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Romanian Journal of Ophthalmology 2024Our purpose was to present a case of a patient diagnosed with herpes zoster ophthalmicus with multiple ocular manifestations. A 70-year-old Caucasian male presented to...
Our purpose was to present a case of a patient diagnosed with herpes zoster ophthalmicus with multiple ocular manifestations. A 70-year-old Caucasian male presented to the hospital for headache and skin hyperesthesia on the scalp and forehead on the left side. The diagnoses of herpes zoster ophthalmicus and acute conjunctivitis were made for the left eye. The patient was followed up for 6 months and during that period the following diagnoses were made for the same eye: peripheral sterile corneal infiltrates, episcleritis, and hypertensive anterior uveitis. Herpes zoster ophthalmicus occurs when the reactivation of the dormant virus involves the ophthalmic division of the trigeminal nerve. The most frequent ocular presentations are conjunctivitis, keratitis, uveitis, episcleritis, and scleritis. The standard therapy consists of antivirals, such as acyclovir, valacyclovir, and famciclovir to limit the replication of the virus. The patient's risk factors, the course of treatment, and the severity of the disease, all affect the prognosis, which is highly variable. Prevention of the disease consists of vaccination with one of the following two vaccines, Zostavax and Shingrix. Final visual acuity for the left eye remained 1 despite numerous manifestations of the disease. VZV = Varicella-zoster virus, BCVA = best-corrected visual acuity, OU = both eyes, OD = right eye, OS = left eye, IOP = intraocular pressure, NCT = non-contact tonometer, ZVX = Zostavax vaccine.
Topics: Male; Humans; Aged; Herpes Zoster Ophthalmicus; Scleritis; Herpes Zoster Vaccine; Conjunctivitis; Uveitis, Anterior
PubMed: 38617727
DOI: 10.22336/rjo.2024.16 -
World Journal of Virology Mar 2024The aim of our minireview is to provide a brief overview of the diagnosis, clinical aspects, treatment options, management, and current literature available regarding... (Review)
Review
The aim of our minireview is to provide a brief overview of the diagnosis, clinical aspects, treatment options, management, and current literature available regarding herpes simplex keratitis (HSK). This type of corneal viral infection is caused by the herpes simplex virus (HSV), which can affect several tissues, including the cornea. One significant aspect of HSK is its potential to cause recurrent episodes of inflammation and damage to the cornea. After the initial infection, the HSV can establish a latent infection in the trigeminal ganglion, a nerve cluster near the eye. The virus may remain dormant for extended periods. Periodic reactivation of the virus can occur, leading to recurrent episodes of HSK. Factors triggering reactivation include stress, illness, immunosuppression, or trauma. Recurrent episodes can manifest in different clinical patterns, ranging from mild epithelial involvement to more severe stromal or endothelial disease. The severity and frequency of recurrences vary among individuals. Severe cases of HSK, especially those involving the stroma and leading to scarring, can result in vision impairment or even blindness in extreme cases. The cornea's clarity is crucial for good vision, and scarring can compromise this, potentially leading to visual impairment. The management of HSK involves not only treating acute episodes but also implementing long-term strategies to prevent recurrences and attempt repairs of corneal nerve endings neurotization. Antiviral medications, such as oral Acyclovir or topical Ganciclovir, may be prescribed for prophylaxis. The immune response to the virus can contribute to corneal damage. Inflammation, caused by the body's attempt to control the infection, may inadvertently harm the corneal tissues. Clinicians should be informed about triggers and advised on measures to minimize the risk of reactivation. In summary, the recurrent nature of HSK underscores the importance of both acute and long-term management strategies to preserve corneal health and maintain optimal visual function.
PubMed: 38616855
DOI: 10.5501/wjv.v13.i1.89934 -
Heliyon Apr 2024The varicella zoster virus (VZV) is a latent viral infection and its reactivation has been reported following different conditions such as immunosuppression. This study...
The varicella zoster virus (VZV) is a latent viral infection and its reactivation has been reported following different conditions such as immunosuppression. This study presents a confirmed case of VZV encephalitis following the first dose administration of the Sinopharm COVID-19 vaccine. A 63-year-old immunocompetent woman who developed VZV encephalitis after first dose administration of Sinopharm COVID-19 vaccine. A final diagnosis of VZV encephalitis was made based on positive CSF PCR results for VZV infection. Treatment was administered with acyclovir and she returned to normal life without any neurological sequelae. In this report, VZV reactivation and VZV encephalitis have been observed after COVID-19 vaccination; however, the results of this report should be considered with some caution, and continued post-vaccine surveillance of adverse events is recommended to explore whether any causal association with VZV reactivation is biologically plausible in this context, or if it is just a coincidence.
PubMed: 38596010
DOI: 10.1016/j.heliyon.2024.e28703 -
Cureus Mar 2024Dengue is an infection with a wider spectrum of disease manifestations, ranging from simple dengue fever to expanded dengue syndrome. Expanded dengue syndrome...
Dengue is an infection with a wider spectrum of disease manifestations, ranging from simple dengue fever to expanded dengue syndrome. Expanded dengue syndrome encompasses multiorgan involvement, including neurological manifestations such as dengue encephalitis, seizures, encephalopathy, coma, hemiparesis, etc. Herein, we present a case of a 50-year-old female with a background history of well-controlled type 2 diabetes mellitus and hypertension for five years on oral medication. The patient presented with a one-day history of altered levels of consciousness, agitation, and aggressive behavior. Before admission, she had a history of high-grade fever with chills and rigors for three days. Serial investigations were performed, and the diagnosis of dengue encephalitis was made amidst the absence of positive findings for encephalitis in most of the imaging modalities except in electroencephalogram (EEG), making this case unique. Initially, it was presumed to be meningoencephalitis. Hence, the patient was initiated on intravenous acyclovir and cefotaxime. After the definitive diagnosis of dengue encephalitis, the given medication was stopped after seven days of administration, and with supportive management, the patient made a successful recovery within 10 days.
PubMed: 38586783
DOI: 10.7759/cureus.55628 -
Indian Pediatrics May 2024Acute encephalitis syndrome (AES) in children results in significant neurocognitive deficits or mortality. It is pertinent to study the AES patterns periodically to...
OBJECTIVE
Acute encephalitis syndrome (AES) in children results in significant neurocognitive deficits or mortality. It is pertinent to study the AES patterns periodically to identify the changes in the etiological trends and outcomes. Our objective was to find the etiological agents of AES, mode of diagnosis, treatment given, and outcomes.
METHODS
We reviewed the electronic records of children aged 1 month to 15 years who were admitted with AES in our centre from January 2015 to December 2019. We analyzed the the clinical, laboratory, and radiological profile of these children and adolescents in relation to their outcome. Poor outcome was defined as death, discharge against medical advice with neurological deficits, or Glasgow Outcome Score Extended (GOS-E) d≤ 5 at the time of discharge.
RESULTS
Among 250 patients admitted with AES during the study period, a definitive etiological diagnosis was established in 56.4% of children (30.4% viral, 22% bacterial). Scrub typhus (11.2%) and dengue (9%) were the two most common underlying illnesses. Serology helped in clinching the diagnosis in 30% of children. A surge in AES cases in the post-monsoon season was observed in our cohort. Third-generation cephalosporin drugs (85.7%) and acyclovir (77.7%) were the most commonly used empiric antimicrobial drugs. About one-third of children (n = 80) had a poor outcome. GCS ≤ 8 at presentation and requirement for invasive ventilation were found to be significant predictors of poor outcome.
CONCLUSION
A definitive diagnosis was obtained in about half of the children with AES. Viral (30.4%) and rickettsial infections (22%) were the common etiologies identified. Poor outcome was observed in 32% of patients.
Topics: Humans; India; Child; Adolescent; Child, Preschool; Female; Male; Infant; Acute Febrile Encephalopathy; Retrospective Studies
PubMed: 38584403
DOI: No ID Found -
Nihon Ronen Igakkai Zasshi. Japanese... 2024Few reports have described acyclovir (ACV) encephalopathy without acute kidney injury (AKI).
INTRODUCTION
Few reports have described acyclovir (ACV) encephalopathy without acute kidney injury (AKI).
OBJECTIVE
This study clarified the clinical features of ACV encephalopathy without AKI compared to that with AKI.
METHODS
Creatinine (Cre) levels were measured on admission. After admission, Cre was measured in a timely manner for the first seven hospital days. The minimum Cre level in these measurements was then determined. ACV encephalopathy was defined when two criteria were met: 1) neurological symptoms appeared after valacyclovir (VACV) administration, and 2) neurological symptoms improved after VACV discontinuation. AKI was defined when the Cre level on admission was >1.5 times higher than the minimum Cre level. The subjects were divided into AKI and non-AKI groups based on these findings.
RESULTS
Eighteen patients had ACV encephalopathy (5 males, mean age 81.3±5.5 years old). All patients were prescribed VACV 3,000 mg/day. The minimum Cre was 1.93±1.76 mg/dL. AKI occurred in 10 (56.6%) patients. VACV was discontinued in all patients, and emergency hemodialysis treatment was administered in 10 (55.6%) patients. All patients recovered. Compared to the AKI group, the non-AKI group had a lower history of taking a Ca-blocker (33.3% vs 80.0%, p=0.092), a lower rate of emergency dialysis (16.9% vs 70.0%, p=0.059) and a longer time to clinical improvement (3.67±1.86 vs 2.20±0.63 days, p=0.073).
CONCLUSION
ACV encephalopathy without AKI is characterized by a low rate of emergency dialysis, which may be linked to a prolonged duration of symptoms.
Topics: Male; Humans; Aged; Aged, 80 and over; Acyclovir; Valacyclovir; Acute Kidney Injury; Renal Dialysis; Brain Diseases; Retrospective Studies
PubMed: 38583972
DOI: 10.3143/geriatrics.61.61 -
BMC Neurology Apr 2024Streptococcus intermedius is a member of the S. anginosus group and is part of the normal oral microbiota. It can cause pyogenic infections in various organs, primarily...
BACKGROUND
Streptococcus intermedius is a member of the S. anginosus group and is part of the normal oral microbiota. It can cause pyogenic infections in various organs, primarily in the head and neck area, including brain abscesses and meningitis. However, ventriculitis due to periodontitis has not been reported previously.
CASE PRESENTATION
A 64-year-old male was admitted to the hospital with a headache, fever and later imbalance, blurred vision, and general slowness. Neurological examination revealed nuchal rigidity and general clumsiness. Meningitis was suspected, and the patient was treated with dexamethasone, ceftriaxone and acyclovir. A brain computer tomography (CT) scan was normal, and cerebrospinal fluid (CSF) Gram staining and bacterial cultures remained negative, so the antibacterial treatment was discontinued. Nine days after admission, the patient's condition deteriorated. The antibacterial treatment was restarted, and a brain magnetic resonance imaging revealed ventriculitis. A subsequent CT scan showed hydrocephalus, so a ventriculostomy was performed. In CSF Gram staining, chains of gram-positive cocci were observed. Bacterial cultures remained negative, but a bacterial PCR detected Streptococcus intermedius. An orthopantomography revealed advanced periodontal destruction in several teeth and periapical abscesses, which were subsequently operated on. The patient was discharged in good condition after one month.
CONCLUSIONS
Poor dental health can lead to life-threatening infections in the central nervous system, even in a completely healthy individual. Primary bacterial ventriculitis is a diagnostic challenge, which may result in delayed treatment and increased mortality.
Topics: Male; Humans; Middle Aged; Streptococcus intermedius; Cerebral Ventriculitis; Anti-Bacterial Agents; Meningitis; Central Nervous System Bacterial Infections; Periodontitis
PubMed: 38580923
DOI: 10.1186/s12883-024-03604-4 -
CNS Drugs May 2024Neurotropic viruses may cause meningitis, myelitis, encephalitis, or meningoencephalitis. These inflammatory conditions of the central nervous system (CNS) may have... (Review)
Review
Neurotropic viruses may cause meningitis, myelitis, encephalitis, or meningoencephalitis. These inflammatory conditions of the central nervous system (CNS) may have serious and devastating consequences if not treated adequately. In this review, we first summarize how neurotropic viruses can enter the CNS by (1) crossing the blood-brain barrier or blood-cerebrospinal fluid barrier; (2) invading the nose via the olfactory route; or (3) invading the peripheral nervous system. Neurotropic viruses may then enter the intracellular space of brain cells via endocytosis and/or membrane fusion. Antiviral drugs are currently used for different viral CNS infections, even though their use and dosing regimens within the CNS, with the exception of acyclovir, are minimally supported by clinical evidence. We therefore provide considerations to optimize drug treatment(s) for these neurotropic viruses. Antiviral drugs should cross the blood-brain barrier/blood cerebrospinal fluid barrier and pass the brain cellular membrane to inhibit these viruses inside the brain cells. Some antiviral drugs may also require intracellular conversion into their active metabolite(s). This illustrates the need to better understand these mechanisms because these processes dictate drug exposure within the CNS that ultimately determine the success of antiviral drugs for CNS infections. Finally, we discuss mathematical model-based approaches for optimizing antiviral treatments. Thereby emphasizing the potential of CNS physiologically based pharmacokinetic models because direct measurement of brain intracellular exposure in living humans faces ethical restrictions. Existing physiologically based pharmacokinetic models combined with in vitro pharmacokinetic/pharmacodynamic information can be used to predict drug exposure and evaluate efficacy of antiviral drugs within the CNS, to ultimately optimize the treatments of CNS viral infections.
Topics: Humans; Central Nervous System Viral Diseases; Viruses; Central Nervous System; Brain; Blood-Brain Barrier; Antiviral Agents
PubMed: 38580795
DOI: 10.1007/s40263-024-01082-3 -
International Medical Case Reports... 2024This case report presents a rare occurrence of herpes zoster (HZ) outbreak in a 50-year-old male following botulinum toxin (BTX) type A injections. The patient developed...
This case report presents a rare occurrence of herpes zoster (HZ) outbreak in a 50-year-old male following botulinum toxin (BTX) type A injections. The patient developed burning swollen lesions on the left forehead four days after receiving BTX injections. Physical examination revealed papules and erosions in a dermatomal distribution. He was diagnosed with HZ and promptly treated with oral acyclovir. The lesions resolved within two weeks without complications. Previous literature reports a few similar HZ outbreaks following aesthetic treatments with BTX injections. The exact mechanism triggering varicella reactivation in these cases remains unclear. Prompt diagnosis and treatment of HZ are crucial in order to minimize outbreak duration and reduce complications. Physicians should maintain awareness of HZ as a potential complication following BTX injections.
PubMed: 38572295
DOI: 10.2147/IMCRJ.S457239 -
International Medical Case Reports... 2024Erythema multiforme (EM) is an acute mucocutaneous hypersensitivity reaction with various etiological factors, including herpes simplex virus type 1 (HSV-1) infection,...
INTRODUCTION
Erythema multiforme (EM) is an acute mucocutaneous hypersensitivity reaction with various etiological factors, including herpes simplex virus type 1 (HSV-1) infection, known as herpes-associated erythema multiforme (HAEM). Oral health-related quality of life (OHRQoL) is a multidimensional concept of biopsychosocial aspects related to oral health. OHRQol contains information for patient-centered treatment plan development. The OHRQoL measurement instrument widely used by clinicians is the oral health impact profile-14 (OHIP-14). This case report aimed to evaluate OHRQoL in HAEM patient, which only manifests on the lips and oral cavity.
CASE
A 25-year-old male patient came to the Department of Oral Medicine with the chief complaint of painful canker sores on the lips. Extra-oral examination revealed serosanguineous crusts on the lips that were painful and easily bleed. Intra-oral examination showed diffused and painful irregular erythematous lesions on the upper and lower labial mucosa. The anti-HSV1 IgG test was positive. The patient was diagnosed with HAEM.
CASE MANAGEMENT
Pharmacological therapy included triamcinolone acetonide 0.1% in orabase, acyclovir tablets, multivitamins, and 0.9% NaCl. Non-pharmacological therapy included advice on maintaining good oral hygiene, avoiding spicy and sour foods, and breaking the bad habit of licking the lips.
CONCLUSION
The patient's physical, psychological, and social conditions showed improvement and returned to normal after 7 days of treatment. In conclusion, oral health is an important factor that can improve the quality of life of HAEM patient.
PubMed: 38566932
DOI: 10.2147/IMCRJ.S456301