Herpes zoster infection

Another topical anesthetic, similar to benzocaine, is lidocaine, which is used to relieve the pain of shingles (herpes zoster) infections. Lidocaine is called an amide anesthetic, because it is not an ester (the alcohol is replaced by an amide, the nitrogen group). Amide anesthetics are metabolized by the liver, and are less prone to cause allergic reactions. If an anesthetic has the letter i in the prefix (lidocaine, prilocaine, bupivacaine), it is an amide anesthetic. 

Shingles herpes zoster, infection due to the re-activation of the latent varicella zoster virus Status epilepticus occurrence of continuous seizures Striae scars in the skin... 

Valacyclovir, the L-valyl ester of acyclovir, is a prodrug that can be administered orally in herpes zoster infections. Its absorption rate is approx, twice that of acyclovir. During passage through the intestinal wall and liver, the valine residue is cleaved by esterases, generating acyclovir. 

Herpes zoster infections There are no data on treatment initiated more than 72 hours after the onset of the rash. Initiate treatment as soon as possible after diagnosis. In clinical trials, treatment was most effective when started within the first 48 hours of rash onset. 

Capsaicin (Zostrix) is approved for the relief of pain following herpes zoster infection (postherpetic neuralgia). The drug depletes neurons of substance P, an endogenous neuropeptide that may mediate cutaneous pain. It is applied to affected skin after open lesions have healed. Local irritation is common. 

Unlabeled Uses Oral, parenteral Prophylaxis of herpes simplex and herpes zoster infections, infectious mononucleosis. 

Topical Treatment adjunct for herpes zoster infections. 

In the past, various serendipitous discoveries have capitalized on the differential expression of enzymes by host and viral infected cells. For example, the prodrug Acyclovir, used widely for the treatment of herpes simplex and herpes zoster infections, is selectively activated through phosphorylation by viral thymidine kinase to acyclovir monophosphate which is then converted to the triphosphate, which inhibits DNA polymerase, by host cellular enzymes. Similarly several 2, 3 -dideoxynucleoside analogs such as Zidovudine (azidothymidine, AZT) and 2, 3 -didehydro-3 -deoxythymidine (D4T) have potent antiviral activity against human immunodeficiency vims (HIV). These compounds are selectively phosphoiylated intracellularly to the 5 -triphosphate derivatives which inhibit the viral reverse transcriptase. 

Acute dacryoadenitis usually responds rapidly to systemic corticosteroids. Patients with viral dacryoadenitis associated with acute epidemic parotitis (mumps), infectious mononucleosis, or herpes zoster infection should receive supportive therapy, such as rest, local application of ice, and use of oral analgesics, such as acetaminophen. Supportive therapy for mumps should be continued for its typical 2- to 4-week self-limiting course. 

In addition to eyelid swelling on the affected side, acute conjimctivitis is the most common ocular manifestation of herpes zoster infection. The conjunctivitis is... 

Conservative treatment of zoster-associated conjunctivitis, including cold compresses, lubricants, and decongestants, carries the lowest risk of treatment-related complications. Treatment of the acute conjunctivitis with topical broad-spectrum antibiotics may help to prevent secondary bacterial infection. Increased patient comfort by reduction of conjunctival inflammation may be affected by the use of topical steroids. Often, a combination antibiotic-steroid is used to accomplish both of these goals. In contrast to herpes simplex infection in which steroids are specifically contraindicated, topical steroids do not exacerbate herpes zoster infection. If steroids are used, the patient should be carefully monitored for intraocular pressure elevation. 

The increased bioavailability and decreased dose frequency, combined with the potential shorter duration of the associated postherpetic neuralgia, argue for careful consideration of these newer agents for the acute treatment of herpes zoster infections. 

Oral famciclovir is used for the treatment of immrmo-competent patients with herpes zoster infections and for the treatment and suppression of recuri ent genital HSV. It is also indicated for the treatment of recuri ent mucocutaneous herpes simplex in both immrmocompetent and immunocompromised patients. Famciclovir is fairly well tolerated. Adverse effects include headache, dizziness, nausea, and diarihea (Scholar and Pratt, 2000). 

Valaciclovir is a prodrug (ester) of aciclovir, i.e. after oral administration the parent aciclovir is released. The higher bioavailability of valaciclovir (about 60%) allows dosing only 8-hourly. It is used for treating herpes zoster infections and herpes simplex infections of the skin and mucous membranes. 

In a phase-2, partly randomized, double-blind, placebo-controlled study of three different doses of abetimus in 58 patients, seven did not receive all doses because of adverse events (2). Five withdrew because of adverse events related to their lupus erythematosus non-renal exacerbations (n = 2), hematuria and hypertension (n — 1), worsening rash (n — 1), and nephritis (n — 1). One patient withdrew because of cellulitis and another because of a localized Herpes zoster infection. None of the reported adverse events was considered to be definitely related to the drug. 

Failure of antiretroviral drug therapy has been attributed to an interaction of carbamazepine with indinavir in a 48-year-old man taking indinavir, zidovudine, and lamivudine his HIV-RNA viral load became undetectable after less than 2 months and he developed a Herpes zoster infection (87). Lower doses of carbamazepine are also required during co-administration of ritonavir, as has been shown in two recent cases. 

Kahl LE. Herpes zoster infections in systemic lupus erythematosus risk factors and outcome. J Rheumatol 1994 21(l) 84-6. 

A 48-year-old HIV-positive man taking indinavir, zidovudine, and lamivudine developed Herpes zoster infection, which was treated with famciclovir. Postherpetic neuralgia was treated with carbamazepine, and his plasma indinavir concentration fell substantially. The carbamazepine was withdrawn after 2.5 months and 2 weeks later HIV-RNA was detectable in his plasma (6 X 10 /ml). His circulating virus was resistant to lamivudine. With a further increase in viral load, his therapy was changed to nevirapine, didanosine, and stavudine. 

Herpes simplex infection Herpes zoster infection Hirsutism (SEDA-6, 146)... 

IFNs have effects in various herpesvirus infections including genital HSV infections, localized herpes-zoster infection, and CMV infections of renal transplant patients. IFN generally is associated with more side effects and inferior results relative to conventional antiviral therapies. Topically applied IFN and trifluridine combinations appear active in acyclovir-resistant mucocutaneous HSV infections. 

Vidarabine is used mainly in human HSV-1 and HSV-2 encephalitis, decreasing the mortality rate from 70 to 30%. Whitley et al. (57) reported that early vidarabine therapy is helpful in controlling complications of localized or disseminated herpes zoster in immunocompromised patients. Vidarabine also is useful in neonatal herpes labialis or genitalis, vaccinia virus, adenovirus, RNA viruses, papovavirus, CMV, and smallpox virus infections. Given the efficacy of vidarabine in certain viral infections, the U.S. FDA approved a 3% ointment for the treatment of herpes simplex keratoconjunctivitis and recurrent epithelial keratitis, and a 2% IV injection for the treatment of herpes simplex encephalitis and herpes zoster infections (Table 43.3). A topical ophthalmic preparation of vidarabine is useful in herpes simplex keratitis but shows little promise in herpes simplex labialis or genitalis. The monophosphate esters of vidarabine are more water-soluble and can be used in smaller volumes and even intramuscularly. These esters are under clinical investigation for the treatment of hepatitis B, systemic and cutaneous herpes simplex, and herpes zoster virus infections in immunocompromised patients. 

An elderly patient taking carbamazepine 200 mg daily then 400 mg daily for neuropathic pain associated with herpes zoster infection was given paroxetine 20 mg daily to treat depression. He developed vertigo, bradycardia and syncope and his plasma sodium was found to he low (120 mmol/L). Sodium levels returned to normal (135 mmol/L) over several weeks after carbamazepine was withdrawn. ... 

A 42-year-old woman, taking lithium carbonate 450 mg twice daily, developed signs of lithium toxicity 6 days after starting treatment with intravenous aciclovir 10 mg/kg, which was given every 8 hours for a severe herpes zoster infection following chemotherapy. Her serum-lithium levels had risen over fourfold to 3.4 mmol/L. The reasons for this interaction are unknown but the authors of the report postulate that aciclovir may have inhibited the renal excretion of lithium. ... 

A 67-year-old man with end-stage renal disease secondary to hypertensive nephropathy developed a herpes zoster infection and was given oral valaciclovir 1 g/day. After 5 days, he complained of hallucinations. Valaciclovir was withdrawn and peritoneal diatysis was continued. The serum aciclovir concentration on admission was 20 mg/1 and fell to 0.7 mg/1 by day 7, when his symptoms had completely resolved. 

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