Acyclovir References

1: Oftalmologia. 2005;49(1):72-7.

Antiherpetical therapy

Dediulescu L, Dediulescu DF.

Spitalul Municipal Ramnicul Sarat.

The development of the antiherpetic therapeutical system was remarkable in the last decade. Nucleoside analogs (5-iodine-2-deoxiuridine, citodine-arabinotide, adenine-arabinotide), as well as specific inhibitors of viruses (Zovirax or Acyclovir) are active medicines for both local and wide-spread forms of the herpes virus infection.

2: J Pak Med Assoc. 2005 Apr;55(4):146-8.

Herpes simplex encephalitis: analysis of 68 cases from a tertiary care hospital in Karachi, Pakistan.

Mekan SF, Wasay M, Khelaeni B, Saeed Z, Hassan A, Sheerani M.

Department of Medicine and Neurology, The Aga Khan University, Karachi.

OBJECTIVE: To evaluate clinical presentation, radiological and cerebrospinal fluid findings and outcome of patients with Herpes simplex encephalitis (HSE). METHODS: The charts of all the patients (n = 88), who were admitted to The Aga Khan University, Karachi with diagnosis of HSE, from 1990-2002, were retrospectively reviewed. Sixty eight patients were included in the study. The variables were identified (including demographic data, signs and symptoms at presentation and laboratory investigations such as CSF analysis including, PCR, serum IgM antibodies, EEG and neuroimaging). The patients were included in the study if they had any three of the five criteria positive in addition to clinical features suggestive of herpes encephalitis. RESULTS: Sixty eight patients, that fulfilled the criteria, were included in the study. Clinical findings included fever, seizures, altered mental status, aphasia and hemiparesis. CSF, analysed in all the patients, was abnormal in 65 patients (96%) and EEG was abnormal in 82% patients. All patients underwent CT or MRI of the brain, 66% patients had abnormal scans. Temporal lobe involvement was seen in 34 patients (50%) and 11 patients had purely extra temporal lesions. All patients were treated with standard Acyclovir. Seven patients died. At the time of discharge, 17 patients showed normal neurological examination, 29 were ambulatory with assistance and 15 were bedridden. CONCLUSION: Our study suggests that large number of patients with HSE have extra temporal involvement on CT or MRI. Majority of patients had complete or good recovery after completion of therapy.

3: J Trop Pediatr. 2005 May 25;

Acute Hemorrhagic Leukoencephalitis Manifesting as Intracerebral Hemorrhage Associated with Herpes Simplex Virus Type I.

Kabakus N, Gurgoze MK, Yildirim H, Godekmerdan A, Aydin M.

Department of Pediatric Neurology, Firat University Faculty of Medicine, Elazig, Turkey.

Acute hemorrhagic leukoencephalitis (AHL) is a rare and usually fatal disorder characterized by an acute onset of neurological abnormalities. It may occur in association with a viral illness or vaccination. Radiology and brain biopsy are essential for the diagnosis. We present a case of AHL mimicking or manifesting as intracerebral hemorrhage associated with herpes simplex virus. A 3-year-old boy was admitted to our hospital with cerebral hemorrhage. The findings of cerebrospinal fluid, MRI and electroencephalogram indicated acute hemorrhagic leukoencephalitis associated with herpes simplex virus involving the left parietal cortex (hemorrhage) and the right temporal lobe (encephalitis). The patient received intravenous dexamethasone (1.5 mg/kg/24 h divided q6 (six times a day) for 5 days, tapered slowly to discontinuation over the next 5 days) and aciclovir (15 mg/kg/every 6 h for 14 days). His clinical condition markedly improved, and after 3 weeks he was discharged from the hospital with moderate right hemiparesis. Mild hemiparesis with normal psychometric testing was determined when he was checked 6 months later. AHL remains misdiagnosed as viral encephalitis because it produces different protean clinical forms. Pediatric patients admitted with cerebral hemorrhage and infarct should be evaluated for presence of hemorrhagic encephalitis-causing agents, especially for herpes simplex. Since, as in our case, treatment with corticosteroid and acyclovir markedly improves conditions of herpes simplex-caused AHL, we suggest that early diagnosis and treatment is of importance for the prognosis.

4: Rinsho Shinkeigaku. 2005 Apr;45(4):293-7.

A case of brainstem encephalitis caused by herpes simplex virus type 1 with possible infection via trigeminal nerve]

Yoshidome Y, Hayashi S, Maruyama Y.

Department of Neurology, Imakiire General Hospital.

A 24-year-old man was admitted to our hospital because of consciousness disturbance, a stiff neck and various brainstem symptoms including a right one-and-a-half syndrome and right peripheral facial palsy a week after an episode of pharyngitis and right facial herpes simplex. Magnetic resonance imaging of the brain on admission showed high-signal intensities in the right pontine tegmentum, right cerebellar peduncle and vermis on fluid-attenuated inversion recovery imaging. Examination of cerebrospinal fluid yielded mononuclear pleocytosis, elevated protein and increased IgM antibodies to herpes simplex virus (HSV) by enzyme immunoassay. HSV-1 specific antibodies also were detected in serum by neutralization test. We gave a diagnosis of brainstem encephalitis caused by HSV-1. The patient was successfully treated with high dose of acyclovir, steroid and intravenous immunoglobulin. He was discharged without any neurologic sequelae. We herein presented a case of atypical encephalitis due to HSV-1 involving mainly the brainstem with possible infection via right trigeminal nerve and summarized recent 35 cases with herpetic brainstem encephalitis since 1990.

5: Contemp Clin Trials. 2005 Jun;26(3):300-10. Epub 2005 Mar 4.

Effect of acyclovir on herpetic ocular recurrence using a structural nested model.

Cole SR, Chu H.

Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street-Room E7640, Baltimore, MD 21205, United States.

Noncompliance with assigned therapies is ubiquitous in randomized clinical trials. Treatment effects may be corrected for noncompliance using Robins' structural nested models, but few examples have been published. The Herpetic Eye Disease Study randomized 703 ocular herpes patients to 365 days of acyclovir or placebo between 1992 and 1996, and achieved over 90% compliance in both arms. The hazard of recurrence in the acyclovir arm was 0.55 times the hazard in the placebo arm using an intent-to-treat approach (95% confidence interval [CI]: 0.41, 0.75). Assuming a structural nested model with a Weibull distribution, the hazard of recurrence under constant exposure to acyclovir was 0.41 times that of the non-exposed (test-based 95% CI: 0.28, 0.72), or 34% larger than the intent-to-treat estimate. Notwithstanding excellent compliance, intent-to-treat estimates may notably undervalue the causal effect of a treatment.

6: Rev Neurol. 2005 May 1-15;40(9):537-40.

Herpes simplex encephalitis in Caceres. An analysis of the last five years.

Sanchez Munoz-Torrero JF, Luengo-Alvarez J, Casado-Naranjo I, Ramirez-Moreno JM, Ruiz-Llano F, Costo-Campoamor A.

Hospital General San Pedro de Alcantara, Caceres, Espana.

INTRODUCTION. Herpes simplex encephalitis (HSE) is a rare disease, although it is still the most common serious viral infection of the central nervous system. Little is currently known about its epidemiology and clinical features in our area. This paper presents a retrospective description of the clinical, diagnostic and progressive characteristics of patients diagnosed with HSE in Caceres General Hospital, and confirmed by means of a polymerase chain reaction (PCR) study for the DNA of the herpes simplex virus over the last 5 years. CASE REPORTS. We found four patients who had been diagnosed with HSE in the last 5 years (3.3 cases/million inhabitants/year; CI at 95% of 2.42-4.18), two males and two females, with an age interval between 58 and 75 years. All the patients had high temperatures and three of them also presented neurological focus. A computerised axial tomography scan of the head performed on admission was interpreted as being normal in all cases, while magnetic resonance imaging of the head carried out in two patients showed lesions compatible with HSE in both cases. Electroencephalographic studies were carried out in two patients and revealed focusing in one of them and severe generalised involvement in the other. Analysis of the cerebrospinal fluid (CSF) disclosed lymphocytic meningitis in four cases, although in one of them the study was normal on admission. In two of the patients, viral meningoencephalitis was suspected from the moment the patient was admitted to hospital. For this reason, early treatment with IV acyclovir was established and the clinical progression was good in both patients, although one of them was left with mild neurological sequelae. The other two cases, who died, had a severe underlying pathology and alternative clinical diagnoses that were reasonable on admission (extensive pneumonia and delirium tremens in one of them, and hypercapnic encephalopathy with severe chronic obstructive pulmonary disease in the other), and the clinical suspicion of HSE and the establishment of treatment were late. CONCLUSIONS. The incidence of HSE in our environment is in the upper interval of that reported in the literature. PCR analysis for the herpes simplex virus in CSF seems to have replaced brain biopsy studies as the diagnostic technique. The underlying severe chronic pathology makes it more difficult to diagnose and worsens the prognosis. A multicentre epidemiological study should be conducted to confirm these findings.

7: Skinmed. 2005 May-Jun;4(3):186-7.

Case study: inoculation herpes barbae.

Parlette EC, Polo JM.

Naval Hospital, Okinawa, Japan ecparlette@hotmail.com.

A 21-year-old white man in otherwise excellent general health was referred for a painful, progressive, facial eruption with associated fever, malaise, and cervicofacial lymphadenopathy. The patient reported that a vesicular eruption progressed from the left side of his face to also involve the right side of his face over the 48 hours preceding his clinic visit. He also reported some lesions in his throat and the back of his mouth causing pain and difficulty swallowing. Four to 7 days before presentation to us, the patient noted exposure to his girlfriend's cold sore. Additionally, he complained of a personal history of cold sores, but had no recent outbreaks. Physical examination revealed a somewhat ill man with numerous vesicles and donut-shaped, 2-4 mm, crusted erosions predominantly on the left side of the bearded facial skin. There were fewer, but similar-appearing lesions, on the right-bearded skin. The lesions appeared folliculocentric (Figure). Cervical and submandibular lymphadenopathy was present. Oral exam showed shallow erosions on the tonsillar pillars and soft palate. Genital examination was normal. The remainder of the physical exam was unremarkable. A Tzanck smear of vesicular lesions was positive for balloon cells and many multinucleated giant cells with nuclear molding. A viral culture was performed which, in several days, came back positive for herpes simplex virus. The complete blood cell count documented a white blood cell count of 8000/mm3 with 82.6% neutrophils and 9.0% lymphocytes. Based on the clinical presentation and the positive Tzanck smear, the patient was diagnosed with herpes simplex barbae, most likely spread by shaving. The patient was started on acyclovir 200 mg p.o. five times daily for 10 days. Oxycodone 5 mg in addition to acetaminophen 325 mg (Percocet; Endo Pharmaceuticals, Chadds Ford, PA) was prescribed for pain relief. A 1:1:1 suspension of viscous lidocaine (Xylocaine; AstraZeneca Pharmaceuticals LP, Wilmington, DE), diphenhydramine (Benadryl; Pfizer Inc., New York, NY), and attapulgite (Kaopectate; Pfizer Inc., New York, NY) was given as a swish and spit to relieve the oral discomfort. Good hygiene, no skin-to-skin contact with others, and no further shaving to prevent autoinoculation were stressed. He was advised to discard his old razor.

8: Fitoterapia. 2005 Jun;76(3-4):374-378.

Antiviral evaluation of plants from Brazilian Atlantic Tropical Forest.

Andrighetti-Frohner CR, Sincero TC, da Silva AC, Savi LA, Gaido CM, Bettega JM, Mancini M, de Almeida MT, Barbosa RA, Farias MR, Barardi CR, Simoes CM.

Laboratorio de Virologia Aplicada, Universidade Federal de Santa Catarina, UFSC, Campus Universitario Trindade, Florianopolis, SC, Brazil; Departamento de Ciencias Farmaceuticas, Universidade Federal de Santa Catarina, UFSC, Campus Universitario Trindade, Florianopolis, SC, Brazil.

The antiviral activity of six medicinal plants from Brazilian Atlantic Tropical Forest was investigated against two viruses: Herpes simplex virus type 1 (HSV-1) and poliovirus type 2 (PV-2). Cuphea carthagenensis and Tillandsia usneoides extracts showed the best antiherpes activity. T. usneoides dichloromethane, ethyl acetate and n-butanol extracts, and Lippia alba n-butanol extract showed inhibition of HSV-1, strain 29R/acyclovir resistant. In addition, only L. alba ethyl acetate extract showed antipoliovirus activity. These results corroborate that medicinal plants can be a rich source of potential antiviral compounds.

9: Arch Pediatr. 2005 May;12(5):526-32.

Infectious complications postengrafment in the first year after autologous stem cell transplantation in children

Ben Salah H, Coze C, Gentet JC, Lautraite C, Andre N, Bernard JL.

Service d'oncologie pediatrique, hopital d'enfants de la Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France. hassen.bensalah@planet.tn

BACKGROUND: Studies on the infectious complications postengrafment in pediatric stem cell transplantation patients are rare. The aim of this study was to assess the incidence, types, outcome and factors affecting late infections. PATIENTS AND METHODS: A single-institution retrospective analysis was done of infections recorded in the first year following engrafment in children who underwent autologous stem cell transplantation for solid tumors from January 1991 to December 2000. A systematic antimicrobial chemoprophylaxis of TMP/SMX was administered. Patients who were at high risk for varicella-zona virus infection received prophylactic acyclovir. RESULTS: Eighty-four assessable patients were enrolled. Fifty-four patients (64%) underwent autologous peripheral blood stem cell transplantation and 30 patients (36%) underwent bone marrow transplantation. Forty-nine episodes of infections were documented in 39 patients (46%) of whom 27 patients (32%) developed infections after the first 100 days post transplantation. Bacterial septicemia occurred in nine patients of whom four patients had a catheter-related septicemia. Twelve patients (14%) developed localized herpes zoster infection. Local fungal infection occurred in five patients. Infection-related death occurred in one patient with non-documented pneumonitis. Univariable analysis showed a correlation between the CD34(+) cell dose <7.5 10(6)/kg and the development of infections (P =0.04). Patients who did not go into remission after transplantation where at high risk for septicemia (P =0.007). Multivariate analysis showed that a history of varicella or pretransplant varicella-zona positivity was the only significant factor for development zoster infection (P =0.01). CONCLUSION: Our study shows that infections in the first year postengrafment following autologous stem cell transplantation for solid tumors have a good prognosis and that the use of TMP/SMX should be the single systematic antimicrobial prophylaxis. The CD34(+) cell dose seems to play a role in preventing late infections.

10: Microbiol Res. 2005;160(2):159-64.

Antibacterial, antifungal, and antiviral activities of the lipophylic extracts of Pistacia vera.

Ozcelik B, Aslan M, Orhan I, Karaoglu T. Department of Pharmaceutical Microbiology, Faculty of Pharmacy, Gazi University, 06330 Ankara, Turkey.

In the present study, antibacterial, antifungal, and antiviral properties of 15 lipohylic extracts obtained from different parts (leaf, branch, stem, kernel, shell skins, seeds) of Pistacia vera were screened against both standard and the isolated strains of Escherichia coli, Pseudomonas aeruginosa, Enterococcus faecalis, Staphylococcus aureus, Candida albicans and C. parapsilosis by microdilution method. Both Herpes simplex (DNA) and Parainfluenza viruses (RNA) were used for the determination of antiviral activity of the P. vera extracts by using Vero cell line. Ampicilline, ofloxocine, ketoconazole, fluconazole, acyclovir and oseltamivir were used as the control agents. The extracts showed little antibacterial activity between the range of 128-256 microg/ml concentrations whereas they had noticeable antifungal activity at the same concentrations. Kernel and seed extracts showed significant antiviral activity compared to the rest of the extracts as well as the controls.