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Acyclovir, epidural injection, herpes zoster, varicella zoster virus.
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Among infants and immunocompromised children cytomegalovirus (CMV) is associated with significant morbidity and mortality.
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The case of an 8-year-old male patient who suffered a reactivation of HSV encephalitis after undergoing amygdalohippocampectomy for complex partial seizures is reported. This patient had previously contracted HSV 1 meningoencephalitis at the age of 16 months. Six years later, a left amygdalohippocampectomy was proposed after the development of intractable partial epilepsy associated with left mesial temporal lesions. During the postoperative period, the patient suffered severe clinical deterioration with partial status epilepticus, aphasia, and hyperthermia, which resolved after intensive antiepileptic treatment supported by acyclovir.
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Cytomegalovirus (CMV) is the most common opportunistic infection following lung transplantation. CMV replication in the lung allograft is described as accelerating the development of bronchiolitis obliterans syndrome (BOS). Finding a strategy to prevent CMV infection is an important issue.
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Herpes simplex virus (HSV), a common latent virus in humans, causes certain severe diseases. Extensive use of acyclovir (ACV) results in the development of drug-resistant HSV strains, hence, there is an urgent need to develop new drugs to treat HSV infection. Houttuynia cordata (H. cordata), a natural herbal medicine, has been reported to exhibit anti-HSV effects which is partly NF-κB-dependent. However, the molecular mechanisms by which H. cordata inhibits HSV infection are not elucidated thoroughly. Here, we report that H. cordata water extracts (HCWEs) inhibit the infection of HSV-1, HSV-2, and acyclovir-resistant HSV-1 mainly via blocking viral binding and penetration in the beginning of infection. HCWEs also suppress HSV replication. Furthermore, HCWEs attenuate the first-wave of NF-κB activation, which is essential for viral gene expressions. Further analysis of six compounds in HCWEs revealed that quercetin and isoquercitrin inhibit NF-κB activation and additionally, quercetin also has an inhibitory effect on viral entry. These results indicate that HCWEs can inhibit HSV infection through multiple mechanisms and could be a potential lead for development of new drugs for treating HSV.
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A previously healthy, 37-year-old immunocompetent man presented with disseminated cutaneous zoster and aseptic meningitis. Varicella zoster virus DNA was recovered from the cerebrospinal fluid (CSF) by the polymerase chain reaction. Cytological evaluation of the CSF revealed 'reactive, highly atypical lymphocytosis'. The patient fully recovered after treatment with aciclovir.
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Primer varisella zoster virüs (VZV) enfeksiyonu benign, kendi kendini sınırlayan bir hastalıktır. Bu çalışmada pediatrik malignitesi olan hastalarda VZV enfeksiyonu ve tedavisine odaklı tecrübelerimizi gözden geçirmeyi amaçladık. Çalışma süresi boyunca; VZV enfeksiyonu tanısı alan pediatrik maligniteli toplam 41 hasta hastaneye yatırıldı. Tüm hastalar ortalama 7 gün (5 ila 21 gün arasında değişen) intravenöz asiklovir ile tedavi edildi. VZV enfeksiyonlarına bağlı olarak hesaplanan atfedilebilir kemoterapi gecikmesi ortalama 8 gündü (2 ile 60 gün arasında değişen). VZV enfeksiyonuna bağlı komplikasyonlar 41 hastadan 3’ünde (%7) akut solunum distres sendromu olarak görüldü ve bu hastalardan hemofagositik lenfohistiyositozu olan bir tanesi asiklovir, geniş spektrumlu antibiyotik ve destekleyici tedaviye rağmen solunum yetmezliği nedeniyle kaybedildi. VZV enfeksiyonları, pediatrik malignite hastalarında hala önemli bulaşıcı hastalıklardan biridir, çünkü sadece ciddi mortaliteye sebep olmakla kalmayıp kemoterapi başlangıcını da geciktirmektedir.
In the eight subjects, the mean age was 38 years, mean acute hospital stay (ALOS) was 40.3 days, and mean rehabilitation length of stay (RLOS) was 75.9 days. Mean admission FIM (AFIM) was 40.1, mean discharge FIM (DFIM) was 69.9. Mean FIM gain was 29.8 and mean FIM efficiency was 0.39. Adult subjects with an AFIM > 30 at 5 weeks from onset of illness (n = 4) had a FIM LOS efficiency of 0.64 and all four were discharged home. None of the adult subjects with an AFIM < 30 at 5 weeks from onset of illness (n = 3, FIM efficiency = 0.14) were discharged home. A child with an AFIM < 30 (n = 1) had a FIM LOS efficiency of 1.24, made good recovery and was discharged home. FIM LOS efficiency of 0.64 in encephalitis is less, as compared to traumatic brain injury (TBI -1.27) and stroke (1.06).
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Presentation of a 34-year-old pregnant woman with skew deviation due to peripheral vestibular dysfunction caused by herpes zoster oticus.
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For many years the clinician's arsenal for managing cytomegalovirus (CMV) retinitis included only systematic therapies that required daily infusions via a central venous catheter. The introduction of cidofovir has permitted biweekly maintenance therapy by peripheral IV. Local therapies, such as the ganciclovir intraocular device and intravitreal injections of cidofovir, fomavirsen, or ganciclovir, have reduced toxicity while increasing absorption of drug in the eye. At the same time, due to highly active antiretroviral therapy (HAART), the incidence of CMV retinitis is dropping. Current investigation into the natural history of CMV retinitis in the era of HAART may ultimately result in new management strategies.
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Eight patients, 3 men and 5 women, aged between 24 and 40 years who had herpes zoster ophthalmicus (HZO) were seen in the Eye Department of the University of Nigeria Teaching Hospital, Enugu between 1994 and 1997. One of the patients was already on treatment for active pulmonary tuberculosis at the time he was first seen. All had skin eruptions at different stages of development in the area of distribution of the first trigeminal nerve on the affected side of the face and head. Ocular examination revealed impaired vision in the affected eye (between 6/12 and hand movement) in all the patients. All had lid oedema while 5 had ptosis (3 partial and 2 complete). Various degrees of conjunctival injection were observed in all patients while 6 of them had corneal anaesthesia and keratitis. Uveal inflammation, present in all the patients varied from mild iritis in 4 individuals to severe iridocyclitis in the remaining 4. Pupils reacted to light sluggishly in 2 patients while they were dilated and fixed in 3 others. None had any associated abnormalities in the posterior segment. Six of the patients consented and were screened for human immunodeficiency virus (HIV) infection. Of these, 4, including the patient with pulmonary tuberculosis, tested seropositive while 2 were seronegative. All 8 were treated with topical acyclovir. This was combined with oral acyclovir in one of the patients. Follow-up period was between 2 and 52 weeks. During this period skin eruptions and anterior segment signs improved in 5 patients while remaining stable in 3 others; post-herpetic neuralgia persisted on the affected side in 4 patients. Patients who were HIV seropositive did not recover as quickly or to the same extent as the seronegative ones. It is concluded that HZO infection may indicate underlying HIV infection in young Africans as has been found in whites.
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A 40-year-old Japanese man with acute myeloid leukemia received allogeneic bone marrow transplantation. On day 101, varicella-zoster virus (VZV) infection occurred, but was improved by administration of acyclovir and immunoglobulin. On day 119, he complained of numbness and double vision, and he was admitted due to exacerbation of the symptoms. The findings of cerebrospinal fluid and magnetic resonance image examination were consistent with the diagnosis of immune-mediated encephalomyelitis (IMEM). Intravenous immunoglobulin therapy was effective and his neurological findings dramatically improved without recurrence. IMEM is a rare non-infectious inflammatory demyelinating disease that can occur after transplantation. We herein describe a case report with a review of the associated literature.
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The aim of the study was to investigate the incidence of herpes simplex virus-1 (HSV-1) infection in mucositis during head and neck cancer radiotherapy.
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As soon as encephalitis in pregnancy is suspected, a combination of acyclovir and penicillin is recommended because the potential benefits far outweigh the risks. Using the HSV PCR, HSV infection in the fetus can be diagnosed.
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To evaluate the skin concentrations of the examined agent in 10 healthy male volunteers linear microdialysis probes with 2 kDa molecular-weight cut-off were inserted intradermally and were perfused with Ringer solution up to 6 h after drug ingestion.
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A 31-year-old woman had recurrent mild flare-ups of polymyositis for years. Fourteen days after low-dose methotrexate was added in an attempt to taper the corticosteroid, she began to feel abdominal and lower back pain, followed by generalized pustulosis, severe liver dysfunction, and disseminated intravascular coagulation. On the diagnosis of varicella-zoster virus (VZV) hepatitis, acyclovir, immune globulin and plasmapheresis were given with a favorable outcome. Physicians should be aware that VZV infection could complicate severe hepatitis in immuno-suppressed patients.
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In patients with endemic pemphigus foliaceus, we recommend complete isolation of the patient when receiving high dosages of systemic immunosuppressive agents. We further suggest the clinical possibility of a synergistic, fatal interaction between active pemphigus foliaceus, varicella zoster virus, herpes simplex virus, immunosuppressive agents, and a systemic activation of α-1 antitrypsin. Thus, we suggest adequate bed spacing, barrier nursing, and preventative testing for α-1 antitrypsin activation are warranted in these patients to address these complications.
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Varicella-zoster virus (VZV) can be fatal or cause severe complications in children with acute lymphoblastic leukemia (ALL). This analysis set out to investigate the morbidity and mortality of VZV vaccination without interruption of maintenance therapy in children with ALL.
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HIV/AIDS-related immune alteration poses many diagnostic and therapeutic challenges. HIV-positive 44-year-old male, on second-line antiretroviral therapy (ART) presented with asymptomatic non healing, well-defined, erythematous ulcer over penis since 8 months with serosanguinous discharge. Inguinal lymph nodes were not palpable. Tzanck smear was negative. Biopsy was not done as the patient was not willing for the same. Acyclovir was given considering herpes infection to which there was no response, and hence azithromycin and metronidazole were given, without improvement. Minocycline was given to take care of possible atypical mycobacterial infection. Due to lack of response, corticosteroid was given for 2 weeks keeping in mind possibility of vasculitis, but there was no improvement. Although investigations to rule out tuberculous etiology were negative, empirical anti-Koch's therapy Category 2 was given without response even after 3 months. Finally, a biopsy was taken from lesion which was suggestive of donovanosis. Trimethoprim Sulfamethoxazole in higher dose was started to which he responded after 2 weeks, and therapy was continued till complete response. Patient is on second-line ART for last 7 years. He is clinically stable, but his CD4 count is hovering at around 250-300 suggestive of ART failure. Virological evaluation was not feasible. Diagnostic challenges posed include possibility of resistant bacterial, viral infection, vasculitis, or drug reaction in a setting of probable ART failure.
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CMV DNA was found in none of the donors, 95 recepients. Severity of clinical symptoms in blood carriers of CMV correlated with the level of DNA CMV (p < 0.001). 85% of those with high levels of DNA CMV (1000 per 10(5) leukocytes) had acute clinical symptoms. 15.8% of all the PCR-positive patients had no symptoms at the time of the examination. Specific antivirus ganciclovir therapy was given to 50% of PCR-positive patients and to 85% of those who had DNA CMV higher than 1000 c. per 10(5) leukocytes. The treatment resulted in a sharp fall or disappearance of DNA CMV and symptoms of CMV disease.