acyclovir and Syndrome

Topics: Accessory Nerve Diseases; Acyclovir; Antiviral Agents; Cranial Fossa, Posterior; Electromyography; Glossopharyngeal Nerve Diseases; Herpes Zoster; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Neck; Rare Diseases; Syndrome; Thymoma; Thymus Neoplasms; Tomography, X-Ray Computed; Vagus Nerve Diseases

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

A 43-year-old woman was admitted with a 14-day history of general malaise, subfebrile temperature, radicular dysaesthesias in the "riding breeches" area, severe pain in the lumbar region and progressive disorders of bladder and rectal emptying. Physical examination showed a conus-cauda syndrome. Differential diagnosis was between myelitis (inflammatory or infectious), space-occupying intraspinal mass or vascular lesion.. Cerebrospinal fluid contained 1700/3 cells and there was intrathecal antibody synthesis against varicella zoster virus (VZV) and positive VZV-DNA analysis in the polymerase chain reaction. Magnetic resonance imaging of the lumbar spine revealed an inflamed enlarged conal and epiconal area with small haemorrhagic spots. There was no evidence of an underlying immune-modulated disease.. With the diagnosis of varicella zoster myelitis with cutaneous changes having been established the clinical signs and symptoms regressed almost completely with aciclovir administration (10mg/kg intravenously for 14 days).. VZV without cutaneous involvement should be considered in the differential diagnosis of the radicular pain syndrome. When clinical signs of beginning myelitis or encephalitis are present, immediate investigations and therapy are necessary.

Topics: Acyclovir; Adult; Antiviral Agents; Diagnosis, Differential; Female; Hemorrhoids; Herpes Zoster; Humans; Myelitis; Pain; Remission Induction; Sacrococcygeal Region; Spinal Nerve Roots; Syndrome

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

We have described a case of herpes genitalis in a patient with Evans's syndrome who had violaceous macules leading to deep ulcerations. This case serves as a reminder that HSV infection may be atypical and have an unusual course in immunocompromised patients. With the availability of specific therapy for this infection, it is important to consider HSV in the differential diagnosis of all ulcerative skin lesions.

Topics: Acyclovir; Anemia, Hemolytic, Autoimmune; Herpes Genitalis; Humans; Immunosuppression Therapy; Male; Middle Aged; Penile Diseases; Recurrence; Skin Ulcer; Syndrome; Thrombocytopenia

Although the antiviral agent, acyclovir, is currently employed for the treatment in Ramsay Hunt syndrome, the benefit of acyclovir on facial nerve is still unknown and remains controversial. This study was designed to evaluate the effect of acyclovir in facial nerve recovery in Ramsay Hunt syndrome.. To evaluate drug effect on facial nerve function, evaluation of the facial voluntary movement and nerve excitability testing were performed. We have used an infusion therapy of acyclovir in combination with a high dose of steroid (AS), which was started within 7 days of onset of facial nerve palsy in 91 patients with Ramsay Hunt syndrome. The results were compared with those of 47 patients whose therapy was steroid alone started within 7 days of onset.. Out of 91 patients treated with AS, nerve exitability was good in 68 (75%), while it was poor in 17 and absent in six. Of 47 patients treated with steroid alone, nerve exitability was good in 25 (53%), while it was poor in 11 and absent in 11. There was statistically significant difference between AS and steroid therapy in the posttreatment degree of nerve function. Complete recovery to grade I in facial voluntary movement was attained in 82 of 91 patients (90%) in the AS therapy, while out of 47 patients treated with steroid alone complete recovery to grade I was attained in only 30 (64%). A statistically significant difference in the recovery rate of facial nerve function was induced between AS and steroid therapy.. The AS therapy was proved to keep good degree of nerve function indicated with nerve excitability testing and improve recovery rate of facial nerve in Ramsay Hunt syndrome. Based on this study, we now believe that the AS therapy is an advisable treatment modality to improve the recovery rate of facial nerve function in Ramsay Hunt syndrome.

Topics: Acyclovir; Adenosine Triphosphate; Anti-Inflammatory Agents; Antiviral Agents; Dextrans; Drug Therapy, Combination; Facial Paralysis; Female; Herpes Zoster Oticus; Humans; Male; Methylprednisolone; Recovery of Function; Severity of Illness Index; Syndrome; Vitamin B 12; Vitamin B 6

Twenty-seven adults with a diagnosis of the chronic fatigue syndrome were enrolled in a double-blind, placebo-controlled study of acyclovir therapy. The patients had had debilitating fatigue for an average of 6.8 years, accompanied by persisting antibodies to Epstein-Barr virus early antigens (titers greater than or equal to 1:40) or undetectable levels of antibodies to Epstein-Barr virus nuclear antigens (titers less than 1:2) or both. Each course of treatment consisted of intravenous placebo or acyclovir (500 mg per square meter of body-surface area) administered every eight hours for seven days. The same drug was then given orally for 30 days (acyclovir, 800 mg four times daily). There were six-week observation periods before, between, and after the treatments. Three patients had acyclovir-induced nephrotoxicity and were withdrawn from the study. Of the 24 patients who completed the trial, similar numbers improved with acyclovir therapy and with placebo (11 and 10, respectively). Neither acyclovir treatment nor clinical improvement correlated with alterations in laboratory findings, including titers of antibody to Epstein-Barr virus or levels of circulating immune complexes or of leukocyte 2',5'-oligoadenylate synthetase. Subjective improvement correlated with various measures of mood. We conclude that acyclovir, as used in this study, does not ameliorate the chronic fatigue syndrome. We believe that the clinical improvement observed in most patients reflected either spontaneous remission of the syndrome or a placebo effect.

Topics: Acyclovir; Adult; Affect; Antibodies, Viral; Antigens, Viral; Body Temperature; Chronic Disease; Clinical Trials as Topic; Fatigue; Female; Herpesviridae Infections; Herpesvirus 4, Human; Humans; Male; Rest; Syndrome

In recent years, there have been an increasing number of reports on overlapping antibodies in autoimmune encephalitis (AE). There are various types of overlapping antibodies, but the clinical significance of each type is not yet clear. Glial antibodies, such as MOG, AQP4, and especially NMDAR, can be detected in patients with AE. However, little is known about the overlapping antibodies of anti-glial fibrillary acidic protein (GFAP), and only a few case reports have described this overlap. Case presentation The patient was a 7-year-old girl with recurrent intermittent fever and seizures, and viral encephalitis was diagnosed at the beginning of the disease. She was discharged after treatment with acyclovir, high-dose immunoglobulins, and valproic acid as an antiseizure medication. Subsequently, the patient still had occasional seizures and abnormal behavior, and the anti-NMDAR antibody test was positive (1:3.2). She was treated with high-dose methylprednisolone and antiseizure therapy. Approximately half a year later, the patient experienced fever and seizures again, serum GFAP IgG was 1:100, and a head MRI indicated new lesions. Improvement was achieved after repeated high-dose methylprednisolone and continuous prednisone anti-inflammatory therapy.. Anti-NMDAR encephalitis combined with GFAP-IgG is uncommon, and repeated tests for AE-associated antibodies may be required in patients with recurrent encephalitis. Compared with cerebrospinal fluid antibody-positive children, serum GFAP IgG-positive children should be comprehensively diagnosed according to their clinical manifestations. It is worth considering whether overlapping antibody syndrome can still be an issue for patients with AE who recover and have negative antibodies after a few months if disease recurrence and new antibodies are detected.

Topics: Acyclovir; Anti-Inflammatory Agents; Anti-N-Methyl-D-Aspartate Receptor Encephalitis; Autoantibodies; Child; Encephalitis; Female; Hashimoto Disease; Humans; Immunoglobulin G; Methylprednisolone; Neoplasm Recurrence, Local; Prednisone; Seizures; Syndrome; Valproic Acid

Herpes Zoster Ophthalmicus (HZO) usually affects the immunocompromised and aged. It results from the reactivation of latent varicella zoster infection in the trigeminal ganglia. Orbital apex syndrome (OAS) is a rare sequela of the disease and tends to be disfiguring and vision-threatening if not addressed. We report on a 43-year-old Ghanaian female living with Human Immunodeficiency Virus infection and on highly active antiretroviral therapy who presented with a 2-month history of a healed vesicular rash left side of the forehead and a droopy left upper eyelid. On examination, she had complete ptosis, visual acuity in the left eye was 6/36, and restricted mobility in all directions of gaze. On anterior segment examination using a slit lamp biomicroscope, the left eye had mild cornea oedema with keratic precipitates and relative afferent pupillary defect (RAPD). Intraocular pressure and posterior segment of the right eye were normal. Computed tomography (CT) Scan of the head was taken to rule out other causes of OAS. Patient was treated with oral acyclovir 400mg five times daily for 30 days, topical steroids and oral prednisolone 60mg daily for 30 days which was tapered. Ptosis improved significantly with mild supraduction and infraduction deficit. Visual acuity improved to 6/12 and all keratic precipitates cleared. The patient, however, developed a corneal scar from a possible neurotrophic ulcer after defaulting treatment for 11 months. OAS , as a rare sequalae of HZO, responds well to oral acyclovir and steroids. Prompt diagnosis and appropriate treatment, even at late presentation, yield positive outcomes.. None declared.

Topics: Acyclovir; Adult; Aged; Antiviral Agents; Female; Ghana; Herpes Zoster Ophthalmicus; HIV Infections; Humans; Prednisolone; Syndrome

Topics: Acyclovir; Aged; Antiviral Agents; Cranial Nerve Neoplasms; Diagnosis, Differential; Facial Neoplasms; Female; Forehead; Herpes Zoster Ophthalmicus; Humans; Meningioma; Neurilemmoma; Skin Ulcer; Syndrome; Trigeminal Nerve Diseases; Trigeminal Nerve Injuries; Wound Healing

A male patient with herpes zoster ophthalmicus (HZO) presented with left exophthalmos, external and internal ophthalmoplegia and decreased visual acuity. A CT scan revealed myositis without significant compression of the optic nerve. Intravenous acyclovir and oral steroids were started with improvement of the symptoms and eventual complete recovery.Orbital apex syndrome is a rare complication of HZO. Multiple pathogenic mechanisms are involved, including a direct cytopathic effect of the virus as in the present case. Early diagnosis and therapy may lead to complete recovery of visual function.

Topics: Acyclovir; Anti-Inflammatory Agents; Antiviral Agents; Exophthalmos; Herpes Zoster Ophthalmicus; Humans; Male; Methylprednisolone; Middle Aged; Ophthalmoplegia; Orbital Myositis; Syndrome; Tomography, X-Ray Computed

Topics: Acyclovir; Aged; Antiviral Agents; Cauda Equina; Comorbidity; Female; Herpesvirus 3, Human; Humans; Peripheral Nervous System Diseases; Radiculopathy; Sciatica; Syndrome; Treatment Outcome

To analyze the electroclinical features, neuroimaging findings, treatment, and outcome of 12 patients with febrile infection-related epilepsy syndrome (FIRES).. This is a retrospective study of 12 children with FIRES with a mean time of follow-up of 6.5 years carried out at the Garrahan Hospital of Buenos Aires between 1997 and 2012.. Eight males and four females had focal status epilepticus preceded by febrile infection with a mean age at presentation of 8.5 years. In the acute period, the treatment included antiepileptic drugs (AEDs) in all cases, immunotherapy in 10 cases, and burst-suppression coma in eight. The ketogenic diet was tried in two, plasmapheresis in one, and rituximab in one. Two patients treated with IVIG and one patient given steroids had a good response, but in this phase only three patients had a prolonged good response to IVIG and a ketogenic diet. No patients died in this period. In the chronic epilepsy phase, all children had seizures arising from neocortical regions. All patients had refractory epilepsy, and most mental retardation, and behavioral disturbances. All received different AEDs and in this phase a third patient was put on a ketogenic diet. One patient was operated without good results. Only two cases had a good outcome after 2 and 10 years of follow-up.. FIRES is a well-defined severe epileptic syndrome, probably in the group of epileptic encephalopathies, characterized by focal or multifocal seizures arising from the neocortical regions with an unknown etiology. Immunoglobulin and the ketogenic diet may be considered a potentially efficacious treatment.

Topics: Acyclovir; Adolescent; Antiviral Agents; Argentina; Child; Child, Preschool; Electroencephalography; Encephalitis, Viral; Female; Follow-Up Studies; Humans; Immunoglobulins, Intravenous; Leukocytosis; Magnetic Resonance Imaging; Male; Retrospective Studies; Seizures, Febrile; Status Epilepticus; Syndrome; Treatment Outcome; Unconsciousness

Describe the case of an Anterior Cord Syndrome secondary to transverse myelitis. ANTERIOR CORD SYNDROME: Anterior Cord syndrome (ACS) is characterized by a lesion that affects the anterior two thirds of the spinal cord while preserving the posterior columns. TRANSVERSE MYELITIS: Transverse myelitis (TM) is an inflammatory disorder with a heterogeneous pathogenesis affecting the spinal cord at one or more segments, resulting in motor, sensory, and autonomic dysfunction in the absence of a preexisting neurological disease or spinal cord compression.. The patient was treated with methylprednisolone, IV Antibiotics, acyclovir, and inpatient rehabilitation.. The patient significantly improved her function throughout inpatient rehabilitation and was discharged after achieving modified independent level with ambulation and all activities of daily living. The patient also gained independence with an intermittent catheterization program and a nightly bowel program, which included suppository and digital stimulation.. This case illustrates the first documented pediatric patient with a unique case of Anterior Cord Syndrome caused by idiopathic transverse myelitis.

Topics: Activities of Daily Living; Acyclovir; Adolescent; Anti-Bacterial Agents; Anti-Inflammatory Agents; Antiviral Agents; Autonomic Nervous System Diseases; Diagnosis, Differential; Female; Humans; Magnetic Resonance Imaging; Methylprednisolone; Motor Neuron Disease; Myelitis, Transverse; Physical Therapy Modalities; Rehabilitation Nursing; Sensation Disorders; Spinal Cord; Syndrome; Treatment Outcome

Lemierre syndrome is a distinct clinical syndrome comprising oropharyngeal sepsis and fever, internal jugular vein thrombosis and remote septic metastases caused by Fusobacterium species. The mortality rate was historically high and although use of antibiotics led to a dramatic fall in incidence, a resurgence has been seen recently. A 14-year-old male developed Lemierre syndrome after tonsillitis. There was extensive leptomeningitis, especially over the clivus, causing 6th and 12th cranial nerve palsies, a clinical feature termed the 'clival syndrome'. He also developed an epidural abscess in the cervical spine, which was unsafe for surgical drainage. Conservative treatment with an extended course of antibiotics and anticoagulation for jugular vein thrombosis led to a good recovery. A 15-year-old female developed Lemierre syndrome after a persistent sore throat lasting 7 weeks. She had palsy of the 12th cranial nerve from clival osteomyelitis. She was treated with a 6-week course of antibiotics and anticoagulants leading to almost full recovery at 3-month review. Awareness of the potential neurological complications of Lemierre syndrome and prompt management are crucial in reducing morbidity and mortality in this 'forgotten disease'.

Topics: Acyclovir; Adolescent; Anti-Infective Agents; Antiviral Agents; Bacteremia; Ceftriaxone; Cranial Nerve Diseases; Diagnosis, Differential; Female; Fusobacterium Infections; Fusobacterium necrophorum; Humans; Jugular Veins; Magnetic Resonance Imaging; Male; Oropharynx; Syndrome; Venous Thrombosis

Topics: Acyclovir; Antineoplastic Agents; Antiviral Agents; Boronic Acids; Bortezomib; Cyclosporine; Dexamethasone; Drug Hypersensitivity; Exanthema Subitum; Herpesvirus 3, Human; Herpesvirus 6, Human; Humans; Male; Melphalan; Middle Aged; Multiple Myeloma; Neoplasm Recurrence, Local; Prednisone; Pyrazines; Syndrome; Virus Activation

The orbital apex syndrome is defined by the association of visual loss, ophtalmoplegia, blepharoptosis, proptosis along with forehead and upper eyelid anesthesia. This syndrome is secondary to traumatism, malignancy or infection of orbital apex. Herpes zoster is an uncommon cause. We discuss the physiopathologic mechanism, evolution and management of this affection.

Topics: Acyclovir; Aged; Antiviral Agents; Female; Herpes Zoster; Humans; Orbital Diseases; Syndrome

Topics: Abnormalities, Multiple; Acute Disease; Acyclovir; Antiviral Agents; Drug Therapy, Combination; False Negative Reactions; Female; Hepatitis, Viral, Human; Humans; Immunohistochemistry; Injections, Intravenous; Kidney Transplantation; Liver; Polymerase Chain Reaction; Simplexvirus; Syndrome; Urogenital Abnormalities; Valacyclovir; Valine; Young Adult

Drug-induced hypersensitivity syndrome (DIHS)/drug rash with eosinophilia and systemic symptoms (DRESS) is a severe multiorgan reaction with reactivation of herpesviruses. Various features are often seen during the course of the disease. Many aspects of this syndrome suggest close similarities between DIHS/DRESS and graft-versus-host disease. We describe a patient with phenobarbital-induced hypersensitivity syndrome who revealed syndrome of inappropriate secretion of antidiuretic hormone (SIADH) associated with limbic encephalitis during the course of the disease. In view of previous reports that SIADH and limbic encephalitis are caused by reactivation of latent herpesviruses after transplantation, both conditions may be secondarily caused by reactivation of latent herpesviruses, which is typically observed in DIHS/DRESS. These neurological symptoms should be added to a growing list of important complications of DIHS/DRESS because of the high mortality rate associated with them.

Topics: Acyclovir; Aged; Anticonvulsants; Antiviral Agents; Coma; Drug Hypersensitivity; Encephalitis; Epilepsy; Humans; Hyponatremia; Inappropriate ADH Syndrome; Male; Phenobarbital; Syndrome; Treatment Outcome

Post-malaria neurological syndrome (PMNS) defined by a post-infective encephalopathy occurring within 2 months after an episode of Plasmodium falciparum infection is still a debated entity. We describe 2 cases of PMNS in 2 patients of African origin, born and living in France. Both patients had severe P. falciparum infection, followed by PMNS. They recovered with no sequelae. These are the first-reported cases of PMNS in patients of African ethnicity and living in France.

Topics: Acyclovir; Adolescent; Adult; Brain Diseases; Cote d'Ivoire; Encephalitis, Herpes Simplex; France; Gambia; Humans; Malaria, Falciparum; Male; Syndrome; Treatment Outcome

Topics: Acyclovir; Adult; Antiviral Agents; Attitude to Death; Bipolar Disorder; Delusions; Female; Herpes Labialis; Herpes Zoster; Humans; Male; Middle Aged; Syndrome

Ramsay-Hunt syndrome (RHS) usually affects adults, but rare cases of preschool children with RHS have been reported. We report a case of RHS in a healthy 4-year-old girl. At the age of 4 years and 5 months, she complained of pain in her mouth and herpes zoster vesicles were noted on the left soft palate and tongue without left pinna, and complete left facial paralysis subsequently developed. She was treated with acyclovir and steroids. Six months later, her facial paralysis had almost fully resolved.

Topics: Acyclovir; Anti-Inflammatory Agents; Antiviral Agents; Child, Preschool; Drug Combinations; Facial Paralysis; Female; Herpes Zoster Oticus; Humans; Mouth Diseases; Prednisolone; Syndrome

We report an immunocompetent patient with recurrent auricular and facial vesicles associated with painful paresthesias and facial paralysis, consistent with Ramsay Hunt syndrome, due to herpes simplex virus (HSV) type 2. Clinical and laboratory-proven acyclovir resistance developed during therapy. Immunologic assays revealed normal reactivity to HSV-2.

Topics: Acyclovir; Adolescent; Adult; Antiviral Agents; Female; Foscarnet; Herpes Zoster Oticus; Herpesvirus 2, Human; Humans; Syndrome; Valacyclovir; Valine

Topics: Acyclovir; Aged; Antiviral Agents; Facial Paralysis; Female; Herpes Zoster Oticus; Humans; Syndrome; Treatment Outcome

Topics: Acyclovir; Adult; Antiviral Agents; Female; Ganglia, Spinal; Herpes Simplex; Herpesvirus 2, Human; Humans; Hypesthesia; Leukocytosis; Myelitis; Radiculopathy; Sacrum; Syndrome; Urinary Retention

Kaposi-Juliusberg's syndrome is a severe herpes simplex virus cutaneous infection, accompanied by general signs. Darier's disease is a rare genodermatosis characterised by keratinisation disorders.. In a 51 year-old patient suffering from Darier's disease since the age of 20, a diffuse vesicular eruption occurred following a herpes eruption on the lower lip. Culture of a vesicle revealed a type 1 Herpes simplex virus. The diagnosis of Kaposi-Juliusberg's syndrome was made.. Kaposi-Juliusberg's syndrome is a "classical" herpes complication of atopic dermatitis. It may also develop on other predisposing territories such as acantholytic dermatitis: pemphigus vulgaris, Hailey-Hailey's disease and Darier's disease. Although a rare complication and life threatening for the patient, Kaposi-Juliusberg's syndrome can now be treated efficiently with intravenous and subsequently oral aciclovir.

Topics: Acyclovir; Antiviral Agents; Darier Disease; Herpes Simplex; Humans; Male; Middle Aged; Prognosis; Syndrome

A rheumatoid arthritis (RA) patient treated with low-dose methotrexate (MTX) therapy suffered from hemophagocytic syndrome (HPS) associated with B-cell lymphoma (B-LAHS). Administration of acyclovir and intravenous immunoglobulin promptly resolved laboratory test abnormalities accompanied with HPS. Moreover, hemophagocytic histiocytes and lymphoma cells in the bone marrow disappeared without anti-cancer therapy. Two months after reintroduction of MTX for RA flare, lymphoma re-grew rapidly without bone marrow involvement and HPS. Two cycles of combination chemotherapy induced the lymphoma to a complete remission/unconfirmed (CRu), but then the chemotherapy was discontinued due to severe side effects. In this case, on the basis of RA and MTX induced immunosuppressive state, Epstein-Barr virus (EBV) infection was associated with the development of HPS and lymphoma. Anti-viral therapy alone was effective against HPS and lymphoma at initial presentation and improved her general condition. This case indicates that anti-cancer therapy should be preceded by anti-viral therapy and withdrawal of immunosuppressive therapy in patients under immunosuppressive therapy, as long as the clinical situation permits.

Topics: Acyclovir; Aged; Antirheumatic Agents; Antiviral Agents; Arthritis, Rheumatoid; Epstein-Barr Virus Infections; Female; Herpesvirus 4, Human; Histiocytosis, Non-Langerhans-Cell; Humans; Lymphoma, B-Cell; Methotrexate; Syndrome

Stroke is the most common neurologic complication of sickle cell disease. Acute chest syndrome (ACS) is a known risk factor for stroke in this population. Two patients (a 12-year-old boy and a 6-year-old girl) developed acute change of mental status and focal neurologic signs during episodes of ACS. The clinical and radiologic findings were compatible with acute necrotizing encephalitis, a variant of acute demyelinating encephalomyelitis. Patients with acute neurologic deterioration in conjunction with ACS should be evaluated thoroughly for other causes of central nervous system disease including infectious/parainfectious processes as well as stroke.

Topics: Acyclovir; Anemia, Sickle Cell; Brain; Child; Doxycycline; Encephalomyelitis; Erythrocyte Transfusion; Female; Humans; Magnetic Resonance Imaging; Male; Pneumonia, Mycoplasma; Syndrome; Tomography, X-Ray Computed; Vancomycin

Topics: Acyclovir; Adult; Cerebrospinal Fluid; Diagnosis, Differential; Follow-Up Studies; Humans; Leukocytes, Mononuclear; Leukocytosis; Male; Meningitis, Aseptic; Recurrence; Spinal Puncture; Syndrome; Time Factors

We address the relationship between reactive hemophagocytic syndrome (RHS), systemic lupus erythematosus (SLE) activity, and treatment in 4 female patients with SLE. Febrile pancytopenia was related to cytologically proven RHS in all patients. Followup was 45+/-7 months from RHS onset. No causal infection could be identified. Outcome could be classified as: (1) RHS onset during a SLE flare and complete efficacy of high dose steroids; (2) death despite therapy for concomitant severe RHS and active SLE; (3) severe RHS in inactive SLE under immunosuppressants, with remission after steroid tapering and cyclophosphamide withdrawal. Three patients were treated with intravenous IgG. We conclude that (1) when SLE is active, RHS should be considered a specific manifestation and treated with steroids; (2) RHS occurring in otherwise inactive SLE might be related to iatrogenic immunosuppression; (3) intravenous IgG treatment might be indicated in both situations.

Topics: Acyclovir; Adult; Anti-Bacterial Agents; Blood Component Transfusion; Combined Modality Therapy; Cyclophosphamide; Fatal Outcome; Female; Follow-Up Studies; Glucocorticoids; Histiocytosis, Non-Langerhans-Cell; Humans; Immunoglobulins, Intravenous; Lupus Erythematosus, Systemic; Syndrome; Treatment Outcome

Topics: Acyclovir; Adult; Antiviral Agents; Atlantic Islands; Causalgia; Chronic Disease; Female; Fibromyalgia; Herpesviridae Infections; Humans; Male; Middle Aged; Pain; Pain Management; Phantom Limb; Risk Factors; Spain; Syndrome; Time Factors

To describe the clinical features of a disorder characterized by chronic multifocal retinal infiltrates and uveitis in individuals with human immunodeficiency virus (HIV) disease.. We reviewed the medical records of HIV-infected patients with multifocal retinal infiltrates of unknown cause seen by investigators at four institutions. The following data were collected: demographic characteristics, presenting signs and symptoms, laboratory test results, and course of disease.. We identified 26 HIV-infected patients (50 involved eyes) with this syndrome. Median CD4+ T-lymphocyte count at presentation was 272 per microl (range, 7 to 2,118 per microl). The most common presenting symptom was floaters. Median visual acuity of involved eyes at presentation was 20/20 (range, 20/15 to 20/100) and remained stable (median, 20/20; range, 20/15 to 20/70) after a median follow-up period of 9 months (range, 0 to 110 months). Typical retinal lesions were gray-white or yellow, irregular in shape, and less than 200 microm in greatest dimension. All were located in the midperiphery or anterior retina and enlarged slowly or remained static in size. Mild to moderate anterior chamber or vitreous humor inflammatory cells were present in 47 of 50 eyes (26 of 26 patients). Retinal lesions possibly responded to zidovudine but not to acyclovir or ganciclovir. Anterior chamber and vitreous humor inflammatory reactions responded to topical or periocular injections of corticosteroid.. Uveitis with chronic multifocal retinal infiltrates is a distinct clinical entity of unknown cause that occurs in HIV-infected patients. Retinal lesions may respond to antiretroviral therapy. Visual prognosis is good.

Topics: Acyclovir; Adult; Anti-HIV Agents; CD4 Lymphocyte Count; CD4-Positive T-Lymphocytes; Chronic Disease; Fundus Oculi; Ganciclovir; HIV Infections; Humans; Male; Middle Aged; Retinal Diseases; Syndrome; Uveitis; Visual Acuity; Zidovudine

Benign recurrent meningitis, or Mollaret's meningitis, is an uncommon disease whose viral origin was long unidentified. Since 1991, about twenty cases have been reported in patients with herpes infection.. A female patient had experienced repeated episodes of spontaneous meningitis since 1983. The episodes resolved spontaneously and no etiology had been identified. A spinal tap was performed when the patient was again hospitalized a new episode of meningitis and PCR amplification of the herpes simplex virus type 2 (HSV 2) was positive. The patient was given long term acyclovir per os. A new spinal tap after resolution of the meningitis episode was PCR HSV2 negative.. HSV2 infection is one of the known causes of Mollaret's meningitis. Long-term antiviral therapy appears to prevent recurrence as was observed in our patient.

Topics: Acyclovir; Adult; Antiviral Agents; Female; Follow-Up Studies; Herpes Genitalis; Herpesvirus 2, Human; Humans; Meningitis, Viral; Polymerase Chain Reaction; Recurrence; Syndrome; Time Factors

Topics: Acyclovir; Adult; Antiviral Agents; Arterial Occlusive Diseases; Eye Diseases; Female; Ganciclovir; Glaucoma; Herpes Zoster Oticus; HIV Seropositivity; Humans; Male; Middle Aged; Ophthalmic Artery; Syndrome

Topics: Acyclovir; Female; Follow-Up Studies; Granulosa Cell Tumor; Herpes Zoster Oticus; Humans; Middle Aged; Ovarian Neoplasms; Syndrome

Topics: Acyclovir; Aged; Aged, 80 and over; Anti-Inflammatory Agents; Antiviral Agents; Cranial Nerve Diseases; Facial Dermatoses; Herpes Simplex; Humans; Injections, Intralesional; Male; Neuritis; Skin Ulcer; Syndrome; Triamcinolone; Trigeminal Nerve

Patients with primary or secondary immunodeficiency are at high risk for B cell lymphoproliferative syndromes (LPS) that are generally Epstein-Barr virus (EBV)-associated. We established a cell line, termed JuWa, from an immunoblastic lymphoma that developed in a child with severe combined immunodeficiency. JuWa cells were representative of the original lymph node as shown by a similar IgH gene rearrangement pattern. The cell line exhibited the typical features of a lymphoblastoid cell line (LCL): (1) growth pattern in large clumps, (2) lack of structural chromosome abnormalities, (3) type III latency with expression of EBV-associated EBNA2 and LMP, as well as B cell activation markers CD23 and CD30, thereby showing characteristics of an EBV producer cell line, i.e. a latent infection with a small subpopulation of cells spontaneously entering the lytic cycle, (4) inducibility of the lytic cycle by IdU and TPA, leading to an increase of early antigen and viral capsid antigen-positive cells from 1 to 15-20%, and (5) elimination of the linear viral genomes by treatment with acyclovir (ACV), without affecting the circular episomal genomes. After withdrawal of ACV, viral replication resumed within 7 days. Thus, JuWa cells support the concept of the LCL-like features of LPS and lymphomas occurring in the setting of immunodeficiency. In our in vitro model, ACV treatment could effectively suppress the viral replication but not cure EBV infection of B cells.

Topics: Acyclovir; Antigens, Viral; Antiviral Agents; Cells, Cultured; DNA, Viral; Female; Herpesviridae Infections; Herpesvirus 4, Human; Humans; Immunophenotyping; In Situ Hybridization; Infant; Lymph Nodes; Lymphocytes; Lymphoproliferative Disorders; Severe Combined Immunodeficiency; Syndrome

Herpes simplex encephalitis in adults and young patients carries a high mortality and morbidity. Its presentation may be nonspecific, sometimes hampering early diagnosis. Two young children are reported with herpes simplex encephalitis in whom the operculum syndrome was an outstanding feature. This syndrome is caused by focal, bilateral cortical damage to the anterior opercular regions resulting in anarthria and impairment of mastication and swallowing. After initiation of treatment with acyclovir in the early stage of the disease, the outcomes in both patients were characterized by good general recovery with persistence of deficits of speech, mastication, and swallowing, more pronounced in the patient who was comatose during the illness. Early recognition of the operculum syndrome as a presenting feature of herpes simplex encephalitis may expedite the diagnosis and thereby improve the prognosis.

Topics: Acyclovir; Cerebral Cortex; Child, Preschool; Deglutition Disorders; Dysarthria; Encephalitis, Viral; Female; Follow-Up Studies; Herpes Simplex; Humans; Infant; Magnetic Resonance Imaging; Male; Neurologic Examination; Syndrome; Tomography, X-Ray Computed

The original TORCH complex described clinically similar congenital infections caused by Toxoplasma gondii, rubella virus, cytomegalovirus, and herpes simplex virus, types 1 and 2. Cutaneous manifestations, including petechiae, purpura, jaundice, and dermal erythropoiesis, are commonly seen in toxoplasmosis, rubella, and cytomegalovirus infections. In herpes simplex virus infections, 80% of symptomatic infants show single or grouped cutaneous vesicles, oral ulcers, or conjunctivitis. Extracutaneous signs and symptoms are variable and can be severe. Significant clinical signs in congenital toxoplasmosis include diffuse intracerebral calcification, chorioretinitis, and microcephaly; congenital rubella can result in deafness, congenital heart disease, retinopathy, and brain calcification. Cytomegalic inclusion disease can include hepatomegaly, splenomegaly, paraventricular calcification, and intrauterine growth retardation. Localized or disseminated congenital herpes virus infection often involves the central nervous system and the eye. Diagnosis is confirmed by culture and identification of species-specific immunoglobulin M within the first 2 weeks of life. Histological examination contributes to the diagnosis in herpes simplex virus infection. Treatment for toxoplasmosis includes pyrimethamine with sulfadiazine or trisulfapyrimidine; congenital herpes simplex virus infection is treated with acyclovir. No specific therapy for congenital rubella or cytomegalovirus infections has been established, and so treatment is primarily supportive.

Topics: Acyclovir; Cytomegalovirus Infections; Herpes Simplex; Humans; Infant, Newborn; Rubella; Skin; Syndrome; Toxoplasmosis, Congenital

The syndrome of inappropriate secretion of antidiuretic hormone is a common consequence of neurologic and pulmonary infections as well as drug intake and many other clinical situations. Its association with herpes varicella-zoster virus infections is scarcely reported in the literature. It generally appears in immunosuppressed patients suffering from serious underlying diseases. There are also a few cases of syndrome of inappropriate secretion of antidiuretic hormone related to vidarabine use. We report the case of a man infected by human immunodeficiency virus who developed a disseminated herpes varicella-zoster virus infection and symptoms due to hyponatremia caused by antidiuretic hormone excess. The patient was cured with saline hypertonic infusion, water restriction, and intravenous administration of acyclovir. To the best of our knowledge, this is the first case of this association in a human immunodeficiency virus infected patient. We propose the use of acyclovir instead of vidarabine in the management of these situations.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; AIDS-Related Opportunistic Infections; Herpes Zoster; HIV-1; Humans; Hyponatremia; Inappropriate ADH Syndrome; Male; Syndrome

Herpes zoster ophthalmicus (HZO) commonly causes isolated ophthalmoplegic syndromes. Visual loss caused by optic neuritis secondary to HZO can be reversible or irreversible. HZO rarely presents as an orbital apex syndrome, when an association with meningo-encephalitis has been reported. We report a case of orbital apex syndrome secondary to HZO treated with systemic steroids and acyclovir. Our patient suffered no systemic complications and displayed a rapid resolution of optic neuropathy. We discuss this case in the light of previous reports and explore the possible pathogenic mechanisms involved.

Topics: Acyclovir; Administration, Oral; Exophthalmos; Female; Herpes Zoster Ophthalmicus; Humans; Middle Aged; Oculomotor Muscles; Optic Nerve Diseases; Orbital Diseases; Prednisone; Syndrome; Tomography, X-Ray Computed

An 11-year-old girl presented with a typical serologically proven infectious mononucleosis with persistent fever, jaundice and hepatosplenomegaly in spite of steroid therapy. Laboratory tests showed pancytopenia, fibrinopenia and hypertriglyceridemia. The liver biopsy revealed an infiltration with hyperbasophilic cells. One month later, a slight improvement was noted and fever disappeared after 4 days on acyclovir therapy. The authors recall the spectrum of the macrophagic activation syndrome.

Topics: Acyclovir; Child; Female; Fever; Histiocytosis, Non-Langerhans-Cell; Humans; Infectious Mononucleosis; Macrophage Activation; Pancytopenia; Phagocytosis; Syndrome

Authors report about a boy with Rasmussen syndrome. This is a chronic localised encephalitis with focal epileptic seizures causing progressive neurologic deficits and mental impairment. The etiology and the clinical features of the syndrome are discussed, and the diagnostic role of the new imaging modalities is emphasized. This is the first report about this entity in Hungary.

Topics: Acyclovir; Carbamazepine; Child, Preschool; Electroencephalography; Encephalitis; Epilepsies, Partial; Humans; Hungary; Intellectual Disability; Magnetic Resonance Imaging; Male; Phenytoin; Syndrome; Tomography, X-Ray Computed

In this study we evaluated the association between cytomegalovirus infection alone or in relation to human leukocyte antigen matching and the development of vanishing bile duct syndrome, a form of chronic hepatic allograft rejection. A total of 81 consecutive liver transplant recipients were studied. Cytomegalovirus infection developed in 46 recipients (57%), and vanishing bile duct syndrome occurred in 9 recipients (11%). Cytomegalovirus infection developed in only five of the nine patients with vanishing bile duct syndrome. Univariate analysis of pretransplant recipient/donor cytomegalovirus serological tests and human leukocyte antigen typing showed they were not significant risk factors for the development of vanishing bile duct syndrome. Time-dependent analysis of cytomegalovirus infection after transplantation as a risk factor for vanishing bile duct syndrome, in a multivariate analysis with human leukocyte antigen match, showed no statistical significance. In our study, no association was found between cytomegalovirus infection alone or in relation to class I or II human leukocyte antigen match and the subsequent development of vanishing bile duct syndrome.

Topics: Acyclovir; Adult; Analysis of Variance; Bile Duct Diseases; Cytomegalovirus Infections; Female; Histocompatibility Testing; Humans; Immunosuppression Therapy; Liver Transplantation; Male; Proportional Hazards Models; Risk Factors; Syndrome; Time Factors

One patient with bilateral acute retinal necrosis underwent encircling scleral buckle, vitrectomy, and intravitreal acyclovir on both eyes. This procedure was performed on the right eye while the retina was attached. The retina of the right eye was reattached by performing fluid-gas exchange and modified panretinal photocoagulation when the retina subsequently detached. Soon after the development of retinal detachment in the left eye, the above surgical procedures were performed on the left eye, and the retina was successfully reattached. Bilateral acute retinal necrosis with significant vitreous opacification, which is a devastating ocular disease causing possible blindness in both eyes, requires more aggressive, early surgical management.

Topics: Acute Disease; Acyclovir; Adult; Fundus Oculi; Humans; Light Coagulation; Male; Necrosis; Retinal Detachment; Retinal Diseases; Scleral Buckling; Syndrome; Vitrectomy

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; Antiviral Agents; Cauda Equina; Ganciclovir; Humans; Male; Peripheral Nervous System Diseases; Syndrome

Topics: Acyclovir; Chronic Disease; Fatigue; Humans; Infectious Mononucleosis; Syndrome

Acute retinal necrosis syndrome in a healthy 32-year-old man was treated successfully with systemic acyclovir and corticosteroids in combination with vitrectomy, 360 degrees encircling band and transscleral cryocoagulation. Herpes simplex virus antibodies were detected in the vitrectomy aspirate supporting the current view that acute retinal necrosis is caused by viruses of the herpes group.

Topics: Acute Disease; Acyclovir; Adult; Humans; Male; Necrosis; Retinitis; Syndrome; Vasculitis; Vitrectomy

Topics: Acyclovir; Adult; Chronic Disease; Female; Herpesviridae Infections; Herpesvirus 4, Human; Humans; Prognosis; Syndrome

Retinal detachment (RD) occurs in more than 50% of eyes with acute retinal necrosis (ARN) and is the leading cause of visual loss in this syndrome. In order to decrease the incidence of RD in ARN, the authors treated 12 eyes of 10 patients with prophylactic laser photocoagulation. Retinal detachment occurred in two eyes (17%). Over the same time period, seven eyes with ARN did not receive prophylactic laser treatment, most often because of dense vitreous debris, with a 67% rate of RD. Prophylactic photocoagulation treatment should be considered in the management of patients with ARN.

Topics: Acute Disease; Acyclovir; Administration, Oral; Adult; Aged; Female; Humans; Injections, Intravenous; Light Coagulation; Male; Middle Aged; Necrosis; Prednisone; Retina; Retinal Detachment; Retinitis; Syndrome; Visual Acuity

A pregnant woman presented with acute retinal necrosis syndrome (ARNS) involving both eyes. She had had varicella eruption one month before the onset of the disease. Antibody titer to the varicella-zoster virus was elevated in the aqueous humor of both eyes. To our knowledge, this is the first report which showed apparent association of varicella eruption with ARNS caused by varicella-zoster virus.

Topics: Acyclovir; Adult; Chickenpox; Female; Fundus Oculi; Humans; Necrosis; Ophthalmoscopy; Prednisolone; Pregnancy; Pregnancy Complications; Retinal Diseases; Syndrome

The syndrome of granulomatous angiitis related to varicella zoster virus infection often manifests as herpes zoster ophthalmicus followed by contralateral hemiplegia. Forty-five cases have been reported to date, and the authors' experience with two additional cases seen in a one-year period is described. Given the frequency of both stroke and herpes zoster ophthalmicus in an aging population, the authors postulate that granulomatous angiitis is underdiagnosed. There is need for increased awareness of this disease by the non-neurologist. Diagnostic and therapeutic considerations are reviewed.

Topics: Acyclovir; Adult; Aged; Angiography; Aphasia; Cerebrovascular Disorders; Diagnostic Errors; Hemiplegia; Herpes Zoster Ophthalmicus; Humans; Male; Steroids; Syndrome; Vasculitis

We treated 13 eyes of 12 patients with the acute retinal necrosis syndrome (ARN) with intravenous acyclovir (1500 mg/M2/day) for an average of 10.9 days. All patients were also treated with oral aspirin or Coumadin. in an attempt to prevent thrombotic complications and nine of twelve patients were treated with oral prednisone after intravenous acyclovir had been initiated. Regression of retinal lesions was first seen on average 3.9 days after initiation of therapy and required 32.5 days on average for completion. No eye developed new retinal lesions or progressive optic nerve involvement 48 hours or more after initiation of therapy, although progression within the first 48 hours was occasionally seen. Treatment did not ameliorate vitritis or prevent retinal detachment, which occurred in 11 of 13 eyes, an average of 59 days after the initiation of therapy. There were no evident ocular or systemic complications of therapy. Our data suggest the need for a prospective randomized clinical trial to evaluate the efficacy of intravenous or oral acyclovir in the treatment of the acute retinal necrosis syndrome.

Topics: Acute Disease; Acyclovir; Adolescent; Adult; Child; Drug Evaluation; Female; Humans; Inflammation; Injections, Intravenous; Male; Middle Aged; Retinal Artery; Retinal Detachment; Retinal Diseases; Retinitis; Syndrome; Vision, Ocular; Vitreous Body

Inoue-Melnick virus (IMV) was isolated from the cerebrospinal fluid of patients with chronic neurologic disorders. The effect of acyclovir (ACV), 9-(2-hydroxyethoxymethyl)-guanine, on the growth of IMV was studied in human diploid cell cultures. ACV markedly inhibited the multiplication of all three IMV serotypes in vitro with the same inhibitory effect. By passage of IMV in the presence of ACV in the medium, ACV-resistant mutants of three IMV serotypes were easily isolated.

Topics: Acyclovir; Cell Line; Humans; Multiple Sclerosis; Myelitis; Optic Neuritis; Serotyping; Syndrome; Viruses

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

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

Two patients with acute retinal necrosis were treated with vitrectomy, intravitreal infusion of acyclovir, and prophylactic scleral buckling procedures. Both patients have had a uneventful postoperative course and a recovery of visual acuity; follow-up has been at five and 14 months. There has been no sign of toxicity from the intravitreally administered acyclovir by electroretinographic or clinical criteria.

Topics: Acute Disease; Acyclovir; Adolescent; Female; Humans; Male; Middle Aged; Necrosis; Retina; Retinal Diseases; Scleral Buckling; Syndrome; Vitrectomy; Vitreous Body