1
|
Mrosik S, Rasokat H, Fabri M, Bopp L. [Human monkeypox (Mpox)]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2024; 75:40-47. [PMID: 38063873 DOI: 10.1007/s00105-023-05268-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/14/2023] [Indexed: 01/12/2024]
Abstract
Until recently, human monkeypox (Mpox) were rarely observed outside of Africa, where the Mpox virus (MPXV) is endemic in some regions. In early May 2022, a global Mpox outbreak occurred. Crucial to this outbreak was human-to-human transmission during sexual activity. In particular, young men who have sex with men (MSM) became ill. In July 2022, this Mpox epidemic was declared a public health emergency of international concern by the World Health Organization. As of 26 September 2023, 90,618 confirmed cases of Mpox have been reported worldwide, with Germany accounting for around 3700 cases. The strongest increase in incidence occurred from May to mid-August 2022; since then, the number of cases has declined significantly as a result of intensive prevention efforts (education, vaccination). Currently, there are only sporadic, smaller outbreaks-in Germany (Berlin) most recently in August 2023. Despite the current calm epidemiological situation worldwide, isolated cases must therefore still be expected in Germany. The clinical picture of the "new" clade IIb-associated Mpox variant, which is mostly transmitted sexually from person to person, differs markedly from that of the "classical" Mpox (clades I and IIa), which, apart from rapidly breaking human infection chains, essentially occur as a zoonosis.
Collapse
Affiliation(s)
- Sebastian Mrosik
- Medizinische Fakultät und Uniklinik Köln, Klinik für Dermatologie und Venerologie, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - Heinrich Rasokat
- Medizinische Fakultät und Uniklinik Köln, Klinik für Dermatologie und Venerologie, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - Mario Fabri
- Medizinische Fakultät und Uniklinik Köln, Klinik für Dermatologie und Venerologie, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - Luisa Bopp
- Medizinische Fakultät und Uniklinik Köln, Klinik für Dermatologie und Venerologie, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
| |
Collapse
|
2
|
Bozzola E, Marchesani S, Ficari A, Brusco C, Spina G, Marchili MR, Guolo S. Assessing the use of antibiotics in pediatric patients hospitalized for varicella. Ital J Pediatr 2022; 48:196. [PMID: 36503563 PMCID: PMC9743721 DOI: 10.1186/s13052-022-01393-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 11/29/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Varicella is considered a mild and self-limiting disease, but, in some cases, it may complicate and require hospitalization. Antibiotics are not the first line therapy but in some cases are prescribed either for the management of varicella-related complications or as a preventive strategy. Aim of this study is to analyze the rate and the patterns of antibiotics used in pediatric patients hospitalized for varicella as well as the relative costs in order to increase insights in antibiotic use in varicella. METHODS Patients less than 18 years hospitalized for varicella at the Bambino Gesù Children's IRCCS Hospital in Rome, Italy, from the 1st of November 2005 to the 1st of November 2021 entered the study. Retrospective data were collected from the hospital's database electronic medical records. The rate, the patterns and the costs of antibiotics used were considered. RESULTS According to the inclusion criteria, we enrolled 810 patients, with a median age of 2.4 years. Out of them, 345 patients (42.6%) underwent antibiotic therapy, of which 307 for a complication (90.0%) and the other 10.0%, antibiotic for the fear of developing complications. The cost for varicella hospitalizations was EUR 2,928,749 (median cost EUR 2689). As for antibiotic therapy, it represented the 5.9% of the total cost (EUR 174,527), with a median cost of EUR 198.8. The cost in patients who underwent antibiotic therapy was significantly higher than in those who did not (p-value < 0.0001), as well as the hospitalization length (p-value < 0.0001). The most commonly prescribed antibiotics were Amoxicillin-clavulanate and Ceftriaxone, which represented the 36.0% and 25.0% of all antibiotic prescription, respectively. Antibiotics may negatively affect the economic cost of hospitalization and the prescription is not always in accordance to guidelines, with potential important repercussions on the development of antimicrobial resistance. Actually, resistance to antibiotics is considered a major risk to the future health of the world population as it may lead to longer hospital stay, increased risk of mortality, health care costs and treatment failures. CONCLUSION Strategies to reduce economical cost, hospitalization length and antimicrobial resistance include ensuring appropriate prescription and administration of empiric antibiotics as well as reducing the circulation of preventable infectious diseases through immunization.
Collapse
Affiliation(s)
- Elena Bozzola
- grid.414125.70000 0001 0727 6809Pediatric Unit, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - Silvio Marchesani
- grid.414125.70000 0001 0727 6809Pediatric Unit, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - Andrea Ficari
- grid.414125.70000 0001 0727 6809Pediatric Unit, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - Carla Brusco
- grid.414125.70000 0001 0727 6809Sanitary Direction Unit, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - Giulia Spina
- grid.414125.70000 0001 0727 6809Pediatric Unit, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - Maria Rosaria Marchili
- grid.414125.70000 0001 0727 6809Pediatric Unit, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - Stefano Guolo
- grid.414125.70000 0001 0727 6809Sanitary Direction Unit, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| |
Collapse
|
3
|
Khalil A, Sotiriadis A, Chaoui R, da Silva Costa F, D'Antonio F, Heath PT, Jones C, Malinger G, Odibo A, Prefumo F, Salomon LJ, Wood S, Ville Y. ISUOG Practice Guidelines: role of ultrasound in congenital infection. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2020; 56:128-151. [PMID: 32400006 DOI: 10.1002/uog.21991] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 01/27/2020] [Indexed: 06/11/2023]
Affiliation(s)
- A Khalil
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - A Sotiriadis
- Second Department of Obstetrics and Gynecology, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - R Chaoui
- Center for Prenatal Diagnosis and Human Genetics, Berlin, Germany
| | - F da Silva Costa
- Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
| | - F D'Antonio
- Women's Health and Perinatology Research Group, Department of Clinical Medicine, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway
- Department of Obstetrics and Gynecology, University Hospital of Northern Norway, Tromsø, Norway
| | - P T Heath
- Paediatric Infectious Diseases Research Group and Vaccine Institute, St George's University of London and St George's University Hospitals NHS Trust, London, UK
| | - C Jones
- Faculty of Medicine and Institute for Life Sciences, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - G Malinger
- Ultrasound Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - A Odibo
- Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - F Prefumo
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - L J Salomon
- Department of Obstetrics and Fetal Medicine, Hopital Necker-Enfants Malades, Assistance Publique-Hopitaux de Paris, Paris Descartes University, Paris, France
| | | | - Y Ville
- Department of Obstetrics and Fetal Medicine, Hopital Necker-Enfants Malades, Assistance Publique-Hopitaux de Paris, Paris Descartes University, Paris, France
| |
Collapse
|
4
|
Abstract
Bacterial, viral, and parasitic pathogens add significant morbidity and even mortality to pregnancy-with adverse effects extending to both the gravida and the newborn. Three herpesviruses deserve considerable attention given the effects of perinatal infection on obstetric outcomes, specifically maternal and neonatal morbidity. In the following review, we will provide a description of cytomegalovirus, herpes simplex virus, and varicella zoster virus. For each viral pathogen, we will describe the epidemiology, natural history, screening and diagnosis modalities, treatments, and implications for antepartum care. Furthermore, we will highlight future directions of work in reducing the morbidities associated with these viral pathogens.
Collapse
|
5
|
Cates M, Donati M, Gillet S, Ustianowski A, Galloway J. Managing varicella zoster virus contact and infection in patients on anti-rheumatic therapy. Rheumatology (Oxford) 2018; 57:596-605. [PMID: 28575315 DOI: 10.1093/rheumatology/kex189] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Indexed: 12/30/2022] Open
Abstract
Chickenpox and shingles can be more severe and occasionally life threatening in immunosuppressed patients. As such, some groups warrant a more detailed history, serological testing and consideration of prophylaxis following contact with the virus. Active disease may also require more aggressive treatment with antivirals. Guidance for the use of varicella zoster immunoglobulin has recently been updated by Public Health England with important implications for rheumatology patients.
Collapse
Affiliation(s)
- Matthew Cates
- Department of Rheumatology, Royal Devon and Exeter Hospital, Barrack Road, Exeter, UK
| | - Matthew Donati
- Department of Virology, Public Health England, Bristol, UK
| | - Sophie Gillet
- Department of Virology, United Hospitals Bristol, NHS Foundation Trust, Bristol, UK
| | - Andrew Ustianowski
- Department of Infectious Diseases, North Manchester General Hospital, Manchester, UK
| | - James Galloway
- Department of Rheumatology, King's College London, London, UK
| |
Collapse
|
6
|
Abstract
This article focuses on the clinically relevant approved antiviral medications available for the treatment of infants and children. A brief overview of drug categories, mechanism of action, resistance, pharmacokinetics, and side effects is provided for the more commonly prescribed antivirals. The patient categories addressed are treatment and prophylaxis of influenza, neonatal herpes simplex virus and congenital cytomegalovirus, treatment and prophylaxis of viral disease in the immunocompromised host, and a brief introduction to the antivirals available to treat hepatitis B and hepatitis C in children.
Collapse
Affiliation(s)
- Claudette L Poole
- Department of Pediatrics, University of Alabama at Birmingham, 1600 6th Avenue South, CHB 308, Birmingham, AL 35233, USA.
| | - David W Kimberlin
- Department of Pediatrics, University of Alabama at Birmingham, 1600 6th Avenue South, CHB 308, Birmingham, AL 35233, USA
| |
Collapse
|
7
|
Warren-Gash C, Forbes H, Breuer J. Varicella and herpes zoster vaccine development: lessons learned. Expert Rev Vaccines 2017; 16:1191-1201. [PMID: 29047317 PMCID: PMC5942150 DOI: 10.1080/14760584.2017.1394843] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 10/17/2017] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Before vaccination, varicella zoster virus (VZV), which is endemic worldwide, led to almost universal infection. This neurotropic virus persists lifelong by establishing latency in sensory ganglia, where its reactivation is controlled by VZV-specific T-cell immunity. Lifetime risk of VZV reactivation (zoster) is around 30%. Vaccine development was galvanised by the economic and societal burden of VZV, including debilitating zoster complications that largely affect older individuals. Areas covered: We describe the story of development, licensing and implementation of live attenuated vaccines against varicella and zoster. We consider the complex backdrop of VZV virology, pathogenesis and immune responses in the absence of suitable animal models and examine the changing epidemiology of VZV disease. We review the vaccines' efficacy, safety, effectiveness and coverage using evidence from trials, observational studies from large routine health datasets and clinical post-marketing surveillance studies and outline newer developments in subunit and inactivated vaccines. Expert commentary: Safe and effective, varicella and zoster vaccines have already made major inroads into reducing the burden of VZV disease globally. As these live vaccines have the potential to reactivate and cause clinical disease, developing alternatives that do not establish latency is an attractive prospect but will require better understanding of latency mechanisms.
Collapse
Affiliation(s)
- Charlotte Warren-Gash
- Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Harriet Forbes
- Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Judith Breuer
- Division of Infection and Immunity, University College London, London, UK
| |
Collapse
|
8
|
Abstract
Antiviral drug discovery has produced a series of drugs active against herpesviruses in vitro. Several of these are now licensed and/or have been used in clinical practice. This article reviews the mechanisms of action of acyclovir, ganciclovir, penciclovir, sorivudine and foscarnet, the development of resistance to these drugs and their pharmacokinetic and cellular toxicities. Based upon the natural histories of HSV, VZV and CMV, treatment objectives for each virus are discussed and the performance of each drug matched against these objectives. Overall, it is concluded that the perfect drug for treating herpesviruses does not exist, but that significant progress has been made towards controlling several herpesvirus diseases. It is suggested that further progress will require not just improved drug discovery programmes, but also an understanding of different pathogeneses and an appreciation by practising physicians that antiviral drugs must be given early in the infectious process to achieve the best results.
Collapse
Affiliation(s)
- P.D. Griffiths
- Royal Free Hospital School of Medicine, Rowland Hill Street, London NW3 2PF, UK
| |
Collapse
|
9
|
Polish consensus guidelines on the use of acyclovir in the treatment and prevention of VZV and HSV infections. J Infect Chemother 2015; 22:65-71. [PMID: 26643900 DOI: 10.1016/j.jiac.2015.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 09/09/2015] [Accepted: 10/01/2015] [Indexed: 11/23/2022]
Abstract
A physician has to perform a benefit-risk assessment each time acyclovir is prescribed "off label" for children. A group of Polish infectious disease experts was created to develop evidence-based guidelines on the use of acyclovir in the treatment and prevention of varicella zoster and herpes simplex infections. In primary varicella zoster virus infections, oral acyclovir treatment is recommended in children over 12 years of age and should be considered in younger children who fall into one of the groups at risk of severe varicella. Intravenous acyclovir therapy in varicella is recommended in patients with immune deficiencies, newborns and in complicated cases. When there is a justified need for prevention of varicella, oral acyclovir prophylaxis may be considered if immunoglobulin cannot be administered, and if it is too late for vaccination. Oral acyclovir treatment of herpes zoster may be beneficial to otherwise healthy patients with a rash in places other than the trunk and in patients over 50 years of age. In immunocompetent patients with herpes simplex infections, indications for treatment with oral acyclovir include primary (genital herpes, skin herpes in children with atopic dermatitis, ocular herpes simplex, severe gingivostomatitis, paronychia and pharyngitis) and recurrent infections. Intravenous acyclovir should be administered for herpes infections in neonates, immunocompromised patients and patients who develop complications including neurological.
Collapse
|
10
|
Kim SR, Khan F, Ramirez-Fort MK, Downing C, Tyring SK. Varicella zoster: an update on current treatment options and future perspectives. Expert Opin Pharmacother 2013; 15:61-71. [PMID: 24289750 DOI: 10.1517/14656566.2014.860443] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Varicella zoster virus is a highly contagious virus that causes a primary infection known as varicella (chickenpox) that may reactivate years later to cause herpes zoster (HZ or shingles). After shingles heal, patients may develop post-herpetic neuralgia (PHN), neuropathic pain syndrome that can cause significant suffering for years and is often refractory to treatment. AREAS COVERED The wide range of treatment and management options for varicella, HZ and PHN are reviewed and discussed. PubMed was the database used for the literature search. EXPERT OPINION Antiviral therapy effectively treats acute varicella and HZ. However, PHN is still difficult to manage, especially with the numerous treatment measures that do not work consistently in all patients. The best approach is to prevent the complication from occurring in the first place by preventing HZ with the HZ vaccine, which have decreased the burden of illness caused by VZ and the incidence of HZ. Unlike the varicella vaccine, the uptake for the HZ vaccine is very low and thereby more patients over the age of 50 years should be encouraged to receive the vaccine to reduce the risk of developing HZ. Initiating treatment with gabapentin and antiviral concomitantly as soon as the rash develops may reduce the severity of complications but there is a lack of data showing these medications preventing the development of PHN.
Collapse
Affiliation(s)
- Sharon R Kim
- The University of Texas Health Science Center, Department of Dermatology , 6655 Travis St, Suite 600, Houston, TX 77030 , USA
| | | | | | | | | |
Collapse
|
11
|
|
12
|
Mustafa MB, Arduino PG, Porter SR. Varicella zoster virus: review of its management. J Oral Pathol Med 2009; 38:673-88. [DOI: 10.1111/j.1600-0714.2009.00802.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
|
13
|
Tunbridge AJ, Breuer J, Jeffery KJM. Chickenpox in adults - clinical management. J Infect 2008; 57:95-102. [PMID: 18555533 DOI: 10.1016/j.jinf.2008.03.004] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2008] [Revised: 03/06/2008] [Accepted: 03/09/2008] [Indexed: 01/30/2023]
Abstract
Acute varicella zoster virus (VZV) infection, or chickenpox, is still perceived by many as a mild infection of childhood. However, chickenpox is increasingly common in adults and adolescents who together with immunosuppressed individuals are at a higher risk of severe infection. Antiviral therapy is available which both ameliorates symptoms and decreases the severity of chickenpox if administered early in the course of the infection. Passive immunisation with varicella zoster immunoglobulin (VZIG) may prevent or attenuate infection following exposure to varicella of an immunocompromised or pregnant individual or a neonate. Active immunisation is available and is universal in many developed countries. This review reflects current best practice in management of chickenpox in adults by specialist physicians in the UK. The accompanying flowchart has been formulated to guide emergency physicians and general practitioners through the decision-making process regarding treatment and admission for specialist care.
Collapse
Affiliation(s)
- A J Tunbridge
- Department of Infection and Tropical Medicine, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK.
| | | | | | | |
Collapse
|
14
|
Affiliation(s)
- Anne A Gershon
- Columbia University College of Physicians and Surgeons, New York, NY, USA
| |
Collapse
|
15
|
Ostrosky-Zeichner L, Rex JH. Antifungal and Antiviral Therapy. Crit Care Med 2008. [DOI: 10.1016/b978-032304841-5.50055-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
16
|
|
17
|
Walsh JB, Geaneyb M. Valaciclovir in secondary and tertiary cases of adult chickenpox. J Eur Acad Dermatol Venereol 2006. [DOI: 10.1111/j.1468-3083.1996.tb00193.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
18
|
Klassen TP, Hartling L, Wiebe N, Belseck EM. Acyclovir for treating varicella in otherwise healthy children and adolescents. Cochrane Database Syst Rev 2005; 2005:CD002980. [PMID: 16235308 PMCID: PMC8407192 DOI: 10.1002/14651858.cd002980.pub3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Acyclovir has the potential to shorten the course of illness which may result in reduced costs and morbidity associated with chickenpox. OBJECTIVES 1) To examine the evidence evaluating the efficacy of acyclovir in alleviating symptoms of chickenpox and shortening the duration of illness. 2) To examine complications of chickenpox and adverse effects associated with acyclovir as reported in the relevant trials. SEARCH STRATEGY We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 2, 2005), MEDLINE (January 1966 to June 2005), and EMBASE (1988 to June 2005). The reference lists of all relevant articles were reviewed. The primary author of relevant studies and the pharmaceutical company that manufactures acyclovir were contacted. SELECTION CRITERIA Randomized controlled trials that evaluated otherwise healthy children zero to 18 years of age, with chickenpox. DATA COLLECTION AND ANALYSIS Two authors independently reviewed the studies for eligibility. Two authors independently assessed methodological quality of the relevant studies using the Jadad scale and allocation concealment. Differences were resolved by consensus. Data were extracted by one author using a structured form and checked by a second. Continuous data were converted to the weighted mean difference (WMD). Weighted mean differences were combined into an overall estimate using random effects. There were too few studies to consider exploring statistical heterogeneity between studies (i.e., differences in reported effects), formally, or to assess for publication bias. MAIN RESULTS Three studies were included. Study quality was three (n = 2) and four (n = 1) on the Jadad scale. Acyclovir was associated with a reduction in the number of days with fever (-1.1 days, 95% CI -1.3 to -0.9) and in reducing the maximum number of lesions (-76 lesions, -145 to -8). Results were less supportive with respect to the number of days to no new lesions and the number of days to the relief of itching. There were no clinically important differences between acyclovir and placebo with respect to complications associated with chickenpox or adverse effects associated with the treatment. AUTHORS' CONCLUSIONS Acyclovir appears to be effective in reducing the number of days with fever and the maximum number of lesions among otherwise healthy children with chickenpox. The results were less convincing with respect to the number of days to no new lesions and relief of itchiness. The clinical importance of acyclovir treatment in otherwise healthy children remains uncertain.
Collapse
Affiliation(s)
- T P Klassen
- University of Alberta, Room 8213, Aberhart Centre One, Department of Pediatrics, 11402 University Avenue, Edmonton, Alberta, Canada T6G 2J3.
| | | | | | | |
Collapse
|
19
|
Hill J, Roberts S. Herpes simplex virus in pregnancy: new concepts in prevention and management. Clin Perinatol 2005; 32:657-70. [PMID: 16085025 DOI: 10.1016/j.clp.2005.05.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Genital herpes simplex virus (HSV) infection is one of the most common viral sexually transmitted diseases in the United States. It is estimated that 45 million adolescents and adults are infected with genital HSV. Most genital herpes infections in the United States are caused by HSV type 2 (HSV-2), and 25% to 30% of women of reproductive age have HSV-2 antibodies. What is more striking is that genital herpes is frequently under-recognized, and that only 5% to 10% of these women have a history of genital herpes. Because such a small percentage of women are aware of being infected with HSV, the risk of maternal transmission of this virus to the fetus or newborn is a significant health issue.
Collapse
Affiliation(s)
- James Hill
- Department of Obstetrics and Gynecology, Department of the Army, Womack Army Medical Center, 2817 Reilly Road MCXC, Fort Bragg, NC 28310-730, USA.
| | | |
Collapse
|
20
|
Abstract
The increase in the number and classes of antiviral agents that has occurred since the 1980s is remarkable. The rapid expansion in therapeutic options for previously untreatable illnesses challenges clinicians to gain familiarity and experience with these new drugs, especially with regard to their use in children. This article describes the clinical utilities, pharmacokinetics, and adverse effects of these new drugs to empower practitioners to use them appropriately.
Collapse
Affiliation(s)
- David W Kimberlin
- Department of Pediatrics, Division of Pediatric Infectious Diseases, The University of Alabama, Birmingham, AL 35233, USA.
| |
Collapse
|
21
|
Cheng V, Tang B, Wu A, Chu C, Yuen K. Medical treatment of viral pneumonia including SARS in immunocompetent adult. J Infect 2004; 49:262-73. [PMID: 15474623 PMCID: PMC7112637 DOI: 10.1016/j.jinf.2004.07.010] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2004] [Indexed: 01/11/2023]
Abstract
Since no randomized controlled trials have been conducted on the treatment of viral pneumonia by antivirals or immunomodulators in immunocompetent adults, a review of such anecdotal experience are needed for the more rational use of such agents. Case reports (single or case series) with details on their treatment and outcome in the English literature can be reviewed for pneumonia caused by human or avian influenza A virus (50 patients), varicella zoster virus (120), adenovirus (29), hantavirus (100) and SARS coronavirus (SARS-CoV) (841). Even with steroid therapy alone, the mortality rate appeared to be lower when compared with conservative treatment for pneumonia caused by human influenza virus (12.5% vs. 42.1%) and hantavirus (13.3% vs. 63.4%). Combination of an effective antiviral, acyclovir, with steroid in the treatment of varicella zoster virus may be associated with a lower mortality than acyclovir alone (0% vs. 10.3%). Combination of interferon alfacon-1 plus steroid, or lopinavir/ritonavir, ribavirin plus steroid were associated with a better outcome than ribavirin plus steroid (0% vs. 2.3% vs. 7.7%, respectively). Combination of lopinavir/ritonavir plus ribavirin significantly reduced the virus load of SARS-CoV in nasopharyngeal, serum, stool and urine specimens taken between day 10 and 15 after symptom onset when compared with the historical control group treated with ribavirin. It appears that the combination of an effective antiviral and steroid was associated with a better outcome. Randomized therapeutic trial should be conducted to ascertain the relative usefulness of antiviral alone or in combination with steroid.
Collapse
Affiliation(s)
- V.C.C. Cheng
- Centre of Infection, Queen Mary Hospital, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - B.S.F. Tang
- Centre of Infection, Queen Mary Hospital, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - A.K.L. Wu
- Centre of Infection, Queen Mary Hospital, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - C.M. Chu
- Department of Medicine, United Christian Hospital, Hong Kong Special Administrative Region, China
| | - K.Y. Yuen
- Centre of Infection, Queen Mary Hospital, The University of Hong Kong, Hong Kong Special Administrative Region, China
- Corresponding author. Tel.: +852-2855-4892; fax: +852-2855-1241.
| |
Collapse
|
22
|
Klassen TP, Belseck EM, Wiebe N, Hartling L. Acyclovir for treating varicella in otherwise healthy children and adolescents. Cochrane Database Syst Rev 2004:CD002980. [PMID: 15106185 DOI: 10.1002/14651858.cd002980.pub2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Acyclovir has the potential to shorten the course of illness which may result in reduced costs and morbidity associated with chickenpox. OBJECTIVES 1) To examine the evidence evaluating the efficacy of acyclovir in alleviating symptoms of chickenpox and shortening the duration of illness. 2) To examine complications of chickenpox and adverse effects associated with acyclovir as reported in the relevant trials. SEARCH STRATEGY We searched The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 1, 2003), MEDLINE (January 1966 to May 2003), and EMBASE (1988 to April 2003). The reference lists of all relevant articles were reviewed. The primary author of relevant studies and the pharmaceutical company that manufactures acyclovir were contacted. SELECTION CRITERIA Randomized controlled trials that evaluated otherwise healthy children zero to 18 years of age, with chickenpox. DATA COLLECTION AND ANALYSIS Two reviewers independently reviewed the studies for eligibility. Two reviewers independently assessed methodological quality of the relevant studies using the Jadad scale and allocation concealment. Differences were resolved by consensus. Data were extracted by one reviewer using a structured form and checked by a second.Continuous data were converted to the weighted mean difference (WMD). Weighted mean differences were combined into an overall estimate using random effects. There were too few studies to consider exploring statistical heterogeneity between studies (i.e., differences in reported effects), formally, or to assess for publication bias. MAIN RESULTS Three studies were included. Study quality was three (n = 2) and four (n = 1) on the Jadad scale. Acyclovir was associated with a reduction in the number of days with fever (-1.1 days, 95% CI -1.3 to -0.9) and in reducing the maximum number of lesions (-76 lesions, -145 to -8). Results were less supportive with respect to the number of days to no new lesions and the number of days to the relief of itching. There were no clinically important differences between acyclovir and placebo with respect to complications associated with chickenpox or adverse effects associated with the treatment. REVIEWERS' CONCLUSIONS Acyclovir appears to be effective in reducing the number of days with fever and the maximum number of lesions among otherwise healthy children with chickenpox. The results were less convincing with respect to the number of days to no new lesions and relief of itchiness. The clinical importance of acyclovir treatment in otherwise healthy children remains controversial.
Collapse
Affiliation(s)
- T P Klassen
- Department of Pediatrics, University of Alberta, 2C3.67 Walter C. Mackenzie, Health Sciences Centre, Edmonton, Alberta, Canada, T6G 2R7
| | | | | | | |
Collapse
|
23
|
Suzuki K, Yoshikawa T, Ihira M, Ohashi M, Suga S, Asano Y. Spread of varicella-zoster virus DNA to the environment from varicella patients who were treated with oral acyclovir. Pediatr Int 2003; 45:458-60. [PMID: 12911484 DOI: 10.1046/j.1442-200x.2003.01746.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The purpose of the present study was to determine the degree of spread of varicella-zoster virus to the environment (VZV) from varicella patients who received oral acyclovir treatment. METHODS Over a period of 8 months, seven healthy children (two girls and five boys, 23-64 months of age) with varicella who visited Fujita Health University School of Medicine were treated with routine doses of oral acyclovir (ACV) for 5 days, commencing within 24 h after onset of the disease. Swab samples from the throats of patients and their family members as well as from air purifier filters in their houses were collected for 7 days as frequently as possible after starting treatment for the disease. The VZV DNA in the samples was identified by a sensitive polymerase chain reaction amplification assay. RESULTS The VZV DNA was detected in 33-100% of throat swab samples from varicella patients by day 7 of the disease, in 17-32% of throat swab samples from family members by day 4 and in 29% of filters from air purifiers by day 3. CONCLUSIONS The results suggest a broad spread of VZV, probably by the airborne route, from the patients with varicella even after the administration of oral ACV.
Collapse
Affiliation(s)
- Kyoko Suzuki
- Department of Pediatrics, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | | | | | | | | | | |
Collapse
|
24
|
Klassen TP, Belseck EM, Wiebe N, Hartling L. Acyclovir for treating varicella in otherwise healthy children and adolescents: a systematic review of randomised controlled trials. BMC Pediatr 2002; 2:9. [PMID: 12356336 PMCID: PMC130054 DOI: 10.1186/1471-2431-2-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2002] [Accepted: 09/30/2002] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Acyclovir has the potential to shorten the course of chickenpox which may result in reduced costs and morbidity. We conducted a systematic review of randomised controlled trials that evaluated acyclovir for the treatment of chickenpox in otherwise healthy children. METHODS MEDLINE, EMBASE, and the Cochrane Library were searched. The reference lists of relevant articles were examined and primary authors and Glaxo Wellcome were contacted to identify additional trials. Two reviewers independently screened studies for inclusion, assessed study quality using the Jadad scale and allocation concealment, and extracted data. Continuous data were converted to a weighted mean difference (WMD). Overall estimates were not calculated due to differences in the age groups studied. RESULTS Three studies were included. Methodological quality was 3 (n = 2) and 4 (n = 1) on the Jadad scale. Acyclovir was associated with a significant reduction in the number of days with fever, from -1.0 (95% CI -1.5,-0.5) to -1.3 (95% CI -2.0,-0.6). Results were inconsistent with respect to the number of days to no new lesions, the maximum number of lesions and relief of pruritus. There were no clinically important differences between acyclovir and placebo with respect to complications or adverse effects. CONCLUSION Acyclovir appears to be effective in reducing the number of days with fever among otherwise healthy children with chickenpox. The results were inconsistent with respect to the number of days to no new lesions, the maximum number of lesions and the relief of itchiness. The clinical importance of acyclovir treatment in otherwise healthy children remains controversial.
Collapse
Affiliation(s)
- Terry P Klassen
- Alberta Research Center for Child Health Evidence, Department of Pediatrics, University of Alberta, 2C3.00 WMC, Edmonton, Alberta, T6G 2R7, Canada
| | - Elaine M Belseck
- Alberta Research Center for Child Health Evidence, Department of Pediatrics, University of Alberta, 2C3.00 WMC, Edmonton, Alberta, T6G 2R7, Canada
| | - Natasha Wiebe
- Alberta Research Center for Child Health Evidence, Department of Pediatrics, University of Alberta, 2C3.00 WMC, Edmonton, Alberta, T6G 2R7, Canada
| | - Lisa Hartling
- Alberta Research Center for Child Health Evidence, Department of Pediatrics, University of Alberta, 2C3.00 WMC, Edmonton, Alberta, T6G 2R7, Canada
| |
Collapse
|
25
|
Abstract
Infections by VZV, the virus that causes chickenpox and herpes zoster, usually are diagnosed by the classic clinical presentations. In immunocompromised patients, however, the atypical presentation can make the diagnosis more challenging. Although varicella typically follows an uncomplicated course in children, adults and immunocompromised patients can develop complications involving several organs; some complications may be fatal. Prevention of disease with the vaccine is ideal. When varicella or zoster infection does occur, proper treatment should be initiated, depending on the age and immune status of the patient.
Collapse
Affiliation(s)
- T Minsue Chen
- Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | | | | | | |
Collapse
|
26
|
Ampofo K, Saiman L, LaRussa P, Steinberg S, Annunziato P, Gershon A. Persistence of immunity to live attenuated varicella vaccine in healthy adults. Clin Infect Dis 2002; 34:774-9. [PMID: 11830801 DOI: 10.1086/338959] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2001] [Revised: 10/25/2001] [Indexed: 12/30/2022] Open
Abstract
The varicella vaccine was approved in 1995 for use in healthy varicella-susceptible children and adults. Long-term immunity in 461 healthy adults who were enrolled in varicella vaccine trials in 1979-1999 were studied. Forty vaccinees (9%), including 19 (21%) of 89 vaccinees with household exposure (HHE) to chickenpox, developed breakthrough chickenpox 8 weeks to 11.8 years (mean, 3.3 years) after vaccination. The median number of skin lesions among the 36 untreated vaccinees was 20 (range, 1-240 lesions), and the number of lesions was essentially the same with time since vaccination. Breakthrough chickenpox was mild, even among vaccinees who did not have seroconversion or those recipients who lost detectable antibody. Lower varicella-zoster virus (VZV) antibody titers measured within 3 months of vaccination as well as at the time of HHE were associated with an increased risk of breakthrough disease. This study demonstrated that the varicella vaccine was effective in providing adults with long-term protection from serious VZV disease.
Collapse
Affiliation(s)
- Krow Ampofo
- Department of Pediatrics, Columbia University, College of Physicians and Surgeons, New York, NY, 10032, USA
| | | | | | | | | | | |
Collapse
|
27
|
Arvin AM. Antiviral therapy for varicella and herpes zoster. SEMINARS IN PEDIATRIC INFECTIOUS DISEASES 2002; 13:12-21. [PMID: 12118839 DOI: 10.1053/spid.2002.29753] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Varicella-zoster virus (VZV) causes 2 clinical illnesses, varicella (chickenpox) and herpes zoster (shingles). The purpose of this review is to describe the role of antiviral therapy in the treatment of VZV infections in healthy and immunocompromised children. Acyclovir is the drug of choice for varicella and herpes zoster. The route of administration may be intravenous or oral, depending on the immunocompetence of the host. The clinical impact of acyclovir therapy is related directly to its use early in the clinical course and to the likely susceptibility of the patient to severe or life-threatening VZV infection. Patients who have the most clinical benefit are otherwise healthy adolescents with varicella infection and high-risk populations of immunocompromised children who have varicella or herpes zoster. The morbidity and mortality of VZV infections are reduced substantially by initiating acyclovir treatment early in the course of the disease.
Collapse
Affiliation(s)
- Ann M Arvin
- Department of Pediatrics and Microbiology and Immunology, Stanford University School of Medicine, CA 94305, USA.
| |
Collapse
|
28
|
Loregian A, Gatti R, Palù G, De Palo EF. Separation methods for acyclovir and related antiviral compounds. JOURNAL OF CHROMATOGRAPHY. B, BIOMEDICAL SCIENCES AND APPLICATIONS 2001; 764:289-311. [PMID: 11817033 DOI: 10.1016/s0378-4347(01)00379-6] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Acyclovir (ACV) is an antiviral drug, which selectively inhibits replication of members of the herpes group of DNA viruses with low cell toxicity. Valaciclovir (VACV), a prodrug of ACV is usually preferred in the oral treatment of viral infections, mainly herpes simplex virus (HSV). Also other analogues such as ganciclovir and penciclovir are discussed here. The former acts against cytomegalovirus (CMV) in general and the latter against CMV retinitis. The action mechanism of these antiviral drugs is presented briefly here, mainly via phosphorylation and inhibition of the viral DNA polymerase. The therapeutic use and the pharmacokinetics are also outlined. The measurement of the concentration of acyclovir and related compounds in biological samples poses a particularly significant challenge because these drugs tend to be structurally similar to endogenous substances. The analysis requires the use of highly selective analytical techniques and chromatography methods are a first choice to determine drug content in pharmaceuticals and to measure them in body fluids. Chromatography can be considered the procedure of choice for the bio-analysis of this class of antiviral compounds, as this methodology is characterised by good specificity and accuracy and it is particularly useful when metabolites need to be monitored. Among chromatographic techniques, the reversed-phase (RP) HPLC is widely used for the analysis. C18 Silica columns from 7.5 to 30 cm in length are used, the separation is carried out mainly at room temperature and less than 10 min is sufficient for the analysis at 1.0-1.5 ml/min of flow-rate. The separation methods require an isocratic system, and various authors have proposed a variety of mobile phases. The detection requires absorbance or fluorescence measurements carried out at 250-254 nm and at lambdaex=260-285 nm, lambdaem=375-380 nm, respectively. The detection limit is about 0.3-10 ng/ml but the most important aspect is related to the sample treatment, mainly when body fluids are under examination. The plasma samples obtained from human blood are pre-treated with an acid or acetonitrile deproteinization and the supernatant after centrifugation is successively extracted before RP-HPLC injection. Capillary Electrophoresis methods are also discussed. This new analytical approach might be the expected evolution, in fact the analyses are improved with regard to time and performance, in particular coated capillary as well as addition of stabilisers have been employed. The time of analysis is shortened arriving at less than half a minute. Furthermore by using an electrochemical detection, and having a calibration linearity in the range of 0.2-20.0 ng/ml, the detection limit is 0.15 microg/ml. The measurements of acyclovir and penciclovir have been presented but in the future other related drugs will probably be available using CE methods.
Collapse
Affiliation(s)
- A Loregian
- Department of Histology, Microbiology and Medical Biotechnologies, University of Padova, Italy
| | | | | | | |
Collapse
|
29
|
Arora A, Magee L, Peck J, Singer J. Antiviral therapeutics for the pediatric population. Pediatr Emerg Care 2001; 17:369-80, quiz; 381-3. [PMID: 11673719 DOI: 10.1097/00006565-200110000-00014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- A Arora
- The Department of Emergency Medicine, Wright State University, School of Medicine, Dayton, Ohio 45429, USA
| | | | | | | |
Collapse
|
30
|
Balfour HH, Edelman CK, Anderson RS, Reed NV, Slivken RM, Marmor LH, Dix L, Aeppli D, Talarico CL. Controlled trial of acyclovir for chickenpox evaluating time of initiation and duration of therapy and viral resistance. Pediatr Infect Dis J 2001; 20:919-26. [PMID: 11642624 DOI: 10.1097/00006454-200110000-00002] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Chickenpox is prevalent in the US despite the availability of an effective vaccine. Acyclovir treatment is limited by concerns about efficacy if given after the first day of rash and by concerns about induction of viral resistance. OBJECTIVE Evaluate initiation and duration of acyclovir treatment of chickenpox and its effect on viral resistance. STUDY DESIGN Randomized, placebo-controlled, double blind trial in immunocompetent patients who were stratified by age at enrollment (children, 2 to 11 years; adolescents, > or = 12 to 18 years; adults, > or = 19 years) and duration of rash (< or = 24 h vs. >24 to 48 h). Lesions were staged, counted and cultured; temperatures and symptoms were recorded daily. INTERVENTION Subjects presenting within 24 h of rash onset (Group A) were randomly assigned to 5 or 7 days of oral acyclovir treatment, 80 mg/kg/day up to a maximum of 3,200 mg/day in four divided doses. Subjects whose rash was >24 to 48 h old were randomized to receive 5 days of acyclovir treatment beginning on the first (Group B1) or second study day (Group B2). Matching placebos were used to ensure that subjects uniformly received 28 doses of study compound. RESULTS Of the 177 subjects recruited Group A patients who were treated on the first day of rash had the greatest number of significantly shortened event times with 5 days of therapy being equivalent to 7 days. There also were some shorter times to events for Group B1 patients who began therapy on the second day of rash vs. Group B2 patients who started acyclovir on the third. These included: time to maximum lesion formation (adolescents, P = 0.007; children, P = 0.03); 50% healing in adolescents (P = 0.005); and residual facial lesions in adults (P = 0.047). The probability of viral shedding was significantly reduced for Group A subjects vs. Group B1 subjects (P = 0.006). Viruses shed during therapy remained susceptible to acyclovir and retained normal thymidine kinase function. CONCLUSIONS Immunocompetent children, adolescents and adults with chickenpox displayed a gradation in their clinical responses to acyclovir that correlated with the time from onset of rash to initiation of therapy. Five days of therapy is sufficient because a 7-day course provided no additional benefit. The susceptibility to acyclovir of viruses shed during treatment did not change; however, the effect of therapy on resistance of latent virus was not assessed.
Collapse
Affiliation(s)
- H H Balfour
- University of Minnesota Medical School, Minneapolis 55455-0392, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Heuchan AM, Isaacs D. The management of varicella-zoster virus exposure and infection in pregnancy and the newborn period. Australasian Subgroup in Paediatric Infectious Diseases of the Australasian Society for Infectious Diseases. Med J Aust 2001; 174:288-92. [PMID: 11297117 DOI: 10.5694/j.1326-5377.2001.tb143273.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Zoster immunoglobulin (ZIG) should be offered to pregnant, varicella-seronegative women with significant exposure to varicella-zoster virus (VZV) (chickenpox) infection. Oral aciclovir prophylaxis should be considered for susceptible pregnant women exposed to VZV who did not receive ZIG or have risk factors for severe disease. Intravenous aciclovir should be given to pregnant women who develop complicated varicella at any stage of pregnancy. Counselling on the risk of congenital varicella syndrome is recommended for pregnant women who develop chickenpox. ZIG should be given to a baby whose mother develops chickenpox up to 7 days before delivery or up to 28 days after delivery. Intravenous aciclovir should be given to babies presenting unwell with chickenpox, whether or not they received ZIG. Breastfeeding of babies infected with or exposed to VZV is encouraged. A mother with chickenpox or zoster does not need to be isolated from her own baby. If siblings at home have chickenpox, a newborn baby should be given ZIG if its mother is seronegative. The newborn baby does not need to be isolated from its siblings with chickenpox, whether or not the baby was given ZIG. After significant nursery exposure to VZV, ZIG should be given to seronegative babies and to all babies born before 28 weeks' gestation.
Collapse
|
32
|
Talan DA, Moran GJ. Update on emerging infections from the Centers for Disease Control and Prevention. Varicella outbreaks among Mexican adults--Alabama, 2000. Ann Emerg Med 2001; 37:350-2. [PMID: 11223775 DOI: 10.1067/mem.2001.113154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- D A Talan
- Department of Emergency Medicine, Olive View-UCLA Medical Center, Sylmar, CA, USA
| | | |
Collapse
|
33
|
Abstract
The evaluation of nontoxic-appearing, young, febrile children has been a subject of considerable debate. Of young, nontoxic-appearing children aged 3 to 36 months with temperatures of 39 degrees C or more and no clear source, approximately 2% to 3% have occult bacteremia. Of these bacteremias, approximately 90% are caused by S. pneumoniae, 5% by nontyphoidal Salmonella sp., and 1% by N. meningitidis. Most children with occult pneumococcal bacteremia improve spontaneously, but approximately 25% of untreated patients have persistent bacteremia or develop new focal infections, including 3% to 6% who develop meningitis. Occult meningococcal bacteremia, although rare, has frequent complications, including meningitis in approximately 40% and death in approximately 4%. Less is known about the natural history of untreated occult nontyphoidal Salmonella bacteremia. Empiric antibiotic treatment of children with occult bacteremia decreases the rate of complications, including meningitis. Few disagree that febrile, young children at risk for occult bacteremia require a careful clinical evaluation and close follow-up. The benefits of laboratory screening and selective empiric antibiotic treatment of febrile children at risk for occult bacteremia have to be weighed against the costs of screening tests and blood cultures, inconvenience, temporary discomfort to patients, risk for side effects of antibiotics, and the role of antibiotics in the development of bacterial resistance. Although great debate exists concerning the role of empiric antibiotics, a strategy for obtaining blood cultures and empirically administering antibiotics on the basis of an increased ANC, in addition to close clinical follow-up, may be effective in reducing the frequency and severity of uncommon but adverse sequelae. A highly effective S. pneumoniae bacterial conjugate vaccine will soon be available, which will benefit all children, and will alter the ways that clinicians evaluate fully immunized young, febrile children.
Collapse
Affiliation(s)
- N Kuppermann
- Department of Internal Medicine, University of California, Davis School of Medicine, USA.
| |
Collapse
|
34
|
Arvin AM. Management of varicella-zoster virus infections in children. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 1999; 458:167-74. [PMID: 10549389 DOI: 10.1007/978-1-4615-4743-3_16] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
The introduction of varicella vaccine for immunization of healthy children is expected to have a gradual impact on the incidence of VZV infections in the population but antiviral therapy remains an important intervention in clinical practice. The efficacy of aciclovir for treatment of primary and recurrent VZV infections in children has reduced the morbidity and mortality of these illnesses in immunocompromised children dramatically. Oral aciclovir is an effective and useful for the management of varicella in healthy children and adolescents.
Collapse
Affiliation(s)
- A M Arvin
- Department of Pediatrics, Stanford University School of Medicine, California 94305, USA
| |
Collapse
|
35
|
Affiliation(s)
- H H Balfour
- Department of Laboratory Medicine, University of Minnesota Medical School, Minneapolis 55455-0392, USA.
| |
Collapse
|
36
|
Snoeck R, Andrei G, De Clercq E. Current pharmacological approaches to the therapy of varicella zoster virus infections: a guide to treatment. Drugs 1999; 57:187-206. [PMID: 10188760 DOI: 10.2165/00003495-199957020-00005] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Varicella zoster virus (VZV), a member of the herpesvirus family, is responsible for both primary (varicella, chickenpox) as well as reactivation (zoster, shingles) infections. In immunocompetent patients, the course of varicella is generally benign. For varicella zoster, post-herpetic neuralgia is the most common complication. In immunocompromised patients (particularly those with AIDS), transplant recipients and cancer patients, VZV infections can be life-threatening. For these patients and also for immunocompetent patients at risk such as pregnant women or premature infants, the current treatment of choice is based on either intravenous or oral aciclovir (acyclovir). The low oral bioavailability of aciclovir, as well as the emergence of drug-resistant virus strains, have stimulated efforts towards the development of new compounds for the treatment of individuals with VZV infections. Among these new compounds, penciclovir, its oral prodrug form famciclovir and the oral pro-drug form of aciclovir (valaciclovir), rank among the most promising. As with aciclovir itself, all of these drugs are dependent on the virus-encoded thymidine kinase (TK) for their intracellular activation (phosphorylation), and, upon conversion to their triphosphate form, they act as inhibitors/alternative substrate of the viral DNA polymerase. Therefore, cross-resistance to these drugs may be expected for those virus mutants that are TK-deficient and thus resistant to aciclovir. Other classes of nucleoside analogues dependent for their phosphorylation on the viral TK that have been pursued for the treatment of VZV infections include sorivudine, brivudine, fialuridine, fiacitabine and netivudine. Among oxetanocins, which are partially dependent on viral TK, lobucavir is now under clinical evaluation. Foscarnet, which does not require any previous metabolism to interact with the viral DNA polymerase, is used in the clinic when TK-deficient VZV mutants emerge during aciclovir treatment. TK-deficient mutants are also sensitive to the acyclic nucleoside phosphonates (i.e. [s]-1-[3-hydroxy-2-phosphonylmethoxypropyl]cytosine; HPMPC); these agents do not depend on the virus-encoded TK for their phosphorylation but depend on cellular enzymes for conversion to their diphosphoryl derivatives which then inhibit viral DNA synthesis. Vaccination for VZV has now come of age. It is recommended for healthy children, patients with leukaemia, and patients receiving immunosuppressive therapy or those with chronic diseases. The protection induced by the vaccine seems, to some extent, to include zoster and associated neuralgia. Passive immuniatin based on specific immunoglobulins does not effectively prevent VZV infection and is therefore restricted to high risk individuals (i.e. immunocompromised children and pregnant women).
Collapse
Affiliation(s)
- R Snoeck
- Rega Institute for Medical Research, Katholieke Universiteit Leuven, Belgium.
| | | | | |
Collapse
|
37
|
Question 2. Med Mal Infect 1998. [DOI: 10.1016/s0399-077x(98)80094-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
38
|
Quinet B. Question 2 bis: analyse de la littérature restreinte à la pédiatrie. Med Mal Infect 1998. [DOI: 10.1016/s0399-077x(98)80099-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
39
|
|
40
|
Carcao MD, Lau RC, Gupta A, Huerter H, Koren G, King SM. Sequential use of intravenous and oral acyclovir in the therapy of varicella in immunocompromised children. Pediatr Infect Dis J 1998; 17:626-31. [PMID: 9686730 DOI: 10.1097/00006454-199807000-00010] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Immunocompromised children are at risk for disseminated varicella infections. Standard management involves hospitalization and intravenous acyclovir for 7 to 10 days. This approach is expensive, is inconvenient and may not be necessary. We undertook a pilot study to assess the safety and efficacy of an alternative approach that utilized a combination of intravenous (i.v.) followed by oral (p.o) acyclovir in a cohort of immunocompromised children. METHODS The cohort consisted of 26 immunocompromised children between the ages of 1.5 and 12.7 years (mean, 6.3). Therapy was commenced with i.v. acyclovir (1500 mg/m2/day in 3 divided doses). Concurrent management included holding or reducing immunosuppressive therapy (by 50%) and administering varicella-zoster immunoglobulin in 69% (11 of 16) of cases where exposure to chickenpox was recognized. Patients were eligible to switch to p.o therapy after receiving a minimum of 48 h of i.v. acyclovir therapy provided they were afebrile; had no new lesions for 24 h; had no internal organ involvement and were able to tolerate oral medications. Patients were observed in hospital for a further 24 h and then discharged provided they remained well. Oral acyclovir was continued for a total of 7 to 10 days (i.v. plus p.o). RESULTS Of the 26 patients 25 were successfully switched from i.v. to p.o after 4.1 +/- 1.2 days (mean +/- SD) (range, 2.3 to 6) Children had fever for a mean of 2.0 +/- 1.6 days (range, 0 to 5) and developed new lesions for 2.9 +/- 0.7 days (range, 2 to 4). All 25 patients switched to p.o therapy had resolution of their disease and no patient required resumption of i.v. therapy. CONCLUSIONS The sequential use of i.v. followed by p.o acyclovir is feasible in the treatment of varicella in immunocompromised children and results in a reduction in duration of intravenous therapy and hospitalization.
Collapse
Affiliation(s)
- M D Carcao
- Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | | | | | | | |
Collapse
|
41
|
Abstract
Pediatric dermatologic disease that have specific therapies and/or specific prophylactic measures are reviewed. Herpes simplex virus and varicella-zoster virus infections, human papillomavirus infections, and molluscum contagiosum infections are discussed with special emphasis on recent advances of therapy and prophylaxis.
Collapse
Affiliation(s)
- Z Trizna
- Department of Dermatology, University of Texas Medical Branch at Galveston, USA
| | | |
Collapse
|
42
|
Abstract
OBJECTIVES To demonstrate the clinical importance of adult chickenpox in terms of morbidity, mortality, and impact on hospital services, in Al Ain, United Arab Emirates. METHODS A review was conducted of 607 consecutive hospitalized cases of adult chickenpox (1985-1996, Al Ain Hospital) for clinical findings and risk of developing varicella pneumonia. RESULTS Leading clinical features were fever (98.9%), myalgia (26.9%), cough (24.6%), headache (15.4%), pharyngitis (14.7%), and profuse rash (12.2%). There were 26 cases of varicella pneumonia, of whom three died with respiratory failure (hospital case fatality 0.5%). Multivariate analysis (odds ratios in parenthesis) showed that cough (12.1), profuse rash (4.5), fever for more than 1 week (3.9), and age over 34 years (2.3) were the most significant predictors of pneumonia. CONCLUSIONS Early aggressive therapy with intravenous acyclovir is recommended in patients at risk of pneumonia. In the community setting, there is a large proportion of adult immigrants (especially from South Asia) who are seronegative and at risk of complications and hospitalization. It is recommended that the varicella vaccine be offered to new immigrants after screening, to benefit themselves and the nonexposed community, and to reduce the economic burden of chickenpox on the health services and employers.
Collapse
Affiliation(s)
- R N Pugh
- Faculty of Medicine and Health Sciences, UAE University, Al Ain, United Arab Emirates
| | | | | |
Collapse
|
43
|
Schutze GE. Acyclovir and related compounds. Pediatr Infect Dis J 1998; 17:265-6. [PMID: 9535266 DOI: 10.1097/00006454-199803000-00026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
44
|
White DK. Acute Viral Infections of the Oral Cavity and Parotid Gland. Oral Maxillofac Surg Clin North Am 1998. [DOI: 10.1016/s1042-3699(20)30343-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
45
|
Ogilvie MM. Antiviral prophylaxis and treatment in chickenpox. A review prepared for the UK Advisory Group on Chickenpox on behalf of the British Society for the Study of Infection. J Infect 1998; 36 Suppl 1:31-8. [PMID: 9514106 DOI: 10.1016/s0163-4453(98)80153-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Prophylactic intervention with varicella-zoster immunoglobulin early in the incubation period can prevent or attenuate the disease manifestations of varicella in susceptible contacts at high risk from this infection. Detailed guidelines are issued in the UK Department of Health publication on Immunization against Infectious Disease. Sensitive immunoassays are available for investigation of antibody status and subclinical seroconversion. Live attenuated varicella vaccine, which has been used successfully post-exposure as well as electively elsewhere, is at present not generally available in the UK. Effective protocols for prophylaxis against varicella with the antiviral agent aciclovir are not yet established. The nucleoside analogue aciclovir (syn: acyclovir, Zovirax) is effective in inhibiting replication of VZV when given at a dosage higher than that required for treatment of HSV, and is currently the only available and approved treatment for varicella in the U.K. Intravenous aciclovir therapy for 5-10 days is effective for varicella in neonates and the immunocompromised, and for varicella pneumonia or other complications in adults and children, if begun early. Oral aciclovir is only effective if begun with 24 h of onset of rash. With that proviso. it is recommended for treatment of varicella in otherwise healthy adults and adolescents, but not for routine use in children under 13 years of age unless they are sibling contacts or have other medical conditions. Aciclovir has a high therapeutic index and good safety profile, but caution is advised with use in pregnancy.
Collapse
Affiliation(s)
- M M Ogilvie
- Department of Medical Microbiology, The University of Edinburgh Medical School, UK
| |
Collapse
|
46
|
Abstract
The epidemiology of chickenpox admissions to an Infectious Diseases Unit was studied over 26 years. Risk factors, markers of disease severity, and complications were analysed in patients admitted during the last 5 years. Some 613 patients were admitted with chickenpox over three 5-year periods between 1968 and 1993. There was a 2.23-fold increase in the number of adults admitted from home between the first and last period. Patients of European origin showed a three-fold increase. The mean age of adults rose from 26.2 to 34.3 years. Some 23% of adults had varicella pneumonitis. Smokers were six times more susceptible to pneumonitis than were non-smokers. Adult asthmatics were not at increased risk, whereas 42% of asthmatic children had chest complications. Seventeen of the 18 immunocompromised patients had a relatively uncomplicated course. Of the children, 32% had secondary skin infections, with no excess complications among those with eczema. Thrombocytopenia and elevated aspartate transaminases were four times and twice, more frequent in adults than children, respectively. These features occurred mostly in males. The male-to-female admission ratio was 2:1 in adults, and 1.2:1 in children. Males in both age groups showed a trend to more severe disease and more primary complications than did females. Our data showed an increase in adult chickenpox admissions. We have identified asthma as a risk factor for pulmonary complications in children, but not adults, and male gender as an independent risk factor for severe chickenpox.
Collapse
Affiliation(s)
- B Bovill
- Department of Infectious & Tropical Diseases, Coppetts Wood Hospital, London, UK
| | | |
Collapse
|
47
|
Abstract
OBJECTIVES Whether oral acyclovir (ACV) given in late incubation can prevent clinical varicella or not. MATERIALS AND METHODS Twenty-seven healthy infants and children susceptible to varicella received oral ACV (40 mg/kg daily in four divided doses) for 5 days, starting 9 or 11 days after exposure from the index case in the family (2 in the classroom). The clinical features were compared with 13 control children who did not receive ACV. Enzyme-linked immunoassay was used to detect varicella-zoster virus (VZV) antibody and, in follow-up immunologic studies, lymphocyte proliferative response was added. In some cases, blood culture and polymerase chain reaction with Southern hybridization were used for detection of viremia. RESULTS Among the 27 children in the treatment group, two (7.4%) developed the disease and seroconversion was observed in 17 subjects (63%). Follow-up immunologic studies in 12 of these 17 seroconverted subjects 30 months later showed persistent cellular and/or humoral immunity to VZV. Only one subject, bled 11 days after exposure, had positive VZV DNA and blood culture for VZV. On the other hand 10 of 13 (77%) control subjects developed clinical varicella. CONCLUSIONS Oral ACV administration to healthy susceptible subjects at the beginning of secondary viremia in the late incubation period (9 days after exposure) can effectively prevent or modify clinical varicella.
Collapse
Affiliation(s)
- T Y Lin
- Department of Medicine, Chang Gung Children's Hospital, Taoyuan, Taiwan, Republic of China
| | | | | | | |
Collapse
|
48
|
Affiliation(s)
- C G Prober
- Stanford University School of Medicine, CA, USA
| |
Collapse
|
49
|
Brody MB, Moyer D. Varicella-zoster virus infection. The complex prevention-treatment picture. Postgrad Med 1997; 102:187-90, 192-4. [PMID: 9224486 DOI: 10.3810/pgm.1997.07.268] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The highly prevalent and contagious varicella-zoster virus is usually benign in healthy persons but may cause substantial morbidity in immunocompromised patients and some adults. New developments in prevention and treatment, as discussed in this article, offer attractive options but also present difficult management decisions for primary care physicians.
Collapse
Affiliation(s)
- M B Brody
- Department of Medicine, Temple University School of Medicine, Philadelphia, PA 19140, USA
| | | |
Collapse
|
50
|
|