1
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Zhou YB, Wang S, Ma L, Wei L. Facial Skin Lesions in a Boy With Wiskott-Aldrich Syndrome. Clin Infect Dis 2023; 77:659-661. [PMID: 37607355 DOI: 10.1093/cid/ciac955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023] Open
Affiliation(s)
- Ya Bin Zhou
- Department of Dermatology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Shan Wang
- Department of Dermatology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Lin Ma
- Department of Dermatology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Li Wei
- Department of Dermatology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
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2
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Leeyaphan C, Nanchaipruek Y, Phinyo P. Therapeutic outcomes and prognostic factors in patients with hypertrophic herpes simplex infection treated with imiquimod: A systematic review and meta-analysis of individual patient data from case reports and case series. J Dermatol 2022; 49:879-886. [PMID: 35632986 DOI: 10.1111/1346-8138.16446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 04/22/2022] [Accepted: 05/05/2022] [Indexed: 11/26/2022]
Abstract
Hypertrophic herpes simplex (HHS) often has atypical presentations, such as a hypertrophic mass or ulcers, with chronic courses. This situation poses a diagnostic challenge and results in delayed treatment. Imiquimod was used as a treatment for HHS by several studies, but the therapeutic outcomes varied. This systematic review and meta-analysis of individual patient data was conducted to investigate the therapeutic outcomes and prognostic factors of imiquimod treatment for patients with HHS. Biomedical databases (Embase, PubMed, Medline, Cochrane Controlled Trials Register, and ClinicalTrials.gov) were searched for all types of clinical studies reporting the complete cure rate and the time to complete response to imiquimod therapy between 1926 and 2021. Quantitative analysis of individual patient data was performed using multivariable flexible parametric survival regression with cluster variance correction. A total of 12 019 articles were identified and screened for eligibility. Twenty-five studies (21 case reports and four case series) with a combined total of 42 patients were included. The complete cure rate for imiquimod treatment was estimated at 88.1%. The median time to complete response was 60 days (95% confidence interval 35-70). Combined treatment, male sex, and an age less than 50 years were identified as significant prognostic factors for a shorter time to complete cure. A severe local reaction was reported in 2.3%. Imiquimod therapy has high effectiveness and safety in curing HHS. Patients who were male or younger than 50 years or whose treatments were combined with thymidine kinase-dependent antivirals had the best prognoses and were more likely to respond to treatment.
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Affiliation(s)
- Charussri Leeyaphan
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Yanisorn Nanchaipruek
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Phichayut Phinyo
- Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Musculoskeletal Science and Translational Research, Chiang Mai University, Chiang Mai, Thailand
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3
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Oliveira SRD, Assoni AS, Vargas TJDS, Daxbacher E. Acyclovir-resistant chronic mucocutaneous herpes with good response to the association with imiquimod in an AIDS patient: case report. An Bras Dermatol 2022; 97:264-266. [PMID: 35039209 PMCID: PMC9073243 DOI: 10.1016/j.abd.2020.10.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/01/2020] [Accepted: 10/13/2020] [Indexed: 11/15/2022] Open
Affiliation(s)
| | | | | | - Egon Daxbacher
- Hospital Federal de Bonsucesso, Rio de Janeiro, RJ, Brazil
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4
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Sasso BM, Florence MEB, Magalhaes RF, Velho PENF, de Souza EM, Cintra ML, Stelini RF. Herpes simplex virus mucocutaneous tumoural lesions - Systematic review. J Clin Virol 2019; 123:104246. [PMID: 31927151 DOI: 10.1016/j.jcv.2019.104246] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 12/09/2019] [Accepted: 12/16/2019] [Indexed: 02/01/2023]
Abstract
The goal was to characterize the clinical-epidemiological profile of patients with mucocutaneous tumoural herpes simplex virus (MCT HSV) lesions across the world. Two researchers extracted and independently reviewed data from the literature search engine PubMed/MEDLINE through October 2018. From 110 reported patients, the following data were available: the patients' ages ranged from 7 to 76 years; the majority was male (62.73 %-69/110) and immunosuppression was found in 97.25 % (106/109, missing 1) cases, of whom 88 were HIV- related. Lesions size varied from 0.2-13 cm, settling in the anogenital region in 76.36 % (84/110) patients; 84.13 % (53/63, missing 47) complained of pain and multiple recurrences were found in 44.94 % (40/89, missing 21) cases. On clinical basis, the initial hypothesis was neoplasia in 36/53 patients. Histopathological diagnosis was achieved in 90 % (90/100, missing 10) cases and was sample size-dependent. Type 2 HSV was detected in 86.07 % (68/79, missing 31) lesions. MCT HSV lesions recurrence after treatment was reported in 33.96 % (18/53, missing 57) patients. Pathophysiology is poorly understood. Physicians should be aware of MCT HSV lesions in immunosuppressed patients to avoid inappropriate therapeutic strategies.
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Affiliation(s)
- Bruna Morassi Sasso
- Pathology Department, University of Campinas (UNICAMP), Rua Tessália Vieira de Camargo, 126 - Cidade Universitária Zeferino Vaz., CEP 13083-887, Campinas, SP, Brazil; Dermatology Department, University of Campinas (UNICAMP), Rua Tessália Vieira de Camargo, 126 - Cidade Universitária Zeferino Vaz., CEP 13083-887, Campinas, SP, Brazil
| | - Michelle Etienne Baptistella Florence
- Pathology Department, University of Campinas (UNICAMP), Rua Tessália Vieira de Camargo, 126 - Cidade Universitária Zeferino Vaz., CEP 13083-887, Campinas, SP, Brazil; Dermatology Department, University of Campinas (UNICAMP), Rua Tessália Vieira de Camargo, 126 - Cidade Universitária Zeferino Vaz., CEP 13083-887, Campinas, SP, Brazil
| | - Renata Ferreira Magalhaes
- Dermatology Department, University of Campinas (UNICAMP), Rua Tessália Vieira de Camargo, 126 - Cidade Universitária Zeferino Vaz., CEP 13083-887, Campinas, SP, Brazil
| | - Paulo Eduardo Neves Ferreira Velho
- Dermatology Department, University of Campinas (UNICAMP), Rua Tessália Vieira de Camargo, 126 - Cidade Universitária Zeferino Vaz., CEP 13083-887, Campinas, SP, Brazil
| | - Elemir Macedo de Souza
- Pathology Department, University of Campinas (UNICAMP), Rua Tessália Vieira de Camargo, 126 - Cidade Universitária Zeferino Vaz., CEP 13083-887, Campinas, SP, Brazil; Dermatology Department, University of Campinas (UNICAMP), Rua Tessália Vieira de Camargo, 126 - Cidade Universitária Zeferino Vaz., CEP 13083-887, Campinas, SP, Brazil
| | - Maria Leticia Cintra
- Pathology Department, University of Campinas (UNICAMP), Rua Tessália Vieira de Camargo, 126 - Cidade Universitária Zeferino Vaz., CEP 13083-887, Campinas, SP, Brazil
| | - Rafael Fantelli Stelini
- Pathology Department, University of Campinas (UNICAMP), Rua Tessália Vieira de Camargo, 126 - Cidade Universitária Zeferino Vaz., CEP 13083-887, Campinas, SP, Brazil.
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5
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Siqueira SM, Gonçalves BB, Loss JB, Estrella RR. Vegetative chronic genital herpes with satisfactory response to imiquimod. An Bras Dermatol 2019; 94:221-223. [PMID: 31090830 PMCID: PMC6486068 DOI: 10.1590/abd1806-4841.20198014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 04/25/2018] [Indexed: 11/25/2022] Open
Abstract
Vegetative chronic genital herpes is an atypical presentation of herpes simplex 2 that it is usually seen in patients coinfected with human immunodeficiency virus. Clinically, it is characterized by extensive ulcers that evolve to chronification and hypertrophic pseudotumor forms. Antiviral drugs are recommended for the treatment, and acyclovir is the most used one. Foscarnet is the treatment of choice to resistant cases, although treatment failure has been reported. We report a male patient, previously diagnosed with human immunodeficiency virus who developed vegetative chronic genital herpes resistant to acyclovir and successfully treated with imiquimod.
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Affiliation(s)
| | | | - Julia Bozetti Loss
- Dermatology Service, Universidade Federal
Fluminense, Niterói (RJ), Brazil
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6
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Parsons K, Cipriano SD, Rosen LB, Browne SK, Walter JE, Stone BL, Keeshin S, Chen K. Severe Facial Herpes Vegetans and Viremia in NFKB2-Deficient Common Variable Immunodeficiency. Front Pediatr 2019; 7:61. [PMID: 30941333 PMCID: PMC6433840 DOI: 10.3389/fped.2019.00061] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 02/18/2019] [Indexed: 11/17/2022] Open
Abstract
With the accessibility of next-generation sequencing modalities, an increasing number of primary immunodeficiency disorders (PIDDs) such as common variable immunodeficiency (CVID) have gained improved understanding of molecular pathogenesis and disease phenotype with the identification of a genetic etiology. We report a patient with early-onset CVID due to an autosomal dominant loss-of-function mutation in NFKB2 who developed a severe herpes vegetans cutaneous infection as well as concurrent herpes simplex virus viremia. The case highlights features of CVID, unique aspects of NF-κB2 deficiency including susceptibility to herpesvirus infections, the detection of neutralizing anticytokine antibodies, and the complexity of medical management of patients with a PIDD that can be aided by a known genetic diagnosis.
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Affiliation(s)
- Karyn Parsons
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Sarah D Cipriano
- Department of Dermatology, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Lindsey B Rosen
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Sarah K Browne
- Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD, United States
| | - Jolan E Walter
- Division of Allergy and Immunology, Department of Pediatrics, Johns Hopkins All Children's Hospital, St. Petersburg, FL, United States.,Division of Allergy and Immunology, Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa, FL, United States.,Division of Allergy and Immunology, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA, United States
| | - Bryan L Stone
- Division of Pediatric Inpatient Medicine, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Susana Keeshin
- Division of Pediatric Infectious Disease, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Karin Chen
- Division of Allergy and Immunology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, United States
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7
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Boix-Vilanova J, Montis MC, Giacaman A, Corral-Magaña O, Bauza A. Herpes vegetans in a human immunodeficiency virus-negative kidney transplant patient. Clin Exp Dermatol 2018; 44:92-94. [PMID: 30259552 DOI: 10.1111/ced.13748] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2018] [Indexed: 11/28/2022]
Affiliation(s)
- J Boix-Vilanova
- Dermatology Service, Hospital Universitari Son Espases, 79, Carretera de Valldemosa, 07120, Palma, Balearic Islands
| | - M C Montis
- Dermatology Service, Hospital Universitari Son Espases, 79, Carretera de Valldemosa, 07120, Palma, Balearic Islands
| | - A Giacaman
- Dermatology Service, Hospital Universitari Son Espases, 79, Carretera de Valldemosa, 07120, Palma, Balearic Islands
| | - O Corral-Magaña
- Dermatology Service, Hospital Universitari Son Espases, 79, Carretera de Valldemosa, 07120, Palma, Balearic Islands
| | - A Bauza
- Dermatology Service, Hospital Universitari Son Espases, 79, Carretera de Valldemosa, 07120, Palma, Balearic Islands
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8
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Hagiwara H, Iwata Y, Saito K, Watanabe S, Arima M, Ono Y, Mizoguchi Y, Kuroda M, Imaizumi K, Sugiura K. Herpes vegetans accompanied by Good's syndrome. J Dermatol 2018; 45:e269-e271. [PMID: 29611233 DOI: 10.1111/1346-8138.14323] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Hiromi Hagiwara
- Department of Dermatology, Fujita Health University, Toyoake, Japan
| | - Yohei Iwata
- Department of Dermatology, Fujita Health University, Toyoake, Japan
| | - Kenta Saito
- Department of Dermatology, Fujita Health University, Toyoake, Japan
| | | | - Masaru Arima
- Department of Dermatology, Fujita Health University, Toyoake, Japan
| | - Yuka Ono
- Department of Dermatology, Fujita Health University, Toyoake, Japan
| | - Yoshikazu Mizoguchi
- Department of Diagnostic Pathology, Fujita Health University, Toyoake, Japan
| | - Makoto Kuroda
- Department of Diagnostic Pathology, Fujita Health University, Toyoake, Japan
| | - Kazuyoshi Imaizumi
- Department of Respiratory and Allergic Medicine, Fujita Health University, Toyoake, Japan
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9
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Herpes Vegetans and Review of Verrucous Lesions of the Anogenital Region. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2017. [DOI: 10.1097/ipc.0000000000000537] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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10
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Tandon S, Singh J, Sinha S, Sharma DP. Recalcitrant hypertrophic herpes genitalis in HIV-infected patient successfully treated with topical imiquimod. Dermatol Ther 2017; 30. [PMID: 28261899 DOI: 10.1111/dth.12479] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 01/27/2017] [Accepted: 02/01/2017] [Indexed: 11/28/2022]
Abstract
Herpes Simplex Virus type 2 is the primary cause of genital ulceration worldwide. The presence of atypical features like deep ulcerations, hypertrophic, or pseudotumoural lesions or unusual location can be a marker for co-infection with HIV. These immunocompromised patients are usually resistant to the conventional antiviral treatment. We present a case of an HIV-infected patient with hypertrophic herpes genitalis, refractory to conventional oral antiviral therapy, who was successfully treated with a combination of oral valcyclovir and topical application of 5% imiquimod.
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Affiliation(s)
- Sidharth Tandon
- Department of Dermatology, Venereology and Leprosy, Post Graduate Institute of Medical Education and Research and Dr. Ram Manohar Lohia Hospital, New Delhi, 110001, India
| | - Jasmeet Singh
- Department of Dermatology, Venereology and Leprosy, Post Graduate Institute of Medical Education and Research and Dr. Ram Manohar Lohia Hospital, New Delhi, 110001, India
| | - Surabhi Sinha
- Department of Dermatology, Venereology and Leprosy, Post Graduate Institute of Medical Education and Research and Dr. Ram Manohar Lohia Hospital, New Delhi, 110001, India
| | - Dr Preeti Sharma
- Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, 110029, India
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11
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Deza G, Martin-Ezquerra G, Curto-Barredo L, Villar García J, Pujol RM. Successful treatment of hypertrophic herpes simplex genitalis in HIV-infected patient with topical imiquimod. J Dermatol 2015; 42:1176-8. [PMID: 26074211 DOI: 10.1111/1346-8138.12969] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 04/26/2015] [Indexed: 11/28/2022]
Abstract
Hypertrophic herpes simplex genitalis is an atypical presentation of genital herpes described in the context of immunosuppression, particularly HIV-positive patients. This situation can become a diagnostic and therapeutic challenge. For this reason, alternative therapies are currently being discussed in the literature. We report a case of hypertrophic genital herpes in a HIV-positive patient who was successfully treated with topical 5% imiquimod after treatment failures with oral and i.v. antivirals.
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Affiliation(s)
- Gustavo Deza
- Department of Dermatology, Hospital del Mar, Barcelona, Spain
| | | | | | | | - Ramon M Pujol
- Department of Dermatology, Hospital del Mar, Barcelona, Spain
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12
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Leeyaphan C, Surawan TM, Chirachanakul P, Prasertworonun N, Punyaratabandhu P, Omcharoen V, Jiamton S. Clinical characteristics of hypertrophic herpes simplex genitalis and treatment outcomes of imiquimod: a retrospective observational study. Int J Infect Dis 2015; 33:165-70. [PMID: 25660091 DOI: 10.1016/j.ijid.2015.02.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 01/29/2015] [Accepted: 02/02/2015] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE Atypical presentations of herpes simplex genitalis are becoming more frequent. The aim of this study was to investigate the atypical clinical manifestations and treatment of this infection. METHODS The charts of patients with herpes simplex genitalis who attended our clinics between January 2009 and December 2013 were reviewed retrospectively. RESULTS Of 294 patients, 147 (50%) were male with a mean (standard deviation, SD) age of 48.3 (16.8) years. An ulcerative lesion was the most common symptom (48.3%), followed by vesicle clusters (36.4%). The mean duration of symptoms at first visit was 6 days. Oral acyclovir was administered to 87.6% of patients. Hypertrophic manifestations were observed in 4.8% (14/294) of patients; 50% (7/294) were male, with a mean age of 44.5 (SD 9) years. All patients with hypertrophic manifestations were infected with HIV. Hypertrophic manifestations had a mean duration of onset of 53.3 days. Acyclovir was prescribed to 11 (78.6%) patients. The mean duration to cure was 40.9 days. Topical imiquimod was given in six resistant cases (42.9%) as adjunctive therapy. CONCLUSIONS Atypical manifestations of herpes simplex genitalis require careful consideration because their frequency is rising, particularly in patients with HIV infection. Although acyclovir is important in their treatment, imiquimod provides an additional benefit in resistant cases.
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Affiliation(s)
- Charussri Leeyaphan
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok 10700, Thailand.
| | - Theetat M Surawan
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok 10700, Thailand
| | - Pornchai Chirachanakul
- Bamrasnaradura Infectious Diseases Institute, Department of Disease Control, Ministry of Public Health, Tiwanon Road, Nonthaburi, Thailand
| | - Nuntida Prasertworonun
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok 10700, Thailand
| | - Praewphan Punyaratabandhu
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok 10700, Thailand
| | - Viboon Omcharoen
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok 10700, Thailand
| | - Sukhum Jiamton
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok 10700, Thailand
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13
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McKendry A, Narayana S, Browne R. Atypical presentations of genital herpes simplex virus in HIV-1 and HIV-2 effectively treated by imiquimod. Int J STD AIDS 2014; 26:441-3. [DOI: 10.1177/0956462414538951] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 05/01/2014] [Indexed: 12/13/2022]
Abstract
Atypical presentations of genital herpes simplex virus have been described in HIV. We report two cases with hypertrophic presentations which were effectively treated with imiquimod, one of which is the first reported case occurring in a patient with HIV-2.
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Affiliation(s)
- Anna McKendry
- St Ann’s Sexual Health Centre, St Ann’s Hospital, Tottenham, London, UK
| | | | - Rita Browne
- St Ann’s Sexual Health Centre, St Ann’s Hospital, Tottenham, London, UK
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14
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Sbidian E, Battistella M, Legoff J, Lafaurie M, Bézier M, Agbalika F, Simon F, Bouscarat F, Cayuela JM, Carcelain G, Houhou N, Bagot M, Molina JM, Janier M, Bachelez H. Recalcitrant pseudotumoral anogenital herpes simplex virus type 2 in HIV-infected patients: evidence for predominant B-lymphoplasmocytic infiltration and immunomodulators as effective therapeutic strategy. Clin Infect Dis 2013; 57:1648-55. [PMID: 24065320 DOI: 10.1093/cid/cit592] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In patients with human immunodeficiency virus (HIV) infection, genital herpetic lesions may be extensive and tend to persist for longer periods; in addition, atypical hypertrophic, ulcerative, or pseudotumor forms have been reported, frequently showing resistance to acyclovir (ACV) treatment. METHODS Between 2003 and 2011, 10 HIV-1-infected patients presenting with chronic pseudotumoral anogenital herpes simplex type 2 (HSV-2) infections were studied. RESULTS All patients developed chronic, hypertrophic HSV-2 anogenital lesions with multilesional presentation in 7 cases and involvement of 2 anatomical sites in 6 of them. At the time of diagnosis, the median CD3(+)CD4(+) absolute blood count was 480.5 cells/µL (range, 165-632 cells/µL), whereas the plasma HIV load was undetectable in all cases. Histopathologic analysis of lesion biopsies showed a moderately dense dermal polytypic plasma cell infiltrate. Detection of HSV-2 by culture and/or polymerase chain reaction was positive for all patients, with evidence for ACV-resistant strains in 6 of 8 cases. In addition, viral resistance to ACV was found only in HSV-2 isolated from ulcerative lesions, whereas purely pseudotumoral ones harbored sensitive strains. Durable control was observed with HSV DNA polymerase inhibitors in only 2 cases, and the immunomodulators imiquimod and thalidomide allowed 5 patients to reach sustained complete response. CONCLUSIONS HSV-2-related pseudolymphoma in HIV-infected patients is characterized by a predominant polyclonal lymphoplasmacytic infiltration, and is frequently refractory to antiherpetic drugs. Immunomodulatory therapeutic strategies using thalidomide showed consistent efficacy, and should be considered early during the course of disease.
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Affiliation(s)
- Emilie Sbidian
- UPEC, LIC EA 4393 and Department of Dermatology, AP-HP Hôpital Henri Mondor, Créteil
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15
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16
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Rapid host immune response and viral dynamics in herpes simplex virus-2 infection. Nat Med 2013; 19:280-90. [PMID: 23467247 DOI: 10.1038/nm.3103] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Accepted: 01/10/2013] [Indexed: 02/07/2023]
Abstract
Herpes simplex virus-2 (HSV-2) is periodically shed throughout the human genital tract. Although a high viral load correlates with the development of genital ulcers, shedding also commonly occurs even when ulcers are absent, allowing for silent transmission during coitus and contributing to high seroprevalence of HSV-2 worldwide. Frequent viral reactivation occurs within ganglia despite diverse and complementary host and viral mechanisms that predispose toward latency, suggesting that viral replication may be constantly occurring in a small minority of neurons at these sites. Within genital mucosa, the in vivo expansion and clearance rates of HSV-2 are extremely rapid. Resident dendritic cells and memory HSV-2 specific T cells persist at prior sites of genital tract reactivation and, in conjunction with prompt innate recognition of infected cells, lead to rapid containment of infected cells. The fact that immune responses usually control viral replication in genital skin before lesions develop provides hope that enhancing such responses could lead to effective vaccines and immunotherapies.
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17
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The immunologic basis for severe neonatal herpes disease and potential strategies for therapeutic intervention. Clin Dev Immunol 2013; 2013:369172. [PMID: 23606868 PMCID: PMC3626239 DOI: 10.1155/2013/369172] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Accepted: 03/06/2013] [Indexed: 12/16/2022]
Abstract
Herpes simplex viruses types 1 and 2 (HSV-1 and HSV-2) infect a large proportion of the world's population. Infection is life-long and can cause periodic mucocutaneous symptoms, but it only rarely causes life-threatening disease among immunocompetent children and adults. However, when HSV infection occurs during the neonatal period, viral replication is poorly controlled and a large proportion of infants die or develop disability even with optimal antiviral therapy. Increasingly, specific differences are being elucidated between the immune system of newborns and those of older children and adults, which predispose to severe infections and reflect the transition from fetal to postnatal life. Studies in healthy individuals of different ages, individuals with primary or acquired immunodeficiencies, and animal models have contributed to our understanding of the mechanisms that control HSV infection and how these may be impaired during the neonatal period. This paper outlines our current understanding of innate and adaptive immunity to HSV infection, immunologic differences in early infancy that may account for the manifestations of neonatal HSV infection, and the potential of interventions to augment neonatal immune protection against HSV disease.
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Elevated CD40 ligand silences α interferon production in an HIV-related immune reconstitution inflammatory syndrome. AIDS 2013; 27:297-9. [PMID: 23238554 DOI: 10.1097/qad.0b013e328359f2f9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Peripheral blood CD4 T-cell and plasmacytoid dendritic cell (pDC) reactivity to herpes simplex virus 2 and pDC number do not correlate with the clinical or virologic severity of recurrent genital herpes. J Virol 2012; 86:9952-63. [PMID: 22761381 DOI: 10.1128/jvi.00829-12] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Leukocytes participate in the immune control of herpes simplex virus (HSV). Data from HIV coinfections, germ line mutations, and case reports suggest involvement of CD4 T cells and plasmacytoid dendritic cells (pDC). We investigated the relationships between these cells and recurrent genital herpes disease severity in the general population. Circulating CD4 T-cell responses to HSV-2 were measured in specimens from 67 immunocompetent individuals with measured genital lesion and HSV shedding rates. Similarly, pDC number and functional responses to HSV-2 were analyzed in 40 persons. CD4 responses and pDC concentrations and responses ranged as much as 100-fold between persons while displaying moderate within-person consistency over time. No correlations were observed between these immune response parameters and genital HSV-2 severity. Cytomegalovirus (CMV) coinfection was not correlated with differences in HSV-2-specific CD4 T-cell responses. The CD4 T-cell response to HSV-2 was much more polyfunctional than was the response to CMV. These data suggest that other immune cell subsets with alternate phenotypes or anatomical locations may be responsible for genital herpes control in chronically infected individuals.
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Abstract
HIV-infected patients may develop rare anogenital pseudotumoral herpes potentially mimicking epidermoid carcinoma. We assessed treatment in five new cases with a median follow-up of 3.3 years. Recurrence and clinical nucleoside analog resistance were observed in all patients. All drug treatments were only temporarily curative and clinical responses varied between patients and recurrences. Foscavir seemed to be the most appropriate second-line treatment and cidofovir or thalidomide should be considered as alternative treatments.
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Lestre SIA, João A, Carvalho C, Serrão VV. Herpes hipertrófico perianal tratado eficazmente com imiquimod. An Bras Dermatol 2011; 86:1185-8. [DOI: 10.1590/s0365-05962011000600020] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2010] [Accepted: 08/29/2010] [Indexed: 11/22/2022] Open
Abstract
A infecção pelo vírus herpes simples tipo 2 (HSV-2) é frequente em pacientes infetados pelo vírus de imunodeficiência adquirida (VIH). Nestes casos, o herpes genital pode ter uma apresentação clínica atípica. As variantes hipertróficas e vegetantes são pouco habituais. Os autores relatam um caso de herpes hipertrófico perianal em paciente infetada pelo VIH, com resposta insatisfatória ao aciclovir e valaciclovir, tratado eficazmente com imiquimod tópico. O herpes genital hipertrófico é, frequentemente, refratário aos tratamentos antivirais. Na nossa experiência, o imiquimod é um tratamento eficaz, seguro e bem tolerado que deverá ser considerado na abordagem terapêutica destes pacientes.
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Barbosa LDN, Souto R, Furtado AL, Gripp AC, Daxbacher E. Associação de aciclovir oral e imiquimode no tratamento de herpes simples genital hipertrófico em paciente com sida: relato de dois casos. An Bras Dermatol 2011; 86:1043-5. [DOI: 10.1590/s0365-05962011000500035] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2010] [Accepted: 07/13/2011] [Indexed: 11/21/2022] Open
Abstract
Herpes simples crônico é doença capaz de gerar apresentações exuberantes, principalmente em pacientes com sida. O provável mecanismo da formação dessas lesões hiperplásicas consiste na invasão viral dos linfócitos T CD4 situados na epiderme. Diante das dificuldades terapêuticas e da grande taxa de insucesso do tratamento nesses pacientes, novas terapias têm sido citadas na literatura atualmente. O conhecimento da imunopatologia ratificou o mecanismo pelo qual o imiquimode poderia ser eficaz como terapia adjuvante aos antivirais. Relatamos aqui dois casos de pacientes tratados com aciclovir associado ao imiquimode tópico que obtiveram resposta clínica excepcional.
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Chronic mucocutaneous herpes simplex virus and varicella zoster virus infections. J Am Acad Dermatol 2010; 66:e217-27. [PMID: 21056516 DOI: 10.1016/j.jaad.2010.07.011] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2010] [Revised: 07/07/2010] [Accepted: 07/14/2010] [Indexed: 12/16/2022]
Abstract
Chronic herpes simplex virus (CHSV) and chronic varicella zoster virus (CVZV) are defined as atypical mucocutaneous wart-like and/or ulcerative HSV or VZV infections, persisting for at least 1 month. Both are commonly associated with HIV infection and may occasionally present with other types of immunosuppression. CHSV and CVZV occur despite the immune restoration effect of highly active antiretroviral therapy for HIV. The clinical polymorphism of CHSV and CVZV makes recognition difficult. Histology, immunohistology, PCR and viral culture all help to confirm the diagnosis. Treatment is frequently complicated by resistance to thymidine kinase (TK)-dependent antivirals, including acyclovir, valacyclovir and famciclovir. Viral culture remains an essential tool for antiviral drug susceptibility testing. Therapeutic alternatives include non-TK-dependent antivirals, such as foscarnet or cidofovir, which directly target viral DNA polymerase. With few exceptions, CHSV and CVZV infections do not constitute significant risk factors for disseminated cutaneous or systemic infection. This review compares the similarities of and differences between CHSV and CVZV infections.
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25
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Baranek T, Zucchini N, Dalod M. Plasmacytoid dendritic cells and the control of herpesvirus infections. Viruses 2009; 1:383-419. [PMID: 21994554 PMCID: PMC3185500 DOI: 10.3390/v1030383] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2009] [Revised: 10/01/2009] [Accepted: 10/08/2009] [Indexed: 01/04/2023] Open
Abstract
Type-I interferons (IFN-I) are cytokines essential for vertebrate antiviral defense, including against herpesviruses. IFN-I have potent direct antiviral activities and also mediate a multiplicity of immunoregulatory functions, which can either promote or dampen antiviral adaptive immune responses. Plasmacytoid dendritic cells (pDCs) are the professional producers of IFN-I in response to many viruses, including all of the herpesviruses tested. There is strong evidence that pDCs could play a major role in the initial orchestration of both innate and adaptive antiviral immune responses. Depending on their activation pattern, pDC responses may be either protective or detrimental to the host. Here, we summarize and discuss current knowledge regarding pDC implication in the physiopathology of mouse and human herpesvirus infections, and we discuss how pDC functions could be manipulated in immunotherapeutic settings to promote health over disease.
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Affiliation(s)
- Thomas Baranek
- Université de la Méditerranée, Centre d’Immunologie de Marseille-Luminy, Parc Scientifique & Technologique de Luminy, Case 906, F13288 Marseille, Cedex 09, France; E-Mails: (T.B.); (N.Z.)
- Institut National de la Santé et de la Recherche Médicale (INSERM), U631, Centre d’Immunologie de Marseille-Luminy, Parc Scientifique & Technologique de Luminy, Case 906, F13288 Marseille, Cedex 09, France
- Centre National de la Recherche Scientifique (CNRS), UMR6102, Centre d’Immunologie de Marseille-Luminy, Parc Scientifique & Technologique de Luminy, Case 906, F13288 Marseille, Cedex 09, France
| | - Nicolas Zucchini
- Université de la Méditerranée, Centre d’Immunologie de Marseille-Luminy, Parc Scientifique & Technologique de Luminy, Case 906, F13288 Marseille, Cedex 09, France; E-Mails: (T.B.); (N.Z.)
- Institut National de la Santé et de la Recherche Médicale (INSERM), U631, Centre d’Immunologie de Marseille-Luminy, Parc Scientifique & Technologique de Luminy, Case 906, F13288 Marseille, Cedex 09, France
- Centre National de la Recherche Scientifique (CNRS), UMR6102, Centre d’Immunologie de Marseille-Luminy, Parc Scientifique & Technologique de Luminy, Case 906, F13288 Marseille, Cedex 09, France
| | - Marc Dalod
- Université de la Méditerranée, Centre d’Immunologie de Marseille-Luminy, Parc Scientifique & Technologique de Luminy, Case 906, F13288 Marseille, Cedex 09, France; E-Mails: (T.B.); (N.Z.)
- Institut National de la Santé et de la Recherche Médicale (INSERM), U631, Centre d’Immunologie de Marseille-Luminy, Parc Scientifique & Technologique de Luminy, Case 906, F13288 Marseille, Cedex 09, France
- Centre National de la Recherche Scientifique (CNRS), UMR6102, Centre d’Immunologie de Marseille-Luminy, Parc Scientifique & Technologique de Luminy, Case 906, F13288 Marseille, Cedex 09, France
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Vaccines and microbicides preventing HIV-1, HSV-2, and HPV mucosal transmission. J Invest Dermatol 2009; 130:352-61. [PMID: 19829304 DOI: 10.1038/jid.2009.227] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
HIV-1, herpes simplex virus type 2 (HSV-2), and human papillomavirus (HPV), among other sexually transmitted infections, represent a major burden for global health. Initial insights into the mucosal transmission of these viral pathogens have raised optimism with regard to the rapid generation of protective vaccines. Nevertheless, setbacks for HIV-1 and HSV-2 vaccines have seriously challenged the initial enthusiasm. Recently, two new vaccines that efficiently prevented HPV infection have renewed the hope that vaccinal prevention of viral mucosal sexually transmitted infections is possible. HIV-1 and HSV-2 differ from HPV, and each virus needs to be tackled with a distinct approach. However, vaccines are not the only possible answer. Topically applied agents (microbicides) are an attractive alternative in the prevention of HIV-1 and HSV-2 mucosal transmission. Progress in understanding the mechanisms of genital transmission of HIV-1 and HSV-2 is required for successful vaccine or microbicide candidates to emerge from current approaches.
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27
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Martín JM, Villalón G, Jordá E. [Update on the treatment of genital herpes]. ACTAS DERMO-SIFILIOGRAFICAS 2009; 100:22-32. [PMID: 19268108 DOI: 10.1016/s1578-2190(09)70006-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Genital herpes is a chronic infection characterized by periodic reactivation. It can produce symptomatic disease in the host although asymptomatic viral excretion can also occur. It is currently the main cause of genital ulceration and an important public health problem that has substantial clinical, psychological, and economic repercussions. This review analyzes the currently available therapeutic options and regimens, which are based mainly on systemic use of antiviral agents such as aciclovir, valacyclovir, and famciclovir. In addition, special emphasis is placed on the prevention and management of this infection in specific situations, such as pregnant, pediatric, and immunocompromised patients.
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Affiliation(s)
- J M Martín
- Servicio de Dermatología, Hospital Clínico Universitario, Valencia, España.
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28
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Martín J, Villalón G, Jordá E. Actualización en el tratamiento del herpes genital. ACTAS DERMO-SIFILIOGRAFICAS 2009. [DOI: 10.1016/s0001-7310(09)70053-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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29
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Nazli A, Yao XD, Smieja M, Rosenthal KL, Ashkar AA, Kaushic C. Differential induction of innate anti-viral responses by TLR ligands against Herpes simplex virus, type 2, infection in primary genital epithelium of women. Antiviral Res 2008; 81:103-12. [PMID: 19013198 DOI: 10.1016/j.antiviral.2008.10.005] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2008] [Revised: 10/02/2008] [Accepted: 10/07/2008] [Indexed: 11/16/2022]
Abstract
Genital epithelial cells (GECs) are the first line of mucosal defense against sexually transmitted infections. We exploited the ability of GECs to mount innate immune responses, by using TLR ligands to induce anti-viral activity against Herpes simplex virus, type 2 (HSV-2). Primary cultures of GECs were grown to confluent, polarized monolayers and found to express different levels of mRNA for TLR1-10. Innate anti-viral responses against HSV-2 infection were determined following treatment with eight different TLR ligands. HSV-2 replication was significantly inhibited following treatment with ligands for TLR3, 5 and 9, while lipo-polysaccharide (LPS), a TLR4 ligand, failed to provide any protection. Biologically active interferon-beta and nitric oxide production by GECs correlated with anti-viral activity. Following treatment with TLR3 ligand Poly I:C, inflammatory cytokines were upregulated. Poly I:C treatment led to activation of downstream transcription factors including interferon regulatory factor-3 (IRF-3) and NFkappaB. Anti-viral responses induced by TLR ligands in GECs may provide a unique alternative to topical microbicides by enhancing body's own mucosal innate defense mechanisms against sexually transmitted viruses.
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Affiliation(s)
- Aisha Nazli
- Center For Gene Therapeutics, Department of Pathology and Molecular Medicine, McMaster University, Michael G. DeGroote Center for Learning and Discovery, Hamilton, Ontario, Canada L8N 3Z5
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Progressive hypertrophic genital herpes in an HIV-infected woman despite immune recovery on antiretroviral therapy. Infect Dis Obstet Gynecol 2008; 2008:592532. [PMID: 18784844 PMCID: PMC2531199 DOI: 10.1155/2008/592532] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2008] [Accepted: 07/13/2008] [Indexed: 11/18/2022] Open
Abstract
Most HIV-infected individuals are coinfected by Herpes simplex virus type 2 (HSV-2). HSV-2 reactivates more frequently in HIV-coinfected individuals with advanced immunosuppression, and may have very unusual clinical presentations, including hypertrophic genital lesions. We report the case of a progressive, hypertrophic HSV-2 lesion in an HIV-coinfected woman, despite near-complete immune restoration on antiretroviral therapy for up to three years. In this case, there was prompt response to topical imiquimod. The immunopathogenesis and clinical presentation of HSV-2 disease in HIV-coinfected individuals are reviewed, with a focus on potential mechanisms for persistent disease despite apparent immune reconstitution. HIV-infected individuals and their care providers should be aware that HSV-2 may cause atypical disease even in the context of near-comlpete immune reconstitution on HAART.
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31
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Abstract
Abstract Herpes simplex viruses are evolutionarily ancient and ubiquitous. In the past 20 years, there has been increasing recognition of a worldwide pandemic of HSV-2 infection. Moreover, HSV-2 prevalence has increased despite fairly widespread use of antiviral drugs for HSV. The success of HSV-1 and HSV-2 stems from latency within long-lived neurons and frequent mucocutaneous shedding. The generally mild medical consequences of HSV infection reflect a functional equilibrium between host and microbe in most immunocompetent persons. However, significant gaps in our knowledge of the correlates of disease severity and HSV immune evasion are limiting rational advances in these areas. Human genetic studies are gradually outlining important innate responses, while recent imaging and biopsy studies have begun to show that the temporal and spatial anatomic interplay between virus reactivation and host immune response may be important in reactivations and disease expression.
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Affiliation(s)
- David M Koelle
- Department of Medicine, University of Washington, Seattle, Washington, USA.
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