1
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Piperi E, Papadopoulou E, Georgaki M, Dovrat S, Bar Illan M, Nikitakis NG, Yarom N. Management of oral herpes simplex virus infections: The problem of resistance. A narrative review. Oral Dis 2024; 30:877-894. [PMID: 37279074 DOI: 10.1111/odi.14635] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 05/02/2023] [Accepted: 05/21/2023] [Indexed: 06/07/2023]
Abstract
Herpes Simplex Virus (HSV) type 1 (HSV-1) and type 2 (HSV-2) are among the most common human viral pathogens, affecting several billion people worldwide. Although in healthy patients clinical signs and symptoms of HSV infection are usually mild and self-limiting, HSV-infections in immunocompromised patients are frequently more aggressive, persistent, and even life-threatening. Acyclovir and its derivatives are the gold standard antiviral drugs for the prevention and treatment of HSV infections. Although the development of acyclovir resistance is a rather uncommon condition, it may be associated with serious complications, especially in immunocompromised patients. In this review, we aim to address the problem of drug resistant HSV infection and discuss the available alternative therapeutic interventions. All relative studies concerning alternative treatment modalities of acyclovir resistant HSV infection published in PubMed between 1989 to 2022 were reviewed. Long-term treatment and prophylaxis with antiviral agents predisposes to drug resistance, especially in immunocompromised patients. Cidofovir and foscarnet could serve as alternative treatments in these cases. Although rare, acyclovir resistance may be associated with severe complications. Hopefully, in the future, novel antiviral drugs and vaccines will be available in order to avoid the existing drug resistance.
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Affiliation(s)
- Evangelia Piperi
- Department of Oral Medicine & Pathology and Hospital Dentistry, School of Dentistry, National and Kapodistrian University of Athens (NKUA), Athens, Greece
| | - Erofili Papadopoulou
- Department of Oral Medicine & Pathology and Hospital Dentistry, School of Dentistry, National and Kapodistrian University of Athens (NKUA), Athens, Greece
| | - Maria Georgaki
- Department of Oral Medicine & Pathology and Hospital Dentistry, School of Dentistry, National and Kapodistrian University of Athens (NKUA), Athens, Greece
| | - Sara Dovrat
- Central Virology Laboratory, Public Health Services, Ministry of Health, Sheba Medical Center, Tel-Hashomer, Israel
| | - Mor Bar Illan
- Oral Medicine Unit, Sheba Medical Center, Tel-Hashomer, Israel
| | - Nikolaos G Nikitakis
- Department of Oral Medicine & Pathology and Hospital Dentistry, School of Dentistry, National and Kapodistrian University of Athens (NKUA), Athens, Greece
| | - Noam Yarom
- Oral Medicine Unit, Sheba Medical Center, Tel-Hashomer, Israel
- School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
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2
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Wang CI, Chen YY, Yang Y, Gau SY, Huang CY, Tsai TH, Huang KH, Lee CY. Risk of herpes simplex virus infection in solid organ transplant recipients: A population-based cross-sectional study. Ann Epidemiol 2024; 89:21-28. [PMID: 38042439 DOI: 10.1016/j.annepidem.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 10/24/2023] [Accepted: 11/27/2023] [Indexed: 12/04/2023]
Abstract
BACKGROUND Herpes simplex virus (HSV) is an opportunistic infection antigen in solid organ transplant (SOT) recipients. However, this phenomenon has received limited attention from epidemiologists. Our study aims to determine the HSV infection risk in SOT recipients. METHODS This was a nationwide population-based cross-sectional study based on the National Health Insurance Research Database from 2002 to 2015. We used propensity score matching to avoid selection bias and analyzed the association between HSV infection and SOT recipients with multiple logistic regression analysis. RESULTS At a 3-year follow-up, SOT recipients had a higher risk of developing HSV, with an adjusted odds ratio (aOR) of 3.28 (95% confidence interval (CI), 2.51-4.29). Moreover, at 6-month, 1-year, and 2-year follow-ups, SOT recipients also had an increased risk of HSV than general patients with aORs of 3.85 (95% CI, 2.29-6.49), 4.27 (95% CI, 2.86-6.36), and 3.73 (95% CI, 2.74-5.08), respectively. In the subgroup analysis, lung transplant recipients (aOR = 8.01; 95% CI, 2.39-26.88) exhibited a significantly higher chance of HSV among SOT recipients, followed by kidney transplant recipients (aOR = 3.33; 95% CI, 2.11-5.25) and liver transplant recipients (aOR = 3.15; 95% CI, 2.28-4.34). CONCLUSION HSV can develop at any time after organ transplantation. SOT recipients had a higher risk of HSV infection than the general population at 6 months, 1 year, 2 years, and 3 years after transplantation, with the highest chance at 1 year after. In addition, the patients who underwent lung transplantion were at higher risk for HSV infection than liver or kidney transplant recipients.
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Affiliation(s)
- Ching-I Wang
- School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan; Department of Medical Education, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
| | - Yan-Yu Chen
- School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan; Department of Medical Education, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
| | - Yih Yang
- Department of Obstetrics and Gynecology, E-Da Hospital, I-Shou University, Kaohsiung 824, Taiwan
| | - Shuo-Yan Gau
- School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
| | - Cheng-Yang Huang
- School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
| | - Tung-Han Tsai
- Department of Health Services Administration, China Medical University, Taichung 40402, Taiwan
| | - Kuang-Hua Huang
- Department of Health Services Administration, China Medical University, Taichung 40402, Taiwan
| | - Chien-Ying Lee
- Department of Pharmacology, Chung Shan Medical University, Taichung 40201, Taiwan; Department of Pharmacy, Chung Shan Medical University Hospital, Taichung 40201, Taiwan.
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3
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Malahe SRK, van Kampen JJA, Manintveld OC, Hoek RAS, den Hoed CM, Baan CC, Kho MML, Verjans GMGM. Current Perspectives on the Management of Herpesvirus Infections in Solid Organ Transplant Recipients. Viruses 2023; 15:1595. [PMID: 37515280 PMCID: PMC10383436 DOI: 10.3390/v15071595] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/12/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
Solid organ transplant recipients (SOTRs) are at high risk of human herpesvirus (HHV)-related morbidity and mortality due to the use of immunosuppressive therapy. We aim to increase awareness and understanding of HHV disease burden in SOTRs by providing an overview of current prevention and management strategies as described in the literature and guidelines. We discuss challenges in both prevention and treatment as well as future perspectives.
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Affiliation(s)
- S Reshwan K Malahe
- Department of Internal Medicine, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands
- Erasmus MC Transplant Institute, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands
| | - Jeroen J A van Kampen
- Department of Viroscience, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands
| | - Olivier C Manintveld
- Erasmus MC Transplant Institute, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands
- Department of Cardiology, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands
| | - Rogier A S Hoek
- Erasmus MC Transplant Institute, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands
- Department of Pulmonary Medicine, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands
| | - Caroline M den Hoed
- Erasmus MC Transplant Institute, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands
| | - Carla C Baan
- Department of Internal Medicine, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands
- Erasmus MC Transplant Institute, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands
| | - Marcia M L Kho
- Department of Internal Medicine, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands
- Erasmus MC Transplant Institute, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands
| | - Georges M G M Verjans
- Department of Viroscience, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands
- HerpeslabNL, Department of Viroscience, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands
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4
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Heldman MR, Aagaard KM, Hill JA. Assessing and restoring adaptive immunity to HSV, VZV, and HHV-6 in solid organ and hematopoietic cell transplant recipients. Clin Microbiol Infect 2022; 28:1345-1350. [PMID: 35150885 PMCID: PMC9363517 DOI: 10.1016/j.cmi.2022.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 12/22/2021] [Accepted: 02/01/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Herpes simplex virus (HSV) 1 and 2, varicella zoster virus (VZV), and human herpesvirus 6 (HHV-6) cause severe infections in immunocompromised hosts. Interventions to optimize virus-specific adaptive immunity may have advantages over antivirals in the prophylaxis and treatment of these infections. OBJECTIVES We sought to review adaptive immune responses and methods for assessing and replenishing cellular and humoral immunity to HSV, VZV, and HHV-6 in solid organ transplant and hematopoietic cell transplant recipients. SOURCES We searched PubMed for relevant studies on immune responses to HSV, VZV, and HHV-6 as well as studies describing methods for evaluating and restoring cell-mediated immunity to other double-stranded DNA viruses in transplant recipients. Recent studies, randomized controlled trials, and investigations highlighting key concepts in clinical virology were prioritized for inclusion. CONTENT We describe the mechanisms of adaptive immunity to HSV, VZV, and HHV-6 and limitations of antivirals as prophylaxis and treatment for these infections in solid organ transplant and hematopoietic cell transplant recipients. We review methods for measuring and restoring cellular immunity to double-stranded DNA viruses; their potential applications to management of HSV, VZV, and HHV-6 in immunocompromised hosts; and barriers to clinical use. Vaccination and virus-specific T cell therapies are discussed in detail. IMPLICATIONS The growing repertoire of diagnostic and therapeutic techniques focused on virus-specific adaptive immunity provides a novel approach to management of viral infections in transplant recipients. Investigations to optimize such interventions specifically in HSV, VZV, and HHV-6 are needed.
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Affiliation(s)
- Madeleine R. Heldman
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Kaja M. Aagaard
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Joshua A. Hill
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA
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5
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Bacterial and Viral Infection and Sepsis in Kidney Transplanted Patients. Biomedicines 2022; 10:biomedicines10030701. [PMID: 35327510 PMCID: PMC8944970 DOI: 10.3390/biomedicines10030701] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 03/14/2022] [Accepted: 03/15/2022] [Indexed: 02/05/2023] Open
Abstract
Kidney transplanted patients are a unique population with intrinsic susceptibility to viral and bacterial infections, mainly (but not exclusively) due to continuous immunosuppression. In this setting, infectious episodes remain among the most important causes of death, with different risks according to the degree of immunosuppression, time after transplantation, type of infection, and patient conditions. Prevention, early diagnosis, and appropriate therapy are the goals of infective management, taking into account that some specific characteristics of transplanted patients may cause a delay (the absence of fever or inflammatory symptoms, the negativity of serological tests commonly adopted for the general population, or the atypical anatomical presentation depending on the surgical site and graft implantation). This review considers the recent available findings of the most common viral and bacterial infection in kidney transplanted patients and explores risk factors and outcomes in septic evolution.
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6
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Multani EK, Bajwa D, Multani PK, Nobakht E, Raj D, Paul RS, Paul RS. EYE DISEASE IN KIDNEY TRANSPLANTATION: CLINICAL CHALLENGES IN A UNIQUE PATIENT POPULATION. Surv Ophthalmol 2021; 67:1252-1269. [PMID: 34954092 DOI: 10.1016/j.survophthal.2021.12.007] [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: 10/28/2020] [Revised: 12/14/2021] [Accepted: 12/20/2021] [Indexed: 11/30/2022]
Abstract
Eye disease is common among kidney transplant recipients and their management is challenging. Chronic kidney disease is associated with ocular complications, both independently and in the context of various systemic disorders. In addition, chronic immunosuppression predisposes kidney transplant recipients to an array of long-term ocular issues. This may be broadly categorized into infections, malignancies, and other immunosuppression-specific side effects. The interdependence of kidney disease, transplant pharmacotherapy and ocular health therefore requires a multispecialty approach. Although the kidney transplant population has grown along with the burden of associated oculopathies, systematic guidelines targeting this patient group are lacking. This evidenced-based narrative review summarizes the pertinent issues that may present in the ophthalmic and optometric clinical settings, with emphasis on collaborative management and directions for future research.
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Affiliation(s)
- Eisha K Multani
- MY EYE DR OPTOMETRISTS LLC, 1330 CONNECTICUT AVE NW, WASHINGTON DC, 20037, UNITED STATES
| | - Dalvir Bajwa
- THE NEWCASTLE UPON TYNE HOSPITALS, NHS FOUNDATION TRUST, ROYAL VICTORIA INFIRMARY, QUEEN VICTORIA ROAD, NEWCASTLE UPON TYNE NE1 4LP, UNITED KINGDOM
| | - Priyanika K Multani
- INLAND VISION CENTER OPTOMETRY, 473 E CARNEGIE DR, SUITE 100, SAN BERNADINO, CA 92408
| | - Ehsan Nobakht
- DIVISION OF KIDNEY DISEASE & HYPERTENSION, GEORGE WASHINGTON UNIVERSITY, 2150 PENNSYVANIA AVENUE, SUITE 3-438, WASHINGTON DC, 20037, UNITED STATES
| | - Dominic Raj
- DIVISION OF KIDNEY DISEASE & HYPERTENSION, GEORGE WASHINGTON UNIVERSITY, 2150 PENNSYVANIA AVENUE, SUITE 3-438, WASHINGTON DC, 20037, UNITED STATES
| | - Rohan S Paul
- DIVISION OF KIDNEY DISEASE & HYPERTENSION, GEORGE WASHINGTON UNIVERSITY, 2150 PENNSYVANIA AVENUE, SUITE 3-438, WASHINGTON DC, 20037, UNITED STATES
| | - Rohan S Paul
- DIVISION OF KIDNEY DISEASE & HYPERTENSION, GEORGE WASHINGTON UNIVERSITY, 2150 PENNSYVANIA AVENUE, SUITE 3-438, WASHINGTON DC, 20037, UNITED STATES.
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7
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Kentley J, Allawh R, Rao S, Doyle A, Ahmad A, Nadhan K, Proby C, Harwood CA, Chung CL. The burden of cutaneous disease in solid organ transplant recipients of color. Am J Transplant 2021; 21:1215-1226. [PMID: 32659869 DOI: 10.1111/ajt.16210] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 06/11/2020] [Accepted: 07/02/2020] [Indexed: 01/25/2023]
Abstract
Organ transplant recipients (OTRs) are at increased risk of cutaneous malignancy. Skin disorders in OTRs of color (OTRoC) have rarely been systematically assessed. We aimed to ascertain the burden of skin disease encountered in OTRoC by prospectively collecting data from OTRs attending 2 posttransplant skin surveillance clinics: 1 in London, UK and 1 in Philadelphia, USA. Retrospective review of all dermatological diagnoses was performed. Data from 1766 OTRs were analyzed: 1024 (58%) white, 376 (21%) black, 261 (15%) Asian, 57 (3%) Middle Eastern/Mediterranean (ME/M), and 48 (2.7%) Hispanic; and 1128 (64%) male. Viral infections affected 45.1% of OTRs, and were more common in white and ME/M patients (P < .001). Fungal infections affected 28.1% and were more common in ME/M patients (P < .001). Inflammatory skin disease affected 24.5%, and was most common in black patients (P < .001). In addition, 26.4% of patients developed skin cancer. There was an increased risk of skin cancer in white vs nonwhite OTRs (HR 4.4, 95% CI 3.5-5.7, P < .001): keratinocyte cancers were more common in white OTRs (P < .001) and Kaposi sarcoma was more common in black OTRs (P < .001). These data support the need for programs that promote targeted dermatology surveillance for all OTRs, regardless of race/ethnicity or country of origin.
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Affiliation(s)
- Jonathan Kentley
- Department of Dermatology, Royal London Hospital, Barts Health NHS Trust, London, UK.,Department of Dermatology, Chelsea and Westminster Hospital, London, UK
| | - Rina Allawh
- Montgomery Dermatology, Lankenau Institute for Medical Research, King of Prussia, Wynnewood, Pennsylvania, USA
| | - Swati Rao
- Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Alden Doyle
- Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Amar Ahmad
- Department of Cancer Intelligence, Cancer Research UK, London, UK
| | - Kumar Nadhan
- Department of Dermatology, John H Stroger Hospital of Cook County, Chicago, Illinois, USA
| | - Charlotte Proby
- Jacqui Wood Cancer Centre, School of Medicine, University of Dundee, Dundee, UK
| | - Catherine A Harwood
- Department of Dermatology, Royal London Hospital, Barts Health NHS Trust, London, UK.,Centre for Cell Biology and Cutaneous Research, Blizard Institute, Queen Mary University of London, London, UK
| | - Christina L Chung
- Montgomery Dermatology, Lankenau Institute for Medical Research, King of Prussia, Wynnewood, Pennsylvania, USA
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8
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Akagi T, Mukai T, Fujita S, Yamamoto T, Fukuda M, Morita Y. Severe oral stomatitis due to reactivation of herpes simplex virus type 1 in a methotrexate-treated patient with dermatomyositis. Immunol Med 2020; 44:56-60. [PMID: 32649847 DOI: 10.1080/25785826.2020.1787585] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
We herein report a case of a 79-year-old Japanese woman who developed severe oral stomatitis during methotrexate (MTX) treatment for dermatomyositis. She had been treated with MTX (12 mg/week) and prednisolone (5 mg/day) for dermatomyositis for 4 years. She developed painful stomatitis, fever, and pancytopenia. Initially, her symptoms were suspected to be caused by mucosal toxicity of MTX. Therefore, the drug was discontinued, and leucovorin was administered. However, oral stomatitis worsened in a few days, resulting in intolerance of oral ingestion due to severe pain. Polymerase chain reaction revealed the presence of herpes simplex virus type 1 (HSV-1) in oral erosive lesions, and blood examination was positive and negative for anti-HSV IgG and anti-HSV IgM, respectively. Therefore, HSV-1 reactivation-induced oral stomatitis was diagnosed, and acyclovir treatment was started, which promptly improved oral stomatitis. HSV-1 reactivation is usually asymptomatic or results in localized vesicular lesions at the mucocutaneous junction of the lips in immunocompetent individuals. Our case illustrates that HSV-1 reactivation induces severe stomatitis in patients treated with low-dose MTX for autoimmune diseases, not just in those with severe immunosuppressive conditions. Of note, HSV-1 reactivation-induced stomatitis is a diagnostic challenge, especially during MTX treatment.
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Affiliation(s)
- Takahiko Akagi
- Department of Rheumatology, Kawasaki Medical School, Kurashiki, Japan
| | - Tomoyuki Mukai
- Department of Rheumatology, Kawasaki Medical School, Kurashiki, Japan
| | - Shunichi Fujita
- Department of Rheumatology, Kawasaki Medical School, Kurashiki, Japan
| | - Takenobu Yamamoto
- Department of Dermatology, Kawasaki Medical School, Kurashiki, Japan
| | - Mikiko Fukuda
- Department of Dermatology, Kawasaki Medical School, Kurashiki, Japan
| | - Yoshitaka Morita
- Department of Rheumatology, Kawasaki Medical School, Kurashiki, Japan
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9
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Santosh ABR, Muddana K. Viral infections of oral cavity. J Family Med Prim Care 2020; 9:36-42. [PMID: 32110562 PMCID: PMC7014888 DOI: 10.4103/jfmpc.jfmpc_807_19] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 11/23/2019] [Accepted: 12/04/2019] [Indexed: 12/15/2022] Open
Abstract
Viral infections of the oral cavity usually manifest as either ulceration or blistering presentation of oral tissues. Oral viral infections are encountered in dental practice but received less clinical interest due to the lesser frequency of patients and diagnostic challenges. The clinical presentation, pathogenic mechanism, investigations, and management of oral viral infections are integrated into the article which will enable general dentists to develop critical thinking processes on differential diagnosis and management through a multidisciplinary approach with specialist dentists.
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Affiliation(s)
- Arvind Babu Rajendra Santosh
- Oral and Maxillofacial Pathologist, School of Dentistry, The University of the West Indies, Mona, Kingston, Jamaica, West Indies, Jamaica
| | - Keerthi Muddana
- Oral and Maxillofacial Pathologist, Department of Oral and Maxillofacial Pathology, Kamineni Institute of Dental Sciences, Sreepuram, Narketpally, Nalgonda - 508 254, Telangana, India
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10
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Abati E, Gagliardi D, Velardo D, Meneri M, Conte G, Cinnante C, Bresolin N, Comi G, Corti S. Herpes Simplex virus type 2 myeloradiculitis with a pure motor presentation in a liver transplant recipient. Transpl Infect Dis 2019; 22:e13236. [PMID: 31868290 DOI: 10.1111/tid.13236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 10/31/2019] [Accepted: 12/09/2019] [Indexed: 12/25/2022]
Abstract
In this case report, we describe the first PCR-confirmed case of HSV2 myeloradiculitis with a purely motor presentation, occurring in a 68-year-old liver transplant recipient. The patient reported ascending weakness with no sensory nor sphincteric symptoms, thereby resembling acute demyelinating inflammatory neuropathy, or Guillain-Barré syndrome. HSV2 was detected in cerebrospinal fluid by PCR, and the patient was successfully treated with intravenous Acyclovir.
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Affiliation(s)
- Elena Abati
- Department of Pathophysiology and Transplantation (DEPT), Dino Ferrari Centre, Neuroscience Section, University of Milan, Milan, Italy
| | - Delia Gagliardi
- Department of Pathophysiology and Transplantation (DEPT), Dino Ferrari Centre, Neuroscience Section, University of Milan, Milan, Italy
| | - Daniele Velardo
- Neurology Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Megi Meneri
- Neurology Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giorgio Conte
- Neuroradiology Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Claudia Cinnante
- Neuroradiology Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Nereo Bresolin
- Department of Pathophysiology and Transplantation (DEPT), Dino Ferrari Centre, Neuroscience Section, University of Milan, Milan, Italy.,Neurology Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giacomo Comi
- Department of Pathophysiology and Transplantation (DEPT), Dino Ferrari Centre, Neuroscience Section, University of Milan, Milan, Italy.,Neurology Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Stefania Corti
- Department of Pathophysiology and Transplantation (DEPT), Dino Ferrari Centre, Neuroscience Section, University of Milan, Milan, Italy.,Neurology Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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11
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Lee DH, Zuckerman RA. Herpes simplex virus infections in solid organ transplantation: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant 2019; 33:e13526. [PMID: 30859647 DOI: 10.1111/ctr.13526] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 02/27/2019] [Indexed: 12/19/2022]
Abstract
These updated guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation review the diagnosis, prevention, and management of HSV in the pre- and post-transplant period. A majority of transplant recipients are seropositive for HSV-1 or 2. Compared with immunocompetent persons, SOT recipients shed HSV more frequently, have more severe clinical manifestations, and are slower to respond to therapy. Most HSV infection is diagnosed on clinical grounds, but patients may present with atypical lesions and/or other clinical manifestations. Acquisition from the donor is rare. Polymerase chain reaction is the preferred diagnostic test unless culture is needed for resistance testing. For limited mucocutaneous lesions, oral therapy can be used; however, in severe, disseminated, visceral or CNS involvement, acyclovir doses of up to 10 mg/kg every 8 hours intravenously should be initiated. Acyclovir-resistant HSV is less common in SOT patients than in HSCT and can be treated with foscarnet, though other novel therapies are currently under investigation. HSV-specific prophylaxis should be considered for all HSV-1 and HSV-2-seropositive organ recipients who are not receiving antiviral medication for CMV prevention that has activity against HSV.
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Affiliation(s)
- Dong H Lee
- Division of Infectious Diseases and HIV Medicine, College of Medicine, Drexel University, Philadelphia, Pennsylvania
| | - Richard A Zuckerman
- Infectious Disease Service for Transplant and Immunocompromised Hosts, Section of Infectious Disease and International Health, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
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12
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Buonomo AR, Zappulo E, Viceconte G, Scotto R, Borgia G, Gentile I. Risk of opportunistic infections in patients treated with alemtuzumab for multiple sclerosis. Expert Opin Drug Saf 2018; 17:709-717. [PMID: 29848085 DOI: 10.1080/14740338.2018.1483330] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Alemtuzumab is a monoclonal anti CD-52 antibody recently approved for use in relapsing-remitting multiple sclerosis(MS). Given that the targeted antigen is primarily expressed on B and T lymphocytes, the administration of this biological drug is associated with rapid but protracted peripheral lymphopenia. AREAS COVERED The impact on infective risk of this immune impairment is still to be fully understood. In this review, we attempt to summarize all the available literature concerning opportunistic infections occurring in patients with MS receiving alemtuzumab. Infective adverse events were observed in more than 70% of patients in phase 2/3 RCTs, mainly of mild-to-moderate severity. Nevertheless, several post-marketing reports documented cases of serious, rare, and unexpected infections. EXPERT OPINION Predictive risk factors and prognostic features of opportunistic infections in this setting still need to be exactly assessed. At present, the only recommended preventive measures consist in anti-herpetic prophylaxis, Listeria-free diet, Tuberculosis prophylaxis and annual Papillomavirus screening. Given the non-negligible risk of unpredicted infective events, we advise physicians to take into account patients' history of infectious diseases and vaccine status and to consider supplementary prophylactic strategies, including screening for Toxoplasma gondii and viral hepatitis serostatus as well as pre-emptive approaches to avert CMV reactivation and Pneumocystosis.
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Affiliation(s)
- Antonio Riccardo Buonomo
- a Department of Clinical Medicine and Surgery - Section of Infectious Diseases , University of Naples "Federico II" , Naples , Italy
| | - Emanuela Zappulo
- a Department of Clinical Medicine and Surgery - Section of Infectious Diseases , University of Naples "Federico II" , Naples , Italy
| | - Giulio Viceconte
- a Department of Clinical Medicine and Surgery - Section of Infectious Diseases , University of Naples "Federico II" , Naples , Italy
| | - Riccardo Scotto
- a Department of Clinical Medicine and Surgery - Section of Infectious Diseases , University of Naples "Federico II" , Naples , Italy
| | - Guglielmo Borgia
- a Department of Clinical Medicine and Surgery - Section of Infectious Diseases , University of Naples "Federico II" , Naples , Italy
| | - Ivan Gentile
- a Department of Clinical Medicine and Surgery - Section of Infectious Diseases , University of Naples "Federico II" , Naples , Italy
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13
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Chung CL, Nadhan KS, Shaver CM, Ogrich LM, Abdelmalek M, Cusack CA, Malat GE, Pritchett EN, Doyle A. Comparison of Posttransplant Dermatologic Diseases by Race. JAMA Dermatol 2017; 153:552-558. [PMID: 28273280 DOI: 10.1001/jamadermatol.2017.0045] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Importance The risk for skin cancer has been well characterized in white organ transplant recipients (OTRs); however, most patients on the waiting list for organ transplant in the United States are nonwhite. Little is known about cutaneous disease and skin cancer risk in this OTR population. Objective To compare the incidence of cutaneous disease between white and nonwhite OTRs. Design, Setting, and Participants This retrospective review of medical records included 412 OTRs treated from November 1, 2011, through April 22, 2016, at an academic referral center. Prevalence and characteristics of cutaneous disease were compared in 154 white and 258 nonwhite (ie, Asian, Hispanic, and black) OTRs. Clinical factors of cutaneous disease and other common diagnoses assessed in OTRs included demographic characteristics, frequency and type of cancer, anatomical location, time course, sun exposure, risk awareness, and preventive behavior. Main Outcomes and Measures Primary diagnosis of malignant or premalignant, infectious, and inflammatory disease. Results The 412 patients undergoing analysis included 264 men (64.1%) and 148 women (35.9%), with a mean age of 60.1 years (range, 32.1-94.3 years). White OTRs more commonly had malignant disease at their first visit (82 [67.8%]), whereas nonwhite OTRs presented more commonly with infectious (63 [37.5%]) and inflammatory (82 [48.8%]) conditions. Skin cancer was diagnosed in 64 (41.6%) white OTRs and 15 (5.8%) nonwhite OTRs. Most lesions in white (294 of 370 [79.5%]) and Asian (5 of 6 [83.3%]) OTRs occurred in sun-exposed areas. Among black OTRs, 6 of 9 lesions (66.7%) occurred in sun-protected areas, specifically the genitals. Fewer nonwhite than white OTRs reported having regular dermatologic examinations (5 [11.4%] vs 8 [36.4%]) and knowing the signs of skin cancer (11 [25.0%] vs 10 [45.4%]). Conclusions and Relevance Early treatment of nonwhite OTRs should focus on inflammatory and infectious diseases. Sun protection should continue to be emphasized in white, Asian, and Hispanic OTRs. Black OTRs should be counseled to recognize the signs of genital human papillomavirus infection. Optimal posttransplant dermatologic care may be determined based on the race or ethnicity of the patients, but a baseline full-skin assessment should be performed in all patients. All nonwhite OTRs should be counseled more effectively on the signs of skin cancer, with focused discussion points contingent on skin type and race or ethnicity.
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Affiliation(s)
| | - Kumar S Nadhan
- Department of Dermatology, Drexel University, Philadelphia, Pennsylvania
| | - Christine M Shaver
- Department of Dermatology, Drexel University, Philadelphia, Pennsylvania
| | - Lauren M Ogrich
- Department of Dermatology, Drexel University, Philadelphia, Pennsylvania
| | - Mark Abdelmalek
- Department of Dermatology, Drexel University, Philadelphia, Pennsylvania
| | - Carrie Ann Cusack
- Department of Dermatology, Drexel University, Philadelphia, Pennsylvania
| | - Gregory E Malat
- Department of Surgery, Drexel University, Philadelphia, Pennsylvania
| | | | - Alden Doyle
- Department of Internal Medicine, Drexel University, Philadelphia, Pennsylvania
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14
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Hemmersbach-Miller M, Duronville J, Sethi S, Miller SE, Howell DN, Henshaw N, Alexander BD, Roberts JK. Hemorrhagic Herpes Simplex Virus Type 1 Nephritis: An Unusual Cause of Acute Allograft Dysfunction. Am J Transplant 2017; 17:287-291. [PMID: 27545820 DOI: 10.1111/ajt.14022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Revised: 08/16/2016] [Accepted: 08/17/2016] [Indexed: 01/25/2023]
Abstract
Interstitial nephritis due to viruses is well-described after solid organ transplantation. Viruses implicated include cytomegalovirus; BK polyomavirus; Epstein-Barr virus; and, less commonly, adenovirus. We describe a rare case of hemorrhagic allograft nephritis due to herpes simplex virus type 1 at 10 days after living donor kidney transplantation. The patient had a favorable outcome with intravenous acyclovir and reduction of immunosuppression.
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Affiliation(s)
- M Hemmersbach-Miller
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, NC
| | - J Duronville
- Division of Nephrology, Department of Medicine, Duke University Medical Center, Durham, NC
| | - S Sethi
- Division of Nephrology, Department of Medicine, Duke University Medical Center, Durham, NC
| | - S E Miller
- Department of Pathology, Duke University Medical Center, Durham, NC
| | - D N Howell
- Department of Pathology, Duke University Medical Center, Durham, NC
| | - N Henshaw
- Clinical Microbiology Laboratory, Duke University Medical Center, Durham, NC
| | - B D Alexander
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, NC
| | - J K Roberts
- Division of Nephrology, Department of Medicine, Duke University Medical Center, Durham, NC
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15
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Abstract
A wide spectrum of drugs can sometimes give rise to numerous adverse orofacial manifestations, particularly dry mouth, taste disturbances, oral mucosal ulceration, and/or gingival swelling. There are few relevant randomized double-blind controlled studies in this field, and therefore this paper reviews the data from case reports, small series, and non-peer-reviewed reports of adverse drug reactions affecting the orofacial region (available from a MEDLINE search to April, 2003). The more common and significant adverse orofacial consequences of drug therapy are discussed.
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Affiliation(s)
- C Scully
- Eastman Dental Institute for Oral Health Care Sciences, University College, University of London, 256 Gray's Inn Road, London WC1X 8LD, UK.
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16
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Bennett L, Dunham S, Yon L, Chapman S, Kenaghan M, Purdie L, Tarlinton R. Longitudinal study of Asian elephants, Elephas maximus, indicates intermittent shedding of elephant endotheliotropic herpesvirus 1 during pregnancy. Vet Rec Open 2015; 2:e000088. [PMID: 26392899 PMCID: PMC4567181 DOI: 10.1136/vetreco-2014-000088] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 06/12/2015] [Accepted: 06/15/2015] [Indexed: 11/04/2022] Open
Abstract
Introduction EEHV-1 is a viral infection of elephants that has been associated with a fatal haemorrhagic syndrome in Asian elephants. Previous studies have suggested that pregnant animals may shed more virus than non-pregnant animals. Methods This study examined whether pregnancy affected the frequency or magnitude of shedding of elephant endotheliotropic herpesvirus 1 (EEHV1) using Taq man real-time PCR on trunk washes from four female elephants from a UK collection over three time periods between 2011 and 2014. These periods included pregnancies in two animals (period 1 and period 3). Behavioural observations made by keepers were also assessed. Results During period 1 there was a high degree of social hierarchical instability which led to a hierarchy change, and was associated with aggressive behaviour. Also during period 1 EEHV-1 shedding was of a higher magnitude and frequency than in the latter two time periods. Conclusions These results suggest that there is no clear relationship between shedding and pregnancy, and that behavioural stressors may be related to an increase in EEHV-1 shedding.
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Affiliation(s)
- Laura Bennett
- School of Veterinary Medicine and Science, University of Nottingham , Sutton Bonington Campus, Loughborough , LE12 5RD, UK
| | - Stephen Dunham
- School of Veterinary Medicine and Science, University of Nottingham , Sutton Bonington Campus, Loughborough , LE12 5RD, UK
| | - Lisa Yon
- School of Veterinary Medicine and Science, University of Nottingham , Sutton Bonington Campus, Loughborough , LE12 5RD, UK
| | - Sarah Chapman
- Twycross Zoo , Burton Road, Atherstone, Warwickshire , CV9 3PX, UK
| | - Megan Kenaghan
- School of Veterinary Medicine and Science, University of Nottingham , Sutton Bonington Campus, Loughborough , LE12 5RD, UK
| | - Laura Purdie
- School of Veterinary Medicine and Science, University of Nottingham , Sutton Bonington Campus, Loughborough , LE12 5RD, UK
| | - Rachael Tarlinton
- School of Veterinary Medicine and Science, University of Nottingham , Sutton Bonington Campus, Loughborough , LE12 5RD, UK
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17
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Kulshreshtha G, Burlot AS, Marty C, Critchley A, Hafting J, Bedoux G, Bourgougnon N, Prithiviraj B. Enzyme-assisted extraction of bioactive material from Chondrus crispus and Codium fragile and its effect on herpes simplex virus (HSV-1). Mar Drugs 2015; 13:558-80. [PMID: 25603348 PMCID: PMC4306952 DOI: 10.3390/md13010558] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 01/04/2015] [Indexed: 11/16/2022] Open
Abstract
Codium fragile and Chondrus crispus are, respectively, green and red seaweeds which are abundant along the North Atlantic coasts. We investigated the chemical composition and antiviral activity of enzymatic extracts of C. fragile (CF) and C. crispus (CC). On a dry weight basis, CF consisted of 11% protein, 31% neutral sugars, 0.8% sulfate, 0.6% uronic acids, and 49% ash, while CC contained 27% protein, 28% neutral sugars, 17% sulfate, 1.8% uronic acids, and 25% ash. Enzyme-assisted hydrolysis improved the extraction efficiency of bioactive materials. Commercial proteases and carbohydrases significantly improved (p ≤ 0.001) biomass yield (40%-70% dry matter) as compared to aqueous extraction (20%-25% dry matter). Moreover, enzymatic hydrolysis enhanced the recovery of protein, neutral sugars, uronic acids, and sulfates. The enzymatic hydrolysates exhibited significant activity against Herpes simplex virus (HSV-1) with EC50 of 77.6-126.8 μg/mL for CC and 36.5-41.3 μg/mL for CF, at a multiplicity of infection (MOI) of 0.001 ID50/cells without cytotoxity (1-200 μg/mL). The extracts obtained from proteases (P1) and carbohydrases (C3) were also effective at higher virus MOI of 0.01 ID50/cells without cytotoxity. Taken together, these results indicate the potential application of enzymatic hydrolysates of C. fragile and C. crispus in functional food and antiviral drug discovery.
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Affiliation(s)
- Garima Kulshreshtha
- Department of Environmental Sciences, Faculty of Agriculture, Dalhousie University, PO Box 550, Truro, NS B2N 5E3, Canada.
| | - Anne-Sophie Burlot
- Laboratoire de Biotechnologie et Chimie Marines, EA3884, UBS, IUEM, F-56000 Vannes, France.
| | - Christel Marty
- Laboratoire de Biotechnologie et Chimie Marines, EA3884, UBS, IUEM, F-56000 Vannes, France.
| | - Alan Critchley
- Acadian Seaplants Limited, 30 Brown Avenue, Dartmouth, NS B3B 1X8, Canada.
| | - Jeff Hafting
- Acadian Seaplants Limited, 30 Brown Avenue, Dartmouth, NS B3B 1X8, Canada.
| | - Gilles Bedoux
- Laboratoire de Biotechnologie et Chimie Marines, EA3884, UBS, IUEM, F-56000 Vannes, France.
| | - Nathalie Bourgougnon
- Laboratoire de Biotechnologie et Chimie Marines, EA3884, UBS, IUEM, F-56000 Vannes, France.
| | - Balakrishnan Prithiviraj
- Department of Environmental Sciences, Faculty of Agriculture, Dalhousie University, PO Box 550, Truro, NS B2N 5E3, Canada.
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18
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Abstract
Oral herpes virus infections (OHVIs) are among the most common mucosal disorders encountered by oral health care providers. These infections can affect individuals at any age, from infants to the elderly, and may cause significant pain and dysfunction. Immunosuppressed patients may be at increased risk for serious and potential life-threatening complications caused by OHVIs. Clinicians may have difficulty in diagnosing these infections because they can mimic other conditions of the oral mucosa. This article provides oral health care providers with clinically relevant information regarding etiopathogenesis, diagnosis, and management of OHVIs.
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Affiliation(s)
- Ramesh Balasubramaniam
- Orofacial Pain Clinic, School of Dentistry, University of Western Australia, 35 Stirling Highway, Crawley, Western Australia 6009, Australia; Perth Oral Medicine and Dental Sleep Centre, St John of God Hospital, Suite 311, 25 McCourt Street, Subiaco, Western Australia 6008, Australia
| | - Arthur S Kuperstein
- Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, 240 South 40th Street, Room 207, Philadelphia, PA 19104, USA
| | - Eric T Stoopler
- Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, 240 South 40th Street, Room 206, Philadelphia, PA 19104, USA.
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19
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Minami M, Kita M, Nakaya T, Yamamoto T, Kuriyama H, Imanishi J. The Inhibitory Effect of Essential Oils on Herpes Simplex Virus Type-1 ReplicationIn Vitro. Microbiol Immunol 2013; 47:681-4. [PMID: 14584615 DOI: 10.1111/j.1348-0421.2003.tb03431.x] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The antiviral effect of 12 essential oils on herpes simplex virus type-1 (HSV-1) replication was examined in vitro. The replication ability of HSV-1 was suppressed by incubation of HSV-1 with 1% essential oils at 4 C for 24 hr. Especially, lemongrass completely inhibited the viral replication even at a concentration of 0.1%, and its antiviral activity was dependent on the concentrations of the essential oil. When Vero cells were treated with the essential oil before or after viral adsorption, no antiviral activity was found, which suggests that the antiviral activity of essential oils including lemongrass may be due to the direct interaction with virions.
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Affiliation(s)
- Masato Minami
- Department of Microbiology, Kyoto Prefectural University of Medicine, Kyoto, Kyoto 602-8566, Japan
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20
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Donalisio M, Nana HM, Ngono Ngane RA, Gatsing D, Tiabou Tchinda A, Rovito R, Cagno V, Cagliero C, Boyom FF, Rubiolo P, Bicchi C, Lembo D. In vitro anti-Herpes simplex virus activity of crude extract of the roots of Nauclea latifolia Smith (Rubiaceae). BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2013; 13:266. [PMID: 24131916 PMCID: PMC3852819 DOI: 10.1186/1472-6882-13-266] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 09/24/2013] [Indexed: 11/17/2022]
Abstract
Background Nauclea latifolia Smith, a shrub belonging to the family Rubiaceae is a very popular medicinal plant in Cameroon and neighboring countries where it is used to treat jaundice, yellow fever, rheumatism, abdominal pains, hepatitis, diarrhea, dysentery, hypertension, as well as diabetes. The ethno-medicinal use against yellow fever, jaundice and diarrhea prompted us to investigate on the antiviral activity of the root bark of N. latifolia. In this study, HSV-2 was chosen as a viral model because of its strong impact on HIV transmission and acquisition. Methods The crude extract under study was prepared by maceration of air-dried and powdered roots barks of N. latifolia in CH2Cl2/MeOH (50:50) mixture for 48 hours, then it was subjected to filtration and evaporation under vacuum. A phytochemical analysis of the crude extract was performed by High Performance Liquid Chromatography coupled with a photodiode array and mass spectrometry (HPLC-PDA-ESI-qMS). The anti-HSV-2 activity was assayed in vitro by plaque reduction and virus yield assays and the major mechanism of action was investigated by virucidal and time of addition assays. Data values were compared using the Extra sum of squares F test of program GraphPad PRISM 4. Results The main components detected in the extract belong to the class of indole alkaloids characteristic of Nauclea genus. Strictosamide, vincosamide and pumiloside were tentatively identified together with quinovic acid glycoside. N. latifolia crude extract inhibited both acyclovir sensitive and acyclovir resistant HSV-2 strains, with IC50 values of 5.38 μg/ml for the former and 7.17 μg/ml for the latter. The extract was found to be most active when added post-infection, with IC50 of 3.63 μg/ml. Conclusion The results of this work partly justify the empirical use of N. latifolia in traditional medicine for the treatment of viral diseases. This extract could be a promising rough material for the development of a new and more effective modern anti-HSV-2 medication also active against acyclovir-resistant HSV-2 strains.
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21
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Wilck MB, Zuckerman RA. Herpes simplex virus in solid organ transplantation. Am J Transplant 2013; 13 Suppl 4:121-7. [PMID: 23465005 DOI: 10.1111/ajt.12105] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- M B Wilck
- Division of Infectious Diseases, Hospital of University of Pennsylvania, Philadelphia, PA, USA
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22
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Zuckerman RA, Limaye AP. Varicella zoster virus (VZV) and herpes simplex virus (HSV) in solid organ transplant patients. Am J Transplant 2013; 13 Suppl 3:55-66; quiz 66. [PMID: 23347214 DOI: 10.1111/ajt.12003] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Revised: 09/06/2012] [Accepted: 09/07/2012] [Indexed: 01/25/2023]
Abstract
Varicella zoster virus (VZV) and the two herpes simplex viruses (HSV) are human α-herpesviruses that establish life-long latency in neural ganglia after initial primary infection. In the solid organ transplant (SOT) population, manifestations of VZV or HSV may be seen in up to 70% of recipients if no prophylaxis is used, some of them life and organ threatening. While there are effective vaccines to prevent VZV primary infection and reactivation in immunocompetent adults, these vaccines are contraindicated after SOT because they are live-virus vaccines. For HSV, prevention has focused primarily on antiviral strategies because the immunologic correlates of protection and control are different from VZV, making vaccine development more challenging. Current antiviral therapy remains effective for the majority of clinical VZV and HSV infections.
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Affiliation(s)
- R A Zuckerman
- Department of Medicine, Section of Infectious Disease and International Health, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
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23
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Khozeimeh F, Jafari N, Attar AM, Jafari S, Ataie M. Comparative analysis of salivary zinc level in recurrent herpes labialis. Dent Res J (Isfahan) 2012; 9:19-23. [PMID: 22363358 PMCID: PMC3283972 DOI: 10.4103/1735-3327.92922] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Recurrent Herpes Labialis (RHL) is one of most common infective vesiculoulcerative lesions. According to some studies administration of topical and/or systemic zinc compositions has been effective in treatment and prevention. This article aims to comparison of zinc level in healthy subjects and RHL patients in acute and convalescent phases. MATERIALS AND METHODS This was a retrospective case - control study, carried on 80 individuals (40 normal and 40 RHL patients) mean age=34.5 and 34.4, respectively. Saliva samples were taken in patients in acute phase once and after healing of lesions in convalescent phase (averagely 21 days later) and in normal individuals. Salivary zinc level concentration was measured by flame atomic absorption spectrophotometer by dry digestion method. The results were statistically analyzed with SPSS software by t-test (α=0.05). RESULTS Results showed that salivary zinc level in case group in acute and convalescent phases were 160.8 (ngr)/(ml)and 205.7 (ngr)/(ml) respectivly and significant differences between them were existed (P <0.05). Also significant differences were existed between zinc concentration in healthy subjects and patient groups (in both phases) (P=.001 and .002 for acute and convalescent phases respectively). CONCLUSION According to the results, zinc level is significantly lower in acute phase than in convalescent phase and significantly lower in both phases compared to healthy individuals,so determination of serum zinc level and prescribing zinc complement in low serum status has both treatmental and preventive effects in RHL patients.
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Affiliation(s)
- Faezeh Khozeimeh
- Department of Oral Medicine and Torabinegad Dental Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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24
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2-[4,5-Difluoro-2-(2-fluorobenzoylamino)-benzoylamino]benzoic acid, an antiviral compound with activity against acyclovir-resistant isolates of herpes simplex virus types 1 and 2. Antimicrob Agents Chemother 2012; 56:5735-43. [PMID: 22908173 DOI: 10.1128/aac.01072-12] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Herpes simplex viruses 1 and 2 (HSV-1 and HSV-2) are responsible for lifelong latent infections in humans, with periods of viral reactivation associated with recurring ulcerations in the orofacial and genital tracts. In immunosuppressed patients and neonates, HSV infections are associated with severe morbidity and, in some cases, even mortality. Today, acyclovir is the standard therapy for the management of HSV infections. However, the need for novel antiviral agents is apparent, since HSV isolates resistant to acyclovir therapy are frequently isolated in immunosuppressed patients. In this study, we assessed the anti-HSV activity of the antiadenoviral compounds 2-[2-(2-benzoylamino)-benzoylamino]benzoic acid (benzavir-1) and 2-[4,5-difluoro-2-(2-fluorobenzoylamino)-benzoylamino]benzoic acid (benzavir-2) on HSV-1 and HSV-2. Both compounds were active against both viruses. Importantly, benzavir-2 had potency similar to that of acyclovir against both HSV types, and it was active against clinical acyclovir-resistant HSV isolates.
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25
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Fisher BT, Alexander S, Dvorak CC, Zaoutis TE, Zerr DM, Sung L. Epidemiology and potential preventative measures for viral infections in children with malignancy and those undergoing hematopoietic cell transplantation. Pediatr Blood Cancer 2012; 59:11-5. [PMID: 22102619 PMCID: PMC4008326 DOI: 10.1002/pbc.23417] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Accepted: 10/11/2011] [Indexed: 12/02/2022]
Abstract
In pediatric patients with malignancy and those receiving hematopoietic stem cell transplants, bacterial and fungal infections have been the focus of fever and neutropenia episodes for decades. However, improved diagnostic capabilities have revealed viral pathogens as a significant cause of morbidity and mortality. Because of limited effective antiviral therapies, prevention of viral infections is paramount. Pre-exposure and post-exposure prophylaxis and antiviral suppressive therapeutic approaches are reviewed. Additionally, infection control practices specific to this patient population are discussed. A comprehensive approach utilizing each of these can be effective at reducing the negative impact of viral infections.
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Affiliation(s)
- Brian T. Fisher
- Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Sarah Alexander
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Christopher C. Dvorak
- Division of Pediatric Blood & Marrow Transplant, University of California San Francisco, San Francisco, California
| | - Theoklis E. Zaoutis
- Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Danielle M. Zerr
- Division of Infectious Diseases, Seattle Children's Hospital, Seattle, Washington
| | - Lillian Sung
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
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26
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Razonable RR. Management of viral infections in solid organ transplant recipients. Expert Rev Anti Infect Ther 2011; 9:685-700. [PMID: 21692673 DOI: 10.1586/eri.11.43] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Management of viral infections after transplantation involves antiviral drug therapy (if available) and reduction in immunosuppression, which allows for development of pathogen-specific immunity to the offending virus. Prevention of viral infections is of the utmost importance, and this may be accomplished through vaccination, antiviral strategies and infection control measures. This article discusses the current management of selected viral pathogens that cause clinical illness in solid organ transplant recipients. The benefits and toxicities of antiviral therapies are discussed in the context of prevention and treatment of various viral diseases. The emerging issue of antiviral resistance is emphasized for cytomegalovirus, recurrent hepatitis B and influenza, while the importance of immunominimization is discussed in the management of BK nephropathy and virus-associated malignancies.
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Affiliation(s)
- Raymund R Razonable
- Division of Infectious Diseases, Department of Medicine, and the William J von Leibig Transplant Center, College of Medicine, Mayo Clinic, Rochester, MN 55905, USA.
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27
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Hemorrhagic cystitis secondary to adenovirus or herpes simplex virus infection following renal transplantation: four case reports. Transplant Proc 2010; 41:4416-9. [PMID: 20005412 DOI: 10.1016/j.transproceed.2009.09.059] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2009] [Revised: 08/07/2009] [Accepted: 09/02/2009] [Indexed: 11/22/2022]
Abstract
Viral infections are common complications following renal transplantation. However, there have been few reported cases of viral cystitis secondary to herpes simplex virus or adenovirus infection. Herein, we have reported four cases of hemorrhagic cystitis secondary to infections with herpes simplex virus and adenovirus following renal transplantation. The etiology was adenovirus in three cases and herpes simplex virus in the remaining case. In all four cases, the primary cause of the renal dysfunction was diabetic nephropathy. All four patients presented with a clinical profile characterized by dysuria, pollakiuria, macroscopic hematuria, and graft dysfunction. Three of the four patients developed these symptoms within the first 3 months after renal transplantation. In all four cases, there was an increase, albeit slight, in creatinine levels, which returned to normal or near-normal values upon resolution of the symptoms. Acute cellular rejection was observed in only one case. Although rare, hemorrhagic cystitis secondary to infection, which typically occurs early in the posttransplant period, causes pronounced symptoms. The infection appears to be self-limiting, resolving completely within 4 weeks.
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28
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Zuckerman R, Wald A. Herpes simplex virus infections in solid organ transplant recipients. Am J Transplant 2009; 9 Suppl 4:S104-7. [PMID: 20070669 DOI: 10.1111/j.1600-6143.2009.02900.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- R Zuckerman
- Department of Medicine, Section of Infectious Disease and International Health, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
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29
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Arduino PG, Porter SR. Herpes Simplex Virus Type 1 infection: overview on relevant clinico-pathological features. J Oral Pathol Med 2008; 37:107-21. [PMID: 18197856 DOI: 10.1111/j.1600-0714.2007.00586.x] [Citation(s) in RCA: 199] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Herpes Simplex Virus Type 1 (HSV-1) is a nuclear replicating enveloped virus, usually acquired through direct contact with infected lesions or body fluids (typically saliva). The prevalence of HSV-1 infection increases progressively from childhood, the seroprevalence being inversely related to socioeconomic background. Primary HSV-1 infections in children are either asymptomatic or following an incubation period of about 1 week gives rise to mucocutaneous vesicular eruptions. Herpetic gingivostomatitis typically affects the tongue, lips, gingival, buccal mucosa and the hard and soft palate. Most primary oro-facial HSV infection is caused by HSV-1, infection by HSV-2 is increasingly common. Recurrent infections, which occur at variable intervals, typically give rise to vesiculo-ulcerative lesions at mucocutaneous junctions particularly the lips (herpes labialis). Recurrent HSV-1 infection within the mouth is uncommon in otherwise healthy patients, although in immunocompromised patients, recurrent infection can be more extensive and/or aggressive. The diagnosis of common herpetic infection can usually be based upon the clinical history and presenting features. Confirmatory laboratory diagnosis is, however, required when patients are, or may be, immunocompromised.
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Affiliation(s)
- Paolo G Arduino
- Department of Biomedical Sciences and Human Oncology, Oral Medicine Section, University of Turin, Turin, Italy.
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Fatahzadeh M, Schwartz RA. Human herpes simplex virus infections: epidemiology, pathogenesis, symptomatology, diagnosis, and management. J Am Acad Dermatol 2007; 57:737-63; quiz 764-6. [PMID: 17939933 DOI: 10.1016/j.jaad.2007.06.027] [Citation(s) in RCA: 265] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2006] [Revised: 04/28/2007] [Accepted: 06/22/2007] [Indexed: 11/29/2022]
Abstract
Eight of the more than 80 known herpesviruses are human pathogens. Human herpes simplex virus (HSV) is a contagious infection with a large reservoir in the general population. It has a potential for significant complications in the immunocompromised host. In addition, psychological distress caused by the negative stigma associated with genital herpes and visible facial lesions in those experiencing frequent outbreaks renders it a challenging clinical dilemma. This article reviews the epidemiology, pathogenesis, and diagnostic features of HSV infections, providing the clinician with an up-to-date understanding of the available management strategies for mucocutaneous HSV-induced disease.
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Affiliation(s)
- Mahnaz Fatahzadeh
- Department of Oral Medicine, New Jersey Dental School, Newark, New Jersey 07103, USA.
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31
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Saddi M, Sanna A, Cottiglia F, Chisu L, Casu L, Bonsignore L, De Logu A. Antiherpevirus activity of Artemisia arborescens essential oil and inhibition of lateral diffusion in Vero cells. Ann Clin Microbiol Antimicrob 2007; 6:10. [PMID: 17894898 PMCID: PMC2099429 DOI: 10.1186/1476-0711-6-10] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2007] [Accepted: 09/26/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND New prophylactic and therapeutic tools are needed for the treatment of herpes simplex virus infections. Several essential oils have shown to possess antiviral activity in vitro against a wide spectrum of viruses. AIM The present study was assess to investigate the activities of the essential oil obtained from leaves of Artemisia arborescens against HSV-1 and HSV-2 METHODS The cytotoxicity in Vero cells was evaluated by the MTT reduction method. The IC50 values were determined by plaque reduction assay. In order to characterize the mechanism of action, yield reduction assay, inhibition of plaque development assay, attachment assay, penetration assay and post-attachment virus neutralization assay were also performed. RESULTS The IC50 values, determined by plaque reduction assay, were 2.4 and 4.1 microg/ml for HSV-1 and HSV-2, respectively, while the cytotoxicity assay against Vero cells, as determined by the MTT reduction method, showed a CC50 value of 132 mug/ml, indicating a CC50/IC50 ratio of 55 for HSV-1 and 32.2 for HSV-2. The antiviral activity of A. arborescens essential oil is principally due to direct virucidal effects. A poor activity determined by yield reduction assay was observed against HSV-1 at higher concentrations when added to cultures of infected cells. No inhibition was observed by attachment assay, penetration assay and post-attachment virus neutralization assay. Furthermore, inhibition of plaque development assay showed that A. arborescens essential oil inhibits the lateral diffusion of both HSV-1 and HSV-2. CONCLUSION This study demonstrates the antiviral activity of the essential oil in toto obtained from A. arborescens against HSV-1 and HSV-2. The mode of action of the essential oil as antiherpesvirus agent seems to be particularly interesting in consideration of its ability to inactivate the virus and to inhibit the cell-to-cell virus diffusion.
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Affiliation(s)
- Manuela Saddi
- Dipartimento di Scienze e Tecnologie Biomediche, Sezione di Microbiologia Medica, Viale Sant'Ignazio 38, 09123 Cagliari, Italy
| | - Adriana Sanna
- Dipartimento di Scienze e Tecnologie Biomediche, Sezione di Microbiologia Medica, Viale Sant'Ignazio 38, 09123 Cagliari, Italy
- Dipartimento di Sanità Pubblica, Università di Cagliari, Cagliari, Italy
| | - Filippo Cottiglia
- Dipartimento Farmaco Chimico Tecnologico, Università di Cagliari, Cagliari, Italy
- Facoltà di Farmacia, Università di Cagliari, Cagliari, Italy
| | - Lorenza Chisu
- Dipartimento di Scienze e Tecnologie Biomediche, Sezione di Microbiologia Medica, Viale Sant'Ignazio 38, 09123 Cagliari, Italy
| | - Laura Casu
- Dipartimento Farmaco Chimico Tecnologico, Università di Cagliari, Cagliari, Italy
- Facoltà di Farmacia, Università di Cagliari, Cagliari, Italy
| | - Leonardo Bonsignore
- Dipartimento Farmaco Chimico Tecnologico, Università di Cagliari, Cagliari, Italy
- Facoltà di Farmacia, Università di Cagliari, Cagliari, Italy
| | - Alessandro De Logu
- Dipartimento di Scienze e Tecnologie Biomediche, Sezione di Microbiologia Medica, Viale Sant'Ignazio 38, 09123 Cagliari, Italy
- Facoltà di Farmacia, Università di Cagliari, Cagliari, Italy
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Nair A, Hunzeker J, Bonneau RH. Modulation of microglia and CD8(+) T cell activation during the development of stress-induced herpes simplex virus type-1 encephalitis. Brain Behav Immun 2007; 21:791-806. [PMID: 17349776 DOI: 10.1016/j.bbi.2007.01.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2006] [Revised: 12/20/2006] [Accepted: 01/08/2007] [Indexed: 01/07/2023] Open
Abstract
The central nervous system (CNS) has been shown to be vulnerable to a variety of insults in animals exposed to glucocorticoids. For example, psychological stress, a known inducer of glucocorticoid production, enhances the susceptibility of mice to herpes simplex virus type-1 (HSV-1) infection and results in the development of HSV-1 encephalitis (HSE). To determine the immune mechanisms by which stress promotes the development of HSE, we examined the role of the glucocorticoid receptor (GR) and the N-methyl-d-aspartate (NMDA) receptor in the development of HSE. Our findings demonstrate that blockade of either the GR or the NMDA receptor enhances survival following HSV-1 infection in stressed mice to levels similar to non-stressed mice. Subsequent studies determined the effect of GR and NMDA receptor blockade on immune function by specifically examining both microglia and CD8(+) T cell activation. Stress inhibited the expression of MHC class I by microglia and other brain-derived antigen presenting cells (CD45(hi)) independent of either the glucocorticoid receptor or the NMDA receptor, suggesting that stress-induced suppression of MHC class I expression in the brain does not affect survival during HSE. Blockade of the NMDA receptor, however, diminished HSV-1-induced increases in class I expression by CD45(hi) cells, suggesting that blockade of the NMDA receptor may limit CNS inflammation. Also, while CD8(+) T cell activation and function in the brain were not affected by stress, the number of CD8(+) T cells in the superficial cervical lymph nodes (SCLN) was decreased in stressed mice via GR-mediated mechanisms. These findings indicate that stress-induced hypocellularity is mediated by the GR while NMDA receptor activation is responsible for enhancing CNS inflammation. The combined effects of GR-mediated hypocellularity of the SCLN and NMDA receptor-mediated CNS inflammation during stress promote the development of HSE.
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MESH Headings
- Animals
- Brain/cytology
- Brain/immunology
- CD8-Positive T-Lymphocytes/immunology
- CD8-Positive T-Lymphocytes/metabolism
- CD8-Positive T-Lymphocytes/virology
- Cytokines/metabolism
- Disease Models, Animal
- Encephalitis, Herpes Simplex/immunology
- Encephalitis, Herpes Simplex/psychology
- Encephalitis, Herpes Simplex/virology
- Herpesvirus 1, Human/immunology
- Major Histocompatibility Complex/physiology
- Male
- Mice
- Mice, Inbred C57BL
- Microglia/immunology
- Microglia/metabolism
- Microglia/virology
- Receptors, Glucocorticoid/antagonists & inhibitors
- Receptors, Glucocorticoid/physiology
- Receptors, N-Methyl-D-Aspartate/antagonists & inhibitors
- Receptors, N-Methyl-D-Aspartate/physiology
- Stress, Psychological/complications
- Stress, Psychological/immunology
- Stress, Psychological/virology
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Affiliation(s)
- Aji Nair
- Graduate Program in Neuroscience, The Pennsylvania State University College of Medicine, Milton S Hershey Medical Center, Hershey, PA 17033, USA
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33
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Arduino PG, Porter SR. Oral and perioral herpes simplex virus type 1 (HSV-1) infection: review of its management. Oral Dis 2006; 12:254-70. [PMID: 16700734 DOI: 10.1111/j.1601-0825.2006.01202.x] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Herpes simplex virus type 1 (HSV-1) gives rise to a variety of clinical disorders and is a major cause of morbidity and mortality worldwide. HSV-1 infections are common in oral and perioral area. The aim of the present report was to critically examine the published literature to evaluate the advantages and limitations of therapy of HSV-1 infection in both immunocompetent and immunocompromised patients. Systemic antiviral therapy has been widely accepted as effective for primary herpetic gingivostomatitis. Aciclovir (ACV) 5% cream seems to be the accepted standard topical therapy for herpes labialis, being both effective and well tolerated, although penciclovir 1% cream has been proposed as a potentially useful treatment. Systemic ACV may be effective in reducing the duration of symptoms of recurrent HSV-1 infection, but the optimal timing and dose of the treatment are uncertain. Aciclovir and famciclovir may be of benefit in the acute treatment of severe HSV-1 disease in immunocompromised patients. There is also evidence that prophylactic oral ACV may reduce the frequency and severity of recurrent attack of herpetic infection in immunocompromised patients, but the optimal timing and duration of treatment is uncertain and can vary in different situations.
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Affiliation(s)
- P G Arduino
- Department of Biomedical Sciences and Human Oncology, University of Turin, Turin, Italy.
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34
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Abstract
Oral herpes virus infections are commonly seen by the dental practitioner. Saliva is a reservoir for the herpes virus, and a variety of infections, both localized and systemic, may be induced by the virus. Patients who are immunocompromised may be at risk for serious and potentially life-threatening complications of herpes virus infections. This article highlights the basic virology and clinical manifestations of herpetic infections and the differential diagnosis and management of oral herpes virus infections.
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Affiliation(s)
- Eric T Stoopler
- Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, 240 South 40th Street, Philadelphia, PA 19104, USA.
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35
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Tabaee A, Saltman B, Shutter J, Hibshoosh H, Markowitz A. Recurrent oral herpes simplex virus infection presenting as a tongue mass. ACTA ACUST UNITED AC 2004; 97:376-80. [PMID: 15024363 DOI: 10.1016/j.tripleo.2003.11.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Reactivation of herpes simplex virus resulting in oral infection is common after cardiac transplantation and usually occurs within the first month posttransplant. The clinical presentation, however, may be atypical. We present a case of a 48-year-old female who presented with a large tongue mass 1 year after cardiac transplantation. Outpatient biopsies and viral stains were nondiagnostic. Because of the high suspicion for malignancy, an excisional biopsy was performed in the operating room. Pathologic analysis was consistent with herpes simplex virus type 1 infection. The patient received antiviral therapy with resolution of infection at follow-up.
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Affiliation(s)
- Abtin Tabaee
- Department of Otolaryngology, Head and Neck Surgery, The New York-Presbyterian Hospital, Columbia University College of Physicians and Surgeons, NY 10032, USA.
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36
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Abstract
Herpesviruses are responsible for many illnesses that affect the oral and maxillofacial region. The most common of these are primary or recurrent HSV infection, but knowledge of the manifestations of the eight herpesviruses that cause infections in humans will provide clinicians with a better understanding and basis for diagnosing and managing patients with these diseases. Immunocompromised patients are at greater risk for serious illness: therefore, clinicians treating transplant patients, patients receiving cancer chemotherapy, or HIV-infected individuals should be aware of the various clinical manifestations of infection with herpesviruses.
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Affiliation(s)
- Eric T Stoopler
- Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, 240 South 40th Street, Philadelphia, PA 19104, USA
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37
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Abstract
The oral and gastrointestinal mucosa acts as an important mechanical barrier that prevents local or systemic invasion by microorganisms. Cytotoxic chemotherapy-induced mucosal injury (MI) of oral cavity and intestinal epithelium occurs in many patients treated for malignancy. Compromise of the mucosal barrier can contribute to local invasion by colonizing microorganisms and, subsequently, to systemic infection. Historically, gram-negative bacteremia has been the most problematic bacterial infection in neutropenic patients, but its incidence has reduced over time because of the use of prophylactic antibiotics. There has been a shift in the type of infecting organisms responsible for bacteremia in these patients, from predominantly gram-negative organisms to gram-positive cocci. The viridans group of streptococci is composed of the most frequent bacterial pathogens associated with MI. When speciated, oral colonizers such as Streptococcus mitis, Streptococcus oralis, and Streptococcus sangulis II are the most frequently identified pathogens. Other systemic infections caused by vancomycin-resistant enterococci, Stenotrophomonas maltophilia, and Candida species have also been associated with MI after cancer treatment. Infection can also exacerbate MI after cancer treatment. The best recognized example is herpes simplex virus type 1 (HSV-1). Latent virus is frequently reactivated in HSV-seropositive patients; this reactivation leads to stomatitis, which can be indistinguishable from MI caused by cytoreductive therapies. Antiviral prophylaxis or treatment can control the virus-induced MI and bring about overall amelioration of MI. Recognition of this infectious cause of MI is important in order for clinicians to anticipate and minimize oral toxicity and to facilitate optimal delivery of the antineoplastic regimen.
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Affiliation(s)
- S A Khan
- University of Florida College of Medicine, Gainesville 32610-0277, USA
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38
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Hernández G, Jiménez C, Arriba L, Moreno E, Lucas M. Resolution of oral ulcerations after decreasing the dosage of tacrolimus in a liver transplantation recipient. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2001; 92:526-31. [PMID: 11709689 DOI: 10.1067/moe.2001.116152] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Oral ulcers have may possible causes, including immunosuppression and drug therapy. Severe cases of oral ulceration merit special consideration because the ulcers may become large enough to alter the quality of life of the patient. The present case involves a male patient who in 1994 received an orthotopic liver transplantation because of alcoholic cirrhosis. The initial immunosuppressive regimen was induced with tacrolimus (4 mg/d) and prednisone (20 mg/d). Ten months after orthotopic liver transplantation, the patient complained of multiple recurrent oral ulcers, dysphagia, and severe oral pain, which did not respond to any of the treatments over a 3-year period. Approximately 3(1/4) years after these unresponsive ulcers appeared, the reduction of the oral dosage of tacrolimus resulted in the total remission of the ulcers. A retrospective analysis demonstrated that appearance of the ulcers coincided with a dose of 9 mg/d of tacrolimus (whole blood levels of 12 ng/mL); the ulcers did not disappear until the dose was reduced to 4 mg/d (whole blood level of 6.6 ng/mL).
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Affiliation(s)
- G Hernández
- Department of Medicine and Buccofacial Surgery, School of Dentistry, Complutense University, Madrid, Spain.
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39
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Abstract
Viral infections are a leading cause of posttransplantation morbidity and mortality. A number of recent developments have altered our understanding and management of these disorders. The pathogenetic roles of several viruses, including human herpesviruses 6 and 8, have been newly established. Molecular-based diagnostic tests now make more rapid diagnosis possible. The licensing of new potent antiviral agents offers a wider choice of drugs for viral prophylaxis and treatment. The use of more potent immunosuppressive agents is responsible in part for the increasing incidence of some viral infections, but this varies among drugs, and individual viruses differ in their sensitivity to immunosuppressive agents. This review summarizes the natural history, diagnosis, prevention, and treatment of many common viral infections after renal transplantation.
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Affiliation(s)
- S R Smith
- Divisions of Nephrology and Infectious Diseases, Duke University Medical Center, Durham, NC 27710, USA
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40
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De Logu A, Loy G, Pellerano ML, Bonsignore L, Schivo ML. Inactivation of HSV-1 and HSV-2 and prevention of cell-to-cell virus spread by Santolina insularis essential oil. Antiviral Res 2000; 48:177-85. [PMID: 11164504 DOI: 10.1016/s0166-3542(00)00127-3] [Citation(s) in RCA: 108] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The essential oil obtained in toto from Santolina insularis was investigated for its antiviral activity on herpes simplex type 1 (HSV-1) and type 2 (HSV-2) in vitro. The IC(50) values, determined by plaque reduction assays, were 0.88 and 0.7 microg/ml for HSV-1 and HSV-2, respectively, while the CC(50) determined by the MTT test on Vero cells was 112 microg/ml, indicating a CC(50)/IC(50) ratio of 127 for HSV-1 and 160 for HSV-2. Results obtained by plaque reduction assays also indicated that the antiviral activity of S. insularis was principally due to direct virucidal effects. Antiviral activity against HSV-1 and HSV-2 was not observed in a post-attachment assay, and attachment assays indicated that virus adsorption was not inhibited. Up to 80% inhibition of HSV-1 was achieved at the concentration of 40 microg/ml by yield reduction assay. Furthermore, reduction of plaque formation assays also showed that S. insularis essential oil inhibits cell-to-cell transmission of both HSV-1 and HSV-2.
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Affiliation(s)
- A De Logu
- Dipartimento di Scienze Chirurgiche e Trapianti d'Organo, Sezione di Microbiologia e Virologia, Università di Cagliari, Via Palabanda 14, 09123, Cagliari, Italy.
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41
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Abstract
Herpetic eye disease is common and is frequently associated with intraocular inflammation or uveitis. Despite recent advances in measuring anti-herpes virus antibodies and viral DNA in ocular fluids, diagnosis remains largely clinical. The two more common syndromes include anterior uveitis, often associated with keratitis, and the acute retinal necrosis (ARN) syndrome. Treatment is complex and requires careful monitoring to provide the appropriate balance of antiviral medication and corticosteroids. Long-term prophylaxis with oral antiviral agents may be required in selected patients to help prevent the vision-compromising complications associated with recurrences.
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Affiliation(s)
- B D Gaynor
- Francis I. Proctor Foundation, UCSF, Medical Center 94143, USA
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42
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Kohl S, Sigouroudinia M, Engleman EG. Adhesion defects of antibody-mediated target cell binding of neonatal natural killer cells. Pediatr Res 1999; 46:755-9. [PMID: 10590035 DOI: 10.1203/00006450-199912000-00018] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Neonates are unusually susceptible to herpes simplex virus infection, which may be explained in part by defects in killing of herpes simplex virus-infected cells by natural killer (NK) cell cytotoxicity and antibody-dependent cellular cytotoxicity. The mechanism for these defects remains poorly defined. We have for the first time used immunomagnetically enriched NK cells to explore neonatal NK cell phenotype and target cell adhesion. CD56-positive neonatal NK cells had markedly lower CD57 expression, but adult level expression of adhesive glycoproteins (CD18, CD44) and Fc receptor for IgG (CD16). Although the cells conjugated normally with target cells in the absence of antibody, antibody-mediated conjugation was significantly lower than that of NK cells from adults (p < 0.002). These results demonstrate intact adhesion in neonatal NK cell cytotoxicity. In contrast, defective neonatal antibody-dependent cellular cytotoxicity is caused, in part, by an adhesion defect in the presence of antibody.
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Affiliation(s)
- S Kohl
- Department of Pediatrics, University of California Medical School, San Francisco General Hospital, USA
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43
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Affiliation(s)
- S Kohl
- Division of Pediatric Infectious Diseases, University of California, San Francisco, San Francisco General Hospital, USA
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44
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Mikloska Z, Sanna PP, Cunningham AL. Neutralizing antibodies inhibit axonal spread of herpes simplex virus type 1 to epidermal cells in vitro. J Virol 1999; 73:5934-44. [PMID: 10364346 PMCID: PMC112655 DOI: 10.1128/jvi.73.7.5934-5944.1999] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The ability of antibodies to interfere with anterograde transmission of herpes simplex virus (HSV) from neuronal axons to the epidermis was investigated in an in vitro model consisting of human fetal dorsal root ganglia innervating autologous skin explants in a dual-chamber tissue culture system. The number and size of viral cytopathic plaques in epidermal cells after axonal transmission from HSV type 1 (HSV-1)-infected dorsal root ganglionic neurons were significantly reduced by addition to the outer chamber of neutralizing polyclonal human sera to HSV-1, of a human recombinant monoclonal group Ib antibody to glycoprotein D (gD), and of rabbit sera to HSV-1 gB and gD but not by rabbit anti-gE or anti-gG. A similar pattern of inhibition of direct infection of epidermal cells by these antibodies was observed. High concentrations of the monoclonal anti-gD reduced transmission by 90%. Rabbit anti-gB was not taken up into neurons, and human anti-gD did not influence spread of HSV in the dorsal root ganglia or axonal transport of HSV antigens when applied to individual dissociated neurons. These results suggest that anti-gD and -gB antibodies interfere with axonal spread of HSV-1, possibly by neutralizing HSV during transmission across an intercellular gap between axonal termini and epidermal cells, and thus contribute to control of HSV spread and shedding. Therefore, selected human monoclonal antibodies to protective epitopes might even be effective in preventing epidermis-to-neuron transmission during primary HSV infection, especially neonatal infection.
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Affiliation(s)
- Z Mikloska
- Centre for Virus Research, Westmead Institutes of Health Research, Westmead Hospital and University of Sydney, Sydney, New South Wales 2145, Australia.
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45
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Infections a CMV. Med Mal Infect 1998. [DOI: 10.1016/s0399-077x(98)80145-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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46
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47
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McCarthy GM, Awde JD, Ghandi H, Vincent M, Kocha WI. Risk factors associated with mucositis in cancer patients receiving 5-fluorouracil. Oral Oncol 1998; 34:484-90. [PMID: 9930359 DOI: 10.1016/s1368-8375(98)00068-2] [Citation(s) in RCA: 91] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Oral mucositis is a dose-limiting toxicity of 5-fluorouracil (5-FU). This prospective cohort study investigated factors associated with mucositis in patients receiving 5-FU for cancer of the digestive tract. Sixty-three patients (mean age 65 years) completed self-administered questionnaires and had interviews, oral examinations and unstimulated whole salivary flow measurements at baseline and follow-up appointments. The duration of follow-up was 2 months. Predictor variables included sociodemographic data, body surface area, diabetes, smoking, alcohol consumption, salivary flow, oral hygiene, presence of prostheses, performance status, regimen of cytotoxic drugs, hematological data, and herpes simplex virus antibody titer. Forty-six per cent of patients developed at least one episode of oral mucositis during cytotoxic treatment. Pearson's chi-square analysis showed that mucositis was significantly associated with xerostomia at baseline, xerostomia during chemotherapy, and lower baseline neutrophil counts (P < or = 0.05). Multiple logistic regression analysis indicated that xerostomia at baseline (odds ratio, OR = 10.0), or baseline neutrophil level under 4000 cells/mm3 (OR = 3.9) were significant predictors of mucositis. Taking into account the effect of neutrophil level at baseline, xerostomia during chemotherapy (OR = 4.5) was also a significant predictor of mucositis. The results showed that xerostomia and lower baseline neutrophil levels are significantly associated with oral mucositis. These variables should be taken into consideration in the design of intervention studies to reduce the frequency and severity of mucositis. More research is required to investigate the role of saliva and neutrophils in the pathogenesis of chemotherapy-induced mucositis.
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Affiliation(s)
- G M McCarthy
- Department of Epidemiology and Biostatistics, Faculty of Medicine & Dentistry, University of Western Ontario, Canada.
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48
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Carr DJ. Increased levels of IFN-gamma in the trigeminal ganglion correlate with protection against HSV-1-induced encephalitis following subcutaneous administration with androstenediol. J Neuroimmunol 1998; 89:160-7. [PMID: 9726838 DOI: 10.1016/s0165-5728(98)00129-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Androstenediol (AED) is a metabolic product of dehydroepiandrosterone (DHEA), an adrenal steroid known to possess immunomodulatory characteristics. The present study was undertaken to assess the efficacy of AED treatment in mice ocularly infected with herpes simplex virus type 1 (HSV-1). The subcutaneous administration of 320 mg/kg AED 4 h prior to viral inoculation was found to enhance the survival of HSV-1-infected mice while lower doses (32.0-100.0 mg/kg) were without effect. However, there were no apparent differences in the viral load in the eye or trigeminal ganglion (TG) 3 or 6 days post infection (p.i.) in vehicle- or AED (320 mg/kg)-treated mice. Likewise, there were no differences in the expression of cytokine or chemokine mRNAs in the eyes or TG early (i.e., 3 days p.i.) following infection. However, by 6 days p.i., there was a significant increase in the expression of the chemokines IP-10, MCP-1, and RANTES and the cytokines interleukin-6 (IL-6) and interferon-gamma (IFN-gamma) in the AED (320 mg/kg)-treated mice compared to vehicle-treated controls as determined by reverse transcription (RT)-polymerase chain reaction (PCR) and quantitative PCR (for IFN-gamma). Likewise, there was a corresponding increase in IFN-gamma and IL-2 but not IL-12 protein in the TG of AED-treated mice 6 days p.i. AED-treatment also induced a rise in splenic natural killer activity in a dose- and time-dependent fashion. Collectively, these results suggest that the protective effect following subcutaneous administration of AED is associated in a rise in selective type 1 cytokines (IL-2 and IFN-gamma) as well as natural killer activity.
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Affiliation(s)
- D J Carr
- Department of Microbiology, Immunology, and Parasitology, LSU Medical Center, New Orleans, LA 70112-1393, USA.
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49
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White DK. Acute Viral Infections of the Oral Cavity and Parotid Gland. Oral Maxillofac Surg Clin North Am 1998. [DOI: 10.1016/s1042-3699(20)30343-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Généreau T, Rozenberg F, Bouchaud O, Marche C, Lortholary O. Herpes esophagitis: a comprehensive review. Clin Microbiol Infect 1997; 3:397-407. [PMID: 11864149 DOI: 10.1111/j.1469-0691.1997.tb00275.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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