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

The cellular immunoincompetence which follows bone marrow transplantation (BMT) allows both primary and reactivation infection with herpes viruses. We report the overall incidence and timing of varicella zoster virus (VZV) infections after BMT, including the clinical course, complications and associated clinical risk features. Of 1186 patients undergoing BMT through 1989, 216 patients developed VZV infection between 4 days and 10.8 years after BMT; 86% of them within the first 18 months. Of all patients transplanted, 15 +/- 3% by 6 months and 52 +/- 14% by 5 years had developed VZV infection. Dermatomal zoster represented 62% of the infections, while 32% had complicated VZV infection--CNS, disseminated or visceral zoster. All serious infections occurred within 7 months of BMT but only two patients died, both from VZV pneumonitis. Allogeneic and autologous recipients had a similar incidence of VZV infection. VZV seropositive patients had more frequent, earlier and often more complicated or disseminated infections. Age > or = 10 years and radiation in the pre-transplant conditioning were significantly and independently associated with higher rates of VZV infection within a multivariate regression model. Using this model, we could define clinical risk groups with distinctly different hazards of VZV infection: age > 10 years, radiation pre-BMT and VZV seropositive patients had a 44% incidence by 3 years versus age < 10 years, no radiation and VZV seronegative had a 0% incidence by 3 years. Acyclovir assigned for prophylaxis of CMV or HSV infection had no effect on the timing or incidence of VZV infection.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Varicella zoster infection after bone marrow transplantation: incidence, risk factors and complications. 819 70

Acyclovir, an antiviral nucleoside analogue, is a widely used agent highly specific for herpes simplex and varicella-zoster viruses. Unintended exposure to acyclovir early in pregnancy, which is not uncommon, may cause excessive maternal and physician anxiety. This drug has not been studied prospectively in large numbers of pregnant women and lacks the Food and Drug Administration's approval for gestational use unless benefits clearly outweigh potential fetal harm. However, data published since acyclovir became available do not indicate increased adverse effects related to its use in pregnancy, especially if prescribed in selected situations, such as disseminated primary herpes simplex infections or maternal varicella pneumonia. This article reports the impact of inadvertent acyclovir exposure on a woman during the first trimester of pregnancy and reviews the literature on acyclovir's pharmacology, safety profile, and potential uses during pregnancy.
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PMID:Uses and safety of acyclovir in pregnancy. 830

Interstitial pneumonia caused by Herpes simplex virus type 1 (HSV-1) is a severe complication of orthotopic liver transplantation (LTX). The records of patients were reviewed who had an LTX at the age of 16 years or older between 1991 and 1994 with a mean follow-up of 21 months (range, 10 to 44 months). Six patients were included who had fever of > 38 degrees C, deterioration of arterial blood gases, radiological evidence of interstitial pneumonia and proof of HSV-1 in bronchoalveolar lavage fluid. All patients were anti-HSV-IgG positive before LTX. All patients were successfully treated with intravenous acyclovir, mechanical ventilation and reduced immunosuppression. Three patients who received cyclosporin A had a rejection which was successfully treated by switching to FK 506. Four patients were discharged in good health. One patient died 36 months after LTX of an unrelated cause. One patient died of urosepsis on postoperative day 139. Acyclovir together with mechanical ventilation and reduced immunosuppression proved to be an effective treatment for HSV-1 pneumonia following LTX.
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PMID:Management of herpes simplex virus type 1 pneumonia following liver transplantation. 874 Jan 5

Prophylactic intervention with varicella-zoster immunoglobulin early in the incubation period can prevent or attenuate the disease manifestations of varicella in susceptible contacts at high risk from this infection. Detailed guidelines are issued in the UK Department of Health publication on Immunization against Infectious Disease. Sensitive immunoassays are available for investigation of antibody status and subclinical seroconversion. Live attenuated varicella vaccine, which has been used successfully post-exposure as well as electively elsewhere, is at present not generally available in the UK. Effective protocols for prophylaxis against varicella with the antiviral agent aciclovir are not yet established. The nucleoside analogue aciclovir (syn: acyclovir, Zovirax) is effective in inhibiting replication of VZV when given at a dosage higher than that required for treatment of HSV, and is currently the only available and approved treatment for varicella in the U.K. Intravenous aciclovir therapy for 5-10 days is effective for varicella in neonates and the immunocompromised, and for varicella pneumonia or other complications in adults and children, if begun early. Oral aciclovir is only effective if begun with 24 h of onset of rash. With that proviso. it is recommended for treatment of varicella in otherwise healthy adults and adolescents, but not for routine use in children under 13 years of age unless they are sibling contacts or have other medical conditions. Aciclovir has a high therapeutic index and good safety profile, but caution is advised with use in pregnancy.
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PMID:Antiviral prophylaxis and treatment in chickenpox. A review prepared for the UK Advisory Group on Chickenpox on behalf of the British Society for the Study of Infection. 951 6

Varicella-zoster virus may cause serious infection, particularly pneumonia, in adult women. Women of child-bearing age should be questioned about immunity to varicella preconceptually, and offered serological testing, and VARIVAX vaccine if indicated. All pregnant patients should be questioned about immunity to varicella during their first prenatal appointment. Susceptible patients should be counseled to avoid contact with individuals who have chickenpox. If exposure occurs, VZIG should be administered within 96 hours in an attempt to prevent maternal infection. Varicella embryopathy may occur as a result of maternal infection particularly in the first half of pregnancy with an incidence of 1% to 2%. Varicella of the newborn is a life-threatening illness that may occur when a newborn is delivered within 5 days of the onset of maternal illness or after postdelivery exposure to varicella. Susceptible neonates should receive VZIG. Acyclovir is active against the varicella-zoster virus, and treatment is indicated in seriously ill adults and neonates.
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PMID:Varicella in pregnancy. 973 99

A 66-year-old woman was admitted to the hospital because of dry coughing. Ten days before admission, the patient had suffered from facial palsy accompanying otic zoster infection (Ramsay Hunt syndrome). Acyclovir was given, and during the two weeks after admission, the facial palsy resolved completely. The dry coughing worsened, and marked eosinophilia developed (1.930/mm3). A chest roentgenogram and a computed tomogram revealed wandering non-segmental infiltration in the left lung field. Examination of a specimen obtained by transbronchial lung biopsy revealed moderate eosinophilic infiltration into thickened alveolar septa and alveolar spaces. An elevated CD 4/CD 8 ratio (4.12) and a high level of eosinophilic cationic protein (8.730 micrograms/l) were found in bronchoalveolar lavage fluid. Eosinophilic pneumonia was diagnosed. The patients condition improved without medication within one month after the onset of the dry coughing. Laboratory results revealed no parasitic or mycotic infection, and both an acyclovir skin test and a lymphocyte stimulation test were negative, which suggested that the pneumonia had been induced by an allergic reaction to unknown antigens resulting from Th 1/Th 2 imbalance after reactivation of varicella-zoster virus latent in sensory ganglia.
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PMID:[Ramsay Hunt syndrome associated with eosinophilic pneumonia]. 975 4

We treated 14 patients with advanced, resistant chronic lymphocytic leukaemia (CLL) including three with >10% prolymphocytes (CLL/PL) with high dose methyl prednisolone (HDMP). All patients had stage C CLL or bulky stage B disease. There were 11 males and 3 females with a median age of 58.5 years (range: 49-69). Six out of eleven CLL patients had a partial response as defined by the NCI guidelines, no patient had a complete remission. The mean duration of PR was 19.6 months with a median of 8 months (range 6-78). Seven patients have died including the 5 non-responders. None of the 3 patients with CLL/PL had a measurable response. Previous treatments included chlorambucil, fludarabine, deoxycoformycin, anthracycline containing regimens such as CHOP and Campath-1H. HDMP was given at a dose of 1 g/m2 for five days, at monthly intervals for one to seven courses depending on the response. H2 antagonists and antimicrobial prophylaxis were given concurrently. Acyclovir prophylaxis was given if there was a recent history of herpes infection. HDMP was generally well tolerated. Side effects included fluid retention, hyperglycaemia, bradycardia (1 patient), herpes simplex (1), and pneumonia (1) in a patient with a previous history of recurrent chest infection and pneumonia. These results suggest that HDMP may be beneficial in the treatment of refractory CLL but is of no value in CLL/PL.
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PMID:High dose methyl prednisolone in refractory chronic lymphocytic leukaemia. 1035 Mar 45

Varicella (chickenpox) is a common childhood illness. Most adults are immune to the virus because of previous exposure. Pregnant women who contract varicella risk complications such as pneumonia. Varicella may be transmitted from mother to fetus and could cause congenital varicella syndrome or perinatal infection. Susceptibility to varicella should be determined before pregnancy. Varicella zoster immune globulin may be considered for the mother or newborn if exposure occurs. Acyclovir may decrease the risk of maternal complications from infection.
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PMID:Varicella infection in pregnancy. 1172 3

Bronchial asthma had been diagnosed in a 33-year-old man, and he had then been treated with a moderate dose of inhaled steroids (fluticason propionate 400 micrograms/day). On year later, he was admitted to our hospital complaining of sore throat, fever, loss of appetite, and skin eruptions. Despite the administration of Acyclovir for three days, varicella pneumonia was diagnosed. Computed tomography of the chest and bronchoscopic examination revealed characteristic findings: nodules with surrounding ground-glass attenuation and multiple vesicles with an ulcerativelesion on the bronchial mucosa, respectively. The demonstration of varicella-zoster virus DNA in a bronchoalveolar lavage specimen by the polymerase chain reaction technique was useful in the formulation of a definitive diagnosis.
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PMID:[An adult patient with varicella-zoster pneumonia while under inhaled steroid treatment]. 1192 24

We report a cluster of 3 cases of nosocomial herpes simplex virus type 1 (HSV-1) pneumonia occurring in close temporal and physical proximity during a 1-week period, which suggested a common source. HSV-1 nosocomial pneumonia occurs in immunocompetent intubated patients and presents as otherwise unexplained profound and/or prolonged hypoxemia (decreased F(IO2), increased P(O2), and decreased A-a gradient) and "failure to wean." The diagnosis of HSV-1 pneumonia is determined by demonstration of characteristic cytopathologic findings (Cowdry type A inclusion bodies) in distal respiratory epithelial cells from bronchoscopic specimens. Acyclovir therapy results in rapid improvement and ability to wean.
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PMID:A cluster of nosocomial herpes simplex virus type 1 pneumonia in a medical intensive care unit. 1708 Mar 87


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