Acyclovir resistance in a patient with chronic mucocutaneous herpes simplex infection

Westheim, Alan; Tenser, Richard B.; Marks, James G.

doi:10.1016/s0190-9622(87)70272-2

Cited by 18 publications

(5 citation statements)

References 19 publications

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“…Per se, the occurrence of TK com plementation supports an important role for HSV TK expression in latency and pathogen esis. It should be noted that, although most HSV TK mutants are resistant to acyclovir because of limited or absent TK expression, including those isolated from immunosuppressed acyclovir-treated patients [110][111][112], other mutants may be resistant to acyclovir because of altered enzyme substrate speci ficity [75,96,113,114] or altered HSV DNA polymerase [114][115][116]. The latter two types of mutants are expected to be acyclovir resistant but TK+ (thymidine phosphorylation posi tive), and it is concluded that TK phenotype and acyclovir sensitivity should be consid ered separately.…”

Section: Detection O F Infectious Virusmentioning

confidence: 99%

Role of Herpes simplex Virus Thymidine Kinase Expression in Viral Pathogenesis and Latency

Tenser¹

1991

Intervirology

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Herpes simplex virus (HSV) thymidine kinase (TK) expression and the HSV TK gene have been evaluated in studies of gene control, as well as in animal and human studies of viral pathogenesis, including HSV latency. In investigations of the biological role of HSV TK, enzyme expression was noted to be important for HSV infection of nonreplicating cells in culture; and, in experimental animal studies, HSV TK was shown to be important for in vivo latent infection of sensory ganglion neurons. Latency in these studies was determined by the ability of HSV to reactivate from sensory ganglion explants. In recent studies, investigators sought to determine whether the role HSV TK expression plays in latency is primarily in the establishment and maintenance of latency or in the reactivation process. Following infection of experimental animals with HSV TK-deficient mutants, the presence of HSV in ganglia was detected in complementation, rescue, and molecular biological studies. Results suggest that HSV TK expression may be important for HSV reactivation from latency. This was supported by in situ hybridization investigations. In the latter studies, HSV latency associated transcript (LAT) was present in ganglion neurons, although reactivation of HSV from such ganglia was defective. LAT-expressing, reactivation-defective infections established by TK mutants of HSV are considered examples of incomplete latency. From the present review, it appears that HSV TK expression, particularly TK expression of HSV-1, is important for the reactivation of latent HSV infection of sensory ganglion neurons, probably because of limited neuronal TK expression and absent replication capacity of these cells.

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Section: Detection O F Infectious Virusmentioning

confidence: 99%

Role of Herpes simplex Virus Thymidine Kinase Expression in Viral Pathogenesis and Latency

Tenser¹

1991

Intervirology

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“…The abnormalities in axonal excitability were those appropriate for loss of slow K 1 channel function. 3 Current protocols for studying the accommodation to hyperpolarization produced by HCN currents now use strong long hyperpolarizing currents as conditioning stimuli to alter membrane potential. 4 This has allowed further insight into the nature of HCN current in human myelinated axons; specifically, that HCN1 is probably expressed on large myelinated axons, but that isoform expression may differ for myelinated afferent and efferent axons.…”

Section: Hcn Channels: Function and Clinical Implicationsmentioning

confidence: 99%

“…The medical and ethical importance of this finding has been emphasized in numerous publications over the past 6 years. [2][3][4] The impact of functional neuroimaging in showing the limitations of the neurologic examination to detect awareness is reminiscent of the earlier impact of DNA genetic studies in showing the limitation of the clinical phenotypic classification of neurogenetic syndromes.…”

mentioning

confidence: 99%

HCN Channels: Function and clinical implications

Burke¹,

Howells²,

Tomlinson³

2013

Neurology

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“…Patients with impaired cellular immunity are more susceptible to developing acyclovir-resistant infections compared with immunocompetent individuals. Persistence of HSV-1 ulcers despite multiple days of antiviral drugs should increase suspicion of acyclovir resistance [7]. In primary infection with HSV-1, clinical symptoms typically appear 2-12 days after the exposure, and may be characterized by the appearance of many lesions that are associated with pain (herpetic gingivostomatitis) and local enlargement of the lymph node [8,9].…”

Section: Introductionmentioning

confidence: 99%

Atypical Presentation of Herpes Simplex Virus Infection in an Immunocompromised Patient

Alghamdi¹,

Albaqami²,

Alharbi³

2023

Cureus

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Immunocompromised patients are at risk of developing atypical herpes simplex virus (HSV) infection, which can be easily misdiagnosed. We present a case of a 69-year-old female who was receiving methotrexate and tofacitinib for a known case of rheumatoid arthritis. She was admitted to the ICU under neurology care after presenting with status epilepticus secondary to bacterial meningitis. She complained of a group of vesicles on the erythematous base accompanied by a burning sensation, erosions with a hemorrhagic crust that extended onto the vermilion lip, and painful oral mucosa erosion that involve the buccal, palatine, and tongue. The clinical differential diagnosis was herpes simplex infection, pemphigus vulgaris, paraneoplastic pemphigus, early drug-induced Stevens-Johnson syndrome, erythema multiform major, and methotrexateinduced mucositis. As the presentation was atypical, steroid treatment was initiated. Subsequent histopathology showed infectious dermatitis consistent with herpes virus infection. After discontinuing steroid treatment and starting an antiviral drug, the patient's symptoms improved within a week.There has been heightened clinical awareness about the atypical clinical presentation of herpes simplex infection in immunocompromised patients. HSV infection should be included in the differential diagnosis along with other vesiculobullous diseases.

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Acyclovir resistance in a patient with chronic mucocutaneous herpes simplex infection

Cited by 18 publications

References 19 publications

Role of Herpes simplex Virus Thymidine Kinase Expression in Viral Pathogenesis and Latency

Role of Herpes simplex Virus Thymidine Kinase Expression in Viral Pathogenesis and Latency

HCN Channels: Function and clinical implications

Atypical Presentation of Herpes Simplex Virus Infection in an Immunocompromised Patient

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