Recurrent herpes labialis in the pediatric population: Prevalence,therapeutic studies,and associated complications

Recurrent herpes labialis (RHL) is an incredibly common condition, though the medical literature evaluating pediatric aspects is limited. This paper assesses prevalence and therapeutic studies of pediatric RHL as well as disease complications. A comprehensive literature search of English‐language citations based on PubMed queries of selected terms was performed, with exclusion if methodology was not discussed, or if studies had 10 or fewer patients. RHL prevalence in pediatrics has been assessed by measures of point and periodic prevalence, though methodologic limitations may under‐ or over‐estimate the true prevalence of RHL. Studies have been conducted to evaluate therapeutic safety, tolerability, and efficacy of antivirals in the pediatric population. Pediatric RHL point prevalence ranges from 0.72% to 5.2% depending on the population study and the methodologies used. Pediatric RHL carries a significant public health burden and is often implicated in patients with eczema herpeticum, erythema multiforme, reactive infectious mucositis eruptions, and hypersensitivity reactions. There are few studies that evaluate the rates of occurrence of these sequelae associated with pediatric RHL.     

放血疗法联合口服抗病毒药物治疗急性期肝胆湿热证带状疱疹的临床效果

目的探讨放血疗法联合口服抗病毒药物治疗急性期肝胆湿热证带状疱疹的临床效果及作用机制。方法选取2018年1月—12月住院部收治的396例急性期肝胆湿热证带状疱疹患者,采用随机数表法分为对照组196例和观察组200例。对照组给予阿昔洛韦片0.2 g,4次/d,龙胆泻肝汤于饭后半小时服用;观察组在对照组的基础上给予放血疗法,比较两组的临床效果,治疗后疼痛、水疱变化情况以及发生后遗神经痛情况。结果对照组和观察组总有效率分别为75.51%和97.50%,观察组显著高于对照组,差异有统计学意义(P0.05);观察组疼痛减轻时间、疼痛消失时间均短于对照组,观察组水疱愈合情况显著优于对照组,差异有统计学意义(P0.05);两组治疗前VAS评分比较,差异无统计学意义(P0.05),治疗后疼痛均明显减轻,观察组治疗后VAS评分显著低于对照组,差异有统计学意义(P0.05);对照组和观察组后遗神经痛发生率分别为3.21%和1.03%,差异无统计学意义(P0.05);两组在治疗过程中均未见明显的不良反应。结论放血疗法联合口服抗病毒药物治疗急性期肝胆湿热证带状疱疹的临床效果显著,可促进水疱结痂脱落,减轻患者疼痛,且安全性高。     

阿昔洛韦中有机溶剂残留的顶空气相色谱法测定

建立了顶空气相色谱法测定阿昔洛韦中甲醇、乙醇、二氧戊环、苯和甲苯的残留量。色谱柱为DB-1毛细管柱,FID检测器。上述5种溶剂分别在5～1 000、8～1 600、0.6～120、0 15～6.0和1.42～284μg/ml浓度范围内线性关系良好。平均回收率为95.0%～100.0%,RSD为0.85%～2.75%。     

Cytomegalovirus infection and disease after liver transplantation

Cytomegalovirus is the single most important pathogen in clinical transplantation. Although much progress has been made in our understanding of the molecular biology and epidemiology of CMV infection and in our ability to diagnosis and treat CMV disease, it remains a major cause of morbidity but is no longer a major cause of mortality after liver transplantation. Risk factors for CMV disease after liver transplantation include donor and recipient serologic status, the use of antilymphocyte therapy, and retransplantation. CMV disease occurs early after transplantation, and the most frequent site of disease is the hepatic allograft. We have treated 79 patients with intravenous ganciclovir, with ultimate control of disease achieved in 69 patients (87.3%). Preliminary results using intravenous immunoglobulin and oral acyclovir for CMV prophylaxis in high-risk patients have been encouraging. In addition to producing clinical syndromes, CMV may have direct immunologic effects and is a marker of the net state of immunosuppression.     

The role of antiviral and immunoglobulin therapy in the prevention of Epstein–Barr virus infection and post-transplant lymphoproliferative disease following solid organ transplantation

Abstract: The recognition of the importance of Epstein–Barr virus (EBV) infection, including EBV-associated post-transplant lymphoproliferative disease (PTLD), has led to a new focus on the prevention of this problem. This paper reviews the scientific rationale behind, and clinical experience with, the use of chemoprophylaxis (using acyclovir or ganciclovir) and immunoprophylaxis (using intravenous immunoglobulin) in the prevention of EBV/PTLD. While some centers have already introduced the use of one or both of these agents as standard prophylaxis against the development of this complication, published data in support of these protocols are currently lacking. Well designed clinical trials are necessary to evaluate the potential role of both antiviral and immunoglobulin agents in the prevention of EBV/PTLD in organ transplant recipients.     

Varicella-zoster virus infection in adult patients after unrelated cord blood transplantation: a single institute experience in Japan

Varicella-zoster virus (VZV) infection was studied in 40 adult patients who underwent cord blood transplantation (CBT) from unrelated donors. Twenty-five patients developed VZV reactivation at a median of 5 months after CBT (range 1.7-26 months). The cumulative incidence of VZV reactivation after CBT was 80% at 30 months. Twenty-two patients developed localized herpes zoster. The remaining three patients developed atypical non-localized herpes zoster, which was associated with visceral dissemination in one patient. All the patients responded well to antiviral therapy. Unexpectedly, the absence of grade II-IV acute graft-versus-host disease (GVHD) was associated with a higher rate of VZV reactivation after CBT (100% versus 55%, P=0.01). These results suggest that recovery of VZV-specific immune responses after CBT is delayed even in patients without severe acute GVHD.     

Altered Mental Status from Acyclovir

Background: Acyclovir is widely used in the treatment of herpes virus infections, particularly herpes simplex virus and varicella-zoster virus. Acyclovir, when given promptly upon the start of a herpes zoster eruption, speeds healing and diminishes acute pain. Objectives: Because acyclovir is a commonly used medication, it is crucial for health providers to be aware of appropriate dosing as well as possible side effects. We present this case to increase awareness of the potential for inappropriate dosing of acyclovir and the presentations of patients with toxic effects. Case Report: We report the case of a 65-year-old man with a past medical history significant for chronic kidney disease who presented to the Emergency Department with progressive confusion and ataxia over 2 days. Thorough questioning in the patient's native language revealed that he had recently started a medication for a “rash.” Neither he nor his family knew the name of the new medication; further investigation revealed it to be acyclovir. Although other diagnoses were considered in the differential diagnosis for this patient with altered mental status, he was treated for presumed acyclovir toxicity and given prompt dialysis, upon which his symptoms resolved. Conclusion: It is important for physicians to remember that even common medications such as acyclovir can have serious side effects and complications. In this case, renal dosing was not used in a patient on hemodialysis. Acyclovir must be renally dosed and carefully monitored through drug level measurement in patients with limited kidney function to prevent serious side effects, such as the neurological sequelae demonstrated in this case report. Emergency physicians should be aware of the potential for inappropriate dosing of this medication and the presentations of patients with toxic effects.     

对比两种给药方案治疗急性视网膜坏死综合征患者的效果

目的：探讨阿昔洛韦+醋酸泼尼松片、丙氧鸟苷+醋酸泼尼松片+阿司匹林两种给药方案治疗急性视网膜坏死综合征的临床疗效。
　　方法：采用随机数字表法将我院急性视网膜坏死综合征患者30例40眼分为 A、B 两组,其中 A 组采用阿昔洛韦+醋酸泼尼松片的给药方案,B 组采用丙氧鸟苷+醋酸泼尼松片+阿司匹林的给药方案,观察并比较两组患者治疗后的临床效果。
　　结果：经过治疗后,B 组总有效率(90%)明显高于 A 组(70%),两种给药方案均有效,差异无统计学意义( P>0.05);两组患者在治疗前视力情况差异无统计学意义(P>0.05);经不同给药方案治疗后,A 组视力≥0.5者9眼,视力0.1~<0.5者3眼,视力0.02~<0.1者6眼,无感光者2眼,B 组视力≥0.5者12眼,视力0.1~<0.5者4眼,视力0.02~<0.1者3眼,无感光者1眼, B 组患者视力恢复情况优于 A 组,差异有统计学意义(P<0.05);B组患者视网膜裂孔、疱疹、口腔溃疡、水痘、病毒性脑炎及中枢神经病变等并发症的发生率(10%)明显低于 A 组(35%),差异有统计学意义(P<0.05)。
　　结论：阿昔洛韦+醋酸泼尼松片、丙氧鸟苷+醋酸泼尼松片+阿司匹林两种给药方案都具有较为肯定的治疗效果,但后者对患者视力的恢复及并发症发生率的降低具有更好的优势。     

Genital herpes due to acyclovir-sensitive herpes simplex virus caused secondary and recurrent herpetic whitlows due to thymidine kinase-deficient/temperature-sensitive virus

Herpes simplex virus (HSV)-2 caused a genital ulcer in a 40-year-old allogenic stem cell recipient, and a secondary herpetic whitlow appeared during 2 months of acyclovir (ACV) therapy. Both genital ulcer, and whitlow were cured 3 months later, but 6 months after recovery the whitlow alone recurred. DNA of the genital, first, and recurrent whitlow isolates showed similar endonuclease digestion fragment profiles. The genital virus was ACV-sensitive, and the two whitlow isolates were ACV-resistant/thymidine kinase (TK)-deficient. The TK gene of the whitlow isolates had the same frame shift from the 274th amino acid and termination at the 347th amino acid due to the deletion of a cytosine at the 819th nucleotide. Because the temperature of the thumb is 33/34 degrees C or lower, the temperature sensitivity of the isolates were compared, and both whitlow isolates were significantly more temperature-sensitive (ts) at 39 degrees C than the genital isolate. The two whitlow isolates showed cutaneous pathogenicity in mouse ear pinna but not midflank, while the genital isolate was pathogenic at both sites, suggesting that temperature adaptation was an important element of pathogenicity in the whitlow. The virus populations of isolates of the genital, and first whitlow were examined by 31, and 82 clones, respectively, and the clones from genital, and whitlow isolates were ACV-sensitive, and -resistant, respectively, showing their homogeneity. The acyclovir-sensitive genital lesion had spread as a TK-deficient/ts herpetic whitlow during ACV treatment, and an apparently TK-deficient virus adapted to the local temperature might have caused the whitlow recurrence.