Herpes labialis in parturients receiving epidural morphine following cesarean section.

A significant association exists between the use of epidural morphine (EM), reactivation of herpes labialis (HL) commonly known as coldsores, and pruritus in the obstetric population. A randomized prospective study was designed to eliminate previously identified confounding variables. Immediately following delivery, parturients having undergone cesarean section with epidural anesthesia with carbonated lidocaine (Xylocaine CO2, Astra, Mississauga, Ontario, Canada) with 1:200,000 epinephrine were sequentially randomized to receive either EM or im opioids for postoperative analgesia. One blood sample was collected for viral serology and two mouthwashes (day 0 and 2) were collected to determine oral viral shedding. The patients were observed daily for 5 days. Coldsores were cultured for herpes simplex virus (HSV). Of 187 patients, 96 received EM and 91 im opioids; herpes labialis occurred in 14 of 96 (14.6%) of the former but in 0 of 91 of the latter (P = 0.0004). All 14 experienced facial pruritus. The two groups were at equal risk for reactivation (seropositivity 64.6% and 62.6%, respectively). Analysis of data for those with positive HSV serology reveals 14 of 62 (22.5%) had EM and herpes labialis compared with 0 of 57 in the im group (P less than 0.0001). The incidence of oral viral shedding was low. Surgical stress, the local anesthetic solution, and epinephrine addition to the local anesthetic were eliminated as confounders. Stepwise logistic regression analysis revealed that EM and a history of herpes labialis in these patients were predictive for reactivating oral HSV.

Vinyl versus latex gloves as barriers to transmission of viruses in the health care setting.

One type of vinyl and seven types of latex gloves without visual defects were tested with respect to their barrier function against high concentrations of three viruses of varying size: herpes simplex virus type 1 (HSV-1, 180 nm), human immunodeficiency virus type 1 (HIV-1, 100 nm), and echovirus type 9 (Echo 9, 25 nm). Viral suspensions of HSV-1 (10(8) TCD50/ml), HIV-1 (10(5) TCD50/ml), and echovirus type 9 (10(7.5)TCD 50/ml) were placed in an inverted glove finger immersed in media and maintained for 3 h at room temperature with sampling performed from outside the glove at 10 min, 30 min, 1 h, 2 h, and 3 h. No cytopathic effect (CPE) was identified after inoculation onto Vero cells or RhMK cells for HSV-1 and Echo 9, respectively, and reverse transcriptase activity was not detected in Hut 78 cells after inoculation of HIV-1 during any of the time intervals. Stretching of a glove finger for 18 h with repetition of the procedure with Echo 9 revealed no CPE. We conclude that under these experimental conditions, intact gloves act as effective barriers to the transmission of viral particles, including HIV in the health care setting.

Recurrent herpes simplex virus labialis and the use of epidural morphine in obstetric patients.

A retrospective study of sequential obstetric patients delivering at University Hospital and receiving epidural anesthesia was conducted to determine if a suggested association exists between the recurrence of oral herpes simplex lesions and the use of epidural morphine. In a retrospective study of 291 patients, 13 of 134 (9.7%) receiving epidural morphine developed recurrent oral herpes lesions in contrast to 1 of 157 (0.6%) not receiving the drug (P less than 0.001). In a prospective hospital-based study of 729 consecutive obstetric patients, 146 patients received epidural opioids (morphine, fentanyl, or both) and 583 did not. Recurrent HSVL lesions occurred in 13 of 140 (9.3%) patients given epidural morphine but in only 6 of 583 (1.0%) not given epidural opioids (P less than 0.001). Three of the 13 patients with HSVL received both epidural morphine and fentanyl and 10 received only epidural morphine. Because of the small numbers of patients receiving only fentanyl, no relation between HSVL reactivation and epidural fentanyl could be established. In patients having caesarean sections, the association of recurrent HSVL and the use of epidural morphine was significant (P = 0.04), suggesting cesarean delivery was not a confounder. A hitherto undescribed triggering agent, epidural morphine, appears to be associated with reactivation of HSVL in obstetric patients in the postpartum period.

Experimental studies of acute and recurrent herpes simplex virus infections in the murine heart and dorsal root ganglia.

The multiplication of HSV-1 and HSV-2 strains in the heart and the corresponding dorsal root ganglia (DRG) was examined in experimentally infected mice. Infectious HSV-1 was recovered from the heart between the second and fourth day after inoculation and 3 days later from the DRG. Both the heart and DRG yielded infectious HSV-2 from the fourth to the twenty-first day after inoculation. The HSV-2, but not the HSV-1, induced recrudescent disease in chronically infected mice up to 18 months after inoculation. These affected mice showed signs of disease similar to those observed during the acute phase of the primary infection. During the recrudescent disease, infectious HSV-2 was recovered both from the heart and DRG. The possibility of using this experimental model for investigating long-term human cardiopathies is discussed.

Management of 41 persons exposed to a rabid dog: unplanned experience with human diploid vaccine.

Thirty-six persons -- veterinarians, technicians and students at a veterinary clinic -- were unwittingly exposed to a rabid dog over a period of 21/2 days. One veterinarian received a penetrating bite, two other individuals were grabbed by the dog but the skin was not penetrated, and many were exposed to saliva or urine or both. In addition, the owner of the dog and his wife and three children, while not bitten, were exposed to saliva. The diagnosis was made post mortem when specimens of the dog's brain were examined by indirect fluorescent antibody testing. All but one of the students had been vaccinated against rabies with hamster kidney vaccine, but eight members of the veterinary college's staff had not been so vaccinated. Treatment started with duck embryo vaccine; if necessary, rabies (human) immune globulin was also given. When one student reacted severely to the first dose of duck embryo vaccine permission was sought to bring a human diploid vaccine into Canada. In five patients the human diploid vaccine was substituted for the duck embryo vaccine because of severe reactions to the latter. Twenty-five staff members and the family of five received both vaccines. Reactions to the human diploid vaccine were minor and transient. Recommendations include the early licensing of the human diploid vaccine in Canada.

Experimental herpes simplex virus carditis in mice.

Herpes simplex virus types 1 and 2 induced acute and chronic cardiac damage in suckling and weaning mice after intranasal inoculation. Signs of virus replication were detected by light, immunofluorescent, and electron microscopy techniques. Virtually all of the cardiac tissues appeared to be susceptible to herpes simplex virus. The myocardium, however, was most regularly affected. The viral lesions were discrete during the acute phase of infection. The cardiac damage, however, was more extensive in some of the chronically infected mice. Morphologically, these lesions either resembled the acute ones or were associated with inflammatory granulomatous and sclerotic changes.

Role of coxsackievirus B4 in the pathogenesis of acute glomerulonephritis.

Coxsackievirus B(4) was isolated from the throat, nose, blood, stools and urine of a 9-year-old boy with acute glomerulonephritis and a pneumonitis. Neutralization test showed a greater than fourfold rise in the antibody titre to coxsackievirus B(4). The antistreptolysin O titre was elevated, but the complement component was within the normal range. The importance of the coxsackievirus B(4) in the pathogenesis of acute glomerulonephritis is clearly indicated; however, further investigations are needed to understand the details of the virus-kidney interaction.