-
Viruses Jun 2023Herpes simplex virus-1 (HSV-1) and -2 (HSV-2) are large, spherically shaped, double-stranded DNA viruses that coevolved with for over 300,000 years, having developed... (Review)
Review
Herpes simplex virus-1 (HSV-1) and -2 (HSV-2) are large, spherically shaped, double-stranded DNA viruses that coevolved with for over 300,000 years, having developed numerous immunoevasive mechanisms to survive the lifetime of their human host. Although in the continued absence of an acceptable prophylactic and therapeutic vaccine, approved pharmacologics (e.g., nucleoside analogs) hold benefit against viral outbreaks, while resistance and toxicity limit their universal application. Against these shortcomings, there is a long history of proven and unproven home remedies. With the breadth of purported alternative therapies, patients are exposed to risk of harm without proper information. Here, we examined the shortcomings of the current gold standard HSV therapy, acyclovir, and described several natural products that demonstrated promise in controlling HSV infection, including lemon balm, lysine, propolis, vitamin E, and zinc, while arginine, cannabis, and many other recreational drugs are detrimental. Based on this literature, we offered recommendations regarding the use of such natural products and their further investigation.
Topics: Humans; Antiviral Agents; Acyclovir; Herpes Simplex; Herpesvirus 1, Human; Herpesvirus 2, Human; Biological Products
PubMed: 37376614
DOI: 10.3390/v15061314 -
American Family Physician Apr 2023Bell palsy should be suspected in patients with acute onset of unilateral facial weakness or paralysis involving the forehead in the absence of other neurologic... (Review)
Review
Bell palsy should be suspected in patients with acute onset of unilateral facial weakness or paralysis involving the forehead in the absence of other neurologic abnormalities. The overall prognosis is good. More than two-thirds of patients with typical Bell palsy have a complete spontaneous recovery. For children and pregnant women, the rate of complete recovery is up to 90%. Bell palsy is idiopathic. Laboratory testing and imaging are not required for diagnosis. When other causes of facial weakness are being considered, laboratory testing may identify a treatable cause. An oral corticosteroid regimen (prednisone, 50 to 60 mg per day for five days followed by a five-day taper) is the first-line treatment for Bell palsy. Combination therapy with an oral corticosteroid and antiviral may reduce rates of synkinesis (misdirected regrowth of facial nerve fibers manifesting as involuntary co-contraction of certain facial muscles). Recommended antivirals include valacyclovir (1 g three times per day for seven days) or acyclovir (400 mg five times per day for 10 days). Treatment with antivirals alone is ineffective and not recommended. Physical therapy may be beneficial in patients with more severe paralysis.
Topics: Child; Female; Humans; Pregnancy; Acyclovir; Antiviral Agents; Bell Palsy; Paralysis; Valacyclovir
PubMed: 37054419
DOI: No ID Found -
International Journal of Molecular... Mar 2022Herpes simplex virus types 1 and 2 HSV1 and 2, namely varicella-zoster VZV and cytomegalovirus CMV, are among the most common pathogens worldwide. They remain in the... (Review)
Review
Herpes simplex virus types 1 and 2 HSV1 and 2, namely varicella-zoster VZV and cytomegalovirus CMV, are among the most common pathogens worldwide. They remain in the host body for life. The course of infection with these viruses is often asymptomatic or mild and self-limiting, but in immunocompromised patients, such as solid organ or bone marrow transplant recipients, the course can be very severe or even life-threatening. Unfortunately, in the latter group, the highest percentage of infections with strains resistant to routinely used drugs is observed. On the other hand, frequent recurrences of genital herpes can be a problem even in people with normal immunity. Genital herpes also increases the risk of acquiring sexually transmitted diseases, including HIV infection and, if present in pregnant women, poses a risk to the fetus and newborn. Even more frequently than herpes simplex, congenital infections can be caused by cytomegalovirus. We present the most important anti-herpesviral agents, the mechanisms of resistance to these drugs, and the associated mutations in the viral genome. Special emphasis was placed on newly introduced drugs such as maribavir and brincidofovir. We also briefly discuss the most promising substances in preclinical testing as well as immunotherapy options and vaccines currently in use and under investigation.
Topics: Acyclovir; Antiviral Agents; Cytomegalovirus; Female; HIV Infections; Herpes Genitalis; Herpes Simplex; Herpes Zoster; Herpesviridae Infections; Humans; Infant, Newborn; Pregnancy
PubMed: 35408788
DOI: 10.3390/ijms23073431 -
Practical Neurology Apr 2023Aciclovir-induced neurotoxicity results from the accumulation of aciclovir and its metabolite 9-carboxymethoxymethylguanine (CMMG). It occurs predominantly in older...
Aciclovir-induced neurotoxicity results from the accumulation of aciclovir and its metabolite 9-carboxymethoxymethylguanine (CMMG). It occurs predominantly in older patients with impaired renal function and is characterised by a combination of confusion and psychiatric changes. Seizures, myoclonus and dysarthria may also occur. Critically, peritoneal dialysis has little effect on reversing the toxic effects of aciclovir. We describe a woman in her 70s with renal failure who developed confusion and seizures after receiving aciclovir. She was ultimately diagnosed with aciclovir-induced neurotoxicity, confirmed by an elevated serum CMMG concentration. This condition is likely to be underdiagnosed and the neurologist's primary challenge is differentiating aciclovir-induced neurotoxicity from viral encephalitis.
Topics: Female; Humans; Aged; Acyclovir; Antiviral Agents; Neurotoxicity Syndromes; Seizures; Encephalitis, Viral; Confusion
PubMed: 36601749
DOI: 10.1136/pn-2022-003597 -
Nature Microbiology Jul 2023Herpes simplex encephalitis is a life-threatening disease of the central nervous system caused by herpes simplex viruses (HSVs). Following standard of care with...
Herpes simplex encephalitis is a life-threatening disease of the central nervous system caused by herpes simplex viruses (HSVs). Following standard of care with antiviral acyclovir treatment, most patients still experience various neurological sequelae. Here we characterize HSV-1 infection of human brain organoids by combining single-cell RNA sequencing, electrophysiology and immunostaining. We observed strong perturbations of tissue integrity, neuronal function and cellular transcriptomes. Under acyclovir treatment viral replication was stopped, but did not prevent HSV-1-driven defects such as damage of neuronal processes and neuroepithelium. Unbiased analysis of pathways deregulated upon infection revealed tumour necrosis factor activation as a potential causal factor. Combination of anti-inflammatory drugs such as necrostatin-1 or bardoxolone methyl with antiviral treatment prevented the damages caused by infection, indicating that tuning the inflammatory response in acute infection may improve current therapeutic strategies.
Topics: Humans; Herpesvirus 1, Human; Herpes Simplex; Acyclovir; Antiviral Agents; Encephalitis, Viral; Organoids
PubMed: 37349587
DOI: 10.1038/s41564-023-01405-y -
Ugeskrift For Laeger May 2018Genital herpes is a common sexually transmissible infection (STI) caused by herpes simplex virus (HSV). Clinically, the infection presents with genital ulcers but may... (Review)
Review
Genital herpes is a common sexually transmissible infection (STI) caused by herpes simplex virus (HSV). Clinically, the infection presents with genital ulcers but may also be asymptomatic. The risk of genital HSV infection is associated with increasing number of sex partners, previous infection with another STI and female sex. The cornerstone of treatment is systemic antivirals such as acyclovir. Counselling on transmission and recurrence risks is essential, and psychological distress is often a consequence of the disease.
Topics: Acyclovir; Antiviral Agents; Female; Herpes Genitalis; Humans; Recurrence; Simplexvirus
PubMed: 29798750
DOI: No ID Found -
Current Pain and Headache Reports Jul 2017Recurrent meningitis is a rare clinical scenario that can be self-limiting or life threatening depending on the underlying etiology. This review describes the causes,... (Review)
Review
PURPOSE OF REVIEW
Recurrent meningitis is a rare clinical scenario that can be self-limiting or life threatening depending on the underlying etiology. This review describes the causes, risk factors, treatment, and prognosis for recurrent meningitis. As a general overview of a broad topic, the aim of this review is to provide clinicians with a comprehensive differential diagnosis to aide in the evaluation and management of a patient with recurrent meningitis.
RECENT FINDINGS
New developments related to understanding the pathophysiology of recurrent meningitis are as scarce as studies evaluating the treatment and prevention of this rare disorder. A trial evaluating oral valacyclovir suppression after HSV-2 meningitis did not demonstrate a benefit in preventing recurrences. The data on prophylactic antibiotics after basilar skull fractures do not support their use. Intrathecal trastuzumab has shown promise in treating leptomeningeal carcinomatosis from HER-2 positive breast cancer. Monoclonal antibodies used to treat cancer and autoimmune diseases are new potential causes of drug-induced aseptic meningitis. Despite their potential for causing recurrent meningitis, the clinical entities reviewed herein are not frequently discussed together given that they are a heterogeneous collection of unrelated, rare diseases. Epidemiologic data on recurrent meningitis are lacking. The syndrome of recurrent benign lymphocytic meningitis described by Mollaret in 1944 was later found to be closely related to HSV-2 reactivation, but HSV-2 is by no means the only etiology of recurrent aseptic meningitis. While the mainstay of treatment for recurrent meningitis is supportive care, it is paramount to ensure that reversible and treatable causes have been addressed for further prevention.
Topics: Acyclovir; Antibodies, Monoclonal; Antiviral Agents; Diagnosis, Differential; Herpes Simplex; Herpesvirus 2, Human; Humans; Meningitis; Meningitis, Aseptic; Prognosis; Recurrence; Secondary Prevention; Valacyclovir; Valine
PubMed: 28551737
DOI: 10.1007/s11916-017-0635-7 -
BMJ Clinical Evidence Jun 2015Chickenpox is extremely contagious. More than 90% of unvaccinated people will become infected during their lifetime, but infection occurs at different ages in different... (Review)
Review
INTRODUCTION
Chickenpox is extremely contagious. More than 90% of unvaccinated people will become infected during their lifetime, but infection occurs at different ages in different parts of the world. In the US, the UK, and Japan, more than 80% of people have been infected by the age of 10 years, and by the age of 20 to 30 years in India, South East Asia, and the West Indies. It is usually a mild and self-limiting disease, but it can be severely complicated by pneumonitis or disseminated disease in some individuals, particularly neonates and those who are immunocompromised.
METHODS AND OUTCOMES
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of treatment for chickenpox in healthy adults and children (including neonates) within 24 hours after onset of rash? What are the effects of treatment for chickenpox in healthy adults and children (including neonates) later than 24 hours after onset of rash? What are the effects of treatment for chickenpox in immunocompromised adults and children (including neonates)? We searched: Medline, Embase, The Cochrane Library, and other important databases up to January 2014 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review).
RESULTS
We found six studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS
In this systematic overview we present information relating to the effectiveness and safety of aciclovir, within 24 hours of onset of rash or later than 24 hours of onset of rash, in otherwise-healthy adults and children (including neonates); and aciclovir in immunocompromised adults and children (including neonates).
Topics: Acyclovir; Chickenpox; Humans; Immunocompromised Host; India; Treatment Outcome
PubMed: 26077272
DOI: No ID Found -
Pediatrics International : Official... Jan 2022
Topics: Acyclovir; Herpes Zoster; Herpes Zoster Ophthalmicus; Humans
PubMed: 35831585
DOI: 10.1111/ped.15111 -
Sexually Transmitted Infections Sep 2017
Topics: Acyclovir; Administration, Oral; Antiviral Agents; Drug Resistance, Viral; Herpes Genitalis; History, 20th Century; History, 21st Century; Humans; Uncertainty
PubMed: 28619732
DOI: 10.1136/sextrans-2016-053005