Clinical Study of Modified Sub-Hibernation Therapy Combined with Ganciclovir on Patients with Viral Encephalitis

Viral encephalitis is an infectious disease of the nervous system caused by multiple viruses entering the brain. This disease is extremely harmful to the human body and has a high mortality rate. Modified sub-hibernation therapy and ganciclovir are the most commonly used treatments for viral encephalitis. The purpose of this article is to further explore the clinical effect of modified sub-hibernation therapy combined with ganciclovir on patients with viral encephalitis. Thirty viral encephalitis patients with severe illness and long-term illness were taken as the research object, and the patients were divided into three groups according to the condition and their own conditions, a control group, a ganciclovir treatment group and a modified sub-hibernation therapy combined ganciclovir observation group. The control group did not receive any treatment, the treatment group was treated with ganciclovir alone, and the observation group was treated with modified sub-hibernation therapy combined with ganciclovir. The diagnosis and prognosis of all patients were analyzed and studied. The results of the study showed that the treatment effective rate of the ganciclovir treatment group was 85.7%, and three patients relapsed after discharge from the hospital. The recurrence rate was 30%. The total effective rate of the modified sub-hibernation therapy combined with the ganciclovir observation group was 95.3%, only one person relapsed after discharge, the recurrence rate was 10%. It can be seen that the treatment of viral encephalitis with modified sub-hibernation therapy combined with ganciclovir has a very good therapeutic effect and the disease recurrence rate is low. It is the first choice for the treatment of viral encephalitis.

Impact of antiviral treatment on long-term prognosis in non-immunocompromised patients with CMV reactivation

Background Reactivation of human cytomegalovirus (CMV) occurs in non-immunocompromised patients with or without specific organ involvement, but it is still unknown whether it has a clinical implication on long-term prognosis or not. Methods A retrospective cohort study evaluating non-immunocompromised adult patients with CMV reactivation was conducted during the period between January 2010 and February 2018. Patients were divided into ganciclovir-treated and non-treated groups. Patients who died within 30 days from CMV reactivation were excluded as they died from complex causes of conditions. Survivors were followed for 30-months to evaluate long-term prognosis. Results A total of 136 patients with CMV reactivation was included, consisting of 66 ganciclovir-treated (48.5%) and 70 non-treated (51.5%) patients. Overall, patients were old-aged (median 70 years old) and most were treated with pneumonia of any cause (91.2%). More patients in ganciclovir-treated group were treated at intensive care unit (43.9% vs 24.3%, respectively) and had higher viral load over 5000 copies/ml (48.5% vs 22.9%) than non-treated group (all P < 0.05). Primary and secondary endpoints including 30-months survival (28.0 vs 38.9%, respectively) and 12-months survival (40.3% vs 49.2%) were not statistically different between the ganciclovir-treated and non-treated groups. In the multivariate analyses, ganciclovir treatment was not associated with 30-months survival (HR 1.307, 95% CI 0.759–2.251) and 12-months survival (HR 1.533, 95% CI 0.895–2.624). Conclusion In a retrospective cohort study evaluating non-immunocompromised patients with CMV reactivation, ganciclovir treatment was not associated with long-term prognosis. Antiviral treatment in this condition would not be necessary unless organ involvement is suspected.

Clinical Characteristics of Virus-related Uveitic Secondary Glaucoma: Focus on Cytomegalovirus and Varicella Zoster Virus

Background: We aimed to analyze the clinical characteristics of secondary glaucoma related to cytomegalovirus (CMV)- and varicella zoster virus (VZV)-positive uveitis. Methods: In this retrospective study, we enrolled 60 patients with secondary glaucoma. All the patients underwent aqueous and serum analyses for viral antibody through enzyme-linked immunosorbent assay. Among the 60 included patients, 22 had CMV-negative Posner-Schlossman syndrome (CMV-negative PSS), 25 had CMV-positive PSS (CMV-PSS), and 13 had VZV-positive anterior uveitis secondary glaucoma (VZV-AUSG). We evaluated the following main indicators: age, disease duration, intraocular pressure (IOP), cup-to-disc ratio, best corrected visual acuity (BCVA), corneal endothelial cell (CEC) count, ocular morphological changes, and medical treatments.Results: We found that 25 of the 47 patients with PSS were CMV-positive. Patients with CMV-PSS had a larger cup-to-disc ratio (p = .043), lower CEC density (p = .017), and more severe CEC loss (p < .001). The CMV-positive PSS group had more patients with iris depigmentation (p = .006). Compared with patients with CMV-PSS, those with VZV-AUSG were older (p = .003), presented a higher IOP (p = .015), and had poorer BCVA (p < .001). Patients with CMV-PSS and VZV-AUSG all accepted ganciclovir treatment, and those with CMV-PSS used fewer antiglaucoma agents simultaneously compared with CMV-negative PSS (p = .005) and VZV-AUSG (p < .001). All three groups had a comparable proportion of patients requiring antiglaucoma surgery.Conclusions: We observed some distinctive clinical features in CMV-PSS that could help clinicians discriminate it from CMV-negative PSS. Further, we found that patients with VZV-AUSG presented a higher IOP and worse visual acuity, and required more antiglaucoma medication than those with CMV-PSS.

Impact of Antiviral Treatment on Long-Term Prognosis in Non-Immunocompromised Patients With CMV Reactivation

Background. Reactivation of human cytomegalovirus (CMV) occurs in non-immunocompromised patients with or without specific organ involvement, but it is still unknown whether it has a clinical implication on long-term prognosis or not.Methods. A retrospective cohort study evaluating non-immunocompromised adult patients with CMV reactivation was conducted during the period between January 2010 and February 2018. Patients were divided into ganciclovir-treated and non-treated groups. Patients who died within 30 days from CMV reactivation were excluded as they died from complex causes of conditions. Survivors were followed for 30-months to evaluate long-term prognosis.Results. A total of 136 patients with CMV reactivation was included, consisting of 66 ganciclovir-treated (48.5%) and 70 non-treated (51.5%) patients. Overall, patients were old-aged (median 70 years old) and most were treated with pneumonia of any cause (91.2%). More patients in ganciclovir-treated group were treated at intensive care unit (43.9% vs 24.3%, respectively) and had higher viral load over 5,000 copies/ml (48.5% vs 22.9%) than non-treated group (all P < 0.05). Primary and secondary endpoints including 30-months survival (28.0 vs 38.9%, respectively) and 12-months survival (40.3% vs 49.2%) were not statistically different between the ganciclovir-treated and non-treated groups. In the multivariate analyses, ganciclovir treatment was not associated with 30-months survival (HR 1.307 95% CI 0.759-2.251) and 12-months survival (HR 1.533 95% CI 0.895-2.624).Conclusion. In a retrospective cohort study evaluating non-immunocompromised patients with CMV reactivation, ganciclovir treatment was not associated with long-term prognosis. Antiviral treatment in this condition would not be necessary unless organ involvement is suspected.

Phenotype and Genotype Study of Novel C480F Maribavir-Ganciclovir Cross-Resistance Mutation Detected in Hematopoietic Stem Cell and Solid Organ Transplant Recipients

Two transplant recipients (1 kidney and 1 hematopoietic stem cell) received maribavir (MBV) after cytomegalovirus (CMV) infection clinically resistant to standard therapy. Both patients achieved CMV DNA clearance within 30 and 18 days; however, the UL97 C480F variant emerged, causing recurrent CMV infection after a cumulative 2 months of MBV and 15 or 4 weeks of ganciclovir treatment, respectively. C480F was not detected under ganciclovir before MBV treatment. Recombinant phenotyping showed that C480F conferred the highest level of MBV resistance and ganciclovir cross-resistance, with impaired viral growth. Clinical follow-up and genotypic and phenotypic studies are essential for the assessment and optimization of patients with suspected MBV resistance.

Effective Prophylactic Therapy for Exposure to Monkey B Virus (Macacine alphaherpesvirus 1)

Zoonotic monkey B virus (Macacine alphaherpesvirus 1; BV) infections are extremely serious and usually fatal. Drugs currently used for treatment were developed for the treatment of herpes simplex virus but are less effective against BV. Effective suppression of viral replication in the skin could prevent the virus from invading the nervous system. To test this hypothesis, the efficacy of topical administration of several drugs against lethal BV infection was evaluated in female BALB/c mice that were infected by scarification. Drugs were then applied to the site of inoculation. As 3% preparations, most drugs were only minimally effective or ineffective. In contrast, ganciclovir and cidofovir were very effective. The ED50 for cidofovir was 0.007%, compared with 1.1% for ganciclovir. At 0.5%, cidofovir protected against both death and neurologic signs, whereas 5% ganciclovir only protected against death but not neurologic involvement. All genotypes of BV were equally susceptible to cidofovir and ganciclovir. For maximal effectiveness, treatment with both cidofovir and ganciclovir had to be initiated within 8 h of infection. Cidofovir was completely protective when administered only on the day of infection, whereas a minimum of 5 d of treatment was required for maximal ganciclovir efficacy. These studies showed that topical cidofovir treatment started soon after BV exposure was very effective in preventing BV from invading the nervous system, whereas ganciclovir treatment was only partially effective. In addition, cidofovir was protective against a ganciclovir-resistant BV mutant, whereas ganciclovir was not. These studies showed that topical cidofovir treatment started soon after BV exposure is more effective than ganciclovir in preventing BV from invading the CNS.