Vidarabine therapy of complicated herpes simplex keratitis

Patients with active herpetic epithelial keratitis who had toxic reactions or were resistant to idoxuridine received vidarabine. Only one of 35 cases of herpetic epithelial keratitis without stromal disease failed to heal. Of 21 patients with active epithelial keratitis complicating stromal keratitis or uveitis. 11 had complete reepithelialization by day 14. Two patients were removed from the trial as treatment failures. The remaining cases healed in 21 to 48 days. In most instances the stromal keratitis was inactivated when the epithelial ulcer healed. In our patients treated with vidarabine, healing of herpes simplex epithelial ulcers was biphasic: Stage 1, progression from an active to an inactive viral ulcer, and Stage 2, complete reepithelialization.

Herpes simplex keratitis in a developing country. Natural history and treatment of epithelial ulcers in Tunisia

Herpes simplex keratitis was found to be a common ophthalmic problem in Tunisia. Dendritic and geographic ulcers were complicated by deep stromal keratitis in 31% of patients, two thirds of whom were known to have been treated previously with corticosteroids. Herpes simplex virus was isolated from 41% of patients from whom corneal material was cultured. To develop an effective program for management of epithelial herpes in developing countries, treatment with idoxuridine was compared with debridement and patching. Average healing time for 31 ulcers treated with idoxuridine was 13 days, with three treatment failures; average healing time for 20 ulcers treated with debridement and patching was five days, with one failure. Debridement and patching of herpetic ulcers was an efficient way to treat herpes simplex keratitis within the context of overall medical care in Tunisia.

Effect of cytosine, arabinoside, iododeoxyuridine, ethyldeoxyuridine, thiocyanatodeoxyuridine, and ribavirin on tail lesion formation in mice infected with vaccinia virus

Mice infected intravenously with vaccinia virus develop characteristic lesions over the entire tail surface. This experimental virus infection presents a highly sensitive and reliable model for evaluating the antivaccinia activity of antiviral compounds. Ara-C (1-beta-D-arabinofuranosylcytosine), ribavirin (1-beta-D-ribofuranosyl-1,2,4-triazole-3-carboxamide), IUdR (5-iodo-2'-deoxyuridine) as well as two novel analogs of IUdR, EtUdR (5-ethyl-2'-deoxyuridine), and NCSUdR (5-thiocyanato-2'-deoxyuridine), were found to inhibit the formation of vaccinia tail lesions, when administered intraperitoneally once daily for 7 days starting immediately after virus infection. The order of (decreasing) activity was: ara-C greater than IUdR greater than NCSUdR greater than ribavirin greater than EtUdR. Various drug combinations, involving IUdR + ara-C, NCSUdR + ara-C, NCSUdR + IUdR, NSCUdR + ribavirin, etc., were evaluated but none proved more efficacious than either compound administered alone.

Current and proposed management of ocular herpes simplex

Current and proposed methods of management of ocular herpetic epithelial disease are reviewed with particular attention to the methods, efficacy and side effects of mechanical debridement, chemotherapy, cryotherapy, and photoinactivation. Special types of herpetic ulceration, including steroid-induced, resistant, indolent, and recurrent ulcers are discussed.

Herpes simplex encephalitis simulating systemic embolism

A case of herpes simplex virus encephalitis is described in a patient known to suffer from chronic atrial fibrillation and whose clinical symptoms suggested cerebral embolism of cardiac origin. The final diagnosis was based on the presence of herpes simplex virus type 1 antibodies in the cerebrospinal fluid and a significant rise in antibody titers in the serum. The patient regained consciousness after craniotomy and treatment with idoxuridine. The case emphasizes that the possibility of herpetic encephalitis should be considered in patients presenting with typical signs of a cerebrovascular accident.

Phosphonoacetic acid in the treatment of experimental ocular herpes simplex infections

Phosphonoacetic acid had a significant antiviral effect when applied topically, both in liquid and ointment preparations, on superficial herpetic keratitis in rabbits and was equally as effective as idoxuridine. It was also effective in the treatment of idoxuridine-resistant herpetic keratitis. Phosphonoacetic acid was not effective in the treatment of experimental herpetic iritis when applied topically but was significantly effective when administered intravenously and subconjunctivally. No significant local or systemic toxicity was encountered.

Therapeutic use of inducers of interferon on Herpes simplex keratitis in humans

The double-stranded RNA interferon inducer polyinosinic-polycytidylic acid (In-Cn) was used to treat acute dendritic keratitis in man in a double-blind manner with IDU. The success rate for this agent was similar to IDU and was found efficacious in cases not responsive to IDU. Prophylaxis with In-Cn did not prevent recurrences of epithelial herpes, but such recurrences were responsive to IDU or In-Cn.

Allergic contact dermatitis caused by idoxuridine. Patterns of cross reactivity with other pyrimidine analogues

Idoxuridine has been used for many years in the treatment of herpex simplex infections of the eye. Use of the drug for herpes simplex infection of the skin is increasing. Ophthalmologists have noted occasional conjunctival and corneal irritant reactions, but no true delayed cutaneous hypersensitivity has been verified. We report four cases of allergic contact dermatitis from idoxuridine, sensitized by both eye and skin applications. Cross reactivity to brominated and chlorinated, but not fluorinated, pyrimidine analogues is noted. Extensive patch testing indicates the general relationship between the structure of pyrimidine compounds and their antigenic cross reactivity.

Idoxuridine ocular insert therapy. Use in treatment of experimental Herpes simplex keratitis

Therapy of acute Herpes simplex keratitis in rabbits with idoxuridine-releasing ocular inserts showed that an application rate of 30mug/hr gave significantly better results than conventional treatment with idoxuridine drops and ointment while exposing the eye to 40% less drug. Delivery rates lower than this were equal or not as effective as drop and ointment therapy and rates up to 100 mug/hr did not produce significantly better results than rates of 30mug/hr. Serial viral cultures demonstrated the persistence of virus beyond the period of clinical resolution of disease in all treatment groups, indicating that therapy should be continued longer than apparent resolution of disease.

[Chemotherapeutic activity of bonafton in experimental herpetic keratitis in rabbits]

Bonaphthone (6-naphthoquinone-1,2) administered per os produces a prounced therapeutic effect in experimental herpetic keratitis of rabbits, induced by the virus of herpes simplex. With the topical appllication of bonaphthone in the form of an ointment the drug also produces a curative action in herpetic keratitis of rabbits. Combined application of bonaphthone locally and enterally in dealing with herpes in rabbits also acts beneficially, the same as its separate use.

Cytomegalovirus in tears from patients with normal eyes and with acute cytomegalovirus chorioretinitis

Cytomegalovirus (CMV) was recovered from the tears in eight of 41 (19.5%) children excreting CMV in their urine or saliva. Tear excretors were all immunosuppressed children with acute lymphocytic leukemia. Three had active CMV chorioretinitis and five did not develop retinal disease in nine to 15 months of observation. To our knowledge this was the first report of the recovery of CMV from tears and of acquired CMV chorioretinitis in children. One patient with active chorioretinitis presented with a disciform elevation of the macula. Therapy with adenine arabinoside (ara-A) or idoxuridine was ineffective in two patients while a third patient treated with ara-Apossibly had a more rapid recovery. However, the significance is uncertain due to the unusual disease presentation and lack of data regarding the nature of cytomegalic inclusion disease chorioretinitis. Areas of retinal calcification were present at autopsy in one patient.

Herpes simplex encephalitis in Hodgkins disease. Isolation of drug-sensitive virus from brain following unsuccessful treatment with idoxuridine

Herpes simplex encephalitis developed in a patient with Hodgkin's disease under therapy. Despite treatment with idoxuridine in a total dose of 280 mg/kg intravenously, he died without showing any clinical response. At autopsy, there was no gross or microscopic evidence of Hodgkin's disease, and virus isolated from the brain postmortem was inhibited in vitro by idoxuridine 0.5 mug/ml. Failure of idoxuridine to affect the course of infection by a drug-sensitive virus may be due to poor tissue penetration, although the role of the Hodgkin's disease cannot be discounted.

Ara-A and IDU therapy of human superficial herpetic keratitis

Ara-A ointment was compared to IDU ointment in patients with dendritic herpes simplex virus infection of the corneal epithelium. Twenty-eight patients were treated with Ara-A ointment and twenty-four with IDU ointment. The lesions healed in 5.1 days with Ara-A and in 6.9 days with IDU. This drug was given in a double-controlled manner, so that neither the patient, nor the investigator knew which drug the patient was receiving. The patient groups were comparable as to length of the dendritic lesion and duration of symptoms. The adverse reactions to each of these drugs were comparable and in no case was there any permanent ocular change from drug use.

Absence of idoxuridine and persistence of herpes simplex virus in brains of patients being treated for encephalitis

Thirty-two specimens of brain from five patients with encephalitis suspected to be caused by herpes simplex virus, type 1 (HSV-1) were assayed for antiviral activity. Each patient received 60-80 mg/kg/day of idoxuridine (IDU) by intravenous infusion. The antiviral assay does not measure anti-HSV-1 antibodies. Biopsies of brain in every patient taken before IDU was used, and portions of several regions of the brain at autopsy were available during courses of treatment in four of the five patients. The last patient died 7 days after completing treatment. A significant concentration of IDU (833 mug/ml) was measured transiently in the cerebrospinal fluid of one patient. Meninges and brains showed inflammatory changes. Within the sensitivity of the test (larger than or equal to 6 mug/g) all specimens contained no IDU. As given, IDU does not achieve therapeutic concentrations in human brain. Further clinical use of IDU in therapy of herpes simplex virus encephalitis is not indicated.

Experimental infection with herpes simplex virus type 2 in newborn rats: Effects of treatment with iododeoxyuridine and cytosine arabinoside

Sprague-Dawley rats were inoculated, within 36 hr of birth, with either of two strains of herpes simplex virus type 2. The effects of treatment for five days with either 5-iododeoxyuridine or cytosine arabinoside in near toxic doses were studied. Evaluation of treatment based on rate of survival, incidence of lesions, and isolation of virus from the central nervous system showed no appreciable difference between treated and untreated littermates. Drug-related effects of retardation of growth and defective development of the cerebellum and retina were found. The validity of therapy with either of these drugs in generalized herpetic infections is questioned because activity was minimal against the infecting agent even when the dosage of the drug was sufficient to produce serious defects in certain developing tissues.

Varicella in Children With Cancer: Seventy-Seven Case

The purpose of this study was to characterize varicella in childhood cancer patients. Seventeen of the 77 patients reviewed were in remission and off all therapy for 3 to 22 months. No one in this group died from varicella or had evidence of visceral dissemination. Among the remaining 60 patients, all of whom were receiving anticancer therapy when they developed vancella, 19 (32%) had visceral dissemination and 4 died, for a mortality rate of 7%. Each of the deaths was associated with primary varicella pneumonitis, with or without acute encephalitis. Visceral dissemination was not related to type or status of malignancy or to duration of specific anticancer therapy. Varicella was more likely to disseminate in children with absolute lymphopenia, less than 500 cells per cubic millimeter, than in patients with higher lymphocyte counts. Cessation of anticancer therapy prior to the onset of lesions appeared to lessen the risk of dissemination. These results show that varicella is more severe in cancer patients on therapy than in the general population or in patients who have completed therapy, but is not highly fatal.