Herpetic infection

Unprotected sex is a major risk factor for contracting STIs and this patient s symptoms are consistent with gonorrhea, as purulent urethral discharge is suggestive of this infection. In addition, the incubation period is also evidence that the infection could be gonococcal. Infection with C. trachomatis is usually associated with a very watery discharge and this patient lacks the characteristic ulcerations commonly observed with other STIs such as syphilis and herpetic infection. 

Several cases have been reported in which herpes simplex virus keratitis developed after initiation of latanoprost therapy. Although these cases are anecdotal, it is known that prostaglandins may play a crucial role in mediating inflammatory events that could incite herpetic infection. 

Common causative organisms in adults with canaliculitis include Staphylococcus aureus and Actinomyces species. Primary herpetic infections (herpes simplex, varicella, and vaccinia) have a higher prevalence among patients younger than age 20 years and often present with cutaneous manifestations of the infectious disease. Chronic allergies may also be associated with canalicular obstruction. Occasionally, patients may suffer from canalicular obstruction as a result of topical antimetabolite treatment such as 5-fluorouracil or mitomycin C. 

The acute onset of unilateral bulbar conjunctival injection and tearing in a young child should always bring to mind the possibility of primary herpetic infection. If the... 

Herpes Simplex Virus Ophthalmia Neonatorum. HSY infection is an uncommon but important cause of neonatal infection and is associated with conjunctivitis in 5% to 10% of cases.The clinical manifestations are nonspecific and include conjimctival hyperemia, chemosis, periorbital edema, and mucous discharge. Corneal involvement is not uncommon and can include dendritic, geographic, or stromal keratitis. Herpetic ophthalmia neonatorum represents a primary herpetic infection. Central nervous system involvement, encephalitis, retinitis, optic neuritis, uveitis, choroiditis, and a fetal viremia can be serious sequelae of primary herpetic infections. 

Inspection of the posterior pole may be hindered by vitreous debris however, it is vitally important to evaluate for CME, a primary cause of visual deficit. Another notable finding in the posterior pole is papillitis, which may occur in a variety of etiologies such as syphilis, herpetic infection, and sympathetic ophthalmia. Chronic long-term complications involving the fundus may include choroidal neovascularization, chorioretinal scarring, epiretinal membrane formation, neovascularization, and retinal detachment. 

Infants born of infected women may come in contact with the virus as they move down the birth canal, and this may result in a severe or even life-threatening neonatal infection. It is estimated that 1 in 350 infants is delivered vaginally during viral shedding, but the incidence of severe herpetic infection in the newborn is approximately 1 in 20,000. ... 

Clinical uses and toxicity The drug is used for prophylaxis and treatment of cytomegalovirus (CMV) infections (including CMV retinitis) and has activity against ganciclovir-resistant strains of this virus (Table 49-1). Foscarnet inhibits herpes DNA polymerase in acyclovir-resistant strains that are thymidine kinase-deficient and may suppress such resistant herpetic infections in patients with AIDS. Adverse effects include nephrotoxicity (30% incidence) with disturbances in electrolyte balance (especially hypocalcemia), genitourinary ulceration, and CNS effects (headache, hallucinations, seizures). 

The drug most likely to suppress herpetic infections in this patient and provide prophylaxis against CMV retinitis is... 

Daheshia M, Kanangat S, Rouse BT Production of key molecules by ocular neutrophils early after herpetic infection of the cornea. Exp Eye Res 1998 67 619-624. 

Shishu, Rajan S, Kamalpreet. (2009). Development of novel microemulsion-based topical formulations of acyclovir for the treatment of cutaneous herpetic infections. AAPS PharmSciTech, 10, 559-565. 

Whitley etaL, 1977). In herpetic keratitis of the eye, it has been clinically found to be as effective as idoxuridine and less irritating. Vidarabine lacks the general usefulness of acyclovir (see below) in other herpetic infections. 

I understand that there is a small risk of developing permanent darkening or undesirable pigment loss at the treated site. There is a rare chance that a scar could develop. There is a small risk that a bacterial infection could develop. There is a small chance the peel could also trigger a flare of a pre-existing Herpetic infection at the treated site. There is a small chance that the condition being treated could worsen after the peeling procedure. The benefits and side effects of the procedure have been explained to me in detail. All of my questions have been answered. 

Active bacterial, viral, fungal, or herpetic infections. 

Infection Active bacterial, viral, fungal or herpetic infection Bacterial and fungal complications in chemical peels are rare (Fig. 20.10). Topical antibiotics and antiviral treatment with acyclovir or valacyclovir should be introduced as soon as this diagnosis is made. Toxic shock syndrome has been reported after an occluded Baker s phenol face peel. 

Varicella infection A 36-year-old man with plaque psoriasis developed a generalized pruritic vesicular eruption, weakness, a high fever, myalgias, anorexia, and progressive respiratory insufficiency after being treated with infliximab for 15 months [135 ]. He had never had chicken pox. A Tzanck smear and a skin biopsy from a vesicle showed typical signs of herpetic infection involving... 

The essential oil from Santolina insularis was also inhibited virus replication against HSV-1 and HSV-2 in vitro (Schnitzler et al. 2008). Its antiviral activity was principally due to direct virucidal effects (De Logu et al. 2000). Lemon balm oil, the essential oil of Melissa officinalis, is capable of exerting a direct antiviral effect on HSV-1 and HSV-2. Considering the lipophilic nature of essential oils, which enable it to penetrate the skin, and a high selectivity index, essential oils might be suitable for topical treatment of herpetic infections (Schnitzler et al. 2008). 

Any prior history of viral infections, such as chronic or recurrent herpes simplex, active dermatoses of the atopic, seborrheic or eczematous types, and medications such as topical or oral retinoids, must be reviewed. Those patients with a history of recurrent herpes infection should be treated prophylactically with oral antiviral agents, preferably Valtrex (valacyclovir), on the morning of the peel and continued for a routine course of therapy. If the patient presents on the morning of the peel with active herpetic infection in the areas to be treated, it is best to postpone the peel until complete resolution has occurred. 

In the era before antiviral medication, I observed four cases which developed mild atrophic scarring after herpes simplex complications. Two herpetic infections followed medium peels and two occurred following phenolic peels... 

Infections other than the activation of herpes are quite rare when the light peels are employed. Medium peels and deep peels can tii er herpetic infection so it is important to determine in advance whether patients are exposed to anyone with cold sores or fever blisters. Even if they deny ever having had herpetic infections, patients are advised... 

The lack of immunosuppressive activity of ara-A at dosage levels hi er than those used in primates makes this drug a potentially effective agent in the systemic treatment of herpetic infections (23 ). 

The antiviral action of 5-iododeox5oiridine (lUdR) (4.9) has already been described in Section 4.0. It is widely prescribed for herpetic infections of the conjimctiva. Cytarabine ( Ara C ) (4./0), more selective, is used for severe generalized herpes in man (see Section 4.0). Vidarabine ( Ara A ) (4.JJ), a newer drug, has given useful clinical results in viral pneumonia and herpetic encephalitis (Section 4.0). The action of all these substances is to block stages in the synthesis of viral nucleic acids. 

---