Despigmentação precoce em caso de ceratopigmentação / Early depigmentation in case of keratopigmentation

RESUMO A ceratopigmentação teve seu primeiro registro pelo filósofo Galeno há muitos séculos como uma estratégia utilizada para o tratamento estético de pacientes com leucomas. As córneas com leucoma são patológicas e, muitas vezes, intolerantes a lentes de contato cosméticas ou próteses oculares, sendo comum a queixa de desconforto excessivo, proporcionado pela superfície corneana irregular. Assim, a ceratopigmentação é uma alternativa para a melhora estética de pacientes com opacidades corneanas. Descrevemos o caso de um paciente do sexo masculino, 39 anos, que apresentou despigmentação precoce em caso de ceratopigmentação associado a quadro de ceratite herpética necrotizante. O paciente foi submetido ao tratamento com aciclovir 2g ao dia e doxiciclina 200mg ao dia, evoluindo com melhora do quadro clínico, apesar da má adesão medicamentosa.

ABSTRACT Keratopigmentation was first recorded many centuries ago by the philosopher Galeno, as a strategy used for the aesthetic treatment of patients with leukomas. Corneas with leucoma are pathological and often intolerant of cosmetic contact lenses or ocular prostheses, with complaints of excessive discomfort provided by the irregular corneal surface being common. Therefore, keratopigmentation is an alternative for the aesthetic improvement of patients with corneal opacities. We describe the case of a 39-year old male patient, who presented early depigmentation in a case of keratopigmentation associated with necrotizing herpetic keratitis. The patient was treated with Acyclovir 2g/day and Doxycycline 200mg/day, evolving with clinical improvement, despite poor medication adherence.

Reasonable selection of antiviral agents for herpes zoster / 中华皮肤科杂志

Antiviral treatment is the core part in the treatment of herpes zoster. Based on the latest studies, consensus and guidelines, this article aims to provide a basis and reference for clinicians to make a reasonable choice of types and doses of antiviral agents. Valacyclovir, a precursor of acyclovir with high oral bioavailability and great convenience of administration, is generally the first choice of oral antiviral agents; for some special cases, such as immunocompromised patients, intravenous drips of acyclovir should be selected when appropriate. Brivudine is often a better choice for patients with severe renal insufficiency; famciclovir or other antiviral agents should be considered for patients resistant to acyclovir; for immunocompromised patients resistant to acyclovir, intravenous drips of foscarnet sodium can be an option. Oral antiviral agents should be administered at adequate doses. Selecting appropriate antiviral agents and their doses can effectively relieve acute symptoms of patients and reduce the probability of postherpetic neuralgia.

Varicella gangrenosa: A rare chickenpox complication

Varicella gangrenosa is a rare but life-threatening dermatological complication of infection with varicella-zoster virus. A healthy 37-year-old male who had been diagnosed with varicella 20 days back was admitted to our hospital with complaints of fever and painful necrotic skin lesions. Physical examination revealed multiple round to oval ulcers covered with eschar predominantly over arms, lower limbs, back of trunk and flanks. Streptococcus pyogenes and Staphylococcus aureus grew in wound culture. Biopsy revealed ulceration and necrosis of epidermis, and edema, hemorrhage and granulation tissue formation involving the dermis and subcutaneous tissue. The patient was treated with acyclovir - parenteral followed by oral, antibiotics and supportive measures. The lesions healed and he was discharged after 20 days. We report this case to draw attention to the fact that varicella gangrenosum, even though a rare complication, may occur in the lesions of chicken pox and that the survival of patient depends on early diagnosis and aggressive treatment

Side Effects of Oral Valacyclovir and Oral Acyclovir in the Treatment of Herpes Zoster

Background: Herpes Zoster is a more sporadic disease than a doe’s primary VZV infection. Herpes Zoster is typically transmitted person to person by direct contact. The lifetime risk of developing Herpes Zoster is between 25% and 30%, rising to 50% in those aged at least 80 years. The aim is to identify the side effects of oral valacyclovir and oral acyclovir in the treatment of herpes zoster.Material & Methods:This randomized clinical trial was conducted in the Department of Dermatology and Venereology, ShaheedSuhrawardy Medical College and Hospital, Dhaka, from April 2016 to September 2016. A total of 60 patients with herpes zoster were enrolled in the study. Group A Valacyclovir was 30 patients, and Group B Acyclovir was 30 patients.Results:In Group-A, it was observed that 6(20.00%) patients had nausea found to be the highest, 4(13.33%) patients had Headache, 3(10.00%) patients had vomiting, 2(6.67%) patients had Diarrhea,0(0.00%) patients had anorexia, 3(10.00%) patients had abdominal pain, and 1(3.33%) patients had dyspepsia found to be lowest in Group-A, and 8(26.67%) patients had nausea found to be highest, 5(16.67%) patients had Headache, 4(13.33%) patients had vomiting, 3(10.00%) patients had Diarrhea,1(3.33%) patients had anorexia, 5(16.67%) patients had abdominal pain, and 1(3.33%) patients had dyspepsia found to be lowest in Group-B of study patients as side effects.Conclusion:The rate of cessation of abnormal sensations, rash healing, and complications or adverse effects was not similar with both the treatments. There were no clinically significant differences in the nature and frequency but there were clinically significant differences in severity of adverse/side events between the two treatment groups. Thus, we conclude that in the management of herpes zoster, valacyclovir accelerates the resolution of pain and offers simpler dosing, and maintains a favorable safety profile than acyclovir.

Encefalitis por Virus Herpes Simplex con PCR persistentemente positivo en líquido cefalorraquídeo. A propósito de un caso neonatal

RESUMEN Las infecciones por herpes virus en la etapa neonatal pueden causar una alta morbimortalidad. La persistencia del virus, a pesar del tratamiento de primera línea, puede llevar a consecuencias devastadoras para el paciente. Presentamos el caso de un paciente neonato con persistencia de Virus Herpes Simplex en LCR, en el cual fue necesario iniciar foscarnet para contener la infección.

ABSTRACT Herpes virus infections in the neonatal stage can cause high morbidity and mortality. The persistence of the virus, despite first-line treatment, can lead to devastating consequences for the patient. We present the case of a neonatal patient with persistence of Herpes Simplex Virus in the CSF, in whic foscarnet treatment was required to contain the infection.

Clinical effect observation of Nd: YAG laser combined with acyclovir in the treatment of herpes labialis / 口腔疾病防治

Objective@#To investigate the clinical efficacy of Nd: YAG laser combined with 3% acyclovir cream in the treatment of herpes labialis. @* Methods @# A total of 72 patients with herpes labialis were enrolled. According to the random number table method, the patients were divided into an observation group and a control group with 36 patients in the observation group and 36 patients in the control group. The Nd: YAG laser combined with 3% acyclovir cream was administered to the observation group, while 3% acyclovir cream was administered to the control group. The total effective rate, scab, scab removal, analgesic time, and quality of life were compared between the two groups.@*Results@# 7 days after treatment, the total effective rate of clinical treatment in the control group was 27 patients (75%), and that in the observation group was 34 patients (94.4%); the contrast difference was statistically significant (P < 0.05). Compared with those in the control group, the crusting, prolapse and analgesic time of the observation group were shorter, and the differences were statistically significant (P < 0.05). Compared with the control group, the observation group had higher quality of life scores, and there was a statistical significance (P < 0.05). @*Conclusion @#For patients with herpes labialis, using Nd: YAG laser combined with 3% acyclovir cream treatment can significantly improve the quality of life of patients and accelerate the speed of patient rehabilitation.

Encefalopatía como forma de presentación de la COVID-19

RESUMEN Introducción: El virus SARS-CoV-2, responsable de la COVID-19 presenta una alta tasa de contagio y es capaz de producir afecciones a diferentes niveles en el organismo, e incluye el sistema nervioso central, con manifestaciones como crisis convulsiva febril y afebril, estado de mal epiléptico, encefalopatías y encefalitis. Objetivo: Describir un paciente con encefalopatía, como forma de presentación de la COVID-19. Caso clínico: Paciente de 25 años con antecedentes de hidrocefalia obstructiva postraumática, con derivación ventrículo - peritoneal, positivo a la COVID-19, quien desarrolló manifestaciones neurológicas, en ausencia de manifestaciones respiratorias. Fue tratado según el protocolo para pacientes con la COVID-19, medidas antiedema cerebral y uso del péptido CIGB-258. Tuvo una evolución favorable hacia la recuperación. Conclusiones: En pacientes con encefalopatía de causa desconocida, en el contexto de la pandemia por la COVID-19, debe considerarse la infección por SARS-CoV-2. La evolución puede ser favorable con el uso de medidas generales y antiedema cerebral.

ABSTRACT Introduction: SARS-CoV-2 virus, responsible for COVID-19, has a high contagion rate and is capable of producing conditions at different levels in the body, and includes the central nervous system, with manifestations such as febrile and afebrile seizures, status epilepticus, encephalopathies and encephalitis. Objective: To describe a patient with encephalopathy, as a form of presentation of COVID-19. Clinical case: A 25-year-old patient with a history of post-traumatic obstructive hydrocephalus, with ventricular peritoneal shunt, positive for COVID-19, who developed neurological manifestations, in the absence of respiratory manifestations. He was treated according to the protocol for patients with COVID-19, anti-cerebral edema measures and use of the CIGB-258 peptide. The patient had a favorable evolution towards recovery Conclusions: In patients with encephalopathy of unknown cause, in the context of the COVID-19 pandemic, SARS-CoV-2 infection should be considered. The evolution can be favorable with the use of general measures and anti-cerebral edema.

Aciclovir endovenoso como tratamiento en la parálisis facial periférica e idiopática en un recién nacido. Reporte de caso

Introducción: la parálisis facial neonatal debida a la parálisis de Bell es rara. El mecanismo de parto traumático representa una etiología más común. Caso clínico: neonato, previamente sano, con parto espontáneo no instrumentalizado y sin complicaciones obstétricas, que cursó con parálisis facial derecha aguda. La imagen cerebral fue normal y los hallazgos clínicos compatibles con parálisis de Bell, con buena respuesta al manejo antirretroviral y fisioterapia. Discusión: la mayoría de infantes con parálisis de Bell mejora con o sin tratamiento y sin secuelas graves. No hay evidencia concluyente en la población pediátrica sobre el beneficio de usar esteroides, solos o con antirretrovirales. Actualmente, tampoco existe un consenso sobre la seguridad de usar esteroides posnatales tardíos, que se deben reservar para neonatos sin otra opción. El aciclovir a dosis de 60 mg/Kg/día es seguro en neonatos. Conclusiones: la parálisis de Bell neonatal puede presentar una respuesta favorable a la terapia antirretroviral y fisioterapia, prescindiendo del uso de esteroides.

SUMMARY Introduction: Neonatal facial palsy due to Bell's palsy is rare. A traumatic delivery mechanism represents a common etiology. Clinical case: Neonate, without previous illnesses, born by spontaneous non-instrumentalized delivery and without any obstetric complications; who presented acute right facial palsy, with normal brain imaging and clinical findings compatible with Bell's palsy, who had a good response to antiretroviral management and physical therapy. Discussion: Most infants with Bell's palsy improve with or without treatment, with no serious sequelae. In pediatric population, evidence on benefits of steroids use, alone or with antiretrovirals, has not been conclusive. There is not a current consensus on the safety of late postnatal steroid use, and they should be reserved for neonates who have no other treatment choice. Acyclovir use at 60/mg/Kg/day it's safe in neonates. Conclusions: Neonatal Bell's palsy may present a favorable response to antiretroviral therapy and an adherent physical rehabilitation program, irrespective of steroids use.

Necrosis retiniana aguda por virus varicela zoster en un paciente inmunocompetente con seguimiento de la respuesta terapéutica mediante reacción de polimerasa en cadena / Acute retinal necrosis by varicella zoster virus in an immunocompetent patient with therapeutic follow up by PCR

Resumen Presentamos el caso de un varón de 63 años, inmunocompetente, con una necrosis retinal aguda (NRA) unilateral. Consultó por visión borrosa, dolor ocular, fotofobia y cefalea. Se confirmó una papilitis y coriorretinitis periférica asociada a vasculitis e isquemia retinal periférica. El estudio molecular por RPC de humor acuoso detectó la presencia de virus varicela zoster. El paciente fue tratado con terapia combinada con corticoesteroides orales, aciclovir oral/intravenoso, ganciclovir intravítreo semanal y luego valaciclovir oral por tres meses. Se demostró una disminución progresiva de la carga viral en el humor acuoso durante el tratamiento. El seguimiento mostró una mejoría del cuadro inflamatorio y una leve recuperación de la agudeza visual, sin embargo, finalmente presentó un desprendimiento de retina con pérdida casi total de la visión unilateral. La NRA es una complicación infrecuente provocada por algunos virus herpes con mal pronóstico visual, desenlace que puede ser mejorado con un diagnóstico y tratamiento precoz con antivirales. El tratamiento prolongado permite evitar la recaída y el compromiso contralateral.

Abstract We present the case of a 63-year-old immunocompetent man with unilateral acute retinal necrosis (ARN). He consulted for blurred vision, eye pain, photophobia, and headache. Papillitis and peripheal chorioretinitis associated with vasculitis and peripheral retinal ischemia was confirmed. PCR from aqueous humor sample detected varicella zoster virus. The patient was treated with a combined therapy of oral corticosteroids, oral / intravenous acyclovir along with weekly intravitreous ganciclovir doses followed by oral valaciclovir for three months. A progressive decrease in viral load in aqueous humor was demonstrated during treatment. Follow-up showed improvement in the inflammatory condition and a slight recovery of visual acuity, however, finally he presented a retinal detachment with total loss of one-sided vision. ARN is an uncommon complication caused by some herpesviruses with a poor visual prognosis, an outcome that can be improved with early diagnosis and treatment using appropriate antivirals. Prolonged treatment reduces relapse frequency and fellow eye compromise.

Effect of Acyclovir on proliferation and migration of human Tenon capsule fibroblasts <i>in vitro</i> / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To explore the effect and mechanism of acyclovir(ACV)on the proliferation and apoptosis of human eye Tenon capsule fibroblasts(HTFs)<i> in vitro</i>. <p>METHODS: HTFs were divided into ACV treatment group and control group; CCK8 was used to detect cell proliferation rate under different concentration gradients, scratch assay was used to detect HTFs migration ability, and flow cytometry was used to detect HTFs apoptosis and cell cycle. <p>RESULTS: Compared with the control group, the proliferation rate of HTFs in the ACV-treated group(final concentrations were 1.125, 2.25, 3.375, 4.5mmol/L)was significantly reduced(<i>P</i><0.05)and was concentration-dependent. The scratch closure rate in the ACV-treated group(final concentrations were 4.5mmol/L)was significantly reduced(<i>P</i><0.05), the apoptosis rate was significantly increased(<i>P</i>=0.0005), the peak value of the cell cycle G0 / G1 increased(<i>P</i>=0.0011), and the S-phase decreased(<i>P</i>=0.0006). The cell cycle is blocked in the G0/G1 phase. <p>CONCLUSION: Acyclovir can promote cell apoptosis by blocking the cell cycle of HTFs, and inhibit the proliferation and migration of HTFs.

Comparative Efficacy of Different Chemotherapeutic Regimens in the Treatment of Peste des Petits Ruminants in West African Dwarf Goats / Eficacia comparativa de diferentes regímenes quimioterapéuticos en el tratamiento de la Peste des petits ruminants (PPR) en cabras enanas de África occidental

Abstract The comparative efficacy of different chemotherapeutic regimes in the treatment of natural clinical infection of Peste des petits ruminants (PPR) infection in West African Dwarf (WAD) goats were determined. Twenty WAD male goats divided into five groups, of four each were used. Group 1 was the combined therapy group treated with Acyclovir, Oxytetracycline and Ivermectin, Group 2 was treated with Acyclovir only, Group 3 was treated with Ivermectin only, Group 4 was treated with Oxytetracycline only and Group 5 was left untreated. Clinical signs such as nasal and ocular discharges, emaciation, anorexia, pyrexia, ulcerative oral lesions, respiratory distress and diarrhoea were observed in these goats during the period of their acclimatization. The prominent post-mortem lesion observed was discontinuous streaks of congestion (Zebra markings) in the mucosa of the colon and rectum. The physiologic parameters (temperature, pulse rate, heart rate, and respiratory rate) were taken daily. It was observed that there was a significant increase in the temperature above normal in the untreated group, suggesting pyrexia. It was also observed that the combined therapy group showed a smaller number of mortality and thus, had a better efficacy when compared to the other chemotherapeutic agents used singly.

Resumen Se determinó la eficacia comparativa de diferentes regímenes quimioterapéuticos en el tratamiento de la infección clínica natural con la Peste de los pequeños rumiantes (PPR) en cabras enanas de África occidental (WAD). Se usaron veinte cabras WAD machos, distribuidas en cinco grupos, de cuatro cabras cada uno. El grupo 1 fue el grupo de terapia combinada, tratado con aciclovir, oxitetraciclina e ivermectina. El grupo 2 fue tratado solo con aciclovir. El grupo 3 fue tratado con ivermectina solamente. El Grupo 4 fue tratado con oxitetraciclina y el grupo 5 no recibió tratamiento. Se observaron signos clínicos como secreciones nasales y oculares, emaciación, anorexia, pirexia, lesiones orales ulcerativas, dificultad respiratoria y diarrea en estas cabras durante su periodo de aclimatación. La lesión post-mórtem más notable que se observó fueron las manchas descontinuas de congestión (como las rayas de la cebra) en la mucosa del colon y del recto. Los parámetros fisiológicos (temperatura, frecuencia del pulso, ritmo cardiaco y frecuencia respiratoria) se midieron diariamente. Se observó que había un aumento significativo en la temperatura por encima de lo normal en el grupo sin tratamiento, lo que sugirió pirexia. También se observó que el grupo de terapia combinada mostró una cifra de mortalidad menor y, por ende, allí hubo una mejor eficacia en comparación con los otros agentes quimioterapéuticos usados solos.

Orthosiphon stamineus water extracts inhibit human herpes virus 1 KOS-1 and acyclovir-resistant strains by virucidal activity and suppressing virus early infection

Aim@#To determine the efficacy and mode of action of hot and cold water extracts of Orthosiphon stamineus leaves against two strains of human herpes virus 1 (HHV-1) i.e. KOS-1 and acyclovir (ACV)-resistant UKM-1 (UKM-1) strains. @*Methodology and results@#Hot and cold water extracts of O. stamineus were not cytotoxic to vero cells as determined by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide) (MTT) assay with 50% cytotoxicity concentration (CC50) values of 3.4 and 3.3 mg/mL respectively. Antiviral activity was determined by plaque reduction assay in post-treatment, pre-treatment and virucidal assays followed by time-addition and time removal assay to relate with the stages during the viral infection cycle. Both extracts displayed antiviral activity against HHV-1 KOS-1 and HHV-1 UKM-1 strains with 50% effective concentration (EC50) values between 0.12-0.15 mg/mL in reducing plaque formation. The calculated selectivity indices (SI) were 23 and 28 for hot and cold water extract respectively, indicating that they have good potential as antiviral agent. The extracts were virucidal towards both HHV-1 KOS-1 and HHV-1 UKM-1 strains which may directly affects the virus structure. This is supported with the fact that exposure of the extracts inhibit viral attachment and penetration to the vero cells. In time-of addition assay, both extracts were effective during the early stage of virus infection cycle for HHV-1 KOS-1 strain which is in parallel with the results from the attachment and penetration studies. For HHV-1 UKM-1 strain, contact to the extracts at any time during post-infection inhibits virus replication and also progeny release. @*Conclusion, significance and impact of study@#Cold and hot water extracts of O. stamineus have good potential as antiviral agent against HHV-1 strain KOS-1 and more importantly against UKM-1 strain which is ACV-resistant. The extracts displayed virucidal effect and inhibition of early virus replication cycle involving viral attachment and penetration to cells.

Epstein-Barr Virus-related Corneal Endotheliitis Accompanied with Secondary Glaucoma

PURPOSE: To report a case of Epstein-Barr virus-related corneal endotheliitis accompanied by secondary glaucoma.CASE SUMMARY: A 73-year-old male presented with blurred vision in his right eye. In the ophthalmic evaluation, there were dispersed keratic precipitates overlying corneal edema. The anterior chamber showed trace ~1+ graded inflammation and an endothelial density decrease. His best-corrected visual acuity and intraocular pressure in the right eye were 0.2 and 34 mmHg, respectively. Paracentesis was performed on the anterior chamber of the right eye to confirm the diagnosis under the suspicion of corneal endotheliitis with trabeculectomy for the intraocular pressure control. Epstein-Barr virus was confirmed using a multiplex polymerase chain reaction (PCR), and oral and eye drops of Acyclovir were used to treat the patient. There was no evidence of a recurrence over 2 years and his intraocular pressure was 12 mmHg and best-corrected visual acuity was maintained at 0.5.CONCLUSIONS: A case of Epstein-Barr virus-related corneal endotheliitis was diagnosed using PCR of the aqueous humor. The patient was treated with an oral antiviral agent and eyedrops without a recurrence.

Widespread hemorrhagic varicella in 2 cases of HIV-AIDS

@#INTRODUCTION: Varicella or commonly known as chicken pox is caused by varicella-zoster virus (VZV) that is usually seen as a vesicular eruption in children. It is a highly contagious infection and is the result of exogenous primary infection of a susceptible individual. Immunocompromised individuals have impaired cell-mediated immunity and are prone to develop severe disease. They may have atypical presentations and lesions may sometimes appear hemorrhagic. CASE REPORT: We report two separate cases of HIV-AIDS patients presenting with erythematous umbilicated papules in which the initial clinical impression was molluscum contagiosum. Skin punch biopsy was done and revealed hemorrhagic varicella. Patients were started on intravenous acyclovir with noted remarkable improvement. CONCLUSION: This case report highlights the clinical and histopathologic features of hemorrhagic varicella. A skin biopsy is mandatory to establish the correct diagnosis and to initiate proper treatment.

Retinal vasculitis associated with epstein-barr virus infection in a young immunocompetent patient. first colombian case report

RESUMEN Introducción. La infección por virus de Epstein-Barr (VEB) suele ser asintomática y persiste durante toda la vida. La afectación ocular es infrecuente, y aunque existen informes de casos, ninguno de ellos proviene de Colombia o Latinoamérica. Presentación del caso. Paciente masculino inmunocompetente con vasculitis retiniana unilateral generalizada, con vasos sin sangre temporales e inferonasales en la periferia, hemorragias intrarretinianas, vitritis intensa y desprendimiento de retina. La presencia de VEB se definió con una técnica de reacción en cadena de la poli-merasa en humor vítreo. El paciente recuperó la agudeza visual con el tratamiento oral antiviral convencional. Discusión. La afectación ocular asociada con el VEB se describe en pacientes inmunocomprometidos, en especial con infección por virus de inmunodeficiencia humana donde puede haber afectación retiniana. En este caso particular se discute la presencia de esta patología en pacientes inmunocompetentes. Conclusiones. La vasculitis retiniana es una entidad rara con mayor asociación a la inmuno-depresión. No existe un algoritmo de diagnóstico de esta enfermedad y la afectación ocular puede ser variable; tampoco existen líneas estándar de tratamiento. La evidencia reportada en el presente caso podría justificar estudios en pacientes seleccionados que muestran un compromiso de la agudeza visual sin una etiología establecida.

ABSTRACT Introduction: Epstein - Barr virus (EBV) infection is usually asymptomatic and persists throughout life. Eye involvement is rare, and even though there are some case reports, none of them comes from Colombia or Latin America. Case presentation: Immunocompetent young man with generalized unilateral retinal vasculitis, temporal and inferonasal bloodless vessels in the periphery, intraretinal hemorrhages, intense vitritis and retinal detachment. Epstein-Barr virus presence was determined using a polymerase chain reaction technique in vitreous humor. The patient recovered visual acuity with conventional antiviral oral treatment. Discussion: Eye involvement associated with Epstein-Barr virus is observed in immunocompromised patients, especially with HIV infection, where retinal involvement may occur. This case reports the presence of this pathology in an immunocompetent patient. Conclusions: Retinal vasculitis is a rare entity, frequently associated with immunocompromise. There is no diagnostic algorithm for this disease and eye involvement may be variable; there are no standard lines of treatment either. The evidence reported here explains the need for studies in selected patients showing visual acuity involvement without an established etiology.

Meningitis linfocítica recurrente por virus herpes simple tipo 2 / Recurrent lymphocytic meningitis by herpes simplex virus type 2

La meningitis linfocítica recurrente o meningitis de Mollaret es una entidad asociada a un gran número de etiologías infecciosas, autoinmunes, toxicológicas y neoplásicas. En la actualidad el virus herpes simple tipo 2 (HSV-2) es el agente más frecuentemente aislado. Afecta frecuentemente a mujeres de mediana edad y tiende a autolimitarse sin secuelas dentro de la primera semana de inicio de síntomas. El diagnóstico se basa en la detección de ácidos nucleicos virales en el líquido cefalorraquídeo. Al momento no se ha demostrado beneficio en el uso de tratamiento antiviral en la prevención de recurrencias.

Recurrent lymphocytic meningitis or Mollaret´s meningitis is a rare condition caused by a number of infectious, autoimmune, toxic and neoplastic diseases. Herpes simplex type 2 is the most commonly isolated agent. It usually compromises middle aged women, with a self-limited clinical presentation that resolves within a week leaving no sequelae. Its diagnosis is mainly based on nucleic acid detection on cerebrospinal fluid. Antiviral prophylaxis has not shown conclusive to avoid recurrences.

Study on Efficacy of Steroids and Acyclovir Treatment in Bells Palsy

Bells palsy is an idiopathic disease of the seventh cranial nerve. This is the most frequent cranial mononeuropathy with an annual incidence of 10 to 40 cases per 100,000 population with geographical variations. Aim: To assess the efficacy of Steroids and Acyclovir in the management of Bell’spalsy. Methods: All the patients with Bell's palsy, without clinical evidence of other cranial nerve damage or central nervous system diseases were included. Patients were divided into 4 groups, control, steroid alone, steroid with acyclovir and acyclovir alone. The study groups of patients were clinically tested in a periodic manner within twelve months at various intervals. The severity of the facial nerve involvement is assessed with House- Brackmann grading (HB) system. Results: In 101 patients, Majority of patients come under grade IV (43.6%) and next comes to grade V (31.7%). 86% of the percentage of patients improved in grade IV, and 68.8% of patients improved in grade V. None of the patients from grade VI showed improvement. Combination of Steroids and acyclovir is definitely useful when compared to the control group. The combination scores over the control group by 1.37 times which is statistically significant (P value= 0.031668). Conclusion: Steroids are safe and are probably effective in the management of bells palsy which improves the rate ofrecovery. Acyclovir in combination with prednisolone is safe and has a definite role in improving facial functional outcomes in patients with Bell’s palsy than using the drugalone.

Encefalitis por herpes simple resistente al aciclovir en un niño tratado satisfactoriamente con el agregado de foscarnet: A propósito de un caso / Acyclovir Unresponsive Herpes Simplex Encephalitis in a child successfully treated with the addition of Foscarnet: Case report

La encefalitis por herpes simple (EHS) es la causa más frecuente de encefalitis focal esporádica en todo el mundo. El aciclovir es el tratamiento preferido para la EHS desde la década de 1980. Después del uso generalizado del aciclovir, se redujo la tasa de mortalidad relacionada con la EHS pero surgieron cepas resistentes. Se ha informado que la incidencia de virus del herpes simple (VHS) resistente al aciclovir es del 0,5 % y del 3,5 %-10 % aproximadamente en los pacientes inmunocompetentes e inmunocomprometidos, respectivamente. En este artículo, describimos el caso de un paciente inmunocompetente de 12 años de edad con encefalitis por VHS-1 tratado satisfactoriamente con aciclovir y foscarnet. En el caso de una condición clínica que desmejora con el tratamiento con aciclovir, incluso si no se demuestra un aumento de la carga viral del VHS en el líquido cefalorraquídeo, se podría considerar la posibilidad de EHS resistente al aciclovir y el agregado de foscarnet al tratamiento con aciclovir.

Herpes simplex encephalitis (HSE) is the most common cause of sporadic focal encephalitis worldwide. Acyclovir is the treatment of choice of HSE since the 1980s. After the widespread use of acyclovir, HSE related mortality rate had reduced but resistant strains emerged. Acyclovir resistant HSV incidence was reported as about 0.5 % and 3.5 %-10 % in immunocompetent and immunocompromised patients, respectively. Herein, a 12-year-old immunocompetent patient with HSV-1 encephalitis who was successfully treated with combined acyclovir and foscarnet therapy is described. In the case of deteriorating clinical condition under acyclovir treatment even if the absence of demonstration of increased CSF HSV viral load, the possibility of acyclovir resistant HSE and the addition of foscarnet to the acyclovir treatment might be considered.

Herpetic Esophagitis in Immunocompetent Child / 대한소아소화기영양학회지

A previously healthy 2.5-year-old male child presented with vomiting, diarrhea, and fever. During hospitalization he developed odynophagia and refusal to eat. His symptoms did not respond to acid suppressant therapy. He underwent upper endoscopy which showed severe inflammation, ulcerations and abundant necrosis. Histopathological features and serological testing were consistent with herpetic esophagitis. He had no history of recurrent infections or history of sick contacts. His immunological work up showed normal level of immunoglobulins and his White Blood Cells subpopulations were normal. His HSV serology was positive. The patient was started on acyclovir 5 mg/kg q 8 hours. He resolved his symptoms within 24 hours of treatment.