herpetic

Topics: Acyclovir; Antiviral Agents; Cytarabine; Herpesviridae Infections; Humans; Stomatitis, Herpetic

Topics: Acyclovir; Herpes Simplex; Humans; Simplexvirus; Stomatitis, Herpetic

Topics: Acyclovir; Antiviral Agents; Counseling; Female; Herpes Genitalis; Herpes Labialis; Humans; Infant, Newborn; Male; Pemphigoid Gestationis; Pregnancy; Pregnancy Complications; Stomatitis, Herpetic

25 patients suffering from recurrent herpes simplex infection were orally treated with acyclovir 5 X 200 mg daily for 5 days. Control examinations were carried out on the 1st, 3rd, 5th, and sometimes on the 7th day of treatment. All patients treated showed a significantly shortened course of the disease and quick decrease of the symptoms. If acyclovir was applied during the prodromal phase, we additionally found inhibited vesicular eruption. There were not observed any dangerous side effects.

Topics: Acyclovir; Administration, Oral; Adult; Female; Herpes Genitalis; Herpes Labialis; Herpes Simplex; Humans; Male; Middle Aged; Recurrence; Stomatitis, Herpetic

A decrease in the in vitro sensitivity to acyclovir (ACV) was observed in successive isolates of herpes simplex virus type 1 from three immunocompromised patients during intravenous therapy with this drug. The ACV-resistant isolate from patient 1 was cross-resistant to dihydroxypropoxymethylguanine and bromovinyldeoxyuridine, but still susceptible to three fluoro-substituted pyrimidines, 2'-fluoro-5-iodo-1-beta-D-arabinofuranosylcytosine (FIAC), 2'-fluoro-5-iodo-1-beta-D-arabinofuranosyluracil (FIAU), and 2'-fluoro-5-iodo-1-beta-D-arabinofuranosylthymine (FMAU). The thymidine kinase (TK) from the resistant isolate showed a 50-fold or greater reduction in affinity for thymidine, FIAU, FMAU, and ACV, but the total enzyme activity was similar to that of the sensitive isolate. The ACV-resistant isolate from patient 2 was also resistant to dihydroxypropoxymethylguanine, bromovinyldeoxyuridine, and the fluoro-substituted compounds; TK activity for this isolate was less than 1% of the patient's pretherapy isolate. An isolate obtained during a subsequent recurrence in patient 2 was susceptible to ACV and the other TK-dependent agents. The ACV-resistant isolate from patient 3 was partially resistant to FIAC and FIAU but still susceptible to FMAU; the viral TK had a 10-fold-lower affinity for ACV, FIAU, and FMAU than did the sensitive pretherapy isolate, while the level of TK activity detected was reduced to 6%. In none of the isolates studied was a change in sensitivity to phosphonoformic acid observed. Compared with the corresponding pretherapy ACV-sensitive isolates, there was a 30-fold decrease in neurovirulence for mice of the two drug-resistant isolates with diminished levels of thymidine-phosphorylating activity and no change in virulence for the third isolate. These findings indicate that mixed patterns of drug-resistance to TK-dependent antiviral compounds can occur in clinical isolates, resulting from changes in either the amount or the affinity of viral TK activity.

Topics: Acyclovir; Adult; Animals; Antiviral Agents; Arabinofuranosyluracil; Bromodeoxyuridine; Cytarabine; Drug Resistance, Microbial; Female; Ganciclovir; Humans; Male; Mice; Mice, Inbred BALB C; Simplexvirus; Stomatitis, Herpetic; Thymidine Kinase; Virulence

Recurrent herpes simplex virus infection is usually benign and self-limiting, but in immunosuppressed patients it can be a chronic destructive process. Eight patients with chronic aggressive herpes simplex virus infection of the oral mucosa are described. All cases occurred in immunocompromised patients. The distinctive clinical presentation of the oral lesions, the diagnosis, and treatment are discussed.

Topics: Acyclovir; Adult; Aged; Chronic Disease; Female; Humans; Immunosuppression Therapy; Male; Middle Aged; Recurrence; Stomatitis, Herpetic

Out of 80 kidney graft recipients treated with cyclosporin A and low dose steroids 19 (23.8%) developed herpes virus infection and from these 15 (18.8%) herpetic stomatitis. Evaluation of enhancing factors for herpetic stomatitis suggested a role of cyclosporin A rather than of steroids and a probable relation to preceding CMV infection. Acyclovir treatment was effective on the course of stomatitis and pain in 12 of the 15 patients. No serious side effects were observed. Leukopenia as a possible hazard was discussed.

Topics: Acyclovir; Cyclosporins; Humans; Immunosuppression Therapy; Kidney Transplantation; Leukocyte Count; Leukopenia; Stomatitis, Herpetic

The case of a 32-year-old patient is reported who in her 35th week of pregnancy was successfully treated with acyclovir because of severe gingivostomatitis herpetica causing general health problems. The child was born 4 weeks later in good health. Acyclovir was thus used for the first time in a pregnant women.

Topics: Acyclovir; Adult; Female; Humans; Infusions, Parenteral; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Trimester, Third; Stomatitis, Herpetic

Herpes simplex virus (HSV) reactivation is common after marrow transplantation, with some patients developing frequent and severe recurrences. Sixty patients were studied to determine both the effect of the specific lymphocyte response to HSV on subsequent recurrences and the effect of acyclovir treatment on restoration of this response. Patients with a positive response after the first HSV recurrence had fewer second recurrences (13 of 28 vs. 18 of 19; P less than .01) and at a longer interval when they did recur (42 vs. 27 days; P less than .0001). Conversely, patients treated with acyclovir had more frequent second recurrences than did those not treated (18 of 21 vs. 13 of 26; P less than .05) and they were at a shorter interval when they did recur (27 vs. 36 days; P = .001). Treated patients also had lower specific lymphocyte responses to HSV. These data confirm the importance of the specific immune response to HSV in the determination of the course of HSV infection after marrow transplant.

Topics: Acyclovir; Adolescent; Adult; Bone Marrow Transplantation; Child; Female; Herpes Genitalis; Herpes Simplex; Humans; Lymphocyte Activation; Male; Recurrence; Simplexvirus; Stomatitis, Herpetic; Time Factors

Recent development of pharmaceutical agents that interfere with reproduction and metabolism of the herpes virus appear to have clinical applications in the treatment of orocutaneous herpetic lesions. Use of topical medications has always been limited by skin penetration. Combining these new pharmaceutical agents with iontotransport techniques has been shown to be effective for treatment of herpetic lesions. Instrumentation and a specially designed applicator electrode are described. Use of this instrumentation and its clinical application is described in the treatment of 32 patients and the results are summarized. Combining the use of the new pharmaceuticals with the iontotransport instrumentation is described as an effective treatment of localized herpetic lesions. Similar technique offers fascinating possibilities in other areas of skin pathology.

Topics: Acyclovir; Herpes Labialis; Humans; Idoxuridine; Iontophoresis; Stomatitis, Herpetic

Topics: Acyclovir; Herpes Simplex; Herpes Zoster; Humans; Mouth Diseases; Stomatitis, Herpetic; Virus Diseases; Warts

It is known that the localized form of herpes simplex virus (HSV) infection does not always show a good prognosis. A preterm infant who evidenced skin and tongue lesions, caused by HSV type 1, was treated by acycloguanosine. The result was satisfactory without any complications. Therefore, a localized form of HSV infection of the newborn infant, even though the patient has a low-birth-weight, should be treated by the drug immediately after the observation of the positive HSV culture.

Topics: Acyclovir; Herpes Simplex; Humans; Infant, Low Birth Weight; Infant, Newborn; Male; Stomatitis, Herpetic

Herpes simplex virus (HSV) type 1 from a bone marrow transplant recipient and HSV type 2 from a patient with genital herpes infection were examined for sensitivity to acyclovir after both patients received therapy with the drug. A 38- and 83-fold shift in sensitivity was detected in association with a marked decrease in viral thymidine kinase activity in isolates from both patients. The resistant HSV-1 isolate was approximately 900 times less neurovirulent to Balb/C mice but had similar cutaneous virulence in hairless mice compared with the patient's sensitive strain. In contrast, there was no difference in pathogenicity between the sensitive and resistant HSV-2 isolates. Latency was detected in the trigeminal ganglia of mice after snout inoculation with both the sensitive and resistant HSV-1 isolates. The ganglion isolate from the resistant HSV-inoculated mouse was found to be sensitive to acyclovir, implying a selection for or reversion of the sensitive phenotype. No trigeminal ganglion latency was detected after inoculation with either HSV-2 isolate. Resistance to acyclovir can arise during therapy as a result of diminished viral thymidine kinase activity but does not appear to be associated with increased virulence.

Topics: Acyclovir; Adult; Animals; Antiviral Agents; Drug Resistance, Microbial; Female; Guanine; Herpes Genitalis; Herpes Labialis; Herpes Simplex; Humans; Male; Mice; Simplexvirus; Stomatitis, Herpetic; Thymidine Kinase

HSV-1 and HSV-2 clinical isolates were tested for their in vitro sensitivity to acyclovir. The median ID50 for 32 genital HSV-2 isolates was 0.215 micrograms/ml and this was not significantly higher than a median value of 0.125 micrograms/ml for 28 oral HSV-1 isolates (p = 0.08). A wider range of ID50s was observed with the HSV-2 isolates compared with the HSV-1 isolates. The concentration of drug required to inhibit virus replication by 90 and 99 percent was approximately 10- and 100-fold greater than that producing 50 percent inhibition.

Topics: Acyclovir; Antiviral Agents; Dose-Response Relationship, Drug; Drug Resistance, Microbial; Female; Guanine; Herpes Genitalis; Humans; Lethal Dose 50; Male; Simplexvirus; Stomatitis, Herpetic; Virus Replication

Topics: Acyclovir; Administration, Topical; Animals; Antiviral Agents; Cranial Nerve Diseases; Facial Dermatoses; Guanine; Herpes Simplex; Injections, Subcutaneous; Mice; Mice, Nude; Stomatitis, Herpetic; Trigeminal Nerve

The therapeutic efficacy of two new antiviral agents, 5-iodo-5'-amino-2', 5'-dideoxyuridine (AIdUrd) and 9-(2-hydroxyethoxymethyl)guanine (ACV), in the model of mouse lip inoculated with herpes simplex virus type 2 is reported. The effects on development of clinical lesions, viral replication in the inoculated lips, and establishment of latent viral infection in the trigeminal ganglia were observed. The earlier the treatment with AIdUrd and ACV was initiated after inoculation, the better was the chemotherapeutic effect. AIdUrd and ACV treatment, when initiated 48 and 72 hr after inoculation, respectively, showed no chemotherapeutic efficacy. Establishment of viral latent infection in sensory ganglia was significantly prevented only when ACV treatment was initiated very early (1 or 3 hr) after inoculation. The results indicate that both drugs have significant antiviral activity, in part dependent on the time of initiation of therapy, and that ACV is superior to AIdUrd as a topical agent for therapy of herpes simplex virus type 2 infections.

Topics: Acyclovir; Animals; Antiviral Agents; Guanine; Herpes Labialis; Idoxuridine; Mice; Rabbits; Stomatitis, Herpetic; Time Factors; Trigeminal Ganglion