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Query: UMLS:C0032285 (pneumonia)
 54,520 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Twenty-three patients with complicated varicella-zoster virus infections were treated with adenine arabinoside. Of 14 patients with herpes zoster, 13 had malignancy treated with irradiation and cytotoxic agents or steroids. Although the duration of active vesicle formation in these patients ranged from two to 14 days before therapy, no new lesions appeared after the fourth day of treatment with adenine arabinoside. Zoster encephalitis developed in one patient on the third day of treatment, and severe postherpetic neuralgia was seen in three patients. Of nine treated patients with primary varicella, six improved, including five with evidence of varicella pneumonia. Two of the three patients with varicella who died were immunosuppressed and had progressive viral pneumonia with persistently high titers of virus in vesicular fluid; the third pateint was a child with Reye's syndrome. Double-blind controlled studies will be necessary to demonstrate the efficacy of adenine arabinoside in the treatment of infections with varicella-zoster virus.
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PMID:Treatment of varicella-zoster virus infections with adenine arabinoside. 16 42

Glucocorticosteroids are the most commonly used immunosuppressive agents. In the following review important mechanisms of action of glucocorticoids on the immunological network are summarized, the relationship between duration of therapy, daily dose and incidence of infections is analysed, and evidence is presented that in some infectious diseases glucocorticoids may even be beneficial. The association between corticosteroid therapy and subsequent infections was calculated by pooling the data from 73 controlled clinical trials (meta-analysis). The rate of infectious complications was not increased in patients given a daily dose of less than 10 mg or a cumulative dose of less than 700 mg prednisone. With increasing doses the occurrence rate of infectious complications increased in patients given corticosteroids as well as in patients given placebo, a finding which suggests that not only the corticosteroid but also the underlying disease state accounts for the steroid-associated infectious complications observed in clinical practice. To analyze the effect of glucocorticoids prescribed as adjuvants in patients with infectious diseases, an analysis of the controlled trials was performed. Some patients with pulmonary tuberculosis or constrictive pericarditis have a better outcome when they are given prednisone. On the other hand, there is no evidence that patients with septic shock or ARDS derive advantage from glucocorticoid therapy. At present there is controversy as to whether patients with bacterial meningitis should be treated with glucocorticosteroids. Patients with hepatitis B should not be treated with glucocorticoids, whereas elderly patients less frequently show postherpetic neuralgia when given glucocorticosteroids. Patients with cerebral malaria should not be given glucocorticosteroids. Aids patients with pneumocystis carinii pneumonia have a higher survival rate when treated with glucocorticosteroids than with placebo.
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PMID:[Glucocorticoids and infection]. 173 19

Major advances have been made in the treatment of herpesvirus infections in the compromised host. Acyclovir is clearly effective in the treatment of HSV infection, and preferable to vidarabine for this purpose. Additional information about the optimal use of acyclovir for treatment or prophylaxis and about the ultimate significance of the phenomena of acyclovir resistance and possible suppression of the specific immune response are needed. The major challenge at this time is the rapid clinical or virologic diagnosis of HSV infection, especially the rarer manifestations such as HSV pneumonia or encephalitis, so that effective therapy can be initiated. The serious manifestations of VZV infection (e.g. cutaneous and visceral dissemination) can also be controlled with either vidarabine or acyclovir, although definition of the agent of choice is still lacking. More information is needed to define the relative efficacy of acyclovir compared with vidarabine, and also to define better treatment regimens for the prevention of post-herpetic neuralgia which remains a major source of morbidity. Use of either oral or topical acyclovir and anti-inflammatory agents in combined regimens is being studied. Interferon, although effective, has little present role in view of the availability of both acyclovir and vidarabine, although it is of interest as a model of an agent that can be administered to outpatients or used in synergistic regimens. The challenge for treatment of CMV is the development of an agent which is effective in vivo. Several promising agents are on the horizon, but much initial work must be done before their effectiveness will become apparent.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Treatment of herpesvirus infections in the immunocompromised host. 241 73

Acyclovir (Zovirax) and zidovudine (Retrovir) dominate antiviral therapy. They interfere with the multiplication of herpes viruses (acyclovir) and HIV (zidovudine) by incorporation into nascent DNA chains and interruption of the further linking of nucleotides. All types of infection caused by herpes simplex virus are potentially treatable by acyclovir, but treatment has to start to be effective. It is especially important to treat immunosuppressed patients because their infections are more prolonged and severe. A typical attack of herpes zoster in an immunocompetent patient is shortened by about 2 days if high doses of acyclovir are given within 3 days of the start of the skin lesions, but unfortunately the incidence of post-herpetic neuralgia is not diminished. Zidovudine lowers early mortality in patients with AIDS and pneumocystis carinii pneumonia. However, much of the effectiveness of zidovudine is lost later; the average prolongation of life in treated patients is estimated to be about 1 year. Some two thirds of patients with AIDS can be treated with zidovudine; in the others the drug is ineffective (Kaposi's sarcoma) or contraindicated. Frequent blood counts are necessary to monitor myelotoxicity.
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PMID:[Antiviral drugs--1988]. 285 Nov 67

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

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

Zika virus: what the dermatologist should know. Probably a new vaccine against herpes zoster and postherpetic neuralgia in older adults. Defining moderate, significant and extensive types of pemphigus with ABSIS et PDAI scores. Biologic Therapies and serious infections in patients with psoriasis. We can be cautiously optimistic, in that tuberculosis is rare but still occurs despite adherence to tuberculosis prevention guidelines. Others serious infections are rare, mainly pneumonia and cellulitis. Hidradenitis suppurativa: an unrecognized paradoxical effect of biologic agents. There is an association between Inflammatory Bowel Disease (IBD) and Hidradenitis suppurativa (HS), mostly with Crohn's disease, suggesting the need to look for signs and symptoms of IBD in HS patients. A study of 550 twins found that genetic and environmental factors each contribute to approximately half of the score of rosacea. Telangiectasia Macularis Eruptiva Perstans is a difficult to diagnose type of mastocytosis, often with a delay and which is associated with a systemic involvement in 50% of cases. Vitiligo. Management and development of new scores for the dermatologist and the patient. Livedoid vasculopathy. Anticoagulation with new molecules could prove an efficient means of treatment. Pyoderma Gangrenosum. Don't forget the toxic etiology. Daily practice: Laboratory monitoring for liver function tests and serum lipid profile during isotretinoin therapy for acne is currently recommended at baseline and every 3 months, depending on the results. Daily practice: Mikailov and al., challenge our habits by their medico economic study and propose an empirical treatment with terbinafine for patients with suspected onychomycosis that is cost effective with minimal effect on patient safety as terbinafine-induced liver injury is very rare. It makes think and especially propose studies to update our recommendations.
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PMID:[What's new in clinical dermatology?] 2942 3

Infectious diseases are a major cause for morbidity and mortality in the older population. Demographic changes will lead to increasing numbers of older persons over the next decades. Prevention of infections becomes increasingly important to ensure healthy aging for the individual, and to alleviate the socio-economic burden for societies. Undoubtedly, vaccines are the most efficient health care measure to prevent infections. Age-associated changes of the immune system are responsible for decreased immunogenicity and clinical efficacy of most currently used vaccines in older age. Efficacy of standard influenza vaccines is only 30-50% in the older population. Several approaches, such as higher antigen dose, use of MF59 as adjuvant and intradermal administration have been implemented in order to specifically target the aged immune system. The use of a 23-valent polysaccharide vaccine against Streptococcus pneumoniae has been amended by a 13-valent conjugated pneumococcal vaccine originally developed for young children several years ago to overcome at least some of the limitations of the T cell-independent polysaccharide antigens, but still is only approximately 50% protective against pneumonia. A live-attenuated vaccine against herpes zoster, which has been available for several years, demonstrated efficacy of 51% against herpes zoster and 67% against post-herpetic neuralgia. Protection was lower in the very old and decreased several years after vaccination. Recently, a recombinant vaccine containing the viral glycoprotein gE and the novel adjuvant AS01B has been licensed. Phase III studies demonstrated efficacy against herpes zoster of approx. 90% even in the oldest age groups after administration of two doses and many countries now recommend the preferential use of this vaccine. There are still many infectious diseases causing substantial morbidity in the older population, for which no vaccines are available so far. Extensive research is ongoing to develop vaccines against novel targets with several vaccine candidates already being clinically tested, which have the potential to substantially reduce health care costs and to save many lives. In addition to the development of novel and improved vaccines, which specifically target the aged immune system, it is also important to improve uptake of the existing vaccines in order to protect the vulnerable, older population.
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PMID:Vaccines to Prevent Infectious Diseases in the Older Population: Immunological Challenges and Future Perspectives. 3239 Oct 17