|
Int J Antimicrob Agents.
2000 Oct; 16(2): 157-9. |
Antiviral therapy of herpes
simplex.
Snoeck R.
Rega Institute for
Medical Research, K.U. Leuven, Minderbroedersstraat 10, B-3000 Leuven, Belgium.
robert.snoeck@rega.kuleuven.ac.be
Herpes simplex virus
(HSV) infections in immunocompromised patients are more severe and invasive
than in non-immunocompromised patients. They are characterised by prolonged
viral shedding and a tendency to heal more slowly. In addition, resistant
viruses are exclusively isolated in immunocompromised patients, requiring other
drugs with distinct mechanisms of action. The reference compound for the
treatment of HSV infections is acyclovir (ACV) that selectively inhibits HSV
DNA replication with low host-cell toxicity. Recently, two molecules,
valaciclovir (VACV), the L-valyl ester of ACV and famciclovir (FCV), the
diacetyl ester of 6-deoxy-penciclovir (PCV), another potent nucleoside
analogue, were developed showing an increased oral bioavailability compared to
the original compounds. Foscavir (PFA) and more recently cidofovir (CDV) are
drugs that do not need the viral thymidine kinase (TK) to be activated and
therefore are the appropriate candidates for the treatment of resistant viruses
emerging under acyclovir or penciclovir.
PMID: 11053800 [PubMed
- indexed for MEDLINE]
|
Pediatr Infect Dis J. 2001
Nov; 20(11): 1094-7. |
|
Development of
acyclovir-resistant herpes simplex virus early during the treatment of herpes
neonatorum.
Levin MJ, Weinberg A, Leary JJ, Sarisky RT.
Section of Infectious
Diseases Department of Pediatrics University of Colorado School of Medicine
Denver, CO, USA.
Genotypic analysis of
herpes simplex virus (HSV) DNA extracted from clinical specimens from a case of
fatal disseminated neonatal HSV demonstrated that an infant developed an
acyclovir-resistant HSV containing a mutation in the HSV thymidine kinase gene
during the first seven days of acyclovir therapy.
PMID: 11734722 [PubMed -
indexed for MEDLINE]
|
Clin Infect Dis. 1997 Mar;
24(3): 334-8. |
Comment in: Clin
Infect Dis. 1998 Mar;26(3):773-4.
Herpes simplex virus
hepatitis: case report and review.
Kaufman B, Gandhi SA, Louie E, Rizzi R, Illei P.
Department of
Anesthesiology, New York University Medical Center, New York 10016, USA.
Hepatitis is an
unusual manifestation of herpesvirus infection. Herpes simplex virus hepatitis
is a difficult diagnosis to establish, and the infection is often fatal. We
report one case of herpes simplex virus hepatitis and review 51 cases in the
literature. Impaired immunity resulting from pregnancy, malignancy,
immunosuppression, or inhalational anesthetics may be predisposing factors.
Fever, nausea, vomiting, abdominal pain, leukopenia, thrombocytopenia,
coagulopathy, and a marked rise in serum transaminase levels are invariably
present. Liver biopsy is the procedure of choice for diagnosis. The liver
appears mottled and has a minimal inflammatory response. Mortality rates
associated with herpes simplex virus hepatitis are high, and early diagnosis
and treatment with acyclovir or vidarabine may produce a favorable outcome.
PMID: 9114181 [PubMed
- indexed for MEDLINE]
|
Arch Pediatr. 1994 Sep;
1(9): 822-5. |
[Neonatal herpes simplex
hepatitis with favorable outcome after treatment with acyclovir]
[Article in French]
Pilorget H, Estoup C, Mariette JB, Fourmaintraux A.
Service de neonataologie
et reanimation neonatale, CHG de Saint-Pierre, Le Tampon, France.
BACKGROUND--Herpes
simplex virus (HSV) may cause severe disease in the neonate with high mortality
and devastating sequellae. This infection presents exceptionally as isolated
fulminant hepatitis. CASE REPORT--An 8 day-old baby was admitted because of
seizures, fever and vomiting. Initial investigations including CSF analysis
were negative and the patient was given ampicillin plus netilmicin. Two skin
vesicles were seen 5 days later containing HSV. A second CSF analysis was
negative as was the brain scan. At that time, liver involvement was evident:
ASAT 3700 IU/l; ALAT 1035 IU/l; prothrombin 37%; fibrinogen 1 g/l. Hemogram
showed WBC: 2,500/mm3 and PNN: 702/mm3. The patient was given acyclovir 40
mg/kg/day IV. Blood and CSF culture remained negative; CSF interferon
concentration was 4 IU/ml. Serologic investigations in both parents were
inconclusive. The disease worsened rapidly with consumption coagulopathy
requiring ventilation support. The dose of acyclovir was increased to 60
mg/kg/day, 9 days after admission. Improvement was noted on the 10th day and
acyclovir was administered orally on the 21st day. The condition was completely
normal 6 months later. CONCLUSION--Early administration of acyclovir may favor
complete recovery of neonatal HSV hepatitis.
PMID: 7842127 [PubMed
- indexed for MEDLINE]
|
Am J Dis Child. 1981 Jan;
135(1): 45-7. |
Fatal disseminated herpes
simplex virus infection in a healthy child.
Moedy JL, Lerman SJ, White RJ.
A well-nourished,
immunocompetent 11-month-old boy died of disseminated herpes simplex virus
infection that caused severe hepatic damage. Herpes simplex virus is rarely a
cause of fulminant hepatitis in a healthy person beyond the neonatal period.
PMID: 7457443 [PubMed
- indexed for MEDLINE]
|
Eur J Pediatr. 1990 May;
149(8): 555-9. |
Three cases of neonatal
herpes simplex virus infection presenting as fulminant hepatitis.
Benador N, Mannhardt W, Schranz D, Braegger C, Fanconi
S, Hassam S, Talebzadeh V, Cox J, Suter S.
Department of
Paediatrics, Hopital cantonal Universitaire, Geneve, Switzerland.
We report three cases
of neonatal herpes simplex virus (HSV) infection presenting as fulminant
hepatitis. None of the patients had clear risk factors for HSV infection and
they all died. Antiviral treatment for HSV is currently available but must be
administered early in the course of the disease before irreversible liver
tissue damage is present. Since the diagnosis may be difficult to establish, we
wish to draw the attention of clinicians to the presentation of neonatal HSV
infection and suggest that in such cases viral cultures, including culture of
liver tissue, should be obtained early and antiviral treatment administered while
awaiting the culture results.
PMID: 2161341 [PubMed
- indexed for MEDLINE]
|
Pediatrie. 1992; 47(6): 445-9. |
[Neonatal
herpes: recurrence after treatment with acyclovir]
[Article in French]
Le Gall MA, Boccara JF, Francoual C,
Houang M, Lebon P, Badoual J.
Service de pediatrie B, hopital Saint-Vincent-de-Paul, Paris, France.
A case of cutaneous herpes relapse with meningitis is reported in a 1.5
month-old infant treated during the first three weeks of life with acyclovir
(ACV) for a neonatal herpes infection. Such a relapse has previously been
described in older children as well as in adults. In this case report, there
was immunological response to herpes virus infection, 2.5 months after the
onset of the infection. The relapse is discussed taking into account the
mechanism of action of ACV, the age of the patient and the immunological
response profile. Because of the high risk of neurological involvement, we
suggest that the relapse should be treated with ACV for a period of time longer
than actually recommended.
PMID: 1331962 [PubMed - indexed for MEDLINE]
|
Clin Microbiol Rev. 2004
Jan; 17(1): 1-13. |
Neonatal
herpes simplex infection.
Kimberlin DW.
Division of Pediatric Infectious Diseases, The University of Alabama at
Birmingham, Birmingham, Alabama 35233.
Tremendous advances have occurred over the past 30 years in the
diagnosis and management of neonatal herpes simplex virus (HSV) disease.
Mortality in patients with disseminated disease has decreased from 85 to 29%,
and that in patients with central nervous system (CNS) disease has decreased
from 50 to 4%. Morbidity has been improved more modestly: the proportion of
patients with disseminated disease who are developing normally at 1 year has
increased from 50 to 83%. While the proportion of patients with neurologic
morbidity following CNS disease has remained essentially unchanged over the
past three decades, the total number of patients who are developing normally
following HSV CNS disease has increased due to the improved survival. Although
additional therapeutic advances in the future are possible, more immediate
methods for further improvements in outcome for patients with this potentially
devastating disease lie in an enhanced awareness of neonatal HSV infection and
disease. A thorough understanding of the biology and natural history of HSV in
the gravid woman and the neonate provides the basis for such an index of
suspicion and is provided in this article.
PMID: 14726453 [PubMed - in process]
|
Arch Dis Child Fetal
Neonatal Ed. 2003 Nov; 88(6): F483-6. |
Relapse of
neonatal herpes simplex virus infection.
Kimura H, Futamura M, Ito Y, Ando Y,
Hara S, Sobajima H, Nishiyama Y, Morishima T.
Department of Pediatrics, Nagoya University Graduate School of
Medicine, Nagoya, Japan. hkimura@med.nagoya-u.ac.jp
BACKGROUND: Neonatal herpes simplex virus (HSV) infection is a severe
disease with high mortality and morbidity. Recurrence of skin vesicles is
common. OBJECTIVE: To determine the features of relapse and identify the
factors related to relapse. DESIGN: Thirty two surviving patients with neonatal
herpes virus infections were enrolled. All patients received acyclovir
treatment. Clinical and virological data were analysed and compared between
relapsed and non-relapsed cases. RESULTS: Thirteen (41%) had either local skin
or central nervous system relapse between 4 and 63 days after completing the
initial antiviral treatment. Nine patients exhibited local skin relapses, and
four developed central nervous system relapses. In one skin and two central
nervous system relapse cases, neurological impairment later developed. Type 2
virus infection was significantly related to relapse (odds ratio 10.4, 95%
confidence interval 1.1 to 99.0). Patients with relapse had worse outcomes than
those without relapse. CONCLUSION: Neonates with HSV type 2 infections have a
greater risk of relapse. Relapsed patients have poorer prognoses.
PMID: 14602695 [PubMed - indexed for MEDLINE]
|
J Infect Dis. 2002 Oct 15;
186 Suppl 1: S40-6. |
Valacyclovir for herpes
simplex virus infection: long-term safety and sustained efficacy after 20
years' experience with acyclovir.
Tyring SK, Baker D, Snowden W.
University of Texas
Medical Branch, Galveston, Texas 77555, USA. styring@utmb.edu
An extensive clinical
trial program combined with 5 years' postmarketing experience with valacyclovir
provides evidence of favorable safety and efficacy in herpes simplex virus
(HSV) management. Valacyclovir enhances acyclovir bioavailability compared with
orally administered acyclovir. Long-term use of acyclovir for up to 10 years
for HSV suppression is effective and well tolerated. Acyclovir is also approved
for use in children, is available in some countries over the counter in cream
formulation for herpes labialis, and has been monitored in over 1000
pregnancies. Safety monitoring data from clinical trials of valacyclovir,
involving over 3000 immunocompetent and immunocompromised persons receiving
long-term therapy for HSV suppression, were analyzed. Safety profiles of
valacyclovir (</=1000 mg/day), acyclovir (800 mg/day), and placebo were
similar. Extensive sensitivity monitoring of HSV isolates confirmed a very low
rate of acyclovir resistance among immunocompetent subjects (<0.5%). The
incidence of resistance among immunocompromised patients remains low at about
5%.
PMID: 12353186 [PubMed
- indexed for MEDLINE]