Herpesvirus hominis infection in patients with myeloproliferative and lymphoproliferative disorders

HSV-1 clinical isolates with unique in vivo and in vitro phenotypes and insight into genomic differences

Strain-specific factors contribute in significant but undefined ways to the variable incidence of herpes simplex virus (HSV) recrudescence. Studies that investigate these strain-specific factors are needed. Here, we used qPCR, in vitro assays, and genomic sequencing to identify important relationships between in vitro and clinical phenotypes of unique HSV-1 clinical isolates. Nine HSV-1 isolates from individuals displaying varying reactivation patterns were studied. Isolates associated with frequent recurrent herpes labialis (RHL) (1) displayed higher rates of viral shedding in the oral cavity than those associated with rare RHL and (2) tended to replicate more efficiently at 33 °C than 39 °C. HSV-1 isolates also displayed a more stable phenotype during propagation in U2OS cells than in Vero cells. Draft genome sequences of four isolates and one variant spanning 95.6 to 97.2 % of the genome were achieved, and whole-genome alignment demonstrated that the majority of these isolates clustered with known North American/European isolates. These findings revealed procedures that could help identify unique genotypes and phenotypes associated with HSV-1 isolates, which can be important for determining viral factors critical for regulating HSV-1 reactivation.

Stress-induced effects on cell-mediated innate and adaptive memory components of the murine immune response to herpes simplex virus infection

Using a murine model, we have previously shown that restraint stress is able to suppress the development of herpes simplex virus (HSV)-specific cytotoxic T lymphocytes (CTL) and natural killer (NK) cell activity in the popliteal lymph nodes following local footpad infection. These studies of the primary cell-mediated immune response to HSV infection have been extended to examine the effects of a similar stressor on the development of HSV-specific memory CTL (CTLm) following local and systemic HSV infection. In addition, the effect of stress on HSV-specific CTLm localization and proliferation in the popliteal lymph node following reexposure to HSV was investigated. Lastly, the ability to stimulate HSV-specific CTLm to the lytic phenotype under conditions of restraint stress was examined. Restraint stress did not inhibit the generation of HSV-specific CTLm. However, restraint stress inhibited the ability to activate CTLm to the lytic phenotype. In HSV seropositive mice (primed prior to stress), restraint stress prevented the in vivo activation and/or migration of HSV-specific CTLm in the popliteal lymph nodes. These findings demonstrate that activation of HSV-specific immunological memory can be inhibited by physiological changes associated with stress. Such immune inhibition may provide a possible mechanism for the development of recrudescent herpetic disease.

Clinical study of herpes simplex virus infection in leukemia

Twenty-nine patients with leukemia were observed for the development of and recovery from oral herpes simplex virus (HSV) lesions. In patients with seropositive test results, lymphocyte and monocyte counts may provide a guide to predict the onset of HSV infections and to indicate when to institute acyclovir prophylaxis. When HSV developed, acyclovir was effective in preventing progression of the lesions, which did not resolve until white cell counts had recovered.

Herpes simplex mimicking leukemia cutis

We present a patient with chronic lymphocytic leukemia who developed a painful penile ulcer that was initially diagnosed as leukemia cutis, as evidenced by an atypical leukemic infiltrate on biopsy. A Tzanck preparation was positive for multinucleated giant cells, and the diagnosis of herpes genitalis was confirmed by viral culture. In patients with hematologic malignancies, herpes simplex virus must be included in the differential diagnosis of ulcerative lesions. The histopathologic findings of inflammatory dermatoses in these patients may include an atypical infiltrate, because of the predominance of atypical inflammatory cells in the peripheral circulation.

Herpes simplex virus, Candida albicans and mouth ulcers in neutropenic patients with non-haematological malignancy

Mouth ulcers are a frequent cause of morbidity in patients rendered neutropenic as a result of chemotherapy. We report here a series of 28 such patients from whom swabs were taken for viral isolation and mycological culture. In 13 patients, herpes simplex virus (type I) was isolated and in 17 patients Candida albicans was cultured. Both organisms were isolated in 9 patients. Our results suggest that both a viral and fungal element may be important in the aetiology of oral ulceration and that antiviral and antifungal agents may each have a role in the prophylaxis and treatment of such patients.

Shedding of herpes simplex virus type 1 into saliva

The shedding of herpes simplex virus Type 1 (HSV-1) into saliva was studied in 110 healthy individuals, 55 patients who were undergoing oral surgery, and 21 immunocompromised patients in an asymptomatic Japanese population. Specimens were collected regularly for up to 2 months from each individual. Virus was recovered on at least one occasion from 4.5% of the healthy individuals, 20% of the patients undergoing oral surgery and 38% of the immunocompromised patients. In those individuals that shed virus, the duration of shedding varied from a mean of 1.2 days in the healthy individuals to 5.8 days in patients undergoing oral surgery, and was 3 days in the immunocompromised patients. The majority of oral surgery patients shed HSV-1 into saliva within 7 days after surgery and immunocompromised patients shed virus almost continuously. The role of surgery in triggering the reactivation of latent HSV-1, and the differences in rates of viral shedding between American and Japanese are discussed.

Postpartum activation of autoimmunity: transient increase of total IgG levels in normal women and in women with autoimmune thyroiditis

The immunoregulatory mechanisms underlying the transient rebound of autoimmune disease activity in the postpartum period were studied by determining serum immunoglobulins, thyroid microsomal antibodies and some viral (cytomegalovirus, Epstein-Barr, varicellae-zoster and mumps) and bacterial (Yersinia enterocolitica and Salmonella) antibodies in women with autoimmune thyroiditis and in healthy postpartum women. A characteristic increase between 2 and 5 months postpartum followed by a decrease to 10-12 months postpartum was observed not only for thyroid microsomal antibody titres in women with autoimmune thyroiditis but also for serum total IgG and IgG subclass levels (but not IgM, IgA or IgE) in both groups of women. This pattern of transient antibody increase was not detected against viral and bacterial antigens. The characteristic alterations of thyroid microsomal antibody titres in the postpartum period of women with autoimmune thyroiditis thus appear to occur as a consequence of an activation of immunoglobulin-producing B cell clones. This activation seems restricted to the IgG class and to certain B cell clones.

The role of an immunoperoxidase technique in the diagnosis of oral herpes simplex virus infection in patients with leukemia

Laboratory techniques are often used to confirm a clinical diagnosis of oral herpes simplex virus (HSV) infection in patients with leukemia. In the present study, an immunoperoxidase technique (IPT) was used to examine smears taken from the oral mucosa of 44 patients with leukemia at Vancouver General Hospital. It was found that the IPT was as sensitive and specific as viral culture in confirming the presence of HSV. The IPT was found to be more predictive of symptomatic oral HSV disease than viral culture because it did not give positive results if there was only viral shedding in the absence of clinical disease. As the IPT is rapid and inexpensive as well as being specific, sensitive, and predictive, it has a definite role in the laboratory confirmation of oral HSV lesions in leukemics.

Virus infections in immunocompromised patients: their importance and their management

Opportunistic viral infections were investigated in 156 adult patients admitted over one year to a medical oncology service: 35% of the total group and 65% of those with acute leukaemia experienced viral infections, 79% of which were with viruses of the herpes group. Surprisingly few enteric viruses were recovered. Reactivation of herpes simplex virus in the brains of these immunosuppressed patients was suggested by the demonstration by nucleic acid hybridization of herpes simplex virus DNA sequences in neurones and endothelial cells in patients with evidence of past infection with virus. Acyclovir was effective in therapy and prophylaxis. Twenty-three strains from 7 patients were tested for sensitivity to this antiviral: in 3 instances clinical resistance was observed but the strains were fully sensitive in vitro, as were all other strains tested.

Herpes simplex virus lymphadenitis mimicking tumoral relapse in a patient with Hodgkin's disease in remission

A patient treated for Hodgkin's disease and presenting 12 years later with a left inguinal lymphadenopathy mimicking a relapse is reported. Histopathological study disclosed large histiocytic granulomas in the sinuses. Some of these granulomas showed necrotic areas with numerous neutrophils. At the edge of the necrotic zones, cells of undetermined origin exhibited intra-nuclear inclusions typical of Herpes simplex virus. The diagnosis was confirmed by immunolabelling, revealing Herpes simplex viral antigens in frozen and paraffin sections, and by ultrastructural studies. The diagnostic value of the histological methodology and pathological changes and the significance of the disease, appearing in a patient treated for Hodgkin's disease are discussed.

Atypical herpes simplex (HSV) infection in a patient with Hodgkin's disease

An atypical presentation of herpes simplex virus type 1 (HSV-I) in the form of nodular tongue lesions was documented by histologic and immunohistochemical studies in a patient with advanced Hodgkin's disease. This represents yet another manifestation of HSV-I in the immunocompromised host and further emphasizes awareness of the oral complications of cancer chemotherapy.

Alteration of lymphocyte transformation response to herpes simplex virus infection by acyclovir therapy

To evaluate the effect of acyclovir (ACV) therapy on the cellular immune response, we sequentially followed 43 patients with culture-proven first episodes of genital herpes simplex virus (HSV) infection. Twenty-three patients who were treated with ACV and 20 who received placebo had blood obtained weekly during the first 6 weeks after onset of lesions and had their in vitro lymphocyte transformation (LT) response to inactivated HSV antigens measured. The mean stimulation index to HSV antigens at week 3 among patients treated with systemic ACV was 3.5 +/- 0.64 compared to 18.4 +/- 6.89 in their placebo-treated counterparts (P less than 0.05). The mean time to the development of the peak LT response to HSV antigens was 4.3 weeks in systemic-treated versus 3.4 in placebo-treated patients (P less than 0.05). The time to the development of the peak in vitro LT response to HSV antigens and the height of that response were, however, similar between topical ACV- and topical placebo-treated patients. The geometric mean HSV-2-neutralizing titer in convalescent sera was 5.4 in recipients of systemic ACV compared to 10.0 in patients treated with systemic placebo (P less than 0.05). The LT response to HSV antigen was also measured at the first recurrence in 11 patients. No differences were found in the time to first recurrence, lesion duration, number of lesions, or mean stimulation index response to inactivated HSV antigens between the six patients treated with systemic ACV during their primary episode and the five given placebo during their primary episode. Systemic ACV therapy appears to diminish the peak in vitro LT response to inactivated HSV antigens as well as to delay the time to development of that peak response. However, the cell-mediated immune response to subsequent episodes appears similar.

Oral acyclovir prophylaxis against herpes simplex virus in non-Hodgkin lymphoma and acute lymphoblastic leukaemia patients receiving remission induction chemotherapy. A randomised double blind, placebo controlled trial

Forty-one patients receiving remission induction chemotherapy with vincristine, adriamycin and prednisolone (VAP) for high grade lymphoma or acute lymphoblastic leukaemia were entered into a double blind, placebo controlled trial of oral acyclovir prophylaxis against herpes simplex virus (HSV) infection. The dose of acyclovir was 200 mg four times daily for the duration of chemotherapy (six weeks). Of the 40 evaluable patients, 20 were randomised to each arm. Prophylactic oral acyclovir significantly reduced the incidence of clinical HSV infection from 60% on placebo to 5% acyclovir (P less than 0.001), and the incidence of viral isolates from 70% on placebo to 5% on acyclovir (P less than 0.001).

Herpes virus infections in patients with neoplastic disease. Diagnosis and therapy

Herpes viruses are among the most common and troublesome opportunistic pathogens infecting patients with neoplastic diseases. The recent development of partially effective and relatively nontoxic antiviral agents offers promise for the prophylaxis or therapy of these infections in high-risk groups. Vidarabine and acyclovir have shown efficacy in several herpes virus infections and are now licensed in the United States. Alpha interferon may also be useful in the prophylaxis or early therapy of certain herpes virus infections. Newer antiviral agents and combination therapies are under study. Early and rapid diagnosis of such infections is critical to the development of effective therapy.

Immunity to herpes simplex virus type 2: recurrent lesions are associated with the induction of suppressor cells and soluble suppressor factors

Cell-mediated immunity to herpes simplex virus type 2 was investigated in infected inbred strain 13/N guinea pigs with (45%), and without, a history of recurrent herpetic disease (A. D. Donnenberg, E. Chaikof, and L. Aurelian, Infect. Immun. 30:99-109, 1980). Induction of suppressor cells capable of reducing the proliferative response of herpes simplex virus type 2-stimulated immune lymphoid cells was demonstrated in spleen cells from animals with a history of recurrent disease at recrudescence and convalescence but not in spleen cells from quiescent animals or from animals without a history of recurrent herpetic disease (seropositive controls). Suppressor cells were also detected in the peripheral blood but only from three of seven studied animals, and only at recrudescence. In addition to inhibitory cell-cell interactions, the herpes simplex virus type 2-activated regulatory cells of animals with recrudescent herpetic lesions elaborated soluble suppressor factors affecting lymphocyte proliferation. Suppression mediated by suppressor factors was observed only when suppressor factors were added at an early stage of in vitro culture and was reversed by medium exchange throughout the 6 days of culture. Sephadex chromatography revealed the presence of factors capable of differentially modulating the proliferative response of herpes simplex virus-stimulated immune cells and concanavalin A-stimulated normal lymphoid cells.

The effect of prostaglandins on the multiplication and cell-to-cell spread of herpes simplex virus type 2 in vitro

Herpes simplex virus type 2 (HSV-2) after infecting an individual has the ability to remain latent in nervous tissues. The factors that control herpesvirus infection, latency, and reactivation are poorly understood. Fever, menstruation, emotional stress, exposure to sunlight, and surgical resection have been associated with activation of latent herpes. The situations which activate latent herpes are associated with a local or systemic rise in prostaglandins. The data presented show that prostaglandin F2 alpha (PGF2 alpha) and E2 (PGE2) enhanced cell-to-cell spread of HSV-2 in an in vitro model. Ibuprofen, a prostaglandin inhibitor, suppressed HSV-2 multiplication as well as cell-to-cell spread. Prostaglandins may play an important role in herpesvirus infections and latency.

Cancer chemotherapy associated symptomatic stomatitis: role of Herpes simplex virus (HSV)

The relationship between oral shedding of Herpes simplex virus (HSV) and cytotoxic cancer chemotherapy was studied. HSV seropositive outpatients receiving cytotoxic chemotherapy had HSV recovered from throat washings in eight of 114 patients (7.0%), significantly more often than HSV seropositive outpatients with malignancy who were not receiving cytotoxic chemotherapy (one of 91 patients; 1.1%; P = 0.04). Twenty-eight HSV seropositive chemotherapy patients and 11 HSV seropositive healthy hospital personnel were studied serially 2-3 times per week over a 3-4 week period for oral HSV shedding. Although a comparable percentage of each group shed HSV at least once (57.1% of chemotherapy patients versus 36.4% of controls), chemotherapy patients had a strikingly higher incidence of multiple positive cultures: 40/218 attempts (18.7%) versus 4/156 attempts (2.6%) for controls (P less than 10(-5)). Among chemotherapy patients who developed clinically evident stomatitis, 12 of 14 (85.7%) had HSV recovered compared to four of 14 (28.6%) without lesions (P = 0.004). We conclude that while oral mucosal HSV infection is associated with symptomatic stomatitis following chemotherapy, HSV does not account for all mucosal lesions in chemotherapy patients.

Virus-specific antibodies in sera from patients with genital herpes simplex virus infection

Virus-specific antibodies against a number of herpes simplex virus type 2 antigens were determined by radioimmunoprecipitation assays in sequential serum samples obtained from 12 patients with initial genital herpes simplex virus infection. The progressive appearance of antibodies to virus-specific antigens was observed; antibodies against a 130,000-molecular-weight glycoprotein complex appeared first, followed by antibodies against the major nucleocapsid polypeptide and then antibodies against a number of other viral antigens, including a polypeptide with a molecular weight of 62,000. Patients who developed a wide variety of antibodies to viral polypeptides shortly after resolution of their initial episode seemed to experience more severe initial infections and more recurrences than did those who reacted poorly with these virus-specific antigens. This was most apparent with respect to antibodies to virus-specific polypeptides with molecular weights between 30,000 and 43,000. Antibody specificity did not change during the course of follow-up regardless of whether serum samples were taken shortly before, during, or after recurrent episodes. Glycoprotein-specific antibodies were quantitated with the purified 130,000-molecular-weight glycoprotein material. No significant fluctuations in these antibody titers were observed before or after recurrences of the disease.

Herpes simplex infection in acute myelogenous leukemia and other hematologic malignancies: a prospective study

To better define the frequency and clinical characteristics of herpes simplex virus (HSV) infection in adult patients with acute myelogenous leukemia (AML), the authors prospectively studied 29 patients undergoing remission induction chemotherapy with twice weekly throat wash cultures for an average of 25.3 days. Ten seropositive patients (34.5%) shed HSV at least once. Eight patients were asymptomatic. Two episodes of herpes labialis were severe and persistent, but no visceral dissemination was observed. Reactivation of HSV infections in AML patients presumably with marked immunosuppression occurs, but less frequently and more benignly than has been suggested. Daunomycin and cytosine arabinoside, which can inhibit HSV replication, may have accounted for this lower frequency of reactivation.

Immune response to herpes simplex virus infections: virus-specific antibodies in sera from patients with recurrent facial infections

Radioimmunoprecipitation assays were used to identify antibodies against a number of herpes simplex virus type 1-specific antigens in serum samples from individuals with recurrent facial herpes virus infections and from seropositive individuals without recurrent infections. Individuals with recurrent infections contributed three sequential serum samples each: immediately after the appearance of lesions, 3 weeks later, and 3 months later. Antibodies against at least 18 viral polypeptides were present in all positive sera: these included antibodies against the major nucleocapsid polypeptide (approximate molecular weight, 150,000) and against two glycopolypeptides with molecular weights of 115,000 to 130,000. No significant differences were observed between the serum samples in regard to their virus-specific antibody composition. The high-molecular-weight glycopolypeptides were partially purified and used in quantitative titration experiments. All sera tested were equally reactive with this material. It was concluded that under the experimental conditions an individual's susceptibility to recurrent herpetic infections could not be correlated with quantitative or qualitative changes in the levels of virus-specific antibodies.

Increased susceptibility to herpes simplex virus infections in children with acute measles

Children with measles treated either in hospital or as outpatients were examined for clinical or laboratory evidence of oropharyngeal herpes simplex virus (HSV) infection. HSV was isolated from 43% of the hospitalized children and 37% of the outpatient children and an additional 9% of the hospitalized group had lesions without the virus being isolated. The incidence of both HSV isolation and clinical lesions in infected children was significantly greater in children hospitalized for measles than in a control group of children hospitalized for tuberculosis. Data from the outpatient group strongly suggest that malnourished children with measles are particularly susceptible to HSV infection. The immunosuppressed state of the children with acute measles was demonstrated by impaired lymphocyte transformation responses to phytohemagglutinin and the inability of their serum to support normal transformation responses by lymphocytes from normal individuals. However the extent of this immunosuppression was unrelated to the susceptibility of the children to HSV infection.

Immunity to herpes simplex virus type 2: cell-mediated immunity in latently infected guinea pigs

Cell-mediated (CMI) and humoral immunity to herpes simplex virus type 2 (HSV-2) were evaluated in infected strain 13/N guinea pigs with (45%) and without a history of recurrent herpetic disease. Virus was isolated by cocultivation from active herpetic lesions (9 of 10) as well as from the footpads (17 of 38), sacral ganglia (7 of 21), and sciatic nerves (1 of 21) of asymptomatic animals. Viral isolates grew in cells of human origin and were neutralized by hyperimmune anti HSV-2 sera. Humoral immunity measured by the presence of virus-neutralizing antibody was similar in both experimental groups. The involvement of CMI in recurrent disease was assessed by comparing lymphocyte transformation (LT) and leukocyte migration inhibition factor (LIF) responses in animals with a history of recurrent disease studied while asymptomatic (quiescent) and in animals without clinical evidence of recurrent disease (seropositive controls). Spleen cells from quiescent animals evidenced significant impairment of both LIF and LT responses as reflected in the requirement of higher antigen concentrations (up to 58-fold) and longer in vitro culture periods (up to 2.5 days) to mount responses comparable in magnitude to those observed in the seropositive control groups. Peripheral blood lymphocyte cultures obtained from quiescent animals showed similar impairment of LIF responses but displayed intact LT response. The data suggest that recurrent disease is associated with an impairment in the generation of anamnestic effector functions as reflected by altered kinetics and dose response patterns in in vitro secondary responses.

Cellular and humoral immunity in the pathogenesis of recurrent herpes viral infections in patients with lymphoma

86 patients with lymphoma were evaluated prospectively for clinical and laboratory evidence of recurrent varicella-zoster, herpes simplex, and cytomegalovirus infections during the first 16 mo of treatment. Cellular immunity to the viral antigens was measured by in vitro lymphocyte transformation and interferon production. Antibody titers and nonspecific measures of cellular immunity, including T-cell quantitation and transformation to phytohemagglutinin, were also assessed. The patients treated with radiation and chemotherapy had the highest incidence of reactivation of each of the viruses (15-19%). Greater susceptibility to herpes viral reactivation in these patients correlated with suppression of cell-mediated immunity to the specific virus. In individual patients, suppression of cellular immunity to the specific herpes viral antigen preceded each episode of reactivation, but recurrent infection did not occur in all patients with diminished specific lymphocyte transformation. Absence of the response appears to be a necessary but not a sufficient condition for the recrudescence of latent infection. Better preservation of cellular immunity to herpes simplex antigen during treatment was associated with infrequent reactivation of herpes simplex. In 25 patients with acute herpes zoster, uncomplicated recovery from the infection was accompanied by the development of lymphocyte transformation and interferon production to varicella-zoster antigen. Quantitation of T-cell numbers and phytohemagglutinin transformation did not correlate with the presence of viral cellular immunity in treated patients. Responses returned while T-cell numbers were low, and the recovery of phytohemagglutinin transformation often preceded recovery of the responses to viral antigens. Although some patients had deficiencies in viral cellular immunity at diagnosis, the duration of the suppression of specific antiviral responses resulting from treatment appears to be the most important factor predisposing to the recurrence of herpes infections in lymphoma patients.

Herpesviruses

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Leukocyte migration inhibitory factor in primary and recurrent ocular infections by herpes simplex-virus

Using a direct assay of leukocyte migration inhibitory factor (LMIF), cell-mediated immunity to herpes simplex virus (HSV) antigen was measured in patients who had primary and recurrent ocular HSV infections. Those with primary and recurrent epithelial disease had a significantly lower production of LMIF than a control population than had had no herpetic infection for at least a year or longer (P less than 0.001). On the contrary, patients with deep stromal involvement and anterior uveitis showed significant migration inhibition with HSV antigen, similar to the one found in the healthy control group. The clinical and possible therapeutic implications of thes findings are discussed.

Cellular immune response in genital herpes simplex virus infection

We studied the relations between the cellular immune response, pre-existing complement-fixing antibody and virus type with duration of virus excretion in genital herpes simplex virus (HSV) infection. Thirty-six patients (seven with HSV-1 and 29 with HSV-2) with genital herpes underwent serologic testing, sequential viral cultures and weekly determination of lymphocyte-transformation stimulation index with inactivated HSV antic n. The duration of virus excretion was shortest in those with pre-existing complement-fixing antibody, was unrelated to virus type, and was inversely correlated with the magnitude of the mean peak stimulation index (r = -0.69, P less than 0.001). Prolonged virus excretion occurred in patients with a delayed and diminished peak index. Recurrent episodes had a higher peak index (29.4 compared to 14.5) (P less than 0.02), an earlier development of the peak during recurrences (9.1 vs. 25.8 days) (P less than 0.01) and a briefer duration of viral shedding than initial episodes. Thus, the temporal course and magnitude of the stimulation index correlate with and may determine the duration of genital HSV infection.

Antibody-mediated recovery from subcutaneous herpes simplex virus type 2 infection

Young adult mice infected with 3 X 10(6) plaque-forming units of herpes simplex virus type 2 (HSV-2) died within 9 to 12 days after spread of the virus from the sites of infection to the spinal cord and brain. Administration of HSV-2-neutralizing antisera prepared in syngenic mice or in rabbits inhibited spread of the virus from the footpad of infected animals and prevented death. A single intraperitoneal inoculum of antiserum (virus-neutralizing titer of 1:128) was effective in protecting mice when the antiserum was given at 8 to 48 h, but not at 72 h, after virus inoculation. Immune sera absorbed with HSV-2-infected cells no longer protected mice from subcutaneous infection, whereas absorption with noninfected cells had no effect. Thus, HSV-2-specific antibodies appeared to be responsible for the protection observed. If the mice were given a sublethal dose of irradiation (390 rads) at 24 h before antibody transfer, protection was no longer obtained. This suggested that the mechanism of protection probably was not solely due to in vivo neutralization of virus, but required the participation of a radiosensitive component which has not yet been defined.

Clinical manifestations of infections with herpesviruses after kidney transplantation: a prospective study of various syndromes

Herpesviruses infections occur commonly following kidney transplantation and immunosuppression, and contribute substantially to morbidity in the transplant recipient. In this prospective study, stomatitis, mononucleosis, hepatitis, or interstitial pneumonia occurred in 24 of 30 patients (80%) as a result of reactivation of latent herpesvirus infections, but the majority of these syndromes were self-limited and the infections were often asymptomatic. Rejection occurred significantly more frequently in CMV-infected patients, but a distinct causal relationship cannot be deduced.

Quality and quantity of survival in acute myeloid leukaemia

The quality of life in leukaemia is as important as its quantity. In fifty-one patients the quality and quantity of life were improved by less aggressive treatment than is usual. By not trying to induce complete remission at all costs, the mobidity and early mortality were reduced and at least an equivalence in survival was obtained.

Herpesvirus hominis infections in renal transplant recipients

A longitudinal, prospective study of herpesvirus hominis (HVH, herpes simplex virus) was carried out in immunosuppressed renal allograft recipients using serologic, virologic and clinical techniques. The final study group consisted of 37 patients of which 31 were followed for at least 2 months and 26 for more than 1 year. A 4-fold rise or more in HVH complement-fixing antibody in relation to titers measured at the time of transplantation was found in 11 patients. Eight of these 11 patients had clinically recognizable herpetic lesions. An additional 9 patients had lesions without titer rise being demonstrable. The 20 of the 37 patients studied (54%) had evidence of active infection with HVH. Because of pain and discomfort herpetic sores were of clinical importance in 11 patients and lasted for 1 month or more in 9. Herpetic keratitis was seen in 3 and left permanent damage to sight in 2. Multiple, extensive, prolonged and sometimes destructive herpetic lesions affected 5 (16%) of all patients studied.