Accuracy of ICD-9-CM codes in identifying infections of pneumonia and herpes simplex virus in administrative data.

PURPOSE: Clinical epidemiology studies increasingly rely on electronic medical records data. The validity of International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes is crucial as they are often used to identify conditions of interest. We evaluated the use of archived ICD-9-CM codes to identify two representative infection-related conditions, pneumonia and herpes simplex virus (HSV), in a defined health system. METHODS: Records were obtained for a sample of 175 and 179 patients with ICD-9-CM codes for pneumonia and HSV, respectively. An adjudicated case status was assigned for each subject. RESULTS: The presence of a single ICD-9-CM code had a positive predictive value of 88% for pneumonia and 86% for HSV. False positives (noncases) accounted for less than 10% of records evaluated for each condition. CONCLUSIONS: Our study demonstrates that ICD-9-CM codes for pneumonia and HSV were valid markers of a true history of these conditions, suggesting that ICD-9-CM codes can be used to successfully identify infection-related conditions in epidemiologic studies. However, validation studies for individual conditions may help identify condition-specific strategies to improve the performance of diagnostic codes.

Clinical features and presentation of infectious scleritis from herpes viruses: a report of 35 cases.

PURPOSE: To describe clinical features and presentation of infectious scleritis resulting from herpes viruses. DESIGN: Retrospective case series. PARTICIPANTS: Thirty-five patients out of 500 with scleritis. METHODS: We reviewed the electronic health records of 500 patients with scleritis, 35 of whom were diagnosed with herpes virus infection, seen at 2 tertiary referral centers. We studied the clinical features and ocular complications of this subset of patient with scleritis. MAIN OUTCOME MEASURES: Correlation between classification, severity, and symptoms (i.e., pain) and diagnosis of herpetic-associated scleritis. Vision loss, presence of associated uveitis, keratitis, glaucoma, or systemic disease were documented over the follow-up period. Other outcome measures included epidemiologic data: age, gender, laterality, visual acuity, duration of symptoms, and underlying systemic or ocular diseases. RESULTS: Of 500 patients with scleritis, 47 (9.4%) had an underlying infectious cause. Thirty-five (74.4%) of these were diagnosed with herpes virus infection, 5 (10.6%) with tuberculosis, and the remaining 7 (14.8%) with other infectious disease. Patients with herpes-associated scleritis were analyzed as a group and then compared with those with idiopathic scleritis. Most patients with herpetic scleritis presented with acute (85.7%) and unilateral (80%) scleral inflammation. Pain was moderate or severe in 68.6% of the patients. The most common type of scleritis was diffuse anterior in 80% (n = 28), followed by nodular anterior 11.4% (n = 4), and necrotizing in 8.6% (n = 3). Necrotizing anterior scleritis was more commonly seen in patients with herpetic scleritis versus patients with idiopathic disease (8.6% vs 1.2%; P<0.05). Unilaterality was also more common in herpetic scleritis (80%) than in idiopathic disease (56.7%; P<0.05). Vision loss was significantly greater in herpetic than idiopathic scleritis (34.3% vs 11.5%; P<0.001). CONCLUSIONS: The association between scleritis and infectious disease may be higher than previously reported by other series. Herpes viruses account for 7% of all scleritis cases and its diagnosis may be challenging when there is not a classically diagnostic clinical picture. We present the observed clinical features of herpetic scleritis and describe the clinical differences at presentation between patients with idiopathic scleritis and those with herpes infection.

Severe herpes simplex virus type-I infections after dental procedures.

BACKGROUND: Recurrences of herpes labialis (RHL) may be triggered by systemic factors, including stress, menses, and fever. Local stimuli, such as lip injury or sunlight exposure are also associated to RHL. Dental extraction has also been reported as triggering event. CASE REPORTS: Seven otherwise healthy patients are presented with severe and extensive RHL occurring about 2-3 days after dental extraction under local anaesthesia. Immunohistochemistry on smears and immunofluorescence on cell culture identified herpes simplex virus type I (HSV-I). Five patients reported more severe prodromal signs than usual. Although all the patients suffered from RHL, none had previously experienced RHL after dental care. Two patients required hospitalisation for intravenous acyclovir therapy, whereas the others were successfully treated with oral valaciclovir or acyclovir. CONCLUSION: Severe and extensive RHL can occur soon after dental extraction under local anaesthesia. Patients with a previous history of RHL seem to be at higher risk. It is not clear whether RHL is linked to the procedure itself, to the anaesthetic procedure or both. As the incidence is unknown, more studies are required to recommend prophylactic antiviral treatment in RHL patients who are undergoing extractions. Dentists should be aware of this potentially severe post-extraction complication.

Microbiology devices; reclassification of Herpes simplex virus types 1 and 2 serological assays. Direct final rule.

The Food and Drug Administration (FDA) is implementing a direct final rule correcting the regulation classifying herpes simplex virus (HSV) serological assays by removing the reference to HSV serological assays other than type 1 and type 2. When reclassifying this device, FDA mistakenly distinguished between HSV serological assays type 1 and type 2 and all other HSV serological assays. At that time, and today, the only preamendments HSV serological assays which FDA was aware of were type 1 and type 2 and, therefore, the classification of HSV assays other than type 1 and type 2 was incorrect. FDA is correcting the classification of this device to eliminate possible confusion resulting from this error. Elsewhere in this issue of the Federal Register, we are publishing a companion proposed rule under FDA's usual procedure for notice and comment to provide a procedural framework to finalize the rule in the event we receive significant adverse comment and withdraw this direct final rule.

Different patterns of herpes simplex virus type 1 infection among college students from Cuernavaca, Mexico.

The goal of this study was to determine herpes simplex virus type 1 (HSV-1) seroprevalence among college students from Morelos State University, Mexico; and to correlate their demographic and sexual behaviour characteristics with HSV-1 infection. Demographic characteristics were associated with HSV-1 among female students. Among male students, sexual behaviour characteristics were associated with HSV-1 seroprevalence. Male students who practised oral sex and did not always use a condom presented higher rates of HSV-1 infection (76.9%) than students who did not have oral sex (52.2%). A different pattern of HSV-1 infection depends on gender among Mexican students analysed.

1828: Clínica y tratamiento del herpes simple / 1828: Clinical diagnosis and treatment of herpes simple

Hace 180 años, la medicina francesa de la observación tenía claros conceptos generales sobre el herpes simple. (AU)

1828: Clínica y tratamiento del herpes simple / 1828: Clinical diagnosis and treatment of herpes simple

Hace 180 años, la medicina francesa de la observación tenía claros conceptos generales sobre el herpes simple.

[Frequency of different infectious agents persistence in mononuclear leukocytes of blood and synovial fluid in patients with rheumatoid arthritis].

The study of persistence in mononuclear leukocytes (ML) of blood and synovial fluid of 218 patients with rheumatoid arthritis (RA) Cytornegalovirus (CMV), the 1-st and 2-nd types of Herpes virus simplex (VH), Epstain-Barr virus (VEB), Mycoplasma arthritidis (Ma), Mycoplasma fermentans (Mf), Ureaplasma urealiticum (U), Chlamidia trachomatis (Ct), viruses of Hepatitis B and C was carry out by direct and indirect immunofruorescence, immunoenzymatic analysis and polymerase chain reaction. An increased frequency of contamination of blood ML with infectious agents in patients with RA was established (57,4% compared with 16,7% in control group). The following infectious agents were revieled more frequently: in ML of blood and synovial fluid the Ma (relatively 20,5% and 15,9%), Mf (15,6% and 13,2%), Ct (18,4% and 13,2%), VH (27,1% and 10,5%), VEB (12,7% and 5,3%) and CMV (11,2% and 7,9%). Types of frequency dynamics of ML contamination with these infectious agents in different time phases of RA were determined.

Meningoencefalitis por mycoplasma pneumoniae en un adulto joven / Mycoplasma pneumoniae meningoencephalitis in a yuong adult

Las infecciones por Mycoplasma pneumoniae presentan complicaciones del sistema nervioso de distinto tipo, que si bien son infrecuentes pueden ser graves; habitualmente tienen evolución favorable pero pueden dejar secuelas permanentes. Se presenta una paciente adulta joven con una meningoencefalitis aguda que no dejó secuelas como complicación de una infección respiratoria baja. El diagnóstico se efectuó por detección de anticuerpos específicos. (AU)

Meningoencefalitis por mycoplasma pneumoniae en un adulto joven / Mycoplasma pneumoniae meningoencephalitis in a yuong adult

Las infecciones por Mycoplasma pneumoniae presentan complicaciones del sistema nervioso de distinto tipo, que si bien son infrecuentes pueden ser graves; habitualmente tienen evolución favorable pero pueden dejar secuelas permanentes. Se presenta una paciente adulta joven con una meningoencefalitis aguda que no dejó secuelas como complicación de una infección respiratoria baja. El diagnóstico se efectuó por detección de anticuerpos específicos.

[Necrotic herpetic retinitis]. / Rétinites nécrosantes herpétiques.

The diagnosis of necrotic herpetic retinitis is suggested on clinical grounds, prompting urgent appropriate intravenous and intravitreal treatment. PCR on ocular samples is most often successful in identifying the herpetic agent. Classic acute retinal necrosis syndrome caused by herpes simplex or zoster virus and the different clinical forms present in immunocompetent or immunodepressed patients are described. The differential diagnosis includes atypical presentation of retinal necrosis caused by toxoplasmosis, syphilis, or ocular lymphoma; the ocular samples are useful in establishing the etiological diagnosis. We describe the different therapeutic strategies in the acute phase and as secondary prophylactic treatment. The clinical outcome appears to be influenced by rapid, appropriate treatment, limiting the extension of the retinal necrosis.

Seroprevalencia del virus herpes simple 2 en mujeres con trabajos de parto que asistieron al Hospital Bertha Calderón Roque, en el período comprendido de noviembre-diciembre del 2000 / Seroprevalence of herpes virus simplex type 2 of woman in labor that attended to the Hospital Bertha Calderón Roque in the period incluyended from movember-december of 2000

Se realizó un estudio descriptivo de corte transversal, en el Hospital bertha Calderón Roque, a todas las pacientes que asistieron en trabajo de parto, durante el período de noviembre-diciembre 2000. El universo de estudio estaba constituído por 192 mujeres, las que se dividieron por grupo de edad donde el grupo de 15-19 años ocupó un 38.5 porciento, siguiéndole el grupo de 20-24 años. El estudio revela que el estado civil de acompañadas ocupa un lugar predominante con un 62 porciento, seguidas de mujeres casadas con un 25 porciento, con respecto a los antecedentes obstetricos el 41.4 porciento de mujeres eranprimigestas, seguidas de las bigestas con un 25.7 porciento en relación al número de abortos tenemos que el 89.6 porciento refieron haber no tenido ningún aborto,en relación al iniciación de su vida sexual refieren el 70 porciento de las pacientes haber iniciado entre los 15-19 años, seguido del grupo entre 10-14 años, que presentó el 15.1 porciento, lo que demuestra la precosidad con que los adolescentes inician sus relaciones sexuales, siendo esto un factor de riesgo para contraer un sinnúmero de enfermedades entre ellas la del herpes genital. La seroprevalencia del virus del Herpes Simple tipo 2 va en ascenso a mitad de las pacientes con historia de úlceras genitales hubo serología positiva, por lo que no siempre existe relación entre hisotria de infección genital y la presencia de anticuerpos HVS-2, por el número de parejas a lo largo de la vida, como comportamiento sexual de riesgo

Evidence for deficiencies in intracerebral cytokine production, adhesion molecule induction, and T cell recruitment in herpes simplex virus type-2 infected mice.

We examined the intracerebral T cell response in mice infected with neurovirulent HSV-2 strains and an avirulent HSV-1. In HSV-2-infected brains, (i) IL-1beta, TNF-alpha and IFN-gamma mRNA expression was low, (ii) ICAM-1 and VCAM-1 were not induced, (iii) few CD4+ or CD8+ cells were detected. By contrast, in HSV-1-infected brains, (i) cytokine mRNA expression was high, (ii) adhesion molecules were strongly expressed, (iii) many T cells were detected. We suggest that deficient T cell extravasation into HSV-2-infected brain regions is caused by negligible ICAM-1 and VCAM-1 expression, which is due to low expression of critical cytokines.

Herpes simple crónico perianal causado por HSV-2 multirresistente / Chronic perianal herpes simplex

Se describe un paciente con el Síndrome de Inmunodeficiencia Adquirida (SIDA) y lesiones de herpes simple crónico perianal causado por el virus del herpes simple tipo 2 (HSV-2), las cuales clínicamente se mostraron resistentes a los distintos esquemas terapéuticos ensayados: aciclovir (ACV) a dosis alta, administrado solo o combinado con interferon, y foscarnet. El tratamiento combiando de ACV e interferon produjo moderada mejoría clínica parcial, estabilización transitoria seguida de reactivación. Durante el curso con foscarnet se apreció una rápida e importante mejoría clínica pero sin llegar a la resolución completa de la lesión, respuesta favorable inicial que fue seguida de reactivación progresiva, refractaria a la droga incluso a dosis que al principio habían sido efectivas

Acute herpes simplex encephalitis: clinical assessment and prognostic data.

Acute herpes simplex encephalitis (HSE) has a grave outcome, and detection of prognostic features is of clinical importance. Thirty patients with HSE were assessed in a retrospective study. Diagnosis was confirmed by serological methods using the indirect immunofluorescence technique (IFT). Antiviral treatment was given to 23 of the patients. Focal convulsions were more frequent in patients below 18 years of age, while confusion and memory disturbances were prevalent among patients above 18. The final outcome was influenced by the degree of severity of the disease at the peak and the state of consciousness and duration of disease prior to the initiation of anti-viral treatment. No correlation was found between antibody levels in serum or in CSF and the outcome. We conclude that the clinical degree of severity the duration of illness prior to treatment and state of consciousness at the initiation of anti-viral treatment are of prognostic importance.

Herpes simples persistente y migratorio en una paciente HIV(+) / Persistent and migratory Herpes simplex in HIV(+) patients

Presentamos el caso de una paciente de veinte años, infectada por el HIV, que seis meses antes de producirse el viraje serológico comenzó a presentar pequeñas lesiones prurigoides en cara, cuya estructura correspondió a una vesícula viral. Posteriormente, junto a las lesiones descriptas, desarrolló una clásica de herpes simple, confirmada por cultivo en tejidos. Proponemos una clasificación de las formas crónicas de herpes simple crónico. Las formas persistente y recurrente ulceradas, suelen observarse en pacientes inmunodeprimidos. (AU)

Herpes simples persistente y migratorio en una paciente HIV(+) / Persistent and migratory Herpes simplex in HIV(+) patients

Presentamos el caso de una paciente de veinte años, infectada por el HIV, que seis meses antes de producirse el viraje serológico comenzó a presentar pequeñas lesiones prurigoides en cara, cuya estructura correspondió a una vesícula viral. Posteriormente, junto a las lesiones descriptas, desarrolló una clásica de herpes simple, confirmada por cultivo en tejidos. Proponemos una clasificación de las formas crónicas de herpes simple crónico. Las formas persistente y recurrente ulceradas, suelen observarse en pacientes inmunodeprimidos.