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1.
BMJ Case Rep ; 17(7)2024 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-38991567

RESUMO

We present a case of a primigravida in her 30s who had a caesarean delivery of dichorionic diamniotic twins at 33 weeks of gestation. Her postpartum course was complicated by a herpes simplex virus (HSV) infection of her nipple, found after her neonates were diagnosed with HSV encephalitis. She was evaluated at her 3-week postpartum visit and reported that her neonates were concurrently admitted to the neonatal intensive care unit with disseminated neonatal HSV-1. The patient and her partner were in a monogamous relationship with no known history of HSV. Physical examination demonstrated a vertical fissure on the face of her right nipple and a small cluster of vesicles on her left hand. PCR swabs of the lesions were positive for HSV-1 at both locations. The patient was started on oral valacyclovir 1000 mg two times per day, topical acyclovir ointment applied 4-6 times per day and mupirocin ointment applied 3 times per day to her breast with resolution of her breast lesions. She was able to continue expressing her breastmilk with the help of a pump and then resumed breastfeeding once her infection was cleared. Her infants recovered after prolonged parenteral antiviral therapy with age-appropriate development at follow-up.


Assuntos
Aciclovir , Antivirais , Encefalite por Herpes Simples , Herpes Simples , Herpesvirus Humano 1 , Mamilos , Humanos , Feminino , Antivirais/uso terapêutico , Antivirais/administração & dosagem , Recém-Nascido , Aciclovir/uso terapêutico , Aciclovir/administração & dosagem , Herpes Simples/diagnóstico , Herpes Simples/tratamento farmacológico , Herpesvirus Humano 1/isolamento & purificação , Encefalite por Herpes Simples/diagnóstico , Encefalite por Herpes Simples/tratamento farmacológico , Valaciclovir/uso terapêutico , Valaciclovir/administração & dosagem , Complicações Infecciosas na Gravidez/diagnóstico , Adulto , Gravidez , Transmissão Vertical de Doenças Infecciosas , Valina/análogos & derivados , Valina/uso terapêutico , Valina/administração & dosagem , Aleitamento Materno
4.
BMJ Case Rep ; 14(3)2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-33649026
6.
AAPS PharmSciTech ; 22(1): 48, 2021 Jan 14.
Artigo em Inglês | MEDLINE | ID: mdl-33447869

RESUMO

The objective of this study was to investigate the processability of hot-melt extrusion (HME) to formulate ocular inserts of valacyclovir hydrochloride and evaluate the in vivo bioavailability of the formulation. To optimize the formulation of this drug, different physical mixtures of the polymers and plasticizer were prepared. The physical mixture was extruded through a co-rotating twin-screw extruder, and the obtained ocular inserts were cut with dimensions of 4 mm × 2 mm × 1 mm to enhance the formulation instillation in the eye. Ocular inserts were evaluated for drug content, weight variation, uniformity of thickness, in vitro drug release, and in vivo drug bioavailability. The ocular inserts were thermally characterized using differential scanning calorimetry (DSC). The attributes observed for the ocular inserts were within the target specifications. The ocular inserts of valacyclovir hydrochloride were successfully prepared using the HME. They provided sustained drug release along with enhanced drug permeation when compared with the eyedrop solution and dissolve completely in 8 h. Additionally, the obtained results demonstrated that the formulation of ocular inserts of valacyclovir hydrochloride using HME was reproducible, robust, and effective method.


Assuntos
Antivirais/administração & dosagem , Implantes de Medicamento , Tecnologia de Extrusão por Fusão a Quente , Valaciclovir/administração & dosagem , Administração Oftálmica , Antivirais/uso terapêutico , Disponibilidade Biológica , Varredura Diferencial de Calorimetria , Composição de Medicamentos/métodos , Liberação Controlada de Fármacos , Ceratite Herpética/tratamento farmacológico , Polímeros/química , Valaciclovir/farmacocinética , Valaciclovir/uso terapêutico
7.
J Clin Pharm Ther ; 46(3): 717-723, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33368338

RESUMO

WHAT IS KNOWN AND OBJECTIVE: The dosages of valaciclovir used for herpes zoster treatment recommended by Chinese pharmaceutical companies can differ considerably from those reported in the literature. This randomized clinical study compares the efficacy and safety of different oral valaciclovir doses for the treatment of herpes zoster in adults. METHODS: A total of 214 patients with herpes zoster were enrolled and randomized into two groups according to age: 98 patients in the 18-44-year group (younger patients) and 116 patients in the 45-74-year group (middle-aged and elderly patients). Patients in the two age groups were then prescribed different doses of valaciclovir. The high-dose group was administered 900 mg of valaciclovir, three times daily for 10 days, whereas the low-dose group was administered 300 mg of valaciclovir, two times daily for 10 days. The efficacy and side effects of these regimens were recorded on days 6, 11 and 30. RESULTS: In total, 207 (of 214 enrolled) patients completed the study. Of the seven patients who discontinued the study, five discontinued because their follow-up time was not fixed and two withdrew after moving to other cities. At the 11th day after treatment, the clinical effect of high-dose valaciclovir groups were significantly better than that of the low-dose valaciclovir groups in middle-aged and elderly patients (p < 0.05). The difference in visual analog scale (VAS) pain scores between the two dose groups was statistically significant in middle-aged and elderly patients at the 6th day(p < 0.05), whereas there was no difference in younger patients (p > 0.05). The VAS scores were significantly lower in high-dose group than in low-dose group at day 11 in both groups of patients(p < 0.05).There was no statistically significant difference in the time to skin scab improvement between the two different dose groups in younger patients (p > 0.05). Among middle-aged and elderly patients, the incidence of postherpetic neuralgia (PHN) was significantly lower in the high-dose group than in the low-dose group (p < 0.05). The difference in the incidence of adverse reactions between the high-dose and low-dose groups was not statistically significant (p > 0.05). Overall, the main side effect was headache. WHAT IS NEW AND CONCLUSION: The present study indicates that early treatment with high-dose valaciclovir can significantly reduce pain in patients, especially in elderly patients, in whom it can also reduce the incidence of PHN. In terms of safety, no significant difference was noted in the incidence of adverse reactions between high- and low-dose groups.


Assuntos
Antivirais/uso terapêutico , Neuralgia Pós-Herpética/tratamento farmacológico , Valaciclovir/uso terapêutico , Adolescente , Adulto , Fatores Etários , Idoso , Antivirais/administração & dosagem , Antivirais/efeitos adversos , China , Relação Dose-Resposta a Droga , Esquema de Medicação , Humanos , Pessoa de Meia-Idade , Medição da Dor , Método Simples-Cego , Valaciclovir/administração & dosagem , Valaciclovir/efeitos adversos , Adulto Jovem
11.
Curr Opin Obstet Gynecol ; 32(5): 342-350, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32739974

RESUMO

PURPOSE OF REVIEW: Congenital Cytomegalovirus (CMV) infection remains a major cause of lifelong disability, with no systematic screening implemented in pregnancy or the postnatal period. In this review article, we outline the preventive strategies, antenatal prognostic features and experimental therapies as well as evidence of efficacy from recent trials. RECENT FINDINGS: A recent randomized, double blinded, placebo-controlled study investigated the efficacy of Valaciclovir in women contracting primary CMV in the periconception period or first trimester. They concluded that Valaciclovir at a dose of 8 g/day is effective in reducing the rate of foetal CMV infection following early maternal primary infection. Administration of CMV hyperimmune globulin (HIG) was investigated in a recent randomized double-masked controlled trial. This study concluded that CMV HIG was ineffective at reducing the risk of congenital CMV among women with primary CMV in early pregnancy. SUMMARY: Congenital CMV infection remains a significant cause of disability. There is currently no vaccine available, with the best preventive strategy being patient education on transmission as well as hygiene measures to reduce risk of exposure. Experimental therapies have been investigated in recent years and there is evidence supporting the use of Valaciclovir. Data for the efficacy of CMV HIG remains inconsistent and administration is currently limited to clinical trial settings.


Assuntos
Infecções por Citomegalovirus/prevenção & controle , Infecções por Citomegalovirus/transmissão , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Antivirais/administração & dosagem , Antivirais/efeitos adversos , Infecções por Citomegalovirus/diagnóstico , Feminino , Humanos , Imunoglobulinas Intravenosas/administração & dosagem , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/virologia , Ultrassonografia Pré-Natal , Valaciclovir/administração & dosagem , Valaciclovir/efeitos adversos
13.
Med. clín (Ed. impr.) ; 154(11): 433-439, jun. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-195535

RESUMO

INTRODUCCIÓN: El citomegalovirus (CMV) es el patógeno oportunista más importante asociado al trasplante. El objetivo de este trabajo fue la caracterización de mutaciones de resistencia de CMV en pacientes receptores de trasplante alogénico de progenitores hematopoyéticos (alo-TPH) y el estudio de factores asociados. MÉTODOS: Se llevó a cabo un estudio retrospectivo de una cohorte de pacientes receptores de alo-TPH con reactivaciones postrasplante de CMV con cargas virales (CV) estables o en aumento, a pesar de un adecuado tratamiento antiviral al menos durante 2semanas. Se realizó el estudio de mutaciones de resistencia de los genes UL97 y UL54 mediante secuenciación Sanger. RESULTADOS: La infección refractaria de CMV de nuestro grupo de pacientes alo-TPH se correspondió con una tasa de infección por virus resistente del 21,43% (3 de 14 pacientes). Todos los pacientes con mutaciones de resistencia presentaron múltiples episodios de reactivación (p-valor 0,01). Las mutaciones encontradas fueron A594V y H520Q en el gen UL97 que confieren resistencia de alto grado a ganciclovir (GCV). Uno de los 3 casos con resistencia antiviral, se documentó con una CV baja (< 1.000 copias/ml) y tras corto tratamiento acumulado de GCV (41 días). CONCLUSIÓN: La mayor parte de los fracasos en el tratamiento del CMV se debió posiblemente a resistencia clínica; la falta de respuesta satisfactoria al tratamiento antiviral no siempre se acompaña de resistencia virológica. No obstante, la aparición de resistencias puede ocurrir de forma temprana tras el inicio del tratamiento anticipado y con CV por debajo de 1.000 copias/ml. El número de episodios de reactivación fue mayor entre los pacientes que se demostró resistencia virológica frente a los que no


INTRODUCTION: Cytomegalovirus (CMV) is the most important opportunistic pathogen associated with transplant. The objective of this study was the characterization of CMV resistance mutations in allogeneic haematopoietic cell transplant recipients (allo-TPH) and the study of associated factors. METHODS: A retrospective study of a cohort of allo-TPH recipients with post-transplant CMV reactivations with stable or increasing viral loads (CV), despite adequate antiviral treatment for at least 2weeks. The study of resistance mutations of the UL97 and UL54 genes was carried out by Sanger sequencing. RESULTS: Refractory CMV infection in our group of allo-TPH patients corresponded with a 21.43% rate of resistant virus infection (3 of 14 patients). All patients with resistance mutations had multiple reactivation episodes (P-value .01). The mutations found were A594V and H520Q in the UL97 gene that confers high-grade resistance to ganciclovir (GCV). One of the 3 cases with antiviral resistance was documented with a low VL (< 1000 copies/ml) and short accumulated GCV treatment (41 days). CONCLUSION: Most of the failures in the treatment of CMV were possibly due to clinical resistance; the lack of satisfactory response to antiviral treatment is not always accompanied by virological resistance. However, the appearance of resistances can occur early after the start of the treatment and with VL below 1000 copies / ml. The number of episodes of reactivation was higher among patients with virological resistance than those who did not


Assuntos
Humanos , Masculino , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Infecções por Citomegalovirus/tratamento farmacológico , Antivirais/administração & dosagem , Farmacorresistência Viral , Transplante Homólogo/métodos , Citomegalovirus/efeitos dos fármacos , Transplante de Células-Tronco Hematopoéticas , Infecções por Citomegalovirus/virologia , Citomegalovirus/genética , Estudos Retrospectivos , Aciclovir/administração & dosagem , Infecções por Citomegalovirus/etiologia , Valaciclovir/administração & dosagem
14.
J Clin Virol ; 127: 104351, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32325395

RESUMO

BACKGROUND: No treatment is currently approved for cytomegalovirus infection in pregnancy. Valacyclovir has been studied in symptomatic cytomegalovirus infected fetuses and seems to reduce the risk of serious sequelae. OBJECTIVES: We used off-label valacyclovir on pregnant women with primary cytomegalovirus infection to reduce the risk of fetal infection. STUDY DESIGN: We treated 12 pregnant women with 8 g/day valacyclovir after diagnosis of cytomegalovirus infection until amniocentesis. We continued treatment until delivery in case of fetal infection. We periodically performed serology and virology tests on the women from referral until delivery and monitored them for adverse effects while on treatment. All women underwent late amniocentesis. We followed up infants for 5-28 months. RESULTS: At the time of amniocentesis, we observed a transmission rate of 17 %, and at birth we observed a transmission rate of 42 %. Two women with negative amniocentesis and infected newborns had viremia reactivation after valacyclovir discontinuation. We observed no symptomatic infections at birth and one isolated sensory-neural hearing loss at follow-up. CONCLUSIONS: This is the first series of antiviral treatment in women with a diagnosis of cytomegalovirus infection before amniocentesis. Valacyclovir may control cytomegalovirus infection while it is administered and reduce transmission at amniocentesis. Late transmission after treatment discontinuation is a risk. We advocate the need for a controlled trial of valacyclovir therapy starting from diagnosis of maternal infection until delivery, regardless of prenatal diagnosis of infection.


Assuntos
Antivirais/administração & dosagem , Infecções por Citomegalovirus/prevenção & controle , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Complicações Infecciosas na Gravidez/tratamento farmacológico , Complicações Infecciosas na Gravidez/virologia , Valaciclovir/administração & dosagem , Anticorpos Antivirais/sangue , Antivirais/uso terapêutico , Pré-Escolar , Infecções por Citomegalovirus/tratamento farmacológico , Infecções por Citomegalovirus/transmissão , Feminino , Idade Gestacional , Humanos , Lactente , Gravidez , Cuidado Pré-Natal/métodos , Valaciclovir/uso terapêutico
15.
J Pak Med Assoc ; 70(3): 537-538, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32207443

RESUMO

Herpes zoster oticus (Ramsay Hunt Syndrome) is characterized by facial nerve paralysis, ear pain and auricular skin rash. It occurs as a result of reactivation oflatent varicella zoster virus infection in the geniculate ganglion of the facial nerve. Major clinical symptoms include 7th nerve paralysis or cranial nerve paralysis and vesicles along the nerve with cocomitant ear pain. Other cranial nerve involvement although uncommon, can be found in some cases. In this study, a 74-year-old female patient had ipsilateral 8th, 9th and 10th cranial nerves injury. Cranial nerve paralysis accompanied with injury has been repor ted in R amsay Hunt Syndrome.


Assuntos
Nervos Cranianos , Difenidramina/administração & dosagem , Herpes Zoster da Orelha Externa , Herpesvirus Humano 3/patogenicidade , Metilprednisolona/administração & dosagem , Valaciclovir/administração & dosagem , Idoso , Antieméticos/administração & dosagem , Antivirais/administração & dosagem , Nervos Cranianos/fisiopatologia , Nervos Cranianos/virologia , Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/etiologia , Pavilhão Auricular/fisiopatologia , Pavilhão Auricular/virologia , Paralisia Facial/diagnóstico , Paralisia Facial/fisiopatologia , Paralisia Facial/virologia , Feminino , Perda Auditiva Neurossensorial/diagnóstico , Perda Auditiva Neurossensorial/virologia , Herpes Zoster da Orelha Externa/diagnóstico , Herpes Zoster da Orelha Externa/tratamento farmacológico , Herpes Zoster da Orelha Externa/fisiopatologia , Humanos , Exame Neurológico/métodos , Exame Físico/métodos , Resultado do Tratamento
18.
Am J Obstet Gynecol ; 223(3): 330-349, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32105678

RESUMO

Cytomegalovirus is the most common congenital infection, affecting 0.5-2% of all live births and the main nongenetic cause of congenital sensorineural hearing loss and neurological damage. Congenital cytomegalovirus can follow maternal primary infection or nonprimary infection. Sensorineurological morbidity is confined to the first trimester with up to 40-50% of infected neonates developing sequelae after first-trimester primary infection. Serological testing before 14 weeks is critical to identify primary infection within 3 months around conception but is not informative in women already immune before pregnancy. In Europe and the United States, primary infection in the first trimester are mainly seen in young parous women with a previous child younger than 3 years. Congenital cytomegalovirus should be evoked on prenatal ultrasound when the fetus is small for gestation and shows echogenic bowel, effusions, or any cerebral anomaly. Although the sensitivity of routine ultrasound in predicting neonatal symptoms is around 25%, serial targeted ultrasound and magnetic resonance imaging of known infected fetuses show greater than 95% sensitivity for brain anomalies. Fetal diagnosis is done by amniocentesis from 17 weeks. Prevention consists of both parents avoiding contact with body fluids from infected individuals, especially toddlers, from before conception until 14 weeks. Candidate vaccines failed to provide more than 75% protection for >2 years in preventing cytomegalovirus infection. Medical therapies such as cytomegalovirus hyperimmune globulins aim to reduce the risk of vertical transmission but 2 randomized controlled trials have not found any benefit. Valaciclovir given from the diagnosis of primary infection up to amniocentesis decreased vertical transmission rates from 29.8% to 11.1% in the treatment group in a randomized controlled trial of 90 pregnant women. In a phase II open-label trial, oral valaciclovir (8 g/d) given to pregnant women with a mildly symptomatic fetus was associated with a higher chance of delivering an asymptomatic neonate (82%), compared with an untreated historical cohort (43%). Valganciclovir given to symptomatic neonates is likely to improve hearing and neurological symptoms, the extent of which and the duration of treatment are still debated. In conclusion, congenital cytomegalovirus infection is a public health challenge. In view of recent knowledge on diagnosis and pre- and postnatal management, health care providers should reevaluate screening programs in early pregnancy and at birth.


Assuntos
Infecções por Citomegalovirus/congênito , Infecções por Citomegalovirus/transmissão , Complicações Infecciosas na Gravidez/virologia , Infecções por Citomegalovirus/complicações , Feminino , Doenças Fetais/diagnóstico , Doenças Fetais/epidemiologia , Doenças Fetais/virologia , Perda Auditiva Neurossensorial/virologia , Humanos , Recém-Nascido , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Transmissão Vertical de Doenças Infecciosas/estatística & dados numéricos , Imageamento por Ressonância Magnética , Doenças do Sistema Nervoso/virologia , Cuidado Pré-Concepcional , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/epidemiologia , Primeiro Trimestre da Gravidez , Diagnóstico Pré-Natal , Testes Sorológicos , Ultrassonografia Pré-Natal , Valaciclovir/administração & dosagem
19.
CEN Case Rep ; 9(3): 200-203, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32016786

RESUMO

Post transplant lymphoproliferative disorder (PTLD) is a rare complication after kidney transplantation. Graft dysfunction is often encountered during the course of the treatment of PTLD, at times leading to need for retransplantation. We describe here the case of a young boy who underwent retransplantation after treatment of early Epstein Barr virus (EBV) related post transplant lymphoproliferative disorder. Our case highlights the various factors needing deliberation before retransplantation including time from remission of PTLD, EBV serostatus and choice of induction and maintenance immunosuppression agents.


Assuntos
Infecções por Vírus Epstein-Barr/complicações , Transplante de Rim/efeitos adversos , Transtornos Linfoproliferativos/etiologia , Disfunção Primária do Enxerto/etiologia , Retratamento/métodos , Antivirais/administração & dosagem , Antivirais/uso terapêutico , Criança , Quimioterapia Combinada , Infecções por Vírus Epstein-Barr/tratamento farmacológico , Infecções por Vírus Epstein-Barr/virologia , Herpesvirus Humano 4/imunologia , Herpesvirus Humano 4/isolamento & purificação , Humanos , Imunossupressores/administração & dosagem , Imunossupressores/uso terapêutico , Transtornos Linfoproliferativos/diagnóstico , Transtornos Linfoproliferativos/virologia , Masculino , Complicações Pós-Operatórias , Indução de Remissão , Resultado do Tratamento , Valaciclovir/administração & dosagem , Valaciclovir/uso terapêutico
20.
Indian J Pharmacol ; 52(6): 472-475, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33666187

RESUMO

OBJECTIVES: The objective was to evaluate the efficacy of antiviral agent valacyclovir compared with famciclovir in the treatment of herpes zoster. MATERIALS AND METHODS: A comparative study was conducted over a period of 1 year. Data relevant to the study were collected from 60 patients, with active herpes zoster presenting to the outpatient department within 72 hr of the first occurrence of zoster rash. They were divided in to two groups of 30 patients each. The first group of patients received valacyclovir tablet 1000 mg thrice daily, whereas those in the second group were given famciclovir tablet 500 mg thrice daily. Both the drugs were given for 7 days. Periodic follow-up till 29th day was done for assessment of the effects of given drugs. RESULTS: Significant decrease was observed on comparison of pain scores between the two groups using the visual analog scale, with the drug valacyclovir, than in the famciclovir group at day 29. Furthermore, valacyclovir treatment accelerated the resolution of zoster associated pain in more number of patients compared with famciclovir. CONCLUSION: Oral valacyclovir administered during acute zoster infection for a period of 7 days offers significant benefit compared to famciclovir by providing a well tolerated and greater resolution of pain while maintaining the favorable safety profile, making valacyclovir more efficacious and a better drug in management of Herpes Zoster in comparison to famciclovir.


Assuntos
Antivirais/uso terapêutico , Famciclovir/uso terapêutico , Herpes Zoster/tratamento farmacológico , Valaciclovir/uso terapêutico , Administração Oral , Adulto , Antivirais/administração & dosagem , Estudos de Coortes , Famciclovir/administração & dosagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Valaciclovir/administração & dosagem , Adulto Jovem
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