Single-day therapy: an expert opinion on a recent development for the episodic treatment of recurrent genital herpes

One common method for treating recurrent genital herpes outbreaks is 3–5 day episodic therapy with nucleoside analogues. However, since maximum viral replication occurs within 24 h after the onset of symptoms, short-term patient-initiated episodic therapy started at prodromal onset or at the first appearance of lesions in patients without a prodrome may represent an important option. In a recent randomized trial, single-day famciclovir treatment decreased lesion healing time and the duration of pain and other symptoms by approximately 2 days compared to placebo, and prevented progression to a full outbreak in almost one in four patients. Because single-day treatment is more convenient than traditional therapies, it may lead to improved patient compliance and better overall management of recurrent genital herpes outbreaks

Post-infectious headache: a reactive headache?

Post-infectious disease syndrome includes both neurological and non-neurological disorders. However, headache as an isolated or a presenting complaint of post-infectious illness has not been well acknowledged in the literature. In this retrospective observation, patients having daily headache of more than 1 week and <4 weeks duration were included. We divided this group into patients having headache with preceding history of febrile illness in the recent past and patients without such history of febrile illness. We compared clinical features and therapeutic responses of various drugs between the groups. There were no significant differences in demographic features in these groups. However, associated neck pain, nausea, photophobia and meningeal signs were more prevalent in patients having history of preceding infection. A relatively lower proportion of subjects showed complete response to drugs at 3 months in post-infectious group. Good responses were noted to steroids in post-infectious group. In conclusion, a subset of patients with daily headache may be because of post-infectious pathology and treatment in the early stage may prevent it from becoming chronic. Large prospective studies are required to confirm these observations

Infection Caused by Herpes Simplex Virus, Varicella-Zoster Virus and Epstein-Barr Virus in Organ Transplant Recipients, and their Diagnosis

Immunosuppressed patients are at risk of severe herpesvirus infections. Herpes simplex (HSV), varicellazoster (VZV) and Epstein-Barr virus (EBV) infections are associated with characteristic syndromes in this population. Typically I-ISV and VZ:V infections cause mucocutaneous lesions; diagnosis is usually con finned by tissue culture or nuorescent microscopy. The availability of effective antiviral agents, and accurate techniques for laboratory diagnosis have improved the management of I-ISV and VZ:V infections. Antibody assays to demonstrate I-ISVorVZ:V infections are of limited value in immunocompromised patients, because the presence of antibodies does not indicate a decreased risk for HSV, varicella or zoster, but indicates susceptibility for reactivated infection. EBV is associated with lymphoproliferative disorders in transplant recipients. Infection of lymphocytes by EBV is a necessary step in achieving B cell transformation and immortalization. The lack of immunosurveillance against EBV-transformed B cells predisposes patients to developing invasive infiltration of transformed B cells . Diagnostic methods for EBV infections include lymphocyte transfom1ation, serology, and detection of DNA by direct hybridization or by DNA amplification. Quantitative oropharyngeal EBV shedding is a good marker for the development of lymphoproliferative disease in transplant recipients. Patients experiencing primary EBV infection are at the highest risk for lymphoproliferative disorders. Prophylactic antiviral therapy may be of benefit in preventing EBV replication and therefore in decreasing the risk for lymphoproliferation

Comparison of the VIDAS RSV assay and the Abbott Testpack RSV with direct immunofluorescence for detection of respiratory syncytial virus in nasopharyngeal aspirates.

The sensitivity and accuracy of the VIDAS RSV assay in testing fresh specimens were 82.7 and 87.1%, respectively, whereas specimens previously frozen at -70 degrees C gave a sensitivity of 96.2% and an accuracy of 95.4%. The sensitivity and accuracy of Abbott Testpack RSV were 92.6 and 91.3% for fresh specimens and 86.8 and 88.1% for frozen specimens. The advantages and drawbacks of the two assays are discussed