Acyclovir-resistant chronic cutaneous herpes simplex in Wiskott-Aldrich syndrome.

A 28-year-old man with Wiskott-Aldrich syndrome presented with ulcerative-proliferative lesions on his face from which herpes simplex type 1 (HSV-1) was isolated. He was initially treated with 10 mg/kg of acyclovir (Zovirax) intravenously every 8 h, but his skin lesions worsened. Clinical resistance to acyclovir was suspected, and therapy with this drug was intensified. The dosage of acyclovir was increased to 45 mg/kg, administered by continuous infusion, and the lesions subsequently resolved. The strain of HSV recovered from the patient showed acyclovir-resistance in vitro, using the colorimetric method with neutral red. Herpes simplex virus resistance to acyclovir is rare. It is more common in immunocompromised patients if subtherapeutic doses are administered in the treatment of chronic persistent forms of infection. Whenever clinical resistance to acyclovir is suspected, the dosage should be increased to 2 mg/kg per h administered via an infusion pump. If no improvement is observed in the patient's condition with this regimen, a phosphorylated medication whose mechanism of action is not dependent on viral thymidine kinase, such as foscarnet (phosphonoformic acid), should be substituted.

[Herpes simplex virus pneumonia following transplantation]. / Pneumopathies à herpès simplex virus (HSV) chez les transplantés.

The HSV (1 or 2) is the cause of serious pulmonary infections among patients who have had a transplantation. This study in retrospect is based on the analysis of 145 patients who underwent a cardiothoracic transplant at the CHU. in Nancy. Confronted with clinical signs calling to mind breathing difficulties, the analysis of the broncho alveolar lavage (or of the bronchial brushing) revealed the viral aetiological agent. The answer from the laboratory is quickly available by immunofluorescence or by immunoperoxidase with viral anti-protein monoclonal antibodies and by the multiplication in vitro of the virus into cell cultures. The HSV 1 was responsible for 8 herpetic lung infections. The specific Acyclovir treatment was used 6 times successfully. When such a direction of treatment was impossible (in 2 cases) the outcome was fatal. The carry HSV is highly frequent and recurrences under immuno-suppressor treatment require an Acyclovir prophylaxis among patients admittedly carrying the virus in a pre-transplanted serum assessment.

[Post-transfusion cytomegalovirus infection in premature infants weighing less than 1,500 g]. / L'infection à cytomégalovirus post-transfusionnelle chez des nouveau-nés prématurés de moins de 1,500 g.

The incidence of cytomegalovirus (CMV) infection among 107 low birth weight transfused infants (birth weight less than or equal to 1,500 g) admitted to an intensive care nursery over an 18 month period was evaluated. The diagnosis of CMV infection was based on specific serologic tests (presence of IgM, increased IgG by ELISA technic) and identification of the virus in the urine. During the first 8 months, the infants received untested blood and CMV disease occurred in 8 infants out of 44 (18.2%). During the following 10 months, all transfusions performed in 63 infants were supposed to be CMV negative. However, 32 infants received untested blood due to emergency, and 5 of them developed a CMV infection (15.6%). Finally, only 31 infants received CMV negative blood without any case of CMV infection. These data clearly demonstrate that, considering the severity of the CMV disease in the premature infants, transfusions should be performed with CMV negative blood products.

[Study of the incidence of complement-fixing antibodies against the cytomegalovirus in 339 subjects]. / Etude de la fréquence des anticorps fixant le complément anticytomégalovirus chez 339 sujets

The authors studied complement-fixing anticytomegalovirus antibodies in a population of 339 subjects, divided up into 8 groups, from birth to 60 years. The adult group consisted of blood donors. At birth, the new-born acquired temporary passive immunity from their mothers ; then they became actively immunised over the course of several years. The increase in the number of immunised subjects was greater during infancy and adolescence, passing from 6 % to 28.1 %, than during adult age (45.1 to 52.9 %). A very important difference of 17 %) definitely separated the age groups of adolescents and young adults. 47.4 % of blood donors have complement fixing anticytomegalo-virus antibodies.