RESUMEN
BACKGROUND: This study evaluated the presence of Epstein-Barr virus type 1 (EBV-1) DNA in patients living with HIV, before and after three different topical therapy protocols for oral hairy leukoplakia (OHL). METHODS: The sample consisted of five patients treated with topical solution of 25% podophyllin resin; six with 25% podophyllin resin plus 5% acyclovir cream; and four with 25% podophyllin resin plus 1% penciclovir cream. DNA was extracted from OHL scrapings and amplified by the PCR using specific primers for EBV-1 (EBNA-1). RESULTS: Clinical healing of OHL lesions was observed across all treatment groups over time. At baseline, EBNA-1 was detected in all OHL lesions. After treatment, OHL samples from three patients treated with 25% podophyllin resin plus 5% acyclovir cream and from one patient treated with 25% podophyllin resin plus 1% penciclovir cream exhibited negative EBNA-1 viral gene encoding. Despite the clinical resolution of OHL, 11 patients (73.3%) showed EBNA-1 positivity immediately after the lesion disappeared. Three patients (20%) treated with podophyllin resin displayed both EBNA-1 positivity and a recurrence of OHL, in contrast to no recurrence in the other two groups. CONCLUSIONS: These findings suggest potential associations between treatment formulations, EBNA-1 persistence, and the recurrence of OHL lesions.
Asunto(s)
Aciclovir , Administración Tópica , Antivirales , ADN Viral , Infecciones por Virus de Epstein-Barr , Herpesvirus Humano 4 , Leucoplasia Vellosa , Humanos , Femenino , Masculino , Antivirales/uso terapéutico , Antivirales/administración & dosificación , Leucoplasia Vellosa/tratamiento farmacológico , Leucoplasia Vellosa/virología , Herpesvirus Humano 4/genética , Herpesvirus Humano 4/aislamiento & purificación , Aciclovir/uso terapéutico , Aciclovir/administración & dosificación , Persona de Mediana Edad , ADN Viral/análisis , Infecciones por Virus de Epstein-Barr/tratamiento farmacológico , Infecciones por Virus de Epstein-Barr/virología , Adulto , Podofilino/uso terapéutico , Podofilino/administración & dosificación , Resultado del Tratamiento , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/virología , Reacción en Cadena de la Polimerasa , Guanina/análogos & derivados , Guanina/uso terapéutico , Guanina/administración & dosificaciónRESUMEN
Herpes simplex virus (HSV) is the leading cause of genital ulcers worldwide. In rare cases, mostly among immunocompromised hosts, HSV infections can present as hypertrophic pseudotumoral forms simulating malignancies or often mistaken as other viral infections, usually resistant to conventional antiviral therapy and often requiring alternative therapeutic approaches. A high level of clinical suspicion is needed. We present a case of woman living with HIV with pseudotumoral vulvar herpes refractory to oral acyclovir, successfully treated with systemic foscarnet and topical imiquimod.
Asunto(s)
Infecciones por VIH , Herpes Genital , Femenino , Humanos , Herpes Genital/diagnóstico , Antivirales/uso terapéutico , Aciclovir/uso terapéutico , Foscarnet/uso terapéutico , Infecciones por VIH/tratamiento farmacológicoRESUMEN
Herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2) infect, respectively, 67% and 13% of the world population, most commonly causing mild symptoms, such as blisters/ulcers. However, severe conditions such as keratitis, encephalitis, and systemic infections may occur, generally associated with the patient's immunological condition. Although Acyclovir® (ACV) and its analogs are the reference drugs for herpetic infections, the number of ACV-resistant HSV infections is growing exponentially. Therefore, new natural products' bioactive compounds have been studied to develop novel effective anti-herpetics. Trichilia catigua is a plant widely used in traditional medicine, including the treatment of skin diseases and sexual infections. In our study, 16 extracts from the bark of T. catigua, obtained with different solvents and their combinations, were evaluated against HSV-1 AR and HSV-2, respectively, ACV resistance and genital strains in vitro. The extracts with the highest selectivity index were used to prepare new topical anti-herpetic formulations and confirmed in vivo. Two new topical formulations were suggested to treat cutaneous and genital herpetic recurrent lesions. The cytotoxicity and antiviral activity were tested using the MTT method. The cytotoxic (CC50) and inhibitory (IC50) concentrations of 50% and the selectivity index (SI: CC50/IC50) were determined. Tc12, Tc13, and Tc16 were added to the formulations. Infected BALB/c mice were treated for 8 days, and the severity of the herpetic lesions was analyzed daily. All CEs showed a CC50 value ranging from 143 to 400 µg/mL, except for Tc3 and Tc10. Tc12, Tc13, and Tc16 showed the best SI in the 0 h, virucidal, and adsorption inhibition assays. In the in vivo test against HSV-1 AR, the infected animals treated with creams were statistically different from the infected non-treated animals and similar to ACV-treated mice. In HSV-2-infected genitalia, similar effects were found for Tc13 and Tc16 gels. The present study demonstrated that extracts from the bark of T. catigua, traditionally used in folk medicine, are a valuable source of active compounds with anti-herpetic activity. The extracts showed a virucidal mechanism of action and prevented the initial stages of viral replication. The cutaneous and genital infections were strongly inhibited by the Tc12, Tc13, and Tc16 extracts. New topical therapeutic alternatives using Trichilia catigua extracts are suggested for patients infected with ACV-resistant strains of HSV.
Asunto(s)
Herpes Simple , Herpesvirus Humano 1 , Meliaceae , Ratones , Animales , Aciclovir/farmacología , Aciclovir/uso terapéutico , Reinfección , Antivirales/farmacología , Antivirales/uso terapéutico , Herpes Simple/tratamiento farmacológico , Herpesvirus Humano 2/fisiología , GenitalesRESUMEN
BACKGROUND: Since the emergence of HSV resistant strains, new antiviral agents have emerged and still are urgently needed, especially those with alternative targets. OBJECTIVE: In this work, we evaluated new quinolone derivatives as anti-HSV. METHODS: For this study, cells were infected and treated with different components to evaluate the profile of HSV replication in vitro. In addition, studies were performed to determine the pharmacokinetic toxicity and profile of the compound. RESULTS: Indeed the EC50 values of these promising molecules ranged between 8 µM and 32 µM. We have also showed that all compounds inhibited the expression of ICP27 viral proteins, which gives new insights in the search for new target for antiherpetic therapy. Chlorine in positions C6 and phosphonate in position C1 have shown to be important for viral inhibition. The chloroquinolone carboxamide derivatives fulfilled "Lipinsky Rule of Five" for good oral bioavailability and showed higher intestinal absorption and blood brain barrier penetration, as well as lower toxicity profile. CONCLUSION: Although the inhibition activities of chloroquinolone carboxamide derivatives were lower than acyclovir, they showed different modes of action in comparison to the drugs currently available. These findings encourage us to continue pre-clinical studies for the development of new anti-HSV-1 agents.
Asunto(s)
Herpesvirus Humano 1 , Replicación Viral , Herpesvirus Humano 2/fisiología , Aciclovir/farmacología , Aciclovir/uso terapéutico , Antivirales/farmacología , Antivirales/uso terapéutico , Herpesvirus Humano 1/fisiologíaRESUMEN
INTRODUCCIÓN: La meningitis bacteriana aguda (MBA) y la encefalitis son infecciones graves y el retraso en el tratamiento determina mayor morbimortalidad. En 2015 la FDA. aprobó un panel de RPC múltiple, BioFire® Filmarray® meningitis-encefalitis (FA-ME), que desde el 2019 se encuentra disponible en nuestro hospital. OBJETIVOS: Estimar número de determinaciones positivas mediante FA-ME, evaluar concordancia con cultivo convencional (CC) y describir si FA-ME permitió realizar cambios en el tratamiento. MATERIAL Y MÉTODOS: Estudio retrospectivo, descriptivo, realizado durante 2019-2021 en el Hospital de Niños Pedro Elizalde. Se revisaron reportes de niños con meningitis, encefalitis y meningoencefalitis y líquido-cefalorraquídeo patológico a quienes se les realizó FA-ME. RESULTADOS: Se incluyó a 32 niños, edad promedio: 48 meses. Fueron positivas 13 determinaciones de FA-ME: siete bacterias y seis virus. En dos MBA obtuvo desarrollo mediante CC. Con FA-ME se ajustó el tratamiento en dos MBA y se acortó el tratamiento intravenoso (IV). DISCUSIÓN: Nuestro trabajo permitió conocer la etiología de cinco MBA con cultivo negativo, de las cuales dos habían recibido antimicrobianos, administrar quimioprofilaxis a contactos epidemiológicos, acortar el tratamiento IV y suministrar menos dosis de aciclovir; en concordancia con la literatura médica. CONCLUSIONES: FA-ME permitió identificar la etiología en cinco MBA que no desarrollaron en CC, ajustar tratamientos empíricos inadecuados y acortar duración del tratamiento parenteral.
BACKGROUND: Bacterial meningitis and encephalitis are life-threatening infections, a delay in its treatment is associated with high mortality. In 2015, FDA approved the Multiplex PCR FilmArray™ meningitis/encephalitis syndromic panel (FA-MEP), and it is available in our hospital since 2019. AIM: To estimate the number of positive FA-MEP, to evaluate the correlation to conventional culture (CC) results and to describe if the FA-MEP technology allowed changes in the treatment. METHODS: Retrospective analysis of children with meningitis, encephalitis and meningoencephalitis and pathological cerebrospinal fluid analysis between 2019-2021, who were subject to FA-MEP testing at the Pedro Elizalde Children's Hospital. RESULTS: 32 children, mean age: 48 months. 11 patients had positive FA-ME tests: 7 bacterial, 6 viral. 2 patients correlated with CC. Based on the FAMEP results, treatment was adjusted in 2 bacterial meningitis and the duration of intravenous treatment was shortened. DISCUSSION: Our study allowed to establish the etiology of 5 culture negative bacterial meningitis, (2 had prior antibiotics), administer chemoprophylaxis to close contacts, and to administer fewer doses of acyclovir. CONCLUSIONS: The FA-MEP allowed us to identify 5 bacterial meningitis that tested negative by CC and early adjustment of inappropriate empirical antibiotics and to shorten the duration of parenteral treatments.
Asunto(s)
Humanos , Lactante , Preescolar , Meningoencefalitis/diagnóstico , Meningoencefalitis/microbiología , Bacterias/aislamiento & purificación , Virus/aislamiento & purificación , Aciclovir/uso terapéutico , Estudios Retrospectivos , Reacción en Cadena de la Polimerasa Multiplex , Meningoencefalitis/etiología , Meningoencefalitis/tratamiento farmacológico , Antiinfecciosos/uso terapéuticoRESUMEN
Herpes viruses are widespread in the human population and can cause many different diseases. Genital herpes is common and can increase the risk of HIV infection and neonatal herpes. Acyclovir is the most used drug for herpes treatment; however, it presents some disadvantages due to its poor oral bioavailability. In this study, some ethylene vinyl acetate devices with different acyclovir amounts (0, 10, and 20 wt.%) were manufactured by fused filament fabrication in two different geometries, an intrauterine device, and an intravaginal ring. Thermal analyses suggested that the crystallinity of EVA decreased up to 8% for the sample loaded with 20 wt.% of acyclovir. DSC, SEM, and FTIR analyses confirmed that the drug was successfully incorporated into the EVA matrix. Moreover, the drug release tests suggested a burst release during the first 24 h followed by a slower release rate sustained up to 80 days. Biological assays showed the biocompatibility of the EVA/ACV device, as well as a 99% reduction in vitro replication of HSV-1. Finally, the EVA presented a suitable performance for 3D printing manufacturing that can contribute to developing personalized solutions for long-term herpes treatment.
Asunto(s)
Antivirales , Infecciones por VIH , Humanos , Recién Nacido , Aciclovir/farmacología , Aciclovir/uso terapéutico , Antivirales/farmacología , Antivirales/uso terapéutico , Genitales , Infecciones por VIH/tratamiento farmacológico , Impresión Tridimensional , SimplexvirusRESUMEN
Central nervous system infections are a medical emergency, due to their high fatality and sequelae. Timely treatment is essential, and should be initially indicated empirically by clinical guidance, without microbiological certainty. Hence the importance of cerebrospinal fluid (CSF) analysis as an etiological and therapeutic guide in the crucial initial hours of management. We report a 57-year-old woman consulting for fever and altered mental status. A brain CAT scan was normal. A lumbar puncture disclosed a CSF with predominance of neutrophils. Suspecting a bacterial meningitis, antimicrobial treatment was started but 48 hours after, the patient did not improve. A new lumbar puncture disclosed a CSF with predominance of lymphocytes. The lymphocyte shift prompted a PCR that was positive for herpes virus. The patient was treated with acyclovir with a good evolution.
Asunto(s)
Antiinfecciosos , Encefalitis por Herpes Simple , Aciclovir/uso terapéutico , Antiinfecciosos/uso terapéutico , Antivirales/uso terapéutico , Encefalitis por Herpes Simple/líquido cefalorraquídeo , Encefalitis por Herpes Simple/tratamiento farmacológico , Humanos , LinfocitosRESUMEN
INTRODUCTION: The SARS-CoV-2 virus, which causes COVID-19, could give rise to damage the nervous system. Many studies have been conducted on this topic, but few have focused specifically on encephalitis. The effect of SARS-CoV-2 on the clinical expression of other neurotropic viruses, such as Herpesviridae, is unknown. CASE REPORTS: We describe the cases of two young men (39 and 18 years old) in whom SARS-CoV-2 had been detected -reverse transcription polymerase chain reaction (RT-PCR)-, and with a clinical diagnosis and cerebrospinal fluid (CSF) analysis consistent with encephalitis. The first patient had a positive PCR for varicella zoster virus in CSF, while the second had a positive PCR for herpes simplex virus types 1 and 2. The first patient, who was recently diagnosed with human immunodeficiency virus, presented with fever, headache, vomiting, cough, inappropriate behaviour and epileptic seizures; the second was seen to have fever, headache, myalgia and exanthema. Both offered the same laboratory findings (lymphopenia and high interleukin 6). CSF showed pleocytosis with a predominance of monomorphonuclear cells, hyperproteinorrachia and normal glycorrhachia. A cranial CT scan showed only mild diffuse cerebral oedema in the first case. Both cases were treated with corticosteroids, antibiotics and acyclovir. The second progressed favourably, while the first did not. CONCLUSIONS: Little is known about co-infection of SARS-CoV-2 with neurotropic viruses, such as Herpesviridae, and we have only limited evidence of direct neurological involvement of SARS-CoV-2, due to the technical difficulty of detecting it in the nervous system, thus making it important to take co-infection into account in order to be able to establish an early diagnosis and treatment to improve prognosis.
TITLE: COVID-19 y encefalitis por herpesvirus.Introducción. El virus SARS-CoV-2, causante de la COVID-19, podría generar lesiones en el sistema nervioso. Son múltiples los estudios relacionados con esto, pero escasos en cuanto a la encefalitis en particular. A su vez, se desconoce el efecto del SARS-CoV-2 sobre la expresión clínica de otros virus neurótropos, como los Herpesviridae. Casos clínicos. Se describen dos casos de varones jóvenes, de 39 y 18 años, con detección de SARS-CoV-2 reacción en cadena de la polimerasa con transcripción inversa (RT-PCR), con diagnóstico clínico y análisis del líquido cefalorraquídeo (LCR) compatibles con encefalitis. En el primer paciente se obtuvo una PCR positiva para el virus de la varicela zóster en el LCR, mientras que, en el segundo, para el virus del herpes simple de los tipos 1 y 2. El primer paciente, con diagnóstico reciente positivo para el virus de la inmunodeficiencia humana, presentó fiebre, cefalea, vómitos, tos, conductas inapropiadas y crisis epiléptica; y el segundo, fiebre, cefalea, mialgias y exantema. Ambos compartieron hallazgos en la analítica (linfopenia e interleucina 6 elevada). En el LCR se observó pleocitosis con predominio de monomorfonucleares, hiperproteinorraquia y glucorraquia normal. La tomografía computarizada de cráneo sólo evidenció un edema cerebral difuso leve en el primer caso. En ambos casos se realizó un tratamiento con corticoides, antibióticos y aciclovir. En el segundo, la evolución fue favorable, mientras que en el primero, no. Conclusiones. Poco se conoce sobre la coinfección del SARS-CoV-2 con virus neurótropos, como los Herpesviridae, lo que se suma a la escasa evidencia de la afectación neurológica directa del SARS-CoV-2, debido a la dificultad técnica para su detección en el sistema nervioso, por lo que es importante considerar la coinfección para realizar un diagnóstico y un tratamiento precoces que mejoren el pronóstico.
Asunto(s)
COVID-19 , Encefalitis , Aciclovir/uso terapéutico , COVID-19/complicaciones , Encefalitis/tratamiento farmacológico , Herpesvirus Humano 3 , Humanos , Masculino , SARS-CoV-2RESUMEN
Central nervous system infections are a medical emergency, due to their high fatality and sequelae. Timely treatment is essential, and should be initially indicated empirically by clinical guidance, without microbiological certainty. Hence the importance of cerebrospinal fluid (CSF) analysis as an etiological and therapeutic guide in the crucial initial hours of management. We report a 57-year-old woman consulting for fever and altered mental status. A brain CAT scan was normal. A lumbar puncture disclosed a CSF with predominance of neutrophils. Suspecting a bacterial meningitis, antimicrobial treatment was started but 48 hours after, the patient did not improve. A new lumbar puncture disclosed a CSF with predominance of lymphocytes. The lymphocyte shift prompted a PCR that was positive for herpes virus. The patient was treated with acyclovir with a good evolution.
Asunto(s)
Humanos , Encefalitis por Herpes Simple/líquido cefalorraquídeo , Encefalitis por Herpes Simple/tratamiento farmacológico , Antiinfecciosos/uso terapéutico , Antivirales/uso terapéutico , Aciclovir/uso terapéutico , LinfocitosRESUMEN
Immunosuppressed patients can suffer from Human alphaherpesvirus (HSV) infection with fast evolution, severe atypical symptomatology, and often-fatal outcome. Thus, the development and validation of new methods in vitro and in vivo to promote an early diagnosis and effective treatment of these patients are crucial. Therefore, this work aimed to develop a cell-based reporter assay for the detection of HSV through the transfection of Vero cells with the ICP10 promoter from HSV-2 linked to the pZsGreen1-1 plasmid. The assay was evaluated on Vero cells infected with HSV-1 or HSV-2 and followed by treating them with anti-HSV agents (acyclovir, gallic acid, convallatoxin, and Uncaria sp. extract) or with no anti-HSV activity agents (Passiflora edulis extract and cardenolide derivatives). The GFP expression was increased by both HSV cellular infection, which was detected by flow cytometry and fluorescence microscopy. F2R Zsgreen1-1 cells infection with 200 and 600 PFU/mL of HSV-2 increased the fluorescence intensity, when compared to the controls, by approximately 30% and 60%, respectively. Infection with 100 and 600 PFU/mL of HSV-1 also increased the fluorescence intensity by approximately 20% and 35%, when compared to the controls, respectively. The F2R ZsGreen1-1 system revealed to be an efficient assay, which can be used for clinical diagnosis, antiviral resistance evaluation, HSV cycle studies, and new antiviral drug research.
Asunto(s)
Herpes Simple , Herpesvirus Humano 1 , Aciclovir/farmacología , Aciclovir/uso terapéutico , Animales , Chlorocebus aethiops , Herpes Simple/tratamiento farmacológico , Herpesvirus Humano 1/genética , Herpesvirus Humano 2/genética , Humanos , Células VeroRESUMEN
RESUMEN La meningoencefalitis por el VZV es una patología poco frecuente que se presenta con la reactivación del virus dentro del organismo. OBJETIVO: Describir la presentación clínica de dos pacientes con neuroinfección por VZV posteriormente a infección por SARS-CoV-2. REPORTE DEL CASO: El primer caso corresponde a un hombre de 59 años con antecedente de neumonía moderada por SARS-CoV-2 que después cursó con meningoencefalitis por VZV y, además, desarrolló un síndrome de Ramsay Hunt. El segundo caso es el de una mujer de 37 años con antecedente de infección leve por SARS CoV-2 con un cuadro de cefalea con signos de alarma, en quien se documentó neuroinfección por VZV
ABSTRACT Meningoencephalitis caused by varicella zoster virus is a rare pathology that presents due to the reactivation of the virus in the organism OBJECTIVE: To describe the clinical presentation of two patients with VZV neuroinfection presented after a SARS CoV-2 infection. CASE REPORT: The first case is a 59 year old male with previous moderate SARS CoV-2 infection who presented meningoencephalitis and was diagnosed with Ramsay Hunt's Syndrome. The second case is a 37 year old female with previous SARS CoV-2 infection who presented with an acute onset headache and was documented with VZV neuroinfection.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Encefalitis por Varicela Zóster/virología , COVID-19/complicaciones , Antivirales/uso terapéutico , Aciclovir/uso terapéutico , Encefalitis por Varicela Zóster/diagnóstico , Encefalitis por Varicela Zóster/tratamiento farmacológicoAsunto(s)
Síndrome de Inmunodeficiencia Adquirida , Herpes Genital , Herpes Simple , Síndrome de Inmunodeficiencia Adquirida/complicaciones , Aciclovir/uso terapéutico , Antivirales/uso terapéutico , Foscarnet/uso terapéutico , Herpes Genital/tratamiento farmacológico , Herpes Simple/tratamiento farmacológico , Humanos , Imiquimod/uso terapéuticoRESUMEN
There are different etiologies of neonatal ophthalmia such as viral ones. Among them, the Herpes simplex virus, both type I and II, is particularly relevant due to its potential severity. It is a rare, in frequent entity, but with a high rate of morbidity and mortality without appropriate diagnosis and management. OBJECTIVE: To describe a case of neonatal ophthalmia caused by Herpes Virus type I, its clinical characteristics, and correct diagnosis. CLINICAL CASE: 8-days old newborn, with no notable history, presenting edema and erythema of eyelids, accompanied by bilateral ocular discharge. Her pes Virus type I infection was diagnosed by PCR, without evidence of disseminated disease or central nervous system involvement. He received full treatment with intravenous Acyclovir with complete clinical improvement. CONCLUSIONS: Herpes Simplex Virus should always be considered as a diffe rential diagnosis in all neonatal ophthalmia. Early and timely diagnosis and treatment are of vital importance.
Asunto(s)
Endoftalmitis , Herpes Simple , Masculino , Femenino , Recién Nacido , Humanos , Herpes Simple/complicaciones , Herpes Simple/diagnóstico , Herpes Simple/tratamiento farmacológico , Aciclovir/uso terapéutico , Simplexvirus , Endoftalmitis/tratamiento farmacológicoRESUMEN
Acute Retinal Necrosis (ARN) is a potentially devastating form of Uveitis. Antivirals are the mainstay treatment for this syndrome. In this letter, we question the current oral Valacyclovir dosage, based on the experience we had with a recent unresponsive ARN case.
Asunto(s)
Síndrome de Necrosis Retiniana Aguda , Uveítis , Aciclovir/uso terapéutico , Antivirales/uso terapéutico , Humanos , Síndrome de Necrosis Retiniana Aguda/diagnóstico , Síndrome de Necrosis Retiniana Aguda/tratamiento farmacológico , Valaciclovir/uso terapéuticoRESUMEN
Background: Sarcoids are the most frequent skin tumors among horses, causing serious lesions due to their different shapes, sizes, degree of invasiveness and distribution on the body. The pathogenesis of sarcoids is multifactorial, with genetic, viral and environmental involvement, making their treatment complex. The aggressiveness and high rate of recurrence of sarcoids makes it difficult to use an effective treatment, which is why there are several therapeutic routes described in the literature. Aiming to describe and expand sarcoid treatments, this paper reports on the use of acyclovir in the treatment of this type of tumor. Cases: Four horses sent to the Large Animal Veterinary Hospital of the Federal University of Lavras - UFLA were diagnosed and treated for sarcoids. Case 1. Lesions on the right ear, region of the masseter muscle of the right side of the face, neck, vulva and medial aspect of the left pelvic limb. Case 2. Lesion in the left groin region. Case 3. Lesions on the face, masseter muscle region on the left side, mandibular region and right ear pinna. Case 4. Lesion in the lateral region of the left pelvic limb, close to the tarsometatarsal joint. All horses had a diagnosis of sarcoid, which was confirmed by histopathological examination of material collected after surgical excision. Macroscopically, the neoplastic lesions were classified as fibroblastic, verrucous and nodular. The tumors exhibited irregular surfaces, keratinization, and a firm consistency. Their surfaces were alopecic, slightly rough, some of them were ulcerated, and their color ranged from greyish to rosy and reddish. All the tumor masses were surgically excised from the 4 horses, and one sarcoid was treated by thermal cauterization with liquid nitrogen due to the lesion's depth and size. In most cases, the sarcoid removal sites were closed with sutures. Only 2 lesions were not sutured due to the impossibility of bringing the edges of tissue close together, or due to proximity to the tarsometatarsal joint. The surgical wounds were cleaned twice a day with sterile saline solution followed by the topical application of Acyclovir. One of the animals received complementary therapy with Cimetidine. Discussion: The equines recovered completely from their sarcoid treatment, and no recurrences were reported a year later. Thus, the combination of treatments employed for the extirpation of sarcoids proved to have greater chances of success. First, all the tumors were surgically removed with the largest possible margins of safety in order to ensure the elimination of neoplastic cells. In the postoperative period, all the animals received topical treatment of the lesions with acyclovir after surgical resection of the tumors. The drug aided the complete healing of post-surgical wounds, and healing time varied according to the size and depth of the lesion. One tumor was treated with liquid nitrogen after surgical excision of the sarcoid. Another horse was treated with cimetidine over a 3-month period after surgical excision of the neoplasm in order to reduce the sarcoid and prevent its evolution. Surgical excision of the sarcoid associated with topical application of acyclovir ointment showed satisfactory results. Moreover, the combination of surgical excision and administration of liquid nitrogen on the lesion and topical application of acyclovir ointment in the postoperative period also provided good results. Given the complexity of sarcoid treatment and the high recurrence rate of these tumors, the use of combined treatments should be taken into account.
Asunto(s)
Animales , Sarcoidosis/veterinaria , Aciclovir/uso terapéutico , Cimetidina/uso terapéutico , Caballos/lesiones , Neoplasias Cutáneas/veterinaria , Cauterización/veterinariaRESUMEN
INTRODUCTION: Acute liver failure (ALF) is a life-threatening condition that remains challenging for physicians despite several advances in supportive care. Etiologies vary worldwide, with herpes simplex virus (HSV) hepatitis representing less than 1% of cases. Despite its low incidence, ALF is a lethal cause of acute necrotizing hepatitis and has a high mortality. Early antiviral treatment is beneficial for survival and decreased liver transplantation necessity. However, plasmapheresis, despite its theoretical potential benefit, is scarcely reported. PATIENT CONCERNS: A 25-year-old woman with no known disease presented with painful pharynx ulcers, increased transaminases and impaired liver function. DIAGNOSIS: ALF due to a disseminated HSV-2 primary infection was diagnosed with a positive polymerase chain reaction for HSV-2 in the biopsied liver tissue and blood. INTERVENTIONS: Empiric antiviral treatment was initiated. After clinical deterioration, plasmapheresis was also initiated. OUTCOMES: After 6 cycles of plasmapheresis and supportive care, the patient's condition improved without undergoing liver transplantation. CONCLUSIONS: ALF is a life-threatening condition, and HSV as an etiology must be suspected based on background, clinical manifestation, and laboratory information. The potential role of plasmapheresis in HSV hepatitis should be considered.
Asunto(s)
Aciclovir/uso terapéutico , Antivirales/uso terapéutico , Herpes Simple/complicaciones , Fallo Hepático Agudo/virología , Plasmaféresis , Adulto , Femenino , Herpesvirus Humano 2/aislamiento & purificación , Humanos , Fallo Hepático Agudo/diagnóstico por imagen , Fallo Hepático Agudo/terapia , Tomografía Computarizada por Rayos XRESUMEN
We present the case of a 63-year-old immunocompetent man with unilateral acute retinal necrosis (ARN). He consulted for blurred vision, eye pain, photophobia, and headache. Papillitis and peripheal chorioretinitis associated with vasculitis and peripheral retinal ischemia was confirmed. PCR from aqueous humor sample detected varicella zoster virus. The patient was treated with a combined therapy of oral corticosteroids, oral / intravenous acyclovir along with weekly intravitreous ganciclovir doses followed by oral valaciclovir for three months. A progressive decrease in viral load in aqueous humor was demonstrated during treatment. Follow-up showed improvement in the inflammatory condition and a slight recovery of visual acuity, however, finally he presented a retinal detachment with total loss of one-sided vision. ARN is an uncommon complication caused by some herpesviruses with a poor visual prognosis, an outcome that can be improved with early diagnosis and treatment using appropriate antivirals. Prolonged treatment reduces relapse frequency and fellow eye compromise.