- Spontaneous splenic rupture complicating primary varicella zoster infection: a case report. [Journal Article]
- BRBMC Res Notes 2018 May 22; 11(1):334
- CONCLUSIONS: There are several reported complications of varicella infection, more commonly in the immunocompromised population. Spontaneous splenic rupture is an unusual complication of primary VZV infection. Here we report the sixth known case in the literature. Splenic rupture should be considered in cases of primary varicella in young adults presenting with abdominal pain.
- Activation of Herpes Simplex Infection after Tattoo. [Journal Article]
- ADActa Dermatovenerol Croat 2018; 26(1):75-76
- Tattooing is a procedure where ink is applied to an area of the skin, mostly intraepidermally (1). This procedure is carried out mainly for aesthetic purposes. Lately, it has been used as a correctiv...
Tattooing is a procedure where ink is applied to an area of the skin, mostly intraepidermally (1). This procedure is carried out mainly for aesthetic purposes. Lately, it has been used as a corrective medical procedure following amputation of mammilla. The procedure is aggressive (2), and the fact that skin is punctured many times with the same needle which cannot be fully sterilized may cause infection of the treated area with bacterial, fungal, or viral agents that may lead to health consequences manifesting in the form of verrucae vulgaris, molluscum contagiosum, and herpes simplex. On the other hand, complications such as granulomas, allergic reactions, Koebner phenomenon, lupus erythematosus, psoriasis, lichen ruber planus, hepatitis C, and HIV infections should also be considered as potential consequences of tattooing (3-7). Even systemic reactions have been reported. Herein we describe a case of herpes infection activation after tattooing. Herein we present the case of a 46-year-old woman, employed in the medical sector, with a two-day history of herpes simplex in the labial area that manifested following application of a cosmetic tattoo meant to outline the lips (Figure 1). Two days after tattoo application, the vesicular lesions appeared along the area that was filled with ink, followed by sub-febrile temperature and fever and a subjective feeling of itching initially, followed by burning sensation and pain. The skin signs located on erythematous base were mainly grouped vesicles with sharply demarcated borders. Regional lymphatic nodes, mainly retro auricular, were enlarged. Within 48 hours, the patient was treated with acyclovir tablets in a dose of 800 mg three times a day and an antipyretic. Acyclovir ointment was administered during the first two days, as well as tetracycline ointment after the second day of the eruption. On the fifth day, we observed regression of the skin changes (Figure 2), and complete healing was achieved after one week. We assessed the medical history of the patient, which revealed the following: hypothyreosis due to lobectomy performed for the treatment of toxic adenoma. The patient was under substitutional therapy with 75 mg levothyroxine. The patient had herpes simplex before, and this was the second herpetic eruption. Herpes simplex is caused by a herpes simplex virus (HSV) type-1 infection that is transmitted through droplets of saliva or direct contact with the affected area, for example during kissing (8-10). Histology reveals intraepidermal blisters, degeneration in epidermal cells at the base of the vesicle, and multilocular eosinophilic inclusional bodies inside cells. Infection is usually more pronounced in the initial phase of disease, where the symptoms are also more intense. Activation of the infection occurs when the body undergoes a decrease in immunity (1), in situations of extensive exposure to the sun, and also in some other circumstances, such as the application of a tattoo as described herein. Tattooing can inoculate the virus or trigger the activation of the herpes virus and other viruses (1,8-10). Tattooing, apart from bringing social stigma in some cases, which is one of the major issues for persons who undergo the procedure, may also cause injuries, contact dermatitis, foreign body granuloma, infections, and allergic reactions including anaphylaxis. Herpes simplex infections are also possible, either by inoculation or reactivation of the HSV. Except in situations where the tattoo is performed for medicinal purposes, tattooing is not a procedure that is supported by dermatologists. Furthermore, tattooing also causes a number of side effects. Allergic reactions (3,4), anaphylactic shock, foreign body granuloma, lichen ruber planus (5), granuloma pyogenes (5), verruca vulgaris, molluscum contagiosum, herpes simplex, and some other bacterial and viral infections.
- In vitro comparison of acyclovir, ganciclovir and cidofovir against equid alphaherpesvirus 3 and evaluation of their efficacy against six field isolates. [Journal Article]
- RARev Argent Microbiol 2018 May 17
- Equid alphaherpesvirus 3 (EHV3) is the etiological agent of equine coital exanthema (ECE), which is a venereal, highly contagious disease, characterized by the formation of papules, vesicles, pustule...
Equid alphaherpesvirus 3 (EHV3) is the etiological agent of equine coital exanthema (ECE), which is a venereal, highly contagious disease, characterized by the formation of papules, vesicles, pustules and ulcers on the external genitalia of mares and stallions. EHV3 remains in a latent state after a successful infection and there are latently infected animals in which the virus is reactivated and generally re-excreted subclinically. There are no available vaccines for this condition and prevention is based on the clinical examination of mares prior to mating, which allows to segregate those showing clinical signs. As this approach does not eliminate the risk of contagion in stallions from subclinically infected mares, there is a need for a specific EHV3 treatment. Nowadays, there exist various antiviral compounds of proven effectiveness for other alphaherpesviruses affecting humans and animals. The aim of the present study was to compare the efficacy of three antiviral compounds, acyclovir, ganciclovir and cidofovir against EHV3 in vitro, and to assess their efficacy against six EHV3 Argentinian field isolates. To determine the efficacy of these compounds in vitro, three parameters were analyzed: reduction of plaque number, reduction of plaque size and reduction of viral production. Additionally, the effectiveness of the three compounds at an optimum concentration previously determined in this study was investigated for the EHV3 field isolates. Based on our results, ganciclovir was the most potent antiviral compound to reduce EHV3 replication in vitro and may thus be a valuable candidate for treatment and prevention of ECE in mares and stallions.
- Tailoring acyclovir prodrugs with enhanced antiviral activity: rational design, synthesis, human plasma stability and in vitro evaluation. [Journal Article]
- AAAmino Acids 2018 May 19
- Bile acid prodrugs have served as a viable strategy for refining the pharmaceutical profile of parent drugs through utilizing bile acid transporters. A series of three ester prodrugs of the antiherpe...
Bile acid prodrugs have served as a viable strategy for refining the pharmaceutical profile of parent drugs through utilizing bile acid transporters. A series of three ester prodrugs of the antiherpetic drug acyclovir (ACV) with the bile acids cholic, chenodeoxycholic and deoxycholic were synthesized and evaluated along with valacyclovir for their in vitro antiviral activity against herpes simplex viruses type 1 and type 2 (HSV-1, HSV-2). The in vitro antiviral activity of the three bile acid prodrugs was also evaluated against Epstein-Barr virus (EBV). Plasma stability assays, utilizing ultra-high performance liquid chromatography coupled with tandem mass spectrometry, in vitro cytotoxicity and inhibitory experiments were conducted in order to establish the biological profile of ACV prodrugs. The antiviral assays demonstrated that ACV-cholate had slightly better antiviral activity than ACV against HSV-1, while it presented an eight-fold higher activity with respect to ACV against HSV-2. ACV-chenodeoxycholate presented a six-fold higher antiviral activity against HSV-2 with respect to ACV. Concerning EBV, the highest antiviral effect was demonstrated by ACV-chenodeoxycholate. Human plasma stability assays revealed that ACV-deoxycholate was more stable than the other two prodrugs. These results suggest that decorating the core structure of ACV with bile acids could deliver prodrugs with amplified antiviral activity.
- Acyclovir lipid nanocapsules gel for oromucosal delivery: A preclinical evidence of efficacy in the chicken pouch membrane model. [Journal Article]
- EJEur J Pharm Sci 2018 May 17
- The study aimed to develop a patient-friendly acyclovir gel with improved efficacy in viral mouth infections, in response to patients' need for an intraoral acyclovir product. Acyclovir was loaded in...
The study aimed to develop a patient-friendly acyclovir gel with improved efficacy in viral mouth infections, in response to patients' need for an intraoral acyclovir product. Acyclovir was loaded in lipid nanocapsules in gel form, and formulae were evaluated for oromucosal delivery. Lipid nanocapsules were prepared by the phase inversion method. Formulae were optimized to achieve maximum acyclovir entrapment and minimum acyclovir precipitation. Colloidal properties, and pharmaceutical performance indicators were assessed. Drug-loaded lipid nanocapsules were in the nanorange (39-120 nm), PdI (0.03-0.2), negative zeta potential, and entrapment efficiency (33-64%). Acyclovir (0.3% w/w) lipid nanocapsules gels were prepared using hydroxyethylcellulose (3% w/w). Resulting gel attributes were considered suitable. Lipid nanocapsules gels (0.3% w/w) showed enhanced Ex vivo acyclovir permeation across, and comparable retention in chicken pouch membrane compared to the 5% marketed cream despite lower drug content. The data provides basis for future exploration of lipid nanocapsules as carrier for transmucosal delivery of acyclovir; the enhanced acyclovir retention in chicken pouch membrane, compared to controls, suggests suitability of lipid nanocapsules for drug delivery to the viral lesion within the buccal membrane.
- Comparative Efficacy and Safety of Different Antiviral Agents for Cytomegalovirus Prophylaxis in Allogeneic Hematopoietic-Cell Transplantation: a Systematic Review and Meta-Analysis. [Journal Article]
- BBBiol Blood Marrow Transplant 2018 May 16
- Over the past 25 years, several randomized controlled trials have investigated the efficacy of different antiviral agents for cytomegalovirus (CMV) prophylaxis in allogeneic hematopoietic-cell transp...
Over the past 25 years, several randomized controlled trials have investigated the efficacy of different antiviral agents for cytomegalovirus (CMV) prophylaxis in allogeneic hematopoietic-cell transplantation. We performed a systematic literature review, conventional meta-analysis and network meta-analysis using a random-effects model and risk ratios (RR) with corresponding 95% confidence intervals (CI) as effect estimates. Fifteen randomized controlled trials were identified, including seven different antiviral agents: acyclovir, ganciclovir, maribavir, brincidofovir, letermovir, valacyclovir, and vaccine. Twelve trials used placebo as comparator while three trials compared different antiviral agents. We found evidence for CMV disease and infection being significantly reduced by antiviral prophylaxis with RR of 0.66 (95% CI, 0.48-0.90) and 0.63 (95% CI, 0.50-0.79). Across the network, ganciclovir showed the best relative efficacy for CMV disease while letermovir provided first rank of being the best option for CMV infection. The risk for death was not significantly influenced by antiviral prophylaxis in the meta-analysis with a RR of 0.92 (95%CI, 0.78-1.08) as well as in the network meta-analysis. In terms of safety, letermovir was at least similar in comparison with placebo and most agents while both letermovir and acyclovir showed significantly reduced risk for serious adverse events compared with ganciclovir with RRs of 0.55 (95% CI, 0.30-1.00) for letermovir and 0.63 (95% CI, 0.42-0.93) for acyclovir. With a probability of 81%, letermovir appears to be the best option in terms of safety. Future randomized head-to-head comparisons are needed to evaluate the definite efficacy and safety of different prophylactic strategies.
- Dissolving polymeric microneedle arrays for enhanced site-specific acyclovir delivery. [Journal Article]
- EJEur J Pharm Sci 2018 May 16
- Acyclovir is widely indicated for the treatment of herpes labialis (cold sores), typically caused by the herpes simplex virus type 1 (HSV-1). However, topical acyclovir has poor efficacy, due to its ...
Acyclovir is widely indicated for the treatment of herpes labialis (cold sores), typically caused by the herpes simplex virus type 1 (HSV-1). However, topical acyclovir has poor efficacy, due to its low skin permeability. The purpose of this study was, therefore, to evaluate the ability of dissolving polymeric microneedle (MN) arrays to improve the local delivery of acyclovir. Acyclovir-loaded dissolving MN arrays (0.49 cm2) were formulated from aqueous blends of Gantrez® S-97 with 361 needles per array (589 ± 9.29 μm height). MN penetrated excised neonatal porcine skin, showing sufficient mechanical strength to resist compression and maintained their appearance after application of a 0.089 N per needle force for 30 s. Dissolution of the needles was observed within 15 min after application to skin and the needles had completely dissolved at 2 h in vitro. In vitro skin permeation studies revealed that the percentage of total acyclovir loading which permeated the skin over a 24 h period using MNs was approximately 45 times higher than that of a commercial cream formulation (Lipsore®). The accumulation of acyclovir at the basal epidermis, the target site of the herpes simplex virus, using MNs was a total of 21.5 μg/cm3in vitro, which is approximately 5 times greater than the 99% inhibition of viral cytopathic effect (ID99) required for HSV infections. This level was also 16 times higher than that obtained using the cream formulation. An in vivo study showed that the use of acyclovir-loaded dissolving MN arrays successfully provided intradermal delivery of acyclovir over a 48 h period and the drug levels in the skin delivered using MN arrays (45.09 ± 13.28 μg/cm3) were superior to those generated by the cream formulation (4.55 ± 1.37 μg/cm3). Accordingly, acyclovir-loaded dissolving MN arrays could be a promising approach for effective local delivery of acyclovir.
- Does suppressive antiviral therapy for herpes simplex virus prevent transmission in an HIV-positive population? A systematic review. [Journal Article]
- CCCan Commun Dis Rep 2016 Feb 04; 42(2):37-44
- CONCLUSIONS: Based on current evidence, suppressive antiviral therapy may reduce HSV detection and viral load, but its impact on HSV transmission is unclear. Clinicians should caution HIV-positive patients with HSV that suppressive therapy may not reduce risk of HSV transmission to susceptible partners.
- [Neonatal facial palsy: identification of herpes simplex virus 1 in cerebrospinal fluid. Case report]. [Journal Article]
- AAArch Argent Pediatr 2018 06 01; 116(3):e468-e470
- Neonatal facial palsy is very uncommon and is generally diagnosed at birth. We present the first published case of neonatal facial palsy with identification of herpes simplex virus 1 in cerebrospinal...
Neonatal facial palsy is very uncommon and is generally diagnosed at birth. We present the first published case of neonatal facial palsy with identification of herpes simplex virus 1 in cerebrospinal fluid. A 35-day-old male was presented at the Emergency Department with mouth deviation to the left and impossibility of full closure of the right eye. There were no symptoms of infection or relevant medical history. Physical examination was compatible with peripheral facial palsy. Studies performed at admission were normal (blood count, biochemical analysis and coagulation blood tests and cerebrospinal fluid analysis). The patient was admitted on oral prednisolone and intravenous aciclovir. Cranial magnetic resonance was normal. Polymerase chain reaction test for herpes simplex virus 1 in cerebrospinal fluid was reported positive after 48 hours of admission. Patient followed good evolution and received prednisolone for 7 days and acyclovir for 21 days. At discharge, neurological examination was normal.
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- Synergistic Effect of ZnO Nanoparticles and Carbon Nanotube and Polymeric Film on Electrochemical Oxidation of Acyclovir. [Journal Article]
- IJIran J Pharm Res 2018; 17(1):52-62
- A simple and selective carbon paste electrode has been developed for the electrochemical determination of acyclovir (ACV). This electrode was designed by incorporation of multi-walled carbon nanotube...
A simple and selective carbon paste electrode has been developed for the electrochemical determination of acyclovir (ACV). This electrode was designed by incorporation of multi-walled carbon nanotubes (MWCNTs) and ZnO nanoparticles into the carbon paste matrix, and then poly (o-aminophenol; OAP) film were subsequently electropolymerized on it. The surface structure of nanoparticles were characterized by scanning electron microscopy (SEM) and transmission electron microscopy (TEM). Surface morphology and electrochemical properties of the prepared nanocomposite modified electrode were investigated by SEM and cyclic voltammetry (CV). The calibration graph was linear over the concentration range 0.089 to 7.96 µg mL-1 for ACV determination with a detection limit of 0.067 µg mL-1. The proposed electrode was successfully applied for ACV determination in pharmaceutical formulations with satisfactory results.