Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0022568 (keratitis)
 5,133 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Acyclovir (aciclovir) is a nucleoside antiviral drug with antiviral activity in vitro against members of the herpes group of DNA viruses. As an established treatment of herpes simplex infection, intravenous, oral and to a lesser extent topical formulations of acyclovir provide significant therapeutic benefit in genital herpes simplex and recurrent orofacial herpes simplex. The effect of acyclovir therapy is maximised by early initiation of treatment, especially in non-primary infection which tends to have a less protracted course than the primary episode. Long term prophylactic oral acyclovir, in patients with frequent episodes of genital herpes simplex, totally suppresses recurrences in the majority of subjects; as with other infections responding to acyclovir, viral latency is not eradicated and pretreatment frequencies of recurrence return after discontinuation of treatment. Caution should accompany the prophylactic use of acyclovir in the general population, due to the theoretical risk of the emergence of viral strains resistant to acyclovir and other agents whose mechanism of action is dependent on viral thymidine kinase. Intravenous acyclovir is the treatment of choice in biopsy-proven herpes simplex encephalitis in adults, and has also been successful in the treatment of disseminated herpes simplex in pregnancy and herpes neonatorium. Intravenous and oral acyclovir protect against dissemination and progression of varicella zoster virus infection, but do not protect against post-herpetic neuralgia. In immunocompromised patients, intravenous, oral and topical acyclovir shorten the clinical course of herpes simplex infections while prophylaxis with oral or intravenous dosage forms suppresses reactivation of infection during the period of drug administration. Ophthalmic application of 3% acyclovir ointment rapidly heals herpetic dendritic corneal ulcers and superficial herpetic keratitis. Thus, despite an inability to eradicate latent virus, acyclovir administered in therapeutic or prophylactic fashion is now the standard antiviral therapy in several manifestations of herpes simplex virus infection, and indeed represents a major advance in this regard. With the exception of varicella zoster virus infections, early optimism concerning the use of the drug in diseases due to other herpes viruses has generally not been supported in clinical investigations.
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PMID:Acyclovir. An updated review of its antiviral activity, pharmacokinetic properties and therapeutic efficacy. 265 90

Seventy-one nonimmunocompromised patients with herpes zoster ophthalmicus, presenting within seven days of onset of characteristic skin eruption, were enrolled in a prospective, longitudinal, randomized, double-masked, placebo-controlled trial with oral acyclovir. In a previous interim report we noted more prompt resolution of dermatomal signs and symptoms with acyclovir treatment. There was also a reduction of viral shedding in acyclovir-treated patients coupled with a trend to greater rate of microdissemination of the virus in placebo-treated patients (Cobo LM, et al. Ophthalmology 1985; 92:1574-83). While further substantiating these findings, we report that a ten-day course of treatment with oral acyclovir (600 mg, five times a day) is well-tolerated and significantly reduces the incidence and severity of the most common complications of herpes zoster ophthalmicus: dendritiform keratopathy, stromal keratitis, and uveitis. While this acyclovir treatment regimen reduces the zoster-related pain during the acute phase of the disease, especially in patients treated within 72 hours of onset of skin lesions, it has no evident effect on either incidence, severity, or duration of post-herpetic neuralgia in the patients studied.
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PMID:Oral acyclovir in the treatment of acute herpes zoster ophthalmicus. 348 32

We have studied certain aspects of the natural history of acute herpes zoster ophthalmicus in placebo-treated patients followed prospectively over one year as part of a therapeutic drug trial. Observations on the incidence of ocular complications relating to the efficacy of oral acyclovir in this disease have been previously published. This report provides supplemental observations on the natural history of frequently observed ocular complications of zoster ophthalmicus: corneal hypesthesia, episcleritis, dendritiform keratopathy, stromal keratitis, anterior uveitis, and post herpetic neuralgia. These ocular complications of zoster typically present within the first two weeks of the diagnosis. This report characterizes the onset of corneal hypesthesia, episcleritis, dendritiform keratopathy, stromal keratitis, and anterior uveitis as well as interrelationships amongst these sequellae of herpes zoster ophthalmicus. Post-herpetic neuralgia occurs in 52% of patients and persists beyond a year in 22% of those affected.
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PMID:Observations on the natural history of herpes zoster ophthalmicus. 349 83

Acyclovir (aciclovir) is a nucleoside analogue antiviral drug related to cytarabine, idoxuridine, trifluridine and vidarabine. In common with these earlier antivirals, acyclovir is active against some members of the herpesvirus group of DNA viruses. The efficacy of topical acyclovir has been convincingly demonstrated in ocular herpetic keratitis, and in initial and primary initial genital herpes infection, but little or no clinical benefit was seen when non-primary initial genital infections were assessed separately. Acyclovir ointment demonstrated little benefit in recurrent genital herpes but topical acyclovir cream decreased the course of the infection by 1 to 2 days. Orally and intravenously administered acyclovir were beneficial in initial genital herpes infections, and oral therapy shortened the duration of recurrent infections by 1 to 2 days but did not ameliorate pain. In non-immunocompromised patients with recurrent herpes simplex labialis, generally little clinical benefit was seen with the use of topical acyclovir ointment even when therapy was initiated during the prodromal phase, while topical acyclovir cream effected small but significant improvements in the clinical but not the symptomological course of the disease. However, in immunocompromised patients, both intravenous and topical acyclovir shortened the clinical course of herpes simplex virus infections occurring mainly on the lips, oral mucosa and face, and prophylaxis with either oral or intravenous acyclovir suppressed the appearance of recurrent lesions from latent virus for the period of drug administration, but acyclovir did not eradicate latent herpesviruses. In non-immunocompromised patients, intravenous acyclovir was shown to decrease the acute pain of zoster, especially in the elderly, but postherpetic neuralgia was not ameliorated. When immunocompromised patients were studied, intravenous acyclovir inhibited the progression of zoster infections and shortened the healing time and duration of viral shedding in patients with cutaneous disseminated zoster. However, acute and post-herpetic pain were not significantly affected. Well designed controlled studies are underway to establish the efficacy of acyclovir in herpes simplex encephalitis and cytomegalovirus infections in immunocompromised patients, infections due to Epstein-Barr virus, and neonatal herpesvirus infections. Despite some aspects of the drug's use which require further clarification, acyclovir will make a major impact on the treatment of herpesviral infections. Barring unexpected findings with wider clinical use, it will become the agent of choice in several conditions.
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PMID:Acyclovir. A review of its pharmacodynamic properties and therapeutic efficacy. 631 32

During a 3-year period, 25 caudalis dorsal root entry zone (DREZ) operations were done for severe, facial pain. Intraoperative brainstem recordings were done before and after DREZ in all patients. Primary diagnosis included refractory trigeminal neuralgia, atypical headaches or facial pain, posttraumatic closed head injuries, postsurgical anesthesia dolorosa, multiple sclerosis, brainstem infarction, postherpetic neuralgia and cancer-related pain. At the time of discharge, good to excellent pain relief was present in 24/25 patients and fair relief in 1. At 1 month, 19/25 (76%) patients had good to excellent results and at 3 months following surgery, 17/25 (68%) continued to have good to excellent pain relief. One year following surgery, 18 patients could be evaluated, 12/18 (67%) still considered their relief as good to excellent, 2 fair and 4 poor. Transient postoperative ataxia was present in 15/25 patients (60%), but was largely resolved at 1 months. In 3/18 (17%) patients, a degree of ataxia was still present at 1 year although in none was it disabling. Two patients had transient diplopia, and 3 had increased corneal anesthesia with 1 later developing a keratitis. No surgical or postsurgical mortality was noted. This procedure has proven to be a satisfactory treatment for many patients with debilitating facial pain syndromes with acceptable morbidity.
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PMID:The caudalis DREZ for facial pain. 971 11

Ocular virus infections remain an important cause of corneal and external disease. Herpes simplex, the most important, is easily treated when it is confined to the epithelium. New studies indicate that herpetic stromal disease and iritis are effectively treated with a combination of corticosteroid and antiviral without additional risk. Recurrences of ocular herpetic disease can be reduced with acyclovir given orally; the benefit seems to be greatest in patients who have had at least one episode of stromal keratitis. Herpes zoster can be treated with either acyclovir or famciclovir, but to be effective, treatment must be initiated within 72 hours of onset. Early treatment reduces the risk of post-herpetic neuralgia and may reduce the risk of ocular complications. Adenovirus infection (epidemic keratoconjunctivitis) is often spread by the ophthalmologist. New medications such as cidofovir appear to be effective against the adenoviruses in non-human systems and may have some effect in man, although previously, drugs that appeared to have an effect in vitro have proven to be ineffective in the clinical setting.
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PMID:Treatment of viral diseases of the cornea and external eye. 1061 81

The aim of five years (2000-2005) study was to investigate the peculiarities of Herpes Zoster in immunocompromised and immunocompetent patients. For this purpose we have investigated the clinical course of Herpes Zoster, disease duration, complications of disease, as in acute phase as well as postherpetic neuralgia in 74 HIV positive (1st group) and 74 HIV negative (2nd group) groups of patients. In both group of patients we have studied the prevalence of the following complications: 1. Acute complications of Herpes Zoster: a) Neurological: motor neuropathy, cranial neuritis, meningoencephalitis, transverse myelitis. b) Ophthalmic: keratitis, iritis, retinitis, visual impairment c) Cutaneous: bacterial superinfection, scarring, disfigurement. d) Visceral: pneumonitis, hepatitis. e) Multidermatomal. 2. The complications of after resolution of infection: a) Postherpetic neuralgia and various duration of pain associated with postherpetic neuralgia such as : < month, 1-6 months, 6-12 months and >1 year durations. b) Recurrent herpes zoster. Herpes Zoster infection was diagnosed based on clinical symptoms and by detection of VZV specific IgM and IgG by ELISA. HIV infection was diagnosed by ELISA method and was confirmed by Western Blot. We found that Herpes Zoster may develop as in HIV positive as well as HIV negative population. Study showed that severe cases of disease (Herpes Zoster), long duration and rate of complications are much higher in HIV/AIDS than in HIV negative group patients. Rate of hospitalization is also higher in HIV/AIDS patients with Herpes Zoster than in HIV negative patients with Herpes Zoster. Frequency of recurrent Herpes Zoster is much higher in HIV/AIDS patients than in HIV negative patients. The postherpetic neuralgia is very frequent complication for both group (HIV positive and HIV negative) Herpes Zoster patients, but its duration longer in HIV/AIDS patients in comparison HIV negative group. There were no significant difference in disease severity, duration and complications among male and female patients.
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PMID:Peculiarities of herpes zoster in immunocompetent and immunocompromised hosts. 1726 87

The syndrome of inappropriate secretion of antidiuretic hormone (SIADH) associated with localized herpes zoster is rarely reported and may be under-appreciated. We describe two diabetic men with herpes zoster ophthalmicus (HZO) who developed hyponatremia (114 and 116 mmol/L) during acute illness. Both were euvolemic and had elevated urine osmolality (435 and 368 mmol/kg.H(2)O) and sodium (Na(+)) concentration (61 and 63 mmol/L) along with normal cardiac, renal, liver, and endocrine function consistent with the diagnosis of SIADH. Thorough investigation for other causes of SIADH, including detailed physical examination, laboratory studies, and computed tomography of the brain, chest, and abdomen, were negative. Despite antiviral therapy (acyclovir) for herpes zoster, ophthalmoplegia, keratitis, and post-herpetic neuralgia (PHN) developed. Even with fluid restriction and high salt diet, SIADH lasted for 3 to 4 months and resolved concomitantly with resolution of PHN, suggesting an association between SIADH and HZO. These two cases raise the potential for herpes zoster infection, especially HZO, to involve the regulatory pathway of ADH secretion, contributing to SIADH. The presence of PHN, which reflects greater neural damage may, at least in part, explain the prolonged ADH secretion and hyponatremia.
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PMID:Syndrome of inappropriate secretion of antidiuretic hormone associated with localized herpes zoster ophthalmicus. 2087 95

Herpes zoster (HZ) is caused by reactivation of latent varicella zoster virus (VZV) in people who have had chicken pox, usually resulting in a painful, unilateral, dermatomal, vesicular rash. Herpes zoster ophthalmicus occurs when the first division of cranial nerve V is involved. HZ is common, with approximately 1 million new cases per year in the United States, and occurs in 1 in 3 persons. Although the rate of HZ increases with age, over half of all cases occur under the age of 60 years. Complications of herpes zoster ophthalmicus include eye disease, postherpetic neuralgia (PHN), and strokes. VZV has also been found in temporal arteritis biopsies. There is growing evidence that HZ is followed by chronic active VZV infection contributing to these complications. In view of this, and the efficacy of suppressive antiviral treatment in reducing recurrent herpes simplex keratitis, a randomized controlled trial of suppressive valacyclovir to reduce new or worsening anterior segment disease and/or PHN is needed. The zoster vaccine (ZV) is safe and effective in reducing the burden of illness, severity of PHN, and incidence of HZ. It is Centers for Disease Control and Prevention recommended for persons aged 60 years and above without impaired cellular immunity, and Food and Drug Administration approved for those aged 50 and older. It is most effective in preventing HZ in recipients in their 50s. Because of underusage of the ZV, it has not impacted the epidemiology of the disease. Barriers to its use include cost, variable reimbursement, frozen storage, and lack of a strong recommendation by doctors.
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PMID:Management and Prevention of Herpes Zoster Ocular Disease. 2611 27

Herpes zoster (HZ) is primarily a disease of nerve tissue but the acute and longer-term manifestations require multidisciplinary knowledge and involvement in their management. Complications may be dermatological (e.g. secondary bacterial infection), neurological (e.g. long-term pain, segmental paresis, stroke), ophthalmological (e.g. keratitis, iridocyclitis, secondary glaucoma) or visceral (e.g. pneumonia, hepatitis). The age-related increased incidence of HZ and its complications is thought to be a result of the decline in cell-mediated immunity (immunosenescence), higher incidence of comorbidities with age and social-environmental changes. Individuals who are immunocompromised as a result of disease or therapy are also at increased risk, independent of age. HZ and its complications (particularly postherpetic neuralgia) create a significant burden for the patient, carers, healthcare systems and employers. Prevention and treatment of HZ complications remain a therapeutic challenge despite recent advances. This is an overview of the multidisciplinary implications and management of HZ in which the potential contribution of vaccination to reducing the incidence HZ and its complications are also discussed.
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PMID:Herpes zoster epidemiology, management, and disease and economic burden in Europe: a multidisciplinary perspective. 2755 30


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