RESUMO
The purpose of the present study was to determine if the quantity of herpes simplex virus (HSV) DNA in the cerebrospinal fluid (CSF) of patients with herpes encephalitis would be useful in establishing the prognosis of the disease and to determine the effect of antiviral therapy on the clearance of viral DNA from the CSF. Quantitation of HSV DNA was done by constructing an internal standard (IS) from the glycoprotein B amplicon which had a 25-bp deletion between primer annealing sites. Each CSF specimen was coamplified with the IS and the ratio of the amount of HSV/amount of IS was compared to the ratios on a standard curve constructed with the same IS plus known amounts of HSV DNA. CSF specimens were available from 16 patients who were treated with intravenous acyclovir, and the amount of HSV DNA ranged from < 25 to 18,000 copies per microliter in CSF obtained before or within 4 days of the initiation of acyclovir therapy. Patients with > 100 copies of HSV DNA per microliter were older, were found by computed tomography to have lesions, and had poorer outcomes than patients with < 100 copies. Follow-up CSF specimens were available from seven patients. In six of these seven patients, the HSV DNA levels decreased during therapy. One patient had a twofold increase in HSV DNA levels after 1 week of therapy and died on day 8. The application of this assay may be helpful in establishing the prognosis and in the monitoring of patients with herpes simplex encephalitis.
Assuntos
Líquido Cefalorraquidiano/virologia , DNA Viral/líquido cefalorraquidiano , Encefalite Viral/diagnóstico , Herpes Simples/diagnóstico , Herpesvirus Humano 1/isolamento & purificação , Reação em Cadeia da Polimerase/métodos , Aciclovir/uso terapêutico , Adolescente , Adulto , Antivirais/uso terapêutico , Sequência de Bases , Criança , Pré-Escolar , DNA Viral/análise , Encefalite Viral/líquido cefalorraquidiano , Encefalite Viral/tratamento farmacológico , Feminino , Herpes Simples/líquido cefalorraquidiano , Herpes Simples/tratamento farmacológico , Herpesvirus Humano 1/genética , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Dados de Sequência Molecular , Prognóstico , Fatores de Tempo , Resultado do Tratamento , Proteínas do Envelope Viral/genéticaRESUMO
We report five infants with congenital cytomegalovirus infection in whom diabetes insipidus developed before initiation of treatment with ganciclovir. Four of five infants required treatment with desmopressin. Magnetic resonance imaging of the brain showed no destruction of the hypothalamus or pituitary gland in any infant. Cortisol levels and results of thyroid function studies were normal in all infants.
Assuntos
Infecções por Citomegalovirus/congênito , Diabetes Insípido/complicações , Infecções por Citomegalovirus/tratamento farmacológico , Diabetes Insípido/diagnóstico , Diabetes Insípido/tratamento farmacológico , Humanos , Recém-Nascido , MasculinoRESUMO
STUDY OBJECTIVE: To determine whether orally administered acyclovir is of therapeutic benefit for varicella in otherwise healthy adolescents, and to compare the severity of the disease in adolescents with that in younger children. DESIGN: Multicenter, randomized, placebo-controlled, double-blind trial. SETTING: Patients' homes and university hospital clinics. PATIENTS: Sixty-eight adolescents between 13 and 18 years of age with varicella entered the study. Of the 62 adolescents with laboratory-confirmed varicella who were included in the final analysis, 31 received acyclovir and 31 received placebo. INTERVENTIONS: Placebo or an 800 mg acyclovir tablet was given orally four times daily for 5 days, beginning within 24 hours of onset of rash. MEASUREMENTS AND MAIN RESULTS: Acyclovir recipients had significant reductions in times to cessation of new lesion formation (p less than 0.001), maximum number of lesions (p = 0.019), and defervescence (p = 0.045). Mean constitutional illness score was significantly reduced on day 4 (0.5 vs 1.5, p = 0.05), as was the mean number of residual hypopigmented lesions present on 28-day follow-up examination (22.7 vs 92.7, p = 0.018). Two complications, both bacterial superinfections, occurred in placebo recipients. Adverse experiences and varicella-zoster virus antibody titers measured 28 days after enrollment were similar in both treatment groups. Comparison of placebo recipients with children 2 to 12 years of age participating in a companion study indicated that varicella is more severe in adolescents: mean maximum total lesions (421 vs 347, p = 0.003), mean maximum constitutional illness score (3.1 vs 2.2, p = 0.032), and mean number of residual lesions (92.7 vs 33.2, p = 0.01) were all greater in the adolescent population. CONCLUSIONS: Oral acyclovir therapy is safe and effective for treatment of varicella in otherwise healthy adolescents; this may be an appropriate subgroup for treatment with antiviral drugs because the disease is more severe in them than in younger children.
Assuntos
Aciclovir/uso terapêutico , Varicela/tratamento farmacológico , Aciclovir/efeitos adversos , Adolescente , Fatores Etários , Varicela/imunologia , Criança , Pré-Escolar , Método Duplo-Cego , Família , Feminino , Herpesvirus Humano 3/imunologia , Humanos , Imunidade Celular/efeitos dos fármacos , Masculino , Índice de Gravidade de Doença , Superinfecção/prevenção & controle , Resultado do TratamentoRESUMO
Two infants developed a protracted pneumonitis with lower respiratory obstruction beginning at one month of age. Lung biopsy in one suggested a viral etiology which prompted an extensive investigation of each infant for specific etiology. Virologic, serologic, immunologic, and electronmicroscopic studies indicated that cytomegalovirus was a major causative factor. The infections were apparently acquired at birth from infected maternal genital tracts and have persisted for prolonged periods of time. Evidence for gross immunologic defect as a precipitating cause was lacking. These infants serve to emphasize the possible pathologic potential of CMV when acquired in early life even in the absence of iatrogenic immunosuppression.