Oral acyclovir for treatment of first-episode herpes simplex virus proctitis

Twenty-nine patients with first-episode rectal herpes simplex virus infection were enrolled in a double-blind trial of oral acyclovir, 400 mg five times daily, vs placebo treatment. Eighty percent of those receiving acyclovir compared with 25% of placebo recipients no longer had herpes simplex virus isolated from their rectal lesions three days after onset of therapy. The median duration of rectal lesions and viral excretion from rectal lesions (median, five and zero days, respectively) was significantly shorter in patients treated with acyclovir than in placebo-treated patients (14 and 11 days, respectively). Durations of local signs and symptoms of proctitis, such as rectal pain, discharge, and friability, were shorter in acyclovir recipients than in placebo recipients, but these differences were not statistically significant. Daily administration of 2 g of oral acyclovir for ten days alleviates some of the clinical signs of herpes simplex virus rectal infection.     

Acyclovir treatment of herpes simplex encephalitis: experience in a district hospital

Herpes simplex encephalitis may be underdiagnosed in Britain. We report eight patients treated at one hospital over three years. Fever, impaired consciousness or focal neurological signs were seen in all patients at presentation but herpes simplex encephalitis was rarely considered as the initial diagnosis. The electroencephalogram was the only initial investigation that was abnormal in each case and was the most useful test in establishing a clinical diagnosis. The diagnosis was confirmed by laboratory methods in each case. Following acyclovir treatment five patients were able to resume normal activities, one patient has moderate disability and two patients died. Three patients showed clinical evidence of relapse but two improved after further treatment with acyclovir. Herpes simplex encephalitis is a treatable condition and should be considered in all patients presenting with fever and neurological signs. The electroencephalogram is usually abnormal and the changes may be characteristic of the condition.     

Herpes simplex encephalitis in infants

Two cases are reported of severe encephalitis in infants that were caused by a primary infection with herpes simplex virus type 1. Both patients presented with focal seizures; the clinical diagnosis was confirmed by the rapid appearance of IgM antibody to herpes simplex virus type 1 in cerebrospinal fluid and serum. In spite of the early use of acyclovir, which was administered by the intravenous route, the clinical response was poor and both infants were left with severe neurological impairment.     

Acyclovir prophylaxis against herpes virus infections in severely immunocompromised patients: randomised double blind trial

Twenty patients undergoing allogeneic bone marrow transplantation and 39 patients receiving remission induction chemotherapy for acute leukaemia were entered into a double blind, placebo controlled stratified trial of acyclovir prophylaxis against herpes group virus infections. Within the transplant group intravenous acyclovir 5 mg/kg twice daily given throughout the period of granulocytopenia completely prevented oropharyngeal herpes simplex virus infection compared with a 50% incidence in the placebo arm (p = 0.033). The acyclovir group also had fewer days of fever during the trial and a shorter duration of leukopenia, possibly because of the prevention of herpes simplex virus infections. There was a high incidence of herpes infections after the trial in patients who received either acyclovir or placebo. In the non-transplant group there was also a significant reduction of herpes simplex virus infection in the oropharynx and oesophagus (two out of 19 patients as compared with 10 out of 20; p = 0.018). Herpes simplex virus was isolated in the acyclovir arm within a day after starting the trial in one patient, and the other failure was due to a virus with reduced sensitivity to acyclovir in a patient who had had several previous courses of the drug. The incidence of herpes infections after stopping treatment was low. The influence of acyclovir on excretion of Epstein-Barr virus in saliva in either group was inconclusive. One patient (transplant group) developed a cytomegalovirus infection while receiving acyclovir. Acyclovir provides effective prophylaxis against oropharyngeal and oesophageal herpes simplex virus infection in severely immunocompromised seropositive (greater than or equal to 1/8) patients. In patients given bone marrow transplants this may have the additional benefit of reducing the time to recovery of an adequate blood count and the number of days of fever.     

Long-term acyclovir suppression of frequently recurring genital herpes simplex virus infection. A multicenter double-blind trial

Normal adults with six or more episodes of genital herpes in the previous year were enrolled in a one-year, multicenter, double-blind trial comparing placebo with 400 mg of acyclovir administered orally twice daily. Patients with episodes during the study were offered 200 mg of acyclovir administered orally five times daily for five days; this allowed comparison of suppressive and episodic treatment. After one year, 227 (44%) of 519 patients receiving suppressive treatment and seven (2%) of 431 receiving placebo (episodic) treatment remained free of recurrences, and the mean numbers of recurrences per year were 1.8 and 11.4, respectively. Among 67 patients who had received suppressive therapy for one year, the mean duration of lesions in the first episode following the discontinuation of treatment was 9.3 days compared with 7.3 days among 45 patients who had received episodic therapy for one year. Treatment was well tolerated, and no changes were noted in the in vitro susceptibility to acyclovir of herpes simplex virus cultured during or after the one-year trial. Continuous or episodic oral acyclovir therapy for one year remained safe and effective.     

Herpes simplex type 2 meningitis treated with acyclovir

A case of meningitis due to a primary genital herpes simplex type 2 infection, and its prompt response to therapy with intravenous acyclovir is reported. This complication of genital herpes is probably underdiagnosed and it is worthwhile searching for evidence of genital herpetic lesions in a young patient presenting with viral meningitis.     

Treatment of resistant herpes simplex virus with continuous-infusion acyclovir

Two patients with acquired immunodeficiency syndrome who developed severe ulcerative proctitis caused by herpes simplex virus type 2 that was resistant to acyclovir were successfully treated with 6 weeks of high-dose, continuous-infusion acyclovir sodium (1.5 to 2.0 mg/kg per hour). Viruses cultured from the lesions were resistant to acyclovir in vitro after the patients had received prolonged therapy with oral and intravenous acyclovir in traditional divided doses. Investigation into the mechanism of the acyclovir resistance revealed changes in the thymidine-kinase activity of both isolates. This viral enzyme phosphorylates acyclovir and is necessary for drug activation. The first patient's isolate was deficient of all thymidine-kinase activity, while the second patient's isolate had a thymidine kinase with altered substrate specificity for acyclovir. The continuous infusion was safe, well tolerated, and done in an outpatient setting with weekly clinic visits and monitoring of creatinine and acyclovir levels.     

复发性病毒性脑炎的临床特点和发病机制探讨

目的 探讨复发性病毒性脑炎的诊断和复发机制.方法 回顾分析150例病毒性脑炎患者,其中5例为复发性病毒性脑炎,还有1例来自尸检病例.其中5例临床高度怀疑为单纯疱疹性脑炎,并且其中2例得到病理结果的证实.结果 6例患者在症状缓解后1个月至2年2个月,再次出现神经系统损害的表现,症状加重.并且6例患者中5例复发时,MRI或CT出现以额、颞灰质损害为主的新病灶;除1例患者死亡,其余5例患者承新给予阿昔洛韦抗病毒治疗后,病情均明显好转;例3脑组织HSV免疫组化染色阳性,例6尸检脑组织内可见细胞内包涵体,HSV免疫组化阳性,提供了病毒感染的直接病理依据.结论 这6例复发性病毒性脑炎复发的机制与病毒活化直接侵犯中枢神经系统有关.复发的原因仍不是十分清楚,可能与阿昔洛韦剂量不足或治疗不够充分有关.阿昔洛韦抗病毒治疗应遵循早期、足最、个体化的治疗原则,将有助于改善预后.     

急性疱疹病毒性脑炎的治疗效果观察

目的：分析研究急性疱疹病毒性脑炎患者的治疗方法以及治疗效果,为临床提供有利的依据。方法方便选取该院在2014年8月—2015年8月所收治的急性疱疹病毒性脑炎患者资料70例开展回顾性分析,依照其不同时期选取3类抗病毒药物,其中使用病毒唑治疗患者15例,使用阿糖胞苷治疗20例,使用无环鸟苷治疗35例,总结70例患者的的临床特征以及治疗方法。结果对于急性疱疹病毒性脑炎患者采取无环鸟苷进行治疗有效率为91.43%,死亡3例,阿糖胞苷治疗有效率为45.00%,死亡8例,病毒唑治疗有效率为66.67%,死亡5例,采取无环鸟苷进行治疗显著优于阿糖胞苷以及病毒唑治疗(P﹤0.05),差异具有统计学意义。结论针对急性疱疹病毒性脑炎患者采取无环鸟苷治疗效果理想,属于一类特效并且低毒抗疱疹疾病药物,应该在临床中大力推广使用。     

单纯疱疹病毒感染后自身免疫性脑炎的研究进展

单纯疱疹病毒脑炎所引发的自身免疫性脑炎日益受到关注,其发病机制可能与单纯疱疹病毒感染神经元后神经元裂解释放抗原引起免疫反应有关。这种继发性的自身免疫性脑炎临床表现多样,早期容易与复发性单纯疱疹病毒性脑炎相混淆,延误治疗导致严重的神经功能缺损及预后不良。脑脊液和血清中检出自身免疫性脑炎相关抗体则有助于诊断,免疫治疗有效。本文结合相关文献综述了单纯疱疹病毒感染后的自身免疫性脑炎的发展历史、发病机制、临床表现、辅助检查和诊疗流程,为临床医生提供借鉴。     

病毒性脑炎急性期治疗的进展

病毒性脑炎是指病毒感染引起的脑实质的炎症。发热、头痛、意识障碍、精神症状、抽搐、神经系统定位体征是其主要临床表现。许多病毒可引起该病,常见的有单纯疱疹病毒、水痘-带状疱疹病毒、巨细胞病毒、肠道病毒70及71、麻疹病毒、风疹病毒、流行性腮腺炎病毒及黄病毒属等,单纯疱疹病毒性脑炎是最常见的。目前临床大多采取综合性的治疗,抗病毒、脑细胞的保护、重要脏器功能的维持及并发症的预防。文章对该病急性期治疗的进展予以综述。     

无环鸟苷-干扰素治疗单疱病毒性角膜炎疗效观察

目的研究无环鸟苷-干扰素联合治疗单纯疱疹病毒性角膜炎（HSK）的临床疗效。方法65例单纯疱疹毒性角膜炎患者随机分为治疗组36例和对照组29例,治疗组以0．1％无环鸟苷与重组人a-干扰素（冻干粉剂）制成的混合滴眼液治疗,对照组以0．1％无环鸟苷滴眼液及环胞苷滴眼液治疗。结果治疗组36例中33例治愈,治愈率91．6％,平均治愈天数30．4d;对照组29例中25例治愈,治愈率89．7％,平均治愈天数39．6d;无环鸟苷-干扰素组同对照组比较治愈率大致相同,无显著性差异,疗程无环鸟苷-干扰素组明显缩短（P〈0．05）。结论无环鸟苷-干扰素联合眼药水治疗HSK,疗效确切,无不良反应,有推广价值。     

Vidarabine therapy for severe herpesvirus infections. An unusual syndrome of chronic varicella and transient immunologic deficiency.

Six patients with severe herpesvirus infections were successfully treated with vidarabine. One patient had a previously undescribed syndrome of chronic cutaneous varicella infection of eight months' duration, associated with transient but complete duppression of lymphocyte response to conconavalin A. Other diagnoses were severe varicella pneumonia, progressive cytomegalovirus pneumonia associated with acute lymphocytic leukemia, herpes simplex encephalitis, severe zoster associated with stage IV lymphoma, and disseminated herpes simplex in a patient receiving high doses of steroids. All patients showed cessation of new lesions or abrupt clinical improvement between days 2 and 4 after initiation of therapy, and all were cured of their clinical infection. Dramatic improvement in all of our patients and the minimal toxicity observed make vidarabine suitable for use in severe herpesvirus infections.     

奈尔斯全身红光治疗系统对治疗单纯疱疹临床疗效观察

目的观察奈尔斯全身红光治疗系统对治疗单纯疱疹的治疗效果。方法对31例单纯疱疹患者进行全身红光照射并常规口服阿昔洛韦800mg/d与单纯疱疹患者20例（采用常规治疗）相对照,比较治疗前后病灶愈合情况。结果疗效：31例患者中痊愈29例（93.5%）,显效1例（3.2%）,有效1例（3.2%）,无效0例（0%）,总痊愈有效率为96.7%。结论奈尔斯全身红光治疗系统对单纯疱疹具有操作简单,安全无副作用,能改善单纯疱疹的自觉症状,延长复发时间有效改善患者的生活质量,是一种值得推广的理疗方法。     

Acyclovir for the treatment and prevention of recurrent infectious herpes simplex keratitis

目的　观察无环鸟苷对HSV 1角膜炎的治疗和预防复发作用。方法　选用 1 0 5例HSV角膜炎病人 ,将病人按临床表现分为 4组 ,即上皮型、基质型、坏死型及HSV角膜炎行角膜移植及结膜瓣遮盖术 ,并对 4组病人选用全身 +局部无环鸟苷治疗。愈后将上皮质型和基质型患者随机分为2组 ,抗复发治疗组和对照组。治疗组给予口服预防量无环鸟苷 3 0 0mg/d ,持续一年。对照组未给予任何药物。结果　上皮型经口服及局部点眼后 96%痊愈。基质型给予口服加局部无环鸟苷点眼 ,同时给予激素滴眼治愈率为 1 0 0 %。坏死型经 1 0 0 0mg/d无环鸟苷静脉应用 ,治愈率达 3 3 % ,余穿孔行结膜瓣遮盖及角膜移植术 ,术后静脉应用无环鸟苷 2周尽快控制病情 ,角膜植片及结膜与伤口愈合。上皮质型和基质型的角膜炎治愈后持续应用无环鸟苷口服 3 0 0mg/d ,随访 1年 ,治疗组有 5例复发 ,对照组有 1 4例复发 ,两组比较有显著的统计学差 (P <0 0 1 )。结论　无环鸟苷局部 +全身治疗对HSV角膜炎有较好的治疗作用 ,低剂量长期口服对控制复发有良好的作用。随访期间未见全身及局部副作用     

HSE模型小鼠的水迷宫实验观察

目的对HSE模型小鼠进行经典的Morris水迷宫实验,以观察评估HSV-1感染后小鼠的学习记忆功能。方法雄性C57BL/6小鼠100只,随机法分为模型组、假手术组、正常组。采用颅内注射法建立HSE动物模型,接种后每日观察各组小鼠的一般状况,并于感染后20天进行经典的Morris水迷宫实验评价认知功能。水迷宫实验共训练5d,记录每天的潜伏期与游泳轨迹,第6天去除平台,记录小鼠在目标象限的停留时间。结果接种后3天开始,模型组小鼠出现进食减少、毛发蓬松、倦怠少动等症状;水迷宫实验中模型组小鼠逃避潜伏期明显延长,目标象限停留时间及经过平台次数较其它两组明显减少(P<0.05)。结论 HSV-1感染后小鼠认知功能明显减退。     

Diseases that mimic herpes simplex encephalitis. Diagnosis, presentation, and outcome. NIAD Collaborative Antiviral Study Group

A total of 432 patients underwent brain biopsy for presumptive herpes simplex encephalitis. Three patient groups were identified. The first group, 195 patients (45%), had herpes simplex encephalitis confirmed by the isolation of herpes simplex virus from brain tissue at biopsy (193 patients) or autopsy (2 patients). The second group, 95 patients (22%), had diseases that were identified but that were not caused by herpes simplex virus. Three subgroups were recognized: (1) 38 patients (9%) with treatable disease, (2) 40 patients (9%) with nontreatable but diagnosed viral infection, and (3) 17 patients (4%) with identified diseases neither of viral etiology nor treatable. The third group, 142 patients (33%), remained without a diagnosis. Clinical presentation of patients in the second group was similar to that of those with herpes simplex encephalitis and those without a diagnosis. Patients in the subgroup with nontreatable but diagnosed viral infections had the greatest likelihood of returning to normal.     

长沙地区疮疹病毒性脑炎的病原研究

目的：探讨长沙地区病毒性脑炎与疱疹病毒感染的关系。方法：应用间接免疫荧光技术（ＩＥＡ）检测病毒性脑炎患者脑脊液或血清中疱疹病毒特异性ＩｇＧ、ＩｇＭ。结果：９２１例病毒性脑炎患者中有１３３例（１４．４％）诊断为单纯疱疹病毒性脑炎,１０岁以下年龄为发病高峰,９例（０．９８％）诊断为巨细胞病毒性脑炎,１２例（１．３％）为水痘－带状疱疹毒性脑炎。结论：长沙地区疱疹病毒性脑炎病原以单纯疱疹病毒最常见;ＩＦＡ     

长沙地区疱疹病毒性脑炎的病原研究

目的 :探讨长沙地区病毒性脑炎与疱疹病毒感染的关系。方法 :应用间接免疫荧光技术 (IFA)检测病毒性脑炎患者脑脊液或血清中疱疹病毒特异性IgG ,IgM。结果 :92 1例病毒性脑炎患者中有 1 33例 (1 4 4% )诊断为单纯疱疹病毒性脑炎 ,1 0岁以下年龄为发病高峰 ,9例 (0 98% )诊断为巨细胞病毒性脑炎 ,1 2例 (1 3 % )为水痘 带状疱疹病毒性脑炎。结论 :长沙地区疱疹病毒性脑炎病原以单纯疱疹病毒最常见 ;IFA法对疱疹病毒性脑炎具有诊断价值     

A case of herpes zoster associated encephalitis with rapid response to acyclovir

A case of herpes zoster encephalitis which responded very rapidly to acyclovir is presented. The differential serum: cerebrospinal fluid antibody response was followed and its value in making the diagnosis is discussed. The penetration of acyclovir into the cerebrospinal fluid was measured, and found to be in agreement with predicted values.