Pain from herpes zoster and postherpetic neuralgia

Under observation there were 82 patients operated on for ulcer disease of the stomach and duodenum. Dissemination of the mucosa with Helicobacter pylori (HP) was studied by means of using the urease test. Before the operation the positive result of the study was obtained in 73 patients (89%). In 1-6 months after the operation the HP infection was found in 29 patients (39.7%). The HP persistence retained in 39.7% of the patients subjected to resection of the stomach in spite of the preoperative treatment including De-nol and Metronidazole. Post-resectional reflux-gastritis and anastomositis were more pronounced in HP carriers. The antireflux variants of anastomoses (transversal, terminolateral gastroduodenal anastomosis and gastrojejunal anastomosis by Roux) were followed by much less HP persistence and less frequent cases of anastomositis and gastritis of the gastric stump.     

The use of capsaicin in herpes zoster ophthalmicus neuralgia

The final stage in the production of a radiotherapy treatment plan must always be an independent check that the linear accelerator settings given on the plan do in fact deliver the required dose distribution. A tool is described that enables rapid checking of diaphragm settings in relation to the patient.     

The effect of treating herpes zoster with oral acyclovir in preventing postherpetic neuralgia. A meta-analysis

BACKGROUND: Herpes zoster is a common affliction in older patients, with up to 15% experiencing some residual pain in the distribution of the rash several months after healing. Despite numerous randomized clinical trials, the effect of treating herpes zoster with oral acyclovir in preventing postherpetic neuralgia remains uncertain because of conflicting results. METHODS: Meta-analysis of published randomized clinical trials on the use of acyclovir to prevent postherpetic neuralgia using the fixed-effects model of Peto. RESULTS: Thirty clinical trials of treatment with oral acyclovir in immunocompetent adults were identified. After excluding studies with duplicate data, suboptimal and topical dosing, non-placebo-controlled or nonrandomized designs, and those using intravenous acyclovir, 5 trials were found to be homogeneous and were combined for analysis. From these trials, the summary odds ratio for the incidence of "any pain" in the distribution of rash at 6 months in adults treated with acyclovir was 0.54 (95% confidence interval, 0.36-0.81). CONCLUSION: Treatment of herpes zoster with 800 mg/d of oral acyclovir within 72 hours of rash onset may reduce the incidence of residual pain at 6 months by 46% in immunocompetent adults.     

Immunomodulating and antiviral therapy in herpes zoster

Two groups of patients with herpes zoster were followed up. The first group was subjected, beside a symptomatic therapy, to an immunological and antiviral treatment. The control group was treated only symptomatically. The immunological preparations used were: the immunostimulant SRE (Corynebacterium parvum), which stimulated the lymphocytes and macrophages, Moroxidin (Virustat-Paris) and Antiherpin (interferon inductor), which acted by blocking the virus replication. The preparations were indigenous and atoxic. A significant difference between the courses of disease in the two groups was observed, namely, the severity and duration of subjective and objective symptoms were more than double and followed by persistent neurological sequelae in the control group in comparison with the patients of the experimental group.     

Cutaneous reactions following herpes zoster infections: report of three cases and a review of the literature

Three patients, one healthy and two immunocompromised, developed cutaneous reactions that histologically mimicked granuloma annulare at sites of resolved varicella-zoster virus (VZV) reactivation infections. Variable latency periods between the infection and the granulomatous reaction were noted. As in other case reports, the presence of VZV DNA in these lesions was inconsistently demonstrated by the polymerase chain reaction (PCR) and appears more common in early, as opposed to late, post-zoster granulomas. In addition to various granulomatous reactions, vasculitic and neoplastic eruptions following resolved VZV infections have been described and are reviewed here. Therapeutically, topical, intralesional and systemic corticosteroids, as well as acyclovir, have been tried with inconsistent results. Although the pathogenesis remains unclear, the presence of VZV DNA in early lesions that histologically do not display viral cytopathic changes, suggests the virus induces an atypical delayed hypersensitivity reaction not affected by antiviral therapy.     

Clinical presentation of herpes zoster in a Singapore hospital

The purpose of the study was to give a histological picture of the different skin regions of the mammary gland in mares. Special emphasis on the dark coating in the sulcus intermammarius was given. As a result, the dark pigmented udder skin can be subdivided into the skin of the Corpus mammae, the sulcus intermammarius and the teat skin. In the sulcus intermammarius the whole epidermis was considerably thicker than usual, especially the stratum corneum (up to 70 layers of cornified layers) and the stratum spinosum. In general, the squamous keratinocytes were unusually large. The histological preparations of the coating revealed a stratum corneum instead of a supposed secretion of the sebaceous glands. The dermal papillae ended immediately below the stratum corneum.     

Scanning and transmission electron microscopic studies of lesional epidermis in herpes zoster

The epidermal skin lesions of herpes zoster were studied by scanning (SEM) and transmission electron microscopy (TEM). When erythematous lesions were observed by TEM, many of the infected keratinocytes showed evidence of cell degeneration, being characterized by swollen nuclei, disappearance of desmosomes, and widening of intercellular spaces. Macrophages and/or lymphocytes migrated through the intercellular spaces between degenerated keratinocytes. In the vesicular lesions, SEM and TEM showed some infiltrating neutrophils, directly adhering to the virus-infected keratinocytes, with swollen nuclei and irregularly clumped chromatin. In some specimens, balloon-degenerated keratinocytes were observed in the cavity. In the pustular stage, ruptured keratinocytes and numerous neutrophils were observed in the reticular-degenerated epidermal tissue. These results suggest that, in herpes zoster, the epidermal damage may be due, at least in part, to cell-mediated host immunity as well as to the cytopathic effect of varicella-zoster virus.     

Amizon in the treatment of nervous system involvement in herpes zoster

The authors submit results of treatment of patients having suffered from postherpetic pain syndrome (herpetic ganglionitis of the cervical, thoracic, lumbosacral localization, postherpetic intercostal neuralgia, ganglionitis of the trigeminal nerve). In viral diseases, amizone has marked analgetic, antiinflammatory, and immunomodulating effects. The drug is well tolerated by patients, is not associated with side effects under prescribed doses (0.25-0.75 as one dose on a three- or four-times daily schedule during the course of treatment lasting three or four weeks). The drug preparation in question is less effective in the treatment of chronic recurring post-therapeutic intercostal neuralgias, radiculalgia.     

Beneficial effects of immunostimulant and antiviral therapy of ophthalmic herpes zoster

In the article, the authors present a relatively uncommon method employed for breast reduction and moulding in gigantomastia. They examine the benefits of the surgical technique based on areolar rotation with a wide superior-lateral dermal areolar flap. The authors point out the fact that postoperative blood supply to the areolas is very good while their sensitivity is preserved.     

Comparative study of transfer factor and acyclovir in the treatment of herpes zoster

Reactivation of varicella herpes virus (VHV), latent in individuals who have previously suffered varicella, gives rise to herpes zoster and in some cases leads to a sequela of post herpetic neuritis with severe pain which is refractory to analgesics. Many different antiviral agents have been tried without achieving satisfactory results. Of all the antiviral agents employed, acyclovir has been the most successful in reducing post herpetic pain. However acyclovir has not been as reliable as interferon alpha (IFN-alpha). We have previously looked into the use of transfer factor (TF) as a modulator of the immune system, specifically with respect to its effectiveness in the treatment of herpes zoster. In this work findings from a comparative clinical evaluation are presented. A double blind clinical trial of TF vs acyclovir was carried out in which 28 patients, presenting acute stage herpes zoster, were randomly assigned to either treatment group. Treatment was administered for seven days and the patients were subsequently submitted to daily clinical observation for an additional 14 days. An analogue visual scale was implemented in order to record pain and thereby served as the clinical parameter for scoring results. The group treated with TF was found to have a more favorable clinical course, P < or = 0.015. Laboratory tests to assess the immune profile of the patients were performed two days prior and 14 days after initial treatment. The results of these tests showed an increase in IFN-gamma levels, augmentation in the CD4+ cell population but not the percentage of T rosettes in the TF treated group. These parameters were however insignificantly modified in patients receiving acyclovir. Although TF treated patients showed an increase in CD4+ counts these cells remained below the levels for healthy individuals. The fact that IFN-gamma levels as well as the counts for CD4+ cells rose in the TF treated group and not in the acyclovir one is very significant and confirms the immunomodulating properties of TF.     

Significance of herpes zoster in HIV/AIDS in Kweneng district, Botswana

OBJECTIVE: To determine the relevance of herpes zoster eruption or scar relative to other symptoms and signs of HIV/AIDS and to look for a syndromic model that could be used in the diagnosis of HIV infection. DESIGN: Retrospective case-control study on data from the results of HIV request forms in the district from 1st January 1993 to 31st March 1996. HIV request forms bearing ELISA positive results represented the cases. SETTING: All the 55 health facilities and one district hospital in Kweneng district, Botswana. SUBJECTS: Six hundred and forty one valid request forms across all age groups and both sexes were analysed. MAIN OUTCOME MEASURES: Proportion of herpes zoster among cases and controls. Sensitivity and specificity test values for herpes zoster as a screening test. Logistic regression on 11 symptoms and signs found to have a significant relationship to ELISA either on the chi 2 test or on tests for the attributes of an ideal screening test. RESULTS: Herpes zoster ranked sixth as the most common sign associated with a positive ELISA result. The difference in the proportion of herpes zoster among cases and controls was highly significant, (chi 2 = 13.1, OR 3.75, CI =1.7-9.3. p = 0.0003). The following also had a significant relationship; chronic diarrhoea, persistent generalised lymphadenopathy (PGL) and non-healing genital ulcers. In addition, herpes zoster and chronic diarrhoea were highly specific and had high positive predictive values for a positive HIV ELISA positive result in 95.5% cases; chronic diarrhoea, weight loss, herpes zoster, persistent generalised lymphadenopathy and non-healing genital ulcers. CONCLUSION: Herpes zoster is an important predictor of HIV/AIDS in Kweng district (PPV = 90%). Used in the above model, prediction rises up to 95.5%. In the absence of an HIV ELISA test, this model alone could be sufficient for a clinical diagnosis of HIV infection, at least in Kweneng. It is also suggested that the presence or a history of herpes zoster scar or eruption be elevated to the status of a major sign in the World Health Organization (WHO) clinical definition for AIDS surveillance.     

Association of herpes zoster ophthalmicus with acquired immunodeficiency syndrome and acute retinal necrosis

We conducted a review to investigate the prevalence of human immunodeficiency virus (HIV), or acquired immunodeficiency syndrome (AIDS), in patients with herpes zoster ophthalmicus, as well as the incidence of acute retinal necrosis after herpes zoster ophthalmicus. All charts of patients seen at our institution between 1987 and 1992 with a primary diagnosis of herpes zoster ophthalmicus were reviewed. Of 112 patients with herpes zoster ophthalmicus, 29 (26%) had HIV or AIDS. All these patients were younger than 50 years at the time of diagnosis. Five of 29 (17%) immunocompromised patients had acute retinal necrosis after herpes zoster ophthalmicus. No acute retinal necrosis was identified in the nonimmunocompromised patients after herpes zoster ophthalmicus. We recommend that all patients younger than 50 years who have herpes zoster ophthalmicus at initial examination be tested for HIV. Additionally, HIV-infected patients should be monitored closely after herpes zoster ophthalmicus for development of acute retinal necrosis. Long-term oral prophylactic as well as initial high-dose intravenous acyclovir may be appropriate in HIV-infected individuals with herpes zoster.     

针灸综合治疗带状疱疹的疗效观察

目的 观察针灸综合治疗方案对带状疱疹的治疗效果.方法 将120例带状疱疹患者随机分为2组.治疗组运用电针、点刺水疱、艾灸综合治疗并配合针灸护理;对照组内服盐酸伐昔洛韦片、醋酸泼尼松,外用阿昔洛韦乳膏.10d后观察总体疗效及患者的皮损结痂时间、脱痂时间和疼痛消失时间.结果 治疗组的痊愈率(65.5%)和有效率(96.5%)明显高于对照组(P<0.05).患者的皮损结痂时间、脱痂时间和疼痛消失时间也优于对照组(P<0.01),具有统计学意义.结论 针灸综合治疗带状疱疹效果显著,皮疹消退快,疼痛缓解快.     

Acyclovir-resistant herpes zoster in human immunodeficiency virus-infected patients: results of foscarnet therapy

We retrospectively studied 18 consecutive cases of acyclovir-resistant zoster. All the patients had chronic skin lesions that failed to heal despite treatment with intravenous acyclovir (30 mg/[kg.d]) in 15 cases and oral acyclovir (4 g/d) in three cases for > 10 days. The mean CD4+ cell count was 20 x 10(6)/L. The mean number of previous zoster episodes was 1.53. Fifteen of the 16 patients evaluable for previous acyclovir treatment had received the drug. Thirteen patients were treated with intravenous foscarnet (200 mg/[kg.d]) for a mean of 17.8 days. Complete healing was observed in 10 (77%) of the 13 treated patients. Zoster relapsed after cessation of foscarnet therapy in five of the 10 responding patients. The median time to relapse was 110 days. Four patients died of varicella-zoster virus-associated visceral complications. These results show that acyclovir-resistant zoster has a poor prognosis but responds well to foscarnet therapy.     

Activity of N-chlorotaurine against herpes simplex- and adenoviruses

Monoclonal antibodies (MAbs) are being widely used for imaging studies, coupled mainly with 99mTc. The antibody ior egf/r3 is a MAb against human epidermal growth factor receptor (hEGF-r), and we have developed a method for optimum labeling of this MAb with 99mTc. The reduction was performed with 2-mercaptoethanol (2-ME) at a molar ratio of 2000:1 (2-ME:MAb) and methylene diphosphonate as transchelant. The integrity of reduced MAb was checked by mean of native polyacrylamide gel electrophoresis (PAGE) and gel filtration chromatography on Superose 12 (purity >99%). Radio colloids remained lower than 2%, and the labeling efficiency was 98.5%. The number of sulfhydryl groups generated was quantified using Ellman's reagent and was found to be 6.65+/-0.69 per antibody molecule. In vitro stability studies in several challenging conditions (DTPA, human serum albumin and human serum) were performed, and no significant loss in binding percentage was seen. Radio receptor assay was used to test immunoreactivity of the reduced MAb. Both labeled and unlabeled MAbs were able to compete for binding to the hEGF-r with radioiodinated EGF. Biodistribution studies in BALB/c mice are reported.     

The importance of MHC-I and MHC-II responses in vaccine efficacy against lethal herpes simplex virus type 1 challenge

To investigate the importance of major histocompatability complex (MHC) class I- and MHC class II-dependent immune responses in herpes simplex virus-1 (HSV-1) vaccine efficacy, groups of beta 2% (MHC I-) and Ab% (MHC II-) mice were inoculated with various vaccines, and then challenged intraperitoneally with HSV-1. Following vaccination with either live avirulent HSV-1, expressed HSV-1 glycoprotein D (gD), or a mixture of seven expressed HSV-1 glycoproteins (7gPs), Ab% (MHC-II-) mice developed no enzyme-linked immunosorbent assay (ELISA) or neutralizing antibody titres. In contrast, significant ELISA and neutralizing antibody titres were induced in beta 2m% (MHC-I-) mice by all three vaccines. The neutralizing antibody titres were similar for all three vaccines, but were only approximately 1/4 to 1/3 of that developed in C57BL/6 (parental) mice vaccinated with the same antigens. All three vaccines protected 100% of the wild-type C57BL/6 mice against lethal challenge with 2 x 10(7) plaque-forming units (PFU) of HSV-1. The live virus vaccine and the 7gPs vaccine also protected 80% of the beta 2m% mice against the same lethal HSV-1 challenge dose. In contrast, in Abo/o mice, none of the vaccines provided significant protection against the same lethal challenge dose of HSV-1. However, at a lower challenge dose of 2 x 10(6) PFU, all three vaccines protected 70-80% of the vaccinated Ab% mice (compared to only 10% survival in mock vaccinated controls). Thus, vaccination provided some protection against lethal HSV-1 challenge in both beta 2m% and Ab% mice; however, the protection was less than that seen in the parental C57BL/6 mice. In addition, Ab% mice were less well protected by vaccination than were beta 2m% mice. Our results suggest that (1) both MHC-I and MHC-II are involved in vaccine efficacy against HSV-1 challenge; (2) both types of responses must be present for maximum vaccine efficacy: and (3) the MHC-II-dependent immune response appeared to be more important than the MHC-I-dependent immune response for vaccine efficacy against HSV-I challenge.     

Gd-DPTA enhanced MRI in Bell's palsy and herpes zoster oticus: an overview and implications for future studies

Magnetic resonance imaging (MRI) is a new and important tool for use in diagnosing and investigating diseases affecting the facial nerve. In recent gadolinium-DTPA enhanced MRI (Gd-MRI) studies it has unequivocally been demonstrated that ipsilateral facial nerve contrast enhancement, predominantly in the meatal portion, is present in both Bell's palsy and herpes zoster oticus. In this overview, the results of MRI studies performed on patients with acute peripheral facial palsy, especially Bell's palsy and herpes zoster oticus, are discussed. The Gd-MRI pattern in Bell's palsy is very similar to that seen in herpes zoster oticus, and the findings reported so far support the theory that an inflammation may be the cause of the nerve injury in both cases. So far, however, Gd-MRI has not been helpful in evaluating the severity and/or prognosis of the facial palsy. Further studies employing improved techniques, including three-dimensional fast (or turbo) spin echo (3DFSE) MRI with heavily T2-weighted sections and high resolution three-dimensional Fourier transform (3DFT) MRI, need to be conducted in order to determine whether it is possible to follow the course of the disease and whether MRI and/or Gd-MRI are useful prognostic tools in the early stages of palsy.