Cases reported "Herpes Simplex"

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1/13. HSV-1--induced acute retinal necrosis syndrome presenting with severe inflammatory orbitopathy, proptosis, and optic nerve involvement.

    OBJECTIVE: To present a unique case in which orbital inflammation, proptosis, and optic neuritis were the initial symptoms of acute retinal necrosis (ARN). The clinical presentation of ARN, as well as the currently recommended diagnostic procedures and guidelines for medical treatment of ARN, are summarized. DESIGN: Interventional case report. TESTING: polymerase chain reaction (PCR) techniques were made on the vitreous for cytomegalovirus, Epstein-Barr virus, herpes simplex virus (HSV), varicella zoster virus, and toxoplasmosis. A full laboratory evaluation was made together with HLA-typing and serologic tests measuring convalescent titers for HSV and other micro-organisms. magnetic resonance imaging scan, computed tomography (CT) scan, and fluorescein angiographic examination were performed. The patient was treated with acyclovir and oral prednisone. MAIN OUTCOME MEASURES: The patient was evaluated for initial and final visual acuity and for degree of proptosis, periocular edema, and vitreitis. RESULTS: The first symptoms and signs of ARN were eye pain, headache, proptosis, and a swollen optic nerve on CT scan. Other than increased c-reactive protein, all blood samples were normal. PCR was positive for HSV-type I in two separate vitreous biopsies. The patient had the strongly ARN-related specificity HLA-DQ7. CONCLUSIONS: This is the first report of HSV-induced ARN presenting with inflammatory orbitopathy and optic neuritis. polymerase chain reaction for HSV-1 was positive more than 4 weeks after debut of symptoms, which is a new finding. The combination of severe vitreitis and retinal whitening, with or without proptosis, should alert the clinician to the possibility of herpes infection and treatment with intravenous acyclovir started promptly.
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2/13. Clinical evaluation of enzyme immunoassay in rapid diagnosis of herpes simplex infections.

    AIMS: To evaluate the performance of antigen detection by IDEIA (NovoNordisk Ltd) in the rapid diagnosis of potentially serious herpes simplex (HSV) infections. methods: Nine hundred and twelve specimens from a variety of clinical sites, including ocular, mucocutaneous, respiratory and genital material, urines and necropsy tissue, were compared by enzyme immunoassay (EIA) and conventional culture for the presence of HSV. RESULTS: The EIA performed to a high level of sensitivity and specificity using a variety of specimen types. Some problems were encountered using cervical swabs from pregnant women and necropsy brain tissue. Analysis of clinical and contact history data of most patients giving discrepant results supported the evidence of recent HSV infection obtained by EIA. The mean culture time was 2.4 days (range one to eight days). CONCLUSIONS: The HSV EIA test performed to a high level of sensitivity (93.7%) and specificity (96.6%) when compared with culture using a variety of clinical material. These results assumed cell culture was 100% sensitive and specific. The actual performance of the EIA test is probably much higher. This approach to rapid HSV diagnosis should be used more widely, particularly in potentially serious cases.
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3/13. Naming impairments following recovery from herpes simplex encephalitis: category-specific?

    An apparently clear case of category-specific naming impairment selectively affecting animals was detected in a patient who had recovered from herpes simplex encephalitis. However, subsequent investigation demonstrated that these category-specific effects could be eliminated by controlling simultaneously for three factors in picture naming: word frequency, concept familiarity, and visual complexity. The results emphasize the importance of controlling for all factors pertinent to picture naming when attempting to demonstrate category specificity in picture naming. Further testing indicated that deficits were also apparent when naming to definition was required, and some impairment in the ability to answer questions about objects and living things was also noted. Theoretical implications of these data are considered.
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4/13. The neurological complications of cardiac transplantation.

    review of the neurological complications encountered in 83 patients who received cardiac homografts over a seven-year period leads to the following conclusions: (1) Neurological disorders are common in transplant recipients, occurring in over 50 per cent of patients. (2) infection was the single most frequent cause of the neurological dysfunction, being responsible for one-third of all CNS complications. (3) The infective organisms were typically those considered to be usually of low pathogenicity: fungi, viruses, protozoa and an uncommon bacterial strain. (4) Other clinical neurological syndromes were related to vascular lesions, often apparently from cerebral ischaemia or infarction occurring during the surgical procedure, metabolic encephalopathies, cerebral microglioma, acute psychotic episodes and back pain from vertebral compression fractures. (5) The infectious complications and probably the development of neoplasms de novo, are related to immunosuppressive therapy which impairs virtually all host defence mechanisms and alters the nature of the host's response to infective agents or other foreign antigens. (6) Because neurological symptoms and signs were usually those of behavioural changes or deterioration in intellectual performance, the neurological examination was often of little value in diagnosing the nature or even the anatomical site of the neuropathological process. (7) The possibility of an infectious origin of the neurological manifestations must be aggressively pursued even in the absence of fever and a significantly abnormal spinal fluid examination. The diagnostic error made most frequently was to ascribe neurological symptoms erroneously to metabolic disturbances or to "intensive care unit psychosis" when they were in fact due to unrecognized CNS infection. (8) maintenance of mean cardiopulmonary bypass pressures above 70 mmHg, particularly in patients with known arteriosclerosis, may reduce operative morbidity. (9) Though increased diagnostic accuracy is possible with routine use of a variety of radiological and laboratory techniques, two further requirements probably must be met before a significant reduction in the frequency of neurological complications will occur: the advent of greater immunospecificity in suppressing rejection of the grafted organ while preserving defences against infection; and a more effective armamentarium of antiviral and antifungal drugs.
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5/13. Treatment of resistant herpes simplex virus with continuous-infusion acyclovir.

    Two patients with acquired immunodeficiency syndrome who developed severe ulcerative proctitis caused by herpes simplex virus type 2 that was resistant to acyclovir were successfully treated with 6 weeks of high-dose, continuous-infusion acyclovir sodium (1.5 to 2.0 mg/kg per hour). viruses cultured from the lesions were resistant to acyclovir in vitro after the patients had received prolonged therapy with oral and intravenous acyclovir in traditional divided doses. Investigation into the mechanism of the acyclovir resistance revealed changes in the thymidine-kinase activity of both isolates. This viral enzyme phosphorylates acyclovir and is necessary for drug activation. The first patient's isolate was deficient of all thymidine-kinase activity, while the second patient's isolate had a thymidine kinase with altered substrate specificity for acyclovir. The continuous infusion was safe, well tolerated, and done in an outpatient setting with weekly clinic visits and monitoring of creatinine and acyclovir levels.
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6/13. Possible transmission of herpes simplex virus by organ transplantation.

    herpes simplex virus commonly reactivates in seropositive transplant recipients but has not been generally thought to be transmissible by the transplanted organ itself. We studied two consecutive cases of disseminated HSV, without mucosal lesions, occurring in a heart and in a pancreatic transplant recipient, and implicate the allografts as the source of the virus. In both cases the recipients were seronegative pretransplant by complement fixation (less than 1:4), neutralization (less than 1:2), and complement enhanced neutralization (less than 1:4), and by radioimmunoprecipitation of HSV-2 antigens with serum followed by polyacrylamide gel electrophoresis (RIPA-PAGE). Both recipients' isolates were HSV-2 by restriction mapping and each donor had antibodies directed specifically against HSV-2, as determined by differential neutralization (HSV-2/HSV-1 ratios 1.46 and 1.58, where greater than 0.85 indicates antibody to HSV-2). Posttransplant, each recipient developed an antibody response with temporal antigenic specificity and complement-enhanced neutralization consistent with primary infection. These findings have important clinical and pathogenic implications and suggest that latent or reactivated HSV-2 dna transplanted in donor tissues may cause severe infection in seronegative and immunosuppressed transplant recipients.
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7/13. Immunological diagnosis in viral infections of the central nervous system: course of antibody titres against homo- and heterologous viruses.

    In clinical cases suspected for viral encephalitis or meningoencephalitis, the estimation of virus-specific antibodies especially in liquor requires high sensitivity as well as specificity. With enzyme immunoassays the sensitivity in detecting antibodies has increased compared to e.g., complement fixation tests. This report concerns the determination of virus-specific antibodies with a commercial enzyme-linked immunosorbent assay (ELISA) in paired liquor/serum samples of four patients with encephalitis or meningoencephalitis. Up to six virus-specific antibodies of the IgG and IgM classes have been determined [herpes simplex virus (HSV), varicella-zoster virus (VZV), cytomegalovirus, mumps virus, measles virus, and rubella virus]. Additionally, serum samples from several patients suffering, or recovered from, diseases caused by HSV and VZV without CNS involvement have been included as controls. The results showed that besides the virus-specific antibody development (IgG and IgM) against the leading virus, i.e., principally concerned in the disease manifestation assumed to be primarily causing the disease, virus-specific antibodies of the IgG and IgM class against a heterologous virus (e.g., VZV) could also be measured with substantial titers. "Cross-reacting" antibodies to both HSV and VZV with the ELISA only appeared and were present in cases where the infection mainly affected the CNS: no such immunological "cross-reactivity" was observed in serum of individuals in "clinically silent" stages of both HSV and VZV infections. The same situation with no measurable "cross-reacting" antibodies was found in cases of acute HSV or VZV diseases where the CNS was not involved. These findings have been discussed with respect to the findings of common antigens, especially between HSV and VZV, and with respect to an unspecific stimulation of immunocompetent cells.
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8/13. herpes simplex virus testing of an obstetric population with an antigen enzyme-linked immunosorbent assay.

    Commercial herpes simplex virus antigen enzyme-linked immunosorbent assay kits were compared to conventional culture for herpes simplex virus with 3237 genital specimens from obstetric patients. These rapid enzyme-linked immunosorbent assay tests had a sensitivity of 34.3% and specificity of 98.1% with primarily cervical specimens from asymptomatic patients. Specimens from vulvar swabs had higher positive rates than those from cervical swabs from the same patient, whether symptomatic or asymptomatic with both culture and enzyme-linked immunosorbent assay. Fifty-six women had enzyme-linked immunosorbent assay false positive tests; use of enzyme-linked immunosorbent assay testing alone could have resulted in 1.7% unnecessary cesarean deliveries. Six cases of neonatal herpes simplex virus infection were identified; two of the mothers had negative cervical cultures the week of delivery preceded by positive vulvar cultures.
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9/13. Recovery from herpes simplex encephalitis: selective impairment of specific semantic categories with neuroradiological correlation.

    The clinical, neuropsychological and neuroradiological features of two patients affected by herpes simplex virus type 1 (HSV-1) encephalitis are described. An experimental study for the assessment of naming, recognition and description displayed in one patient a persistent significant impairment in naming living things. The other patient showed a failing "semantic memory" for the same categories, although a significant impairment emerged only for plants. In both patients, the late neuroradiological sequelae were localised mainly in the inferior and middle gyri of the left temporal lobe and in the left-side insula. In one patient, the right-side insula was also involved. The selective cerebral damage induced by HSV-1 is stressed and a correlation between the neuroradiological and neuropsychological findings is attempted. The stereotyped anatomical and neuropsychological changes lead to the belief that the virus may recognise, within the limbic system, particular cellular "strains" on the basis of their molecular specificity.
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10/13. Category specific semantic impairments.

    We report a quantitative investigation of the visual identification and auditory comprehension deficits of 4 patients who had made a partial recovery from herpes simplex encephalitis. Clinical observations had suggested the selective impairment and selective preservation of certain categories of visual stimuli. In all 4 patients a significant discrepancy between their ability to identify inanimate objects and inability to identify living things and foods was demonstrated. In 2 patients it was possible to compare visual and verbal modalities and the same pattern of dissociation was observed in both. For 1 patient, comprehension of abstract words was significantly superior to comprehension of concrete words. Consistency of responses was recorded within a modality in contrast to a much lesser degree of consistency between modalities. We interpret our findings in terms of category specificity in the organization of meaning systems that are also modality specific semantic systems.
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