Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0018681 (headache)
 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The efficacy and toxicity of foscarnet cream for the treatment of mucocutaneous herpes simplex virus lesions or lesions that were clinically unresponsive to systemic acyclovir treatment (median, 30.5 days) in AIDS patients were studied in a phase I/II, open-label, nonrandomized multicenter trial. In the study, 20 patients with advanced stages of AIDS were treated with foscarnet 1% cream five times a day for a mean duration of 34.5 days. Response of index lesions (n = 20) was judged to be completely healed (8 lesions), excellent (4 lesions), or good (1 lesion) in 65% of lesions. The median time to first negative herpes simplex virus culture of index lesion was 8 days. Among 15 patients with pain at baseline, 11 had complete resolution of pain and 2 had at least a 50% reduction. Clinical adverse events included skin ulceration (4 patients), application site reactions (3 patients), fever (3 patients), and headache (3 patients). Five (25%) patients developed new lesions due to herpes simplex virus at sites other than those being treated topically while enrolled in the study. Topical foscarnet 1% cream appears to be a safe and effective treatment for acyclovir-unresponsive mucocutaneous herpes simplex virus infection in AIDS patients.
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PMID:Treatment of mucocutaneous herpes simplex virus infections unresponsive to acyclovir with topical foscarnet cream in AIDS patients: a phase I/II study. 1042 8

Encephalitis is an acute infection of brain parenchyma characterized clinically by fever, headache, and an altered level of consciousness. There may also be focal or multifocal neurologic deficits, and focal or generalized seizure activity. This article discusses the clinical presentation, diagnosis, and treatment of herpes simplex virus (HSV) encephalitis, the arthropodborne viral encephalidities, Rocky Mountain spotted fever, viral encephalitis in the immunocompromised patient, and postinfectious encephalomyelitis.
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PMID:Encephalitis. 1051 30

Viral encephalitis presents with fever, headache, focal and generalized neurologic symptoms and signs, seizures, and CSF pleocytosis. Herpes simplex Virus (HSV) 1 and arboviruses (flaviruses) are the most common causes of encephalitis in Switzerland. The initial work-up in a suspected encephalitis includes CSF analysis, EEG, and brain CT or MRI. The identification of the responsible agent usually occurs with polymerase chain reaction or serology. The differential diagnosis to other infectious and non-infectious acute CNS-disorders may initially be arduous. A specific treatment is possible only in encephalitis caused by viruses of the herpes group. Active immunization should be considered in subjects at high risk for tick-borne encephalitis. With early treatment the prognosis may be satisfactory also in HSV encephalitis.
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PMID:[Viral encephalitis]. 1059 77

We examined the serial MRI diffusion weighted images (DWIs) in two patients with acute viral encephalitis similar to herpes simplex encephalitis (HSE). Patient 1. A 27-year-old woman was admitted to the psychiatry ward for her confusional state and convulsions. Because of abnormal CSF findings she was transferred to the neurology ward, and the infusion of acyclovir was started. On disease day 5. MRI demonstrated high signal intensity in the left lateral lobe both on T2 weighted images (T2WIs) and DWIs. On day 18, MRI showed progression of the lesions, so acyclovir was changed to ara-A. On day 26, no improvement was seen clinically or radiologically. Then, combination therapy with acyclovir, ara-A and gamma-globulin was began. On day 36, she recovered completely, and abnormal intensity in MRI disappeared both on T2WIs and DWIs. Therefore, antiviral agent therapy was discontinued. Patient 2. A 31-year-old man was admitted for headache, fever and aphasia. On the next day, acyclovir was started and both DWIs and T2WIs of MRI demonstrated a high signal intensity in the left temporal lobe. Ten days later, he became perfectly well, and the increased signal intensity disappeared on DWIs, but not on T2WIs. Treatment was therefore discontinued. No relapse was in either patient. We concluded that serial MRI DWIs may be useful to determine when to discontinue the treatment in encephalitis.
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PMID:[The clinical usefulness of MRI diffusion weighted images in herpes simplex encephalitis-like cases]. 1065 72

At a recent seminar on pain management in Atlanta, researchers reported that health care providers do poorly when it comes to recognizing and managing the pain suffered by patients with AIDS. This lack of adequate attention is reflected in the lack of relevant studies about pain management in the medical literature. As with cancer, AIDS pain increases with disease progression. However, patients with AIDS tend to be more depressed than cancer patients, and have a higher rate of suicidal thoughts. Experts at the seminar discussed the obstacles involved in treating pain in AIDS patients who have a history of substance abuse. According to one study, pain medication addiction is rare in patients. Providers must distinguish between tolerance and physical dependence. Guidelines for managing pain in substance abusers include respecting the patient's reports of pain, and setting clear goals and conditions for opioid therapy. Using a team approach that recognizes pharmacological and non-pharmacological interventions, and that pays attention to psychosocial issues will also lead to greater success in treating patients with pain. The most common painful illnesses are HIV-related headaches, herpes simplex, peripheral neuropathy, back pain, herpes zoster, and throat pain.
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PMID:Clinicians not providing necessary pain relief for AIDS patients. 1136 81

The efficacy and safety of recombinant human interferon gamma (rIFN-gamma) in the reduction of opportunistic disease in patients with advanced HIV-1 infection are assessed. A 12-month double-blind, placebo-controlled, multicenter, Phase III trial of rIFN-gamma in HIV-positive patients with CD4 < 100 x 10(9)/liter on stable antiretroviral therapy. Eighty-four patients were allocated treatment on a 1:1 basis to rIFN-gamma or placebo. Patients received rIFN-gamma 0.05 mg/m(2) or 0.9% saline subcutaneously three times weekly for 48 weeks (optional extension to 18 months). The primary end point was the incidence of opportunist infections (CDC categories B/C). Secondary end points included mortality, immunological, and virological parameters. Patients on placebo had a mean of 3.45 opportunist infections (OIs) in the first 48 weeks. Patients treated with rIFN-gamma had a mean of 1.71 OIs (p = 0.04). However, the model showed overdispersion and the inclusion of a dispersion factor raised the p value to 0.13. rIFN-gamma appeared to have a particular effect on the incidence of Candida, herpes simplex, and cytomegalovirus infections. Three-year survival in the rIFN-gamma arm was 28% compared to 18% in the placebo group (not significant). rIFN-gamma-associated side-effects of headache, fatigue, rigors, influenza-like symptoms, depression, myalgia, and granulocytopenia were reversible. There was no evidence for HIV activation. Although not significant, the trend towards decreased opportunistic infections and increased survival warrants consideration of further trials of rIFN-gamma. The study gives additional information on the safety profile of this cytokine.
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PMID:A phase III study of recombinant human interferon gamma to prevent opportunistic infections in advanced HIV disease. 1142 20

In order to study the long-term course after herpes simplex virus type 2 (HSV-2) meningitis and/or myeloradiculitis the records of 40 consecutive patients were studied. During the year following the acute phase, verified or suspected neurologic recurrences were noted in nearly half of the patients: 1 or more episodes of recurring meningitis were noted in 8 patients; new episodes of myelitis or radiculitis in 3; distinct attacks of headache in 4; and diffuse neurologic complaints impairing daily life in 3. Recurring mucocutaneous symptoms were observed in 16 patients. Eleven patients experienced concurrent or separate episodes of recurring mucocutaneous and neurologic symptoms, 7 had neurologic recurrences only and 5 had only mucocutaneous recurrences. As considerable morbidity may result, patients with HSV-2 meningitis and/or myeloradiculitis should be identified by means of thorough history-taking, careful examination and a specific viral diagnosis in order to enable adequate advice and counseling to be provided and to aid decision-making regarding antiviral therapy.
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PMID:Neurologic morbidity after herpes simplex virus type 2 meningitis: a retrospective study of 40 patients. 1206 91

Laboratory findings for cerebrospinal fluid (CSF) specimens were correlated with clinical presentations and histories in 55 cases of encephalitis or meningitis due to herpes simplex virus (HSV), as determined by polymerase chain reaction (PCR)-based detection of HSV DNA. Sixteen patients (29%) had HSV encephalitis (HSVE), 3 had mild or "atypical" meningoencephalitis, 34 (64%) had HSV meningitis (HSVM), and 1 had disseminated neonatal HSV infection. CSF findings included elevated leukocyte counts and/or elevated CSF protein levels in all HIV DNA-positive specimens. CSF leukocyte and protein abnormalities were more pronounced in cases of HSVM than they are in cases of HSVE. Patients with HSVE who had only mild CSF abnormalities also had minimal numbers of erythrocytes in the CSF. Patients with HSVM were younger than were patients with HSVE and were predominantly female. Eleven patients with HSVM reported having prior episodes, and 5 reported a history of recurrent headaches. These findings suggest that milder forms of HSV infection of the central nervous system may be identified by PCR for HSV. Prescreening of CSF specimens for the presence of leukocytes or elevated protein level may improve test utilization.
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PMID:Differences in laboratory findings for cerebrospinal fluid specimens obtained from patients with meningitis or encephalitis due to herpes simplex virus (HSV) documented by detection of HSV DNA. 1214 25

Anecdotal case reports describe the occurrence of cystoid macular edema, iritis, herpes simplex keratitis, periocular skin darkening, and headaches in patients treated with prostaglandin analogs for glaucoma. The purpose of this article is to critically analyze these anecdotal case reports in light of a few well-controlled, randomized clinical studies to determine whether conclusions can be made about a causal relationship between the use of prostaglandin analogs and the occurrence of these side effects. None of these putative side effects has been proven to be causally related to latanoprost therapy using valid scientific methodology. These possible side effects occur rarely. Cystoid macular edema, iritis, and herpes simplex keratitis occur in eyes with risk factors. To scientifically establish a causal relationship between drug therapy and rare side effects, repeated rechallenging with masked controls is required. With rare exception, such methodology has not been used with any of these putative side effects. Nevertheless, even without firm establishment of a causal relationship, caution is advised with the use of prostaglandin analogs in eyes with risk factors for cystoid macular edema, iritis, and herpes simplex keratitis until properly designed, large, controlled studies provide more definitive information.
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PMID:Putative side effects of prostaglandin analogs. 1220 18

The US Centers for Disease Control in 1982 listed conditions and infections then associated with AIDS. That case definition, used as a model for many countries, was designed primarily for epidemiologic surveillance and now includes more than 20 conditions. The definition, however, requires diagnostic and laboratory technologies which are not always available in developing countries. The World Health Organization (WHO) therefore published the Bangui definition in 1985 which uses clinical criteria alone. Many developing countries have adapted this definition to the types of pathogens they encounter domestically. According to the AIDS clinical definition, the presence of generalized Kaposi sarcoma or cryptococcal meningitis is sufficient for the diagnosis of AIDS. AIDS is also diagnosed if at least two major signs and one minor sign are present in the absence of known causes of immunosuppression such as malnutrition. Major signs are fever for more than one month, loss of more than 10% of body weight, and diarrhea for more than one month. Minor signs include cough for more than one month, generalized pruritic dermatitis, recurrent herpes zoster or shingles, oropharyngeal candidiasis or thrush, chronic or aggressive ulcerative herpes simplex, and persistent generalized lymphadenopathy. WHO has also developed criteria for diagnosing symptomatic HIV infection as an aid to individual case management. These criteria, however, are not intended to replace the Bangui AIDS case definitions developed for epidemiological purposes. The diagnosis of symptomatic HIV infection is made through physical examination and the taking of a very detailed case history. In so doing, there may be cardinal, characteristic, and/or associated findings. Cardinal findings of HIV infection are Kaposi sarcoma, oesophageal candidiasis, cytomegalovirus retinitis, Pneumocystis carinii pneumonia, and Toxoplasma encephalitis. Characteristic findings include oral thrush in a patient not taking antibiotics; hairy leukoplakia; cryptococcal meningitis; miliary, extrapulmonary,, or non-cavity pulmonary tuberculosis; current or past herpes zoster or shingles; severe prurigo; Kaposi sarcoma of a less than generalized or rapidly progressive nature; and high-grade B-cell extranodal lymphoma. Finally, associated findings in the absence of any other obvious cause of immunosuppression are recent and/or explained weight loss of more than 10% of body weight; fever for more than one month; diarrhea for more than one month; ulcers for more than one month; cough for more than one month; neurological complaints or findings, peripheral neuropathy, dementia, and progressively worsening headache; generalized lymphadenopathy; previously unseen drug reactions; and severe or recurrent skin infections. A person has symptomatic HIV infection if there are one or more cardinal findings, two or more characteristics findings, one characteristic finding and two or more associated findings, three or more associated findings together with any risk factors, or two associated findings together with a positive HIV test result. Malawi, Zambia, Thailand, and the English-speaking Caribbean are adapting these criteria for national use.
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PMID:Diagnosing symptomatic HIV infection and AIDS in adults. 1228 34


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