Acyclovir scientific update |
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Graefes Arch Clin Exp Ophthalmol. 2007 May 4;
Lauretti P, Micera A, Ghinelli E, Aloe L, Rama P, Bonini S.
Interdisciplinary Center for Biomedical Research (CIR), Laboratory of Ophthalmology, University Campus Bio-Medico of Rome, Via E. Longoni, 83 00155, Rome, Italy.
Topical treatment with nerve growth factor in an animal model of herpetic keratitis.
Effectiveness of topical treatment with nerve growth factor in a herpetic keratiti animal model.
BACKGROUND: In vitro and in vivo studies demonstrated the antiviral efficacy of nerve growth factor (NGF) and its
cyto-protective effect in herpes simplex virus (HSV)-infected cells. The aims of this study were to evaluate the
role of endogenous NGF in HSV corneal infection, and the effects of topical NGF treatment on herpetic keratitis.
METHODS: Herpetic keratitis was induced in 40 rabbits with the HSV-1 McKrae strain. Animals were divided into four
groups, and treated with topical neutralizing anti-NGF antibodies, NGF, acyclovir or balanced salt solution (BSS)
respectively. The clinical course of HSV keratitis was evaluated and scored by slit-lamp examination. In addition,
biochemical (immunohistochemistry for glycoprotein D) and molecular (nested PCR for glycoprotein D) analyses were
carried out to estimate viral replication. RESULTS: Treatment with anti-NGF antibodies induced a more severe
keratitis associated with increased biochemical and molecular markers of active viral replication. Two animals in
this group developed lethal HSV encephalitis. Conversely, topical treatment with NGF induced a significant
amelioration of clinical and laboratory parameters when compared to the BSS treated group (control). No significant
differences were observed between NGF- and acyclovir-treated groups. CONCLUSIONS: This study demonstrated the
crucial role of endogenous NGF in herpetic keratitis. The comparable effects of NGF and acyclovir confirm the
antiviral activity of NGF, and indicate a potential use of topical NGF in herpetic keratitis.
Ann Dermatol Venereol. 2007 Apr;134(4):369-73.
Kluger N, Boutboul D, Molinari E, Haroche J, Rozenberg F, Amoura Z, Frances C.
Universite Montpellier I, Service de Dermatologie, Hopital Saint Eloi, CHU Montpellier.
Acute hepatitis during primary herpes simplex type 2 infection in a patient with systemic lupus erythematosus.][Article in French
Primary herpes simplex type 2 infection in a patient who is affected with systemic lupus erythematosus and acute hepatitis.
BACKGROUND: Herpes simplex virus hepatitis is a rare complication associated with a poor prognosis and a high
mortality rate. It mainly affects adults with impaired cell-mediated immunity. Mucocutaneous involvement is seen in
only 57% to 70% of patients and the clinical aspects of the lesions may sometimes be misleading. Here we report a
new case that developed during primary HSV-2 infection in a patient with systemic lupus erythematosus.CASE REPORT:
A 57 year-old man with systemic lupus erythematosus treated with oral prednisone presented a disseminated
varicella-like eruption with acute liver failure related to primary genital HSV-2 infection. Type-specific HSV
deoxyribonucleic acid amplification by polymerase chain reaction on serum and oral lesion samples revealed type 2
HSV. Dramatic improvement was observed with parenteral acyclovir.DISCUSSION: Hepatitis due to HSV is a rare but
potentially fatal disorder chiefly affecting adults with impaired immune systems. In this case, HSV affects the
liver during primary or recurrent infection. If initiated quickly, parenteral acyclovir can cure hepatitis, which
means that this diagnosis must be considered in both immunocompromised and immunocompetent patients with high
fever, leucopoenia and marked elevation of aminotransferase levels. Mucocutaneous signs are present in only 57 to
70% of cases. Careful physical examination to detect herpes lesions should be done in all cases of acute liver
failure. HSV viremia testing may confirm the diagnosis by non-invasive means. Patients with systemic lupus
erythematosus are at increased risk for infection due to immunosuppressive drugs, but also to numerous intrinsic
immunologic abnormalities such as a recently reported deficit in NK cells and plasmacytoid dendritic cells.
Am J Med Sci. 2007 Mar;333(3):191-3.
Chen LI, Chang JM, Kuo MC, Hwang SJ, Chen HC.
From the Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Combined herpes viral and candidal esophagitis in a CAPD patient: case report and review of literature.
Reports and reviews of literature of a CAPD patient with combined herpes viral and candidal esophagitis.
Concomitant herpetic and candidal esophagitis is a very rare disease that had not been reported in uremic patients.
A 57-year-old woman receiving continuous ambulatory peritoneal dialysis (CAPD) therapy for 3 years was admitted due
to CAPD-related peritonitis. Endoscopic examination was performed due to severe epigastralgia and upper
gastrointestinal bleeding, and combined herpetic and candidal esophagitis was diagnosed. Intravenous acyclovir and
fluconazole were prescribed and symptoms improved. The patient subsequently died due to progressive sepsis and
respiratory failure. This is the first report of a dual infectious esophagitis in a uremic patient. Since
infectious esophagitis may cause severe complications, early diagnosis and aggressive treatment are important.
Cornea. 2006 Dec;25 Suppl 1:S64-7
Higaki S, Itahashi M, Deai T, Fukuda M, Shimomura Y.
From the Department of Ophthalmology, Kinki University School of Medicine, Osaka, Japan.
Effect of oral valaciclovir on herpetic keratitis.
Oral valaciclovir medication for herpetic keratitis .PURPOSE:: To examine the efficacy of valaciclovir (VACV) oral formulation as an alternative to topical treatments in a case of herpetic keratitis. METHODS:: The patient was a 61-year-old man who presented with dendritic keratitis in his left eye. After recognizing his difficulty in using eye ointment, we prescribed oral VACV 500 mg tablets twice daily for 7 days. We also describe our experiments with orally administered VACV in a mouse model of this disease. In this study, 143 Balb/c mice were inoculated with herpes simplex virus type 1 (HSV)-1 in each eye and treated with oral VACV 50 or 100 mg/kg twice daily, oral acyclovir (ACV) 50 mg/kg 5 times/d, 3% ACV eye ointment (ACV-O) 5 times/d, 3% ACV eye drops 5 times/d, or control for 5 days. RESULTS:: After 7 days, the patient's lesion was observed healed. Corrected left visual acuity was also improved, and HSV DNA was below detectable level. In the mouse study, slit-lamp examination on days 3, 4, 5, and 7 revealed that all 5 ACV and VACV treatment groups were significantly more effective in improving symptoms of herpetic epithelial keratitis versus control (P < 0.05). Moreover, VACV 100 mg/kg was superior to other treatments. Viral titers in mouse eyeball and trigeminal ganglia were lowest in the VACV 100 mg/kg group versus other treatment groups. CONCLUSION:: Our case example suggests that when frequent application, blurred vision, and foreign body sensation after ACV-O application cause difficulty for patients to follow treatment, oral VACV might be an effective and safe option for patients with herpetic keratitis.
J Viral Hepat. 2005 Jan;12(1):2-9.
Niro GA, Rosina F, Rizzetto M.
Division of Gastroenterology, Hospital 'Casa Sollievo Della Sofferenza', IRCCS, San Giovanni Rotondo (FG), Italy.
Treatment of hepatitis D.
Hepatitis D treatment methodology .Summary. Delta virus related chronic hepatitis is difficult to treat. The response to alpha-interferon (IFN), which still represents the only therapy for chronic hepatitis D, varies widely and occurs at different times from the beginning of treatment. The rate of response is proportional to the dose of IFN, with 9 million units (MU) three times a week being more effective than 3 MU thrice weekly. Sustained responses are unusual and are accompanied by the clearance of serum hepatitis B virus surface antigen (HBsAg), seroconversion to anti-HBs and improvement of liver histology. Although disease of a short-standing may respond better to therapy, clear predictors of response are still unidentified. Besides IFN, other therapeutic approaches such as immunosuppressive drugs, acyclovir, ribavirin and thymosin, have been unhelpful. Available evidence does not support the use of deoxynucleotide analogues. Famciclovir has no effect on disease activity and hepatitis D virus (HDV)-RNA levels. Twelve- or 24-month lamivudine treatment does not significantly affect biochemical, virological or histological parameters. Pegylated-IFN could represent a reasonable therapeutic option in the long-term treatment required for chronic hepatitis D. Antisense oligonucleotides and prenylation inhibitors hold promise as therapeutic agents of the future. Liver transplantation provides a valid option for end-stage HDV liver disease; the risk of re-infection is lower for HDV than for HBV under long-term administration of hyperimmune serum against HBsAg. Molecularly tailored drugs capable of interfering with crucial viral replicative processes of HDV appear to be the best prospect in the treatment of hepatitis D.
Semin Pediatr Infect Dis. 2005 Jan;16(1):7-16.
Kimberlin DW, Whitley RJ.
Neonatal herpes: What have we learned.
What is Neonatal herpes simplex virus (HSV) infection?
Neonatal herpes simplex virus (HSV) infection usually is acquired during the birth process, as the neonate comes in contact with the virus during passage through an infected birth canal. After an incubation period which can last as long as 2 to 4 weeks, neonatal HSV disease then manifests in 1 of 3 ways: (1) disseminated disease, with visceral organ involvement (including infection of the brain in two-thirds to three-quarters of patients); (2) central nervous system disease (with no other visceral organ involvement, but with skin lesions in two-thirds of patients); or (3) disease limited to the skin, eyes, and/or mouth (ie, SEM disease). Diagnostic advances in recent years have focused primarily on applying polymerase chain reaction technology to babies suspected of having neonatal HSV disease. Treatment of neonatal HSV disease with intravenous acyclovir has improved the likelihood of survival substantially, although neurologic morbidity remains a common sequelae, especially among survivors of central nervous system disease. Despite these advances, the duration of time from onset of symptoms and initiation of antiviral therapy has remained unchanged for the past 20 years. The surest way to improve outcomes rapidly at this point is to raise awareness of neonatal HSV disease, resulting in the establishment of earlier diagnoses and more rapid institution of antiviral therapy. In the longer term, development of a bedside nucleic acid detection kit for real-time detection of HSV DNA in the maternal genital tract at the time of delivery could identify which babies are at risk of developing neonatal HSV disease.
Croat Med J. 2005 Jun;46(3):458-62.
Copur MS, Deshpande A, Mleczko K, Norvell M, Hrnicek GJ, Woodward S, Frankforter S, Mandolfo N, Fu K, Chan WC.
M. Sitki Copur, Saint Francis Cancer Center, 2116 W Faidley Ave, Grand Island, NE 68802-9804, USA,
Full clinical recovery after topical acyclovir treatment of epstein-barr virus associated cutaneous B-cell lymphoma in patient with mycosis fungoides.
Topical acyclovir treatment of epstein-barr virus linked cutaneous B-cell lymphoma and full recovery after the treatment in a patient with mycosis fungoides.
Primary cutaneous T- and B-cell lymphomas are a heterogeneous group of diseases with varied clinical presentations and prognosis. The use of new molecular, histological, and clinical criteria has improved their recognition. Cutaneous B-cell and T-cell lymphomas are seldom found together in the same patient. Here we report a rare case of mycosis fungoides variant of a cutaneous T-cell lymphoma (CTCL) which later developed Epstein-Barr virus (EBV) associated cutaneous B-cell lymphoproliferative disorder. The patient initially presented with generalized erythroderma, extensive plaques, and axillary lymphadenopathy. Histopathology and immunophenotyping of her tumor from the right breast nodule revealed a T-cell lymphoma consistent with mycosis fungoides. She was initially treated with pentostatin, followed by topical mechlorethamine and topical steroids. After progression of her mycosis fungoides with worsening diffuse skin lesions on this regimen, her treatments were changed to oral bexarotene with an initial partial response followed by stable disease. Three years from her initial presentation, she developed ulcerated cauliflower-like nodules on her forehead. Biopsy of these lesions revealed EBV-positive large- and medium-sized pleomorphic B-cells consistent with EBV-driven B-cell lymphoproliferative disorder. She was treated with topical acyclovir cream on the involved skin areas while continuing with oral bexarotene for mycosis fungoides. Skin lesions gradually diminished and totally disappeared after four weeks of topical acyclovir treatment. Bexarotene treatment was continued for another year until the mycosis fungoides progressed and became wide spread causing her death four and a half years after the initial diagnosis. The coexistence of two cutaneous non-Hodgkin lymphomas of different lineage in the same patient and the complete clinical response of EBV-related B-cell cutaneous component to topical acyclovir makes this rare case particularly interesting.
Skinmed. 2005 May-Jun;4(3):186-7.
Parlette EC, Polo JM.
Naval Hospital, Okinawa, Japan
Case study: inoculation herpes barbae.
A detailed study on inoculation herpes barbae. 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.
Acyclovir description...
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Drug category:Antibacterial and antiviral agent
 Acyclovir scientific update
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