Age-Related Impairment of Innate and Adaptive Immune Responses Following Intranasal Herpes Simplex Infection

Immune function declines with age, leading to an increased vulnerability to respiratory viral infections. The mechanisms by which aging negatively impacts the innate and adaptive immune system leading to enhanced susceptibility to infections remain to be fully elucidated. In the present study, we used a mouse model of intranasal infection with herpes simplex virus type 1 (HSV-1), a virus that can enter the lungs through the nasal route causing pneumonia, a serious health concern in the elderly. Following intranasal inoculation of young (6 weeks), adult (36 weeks), and aged (68 weeks) with HSV-1 (KOS strain) we: (i) compared the local and systemic innate and adaptive immune response to infection; and (ii) correlated the level and type of immune response to protection against HSV-1 infection. Compared to young and adult mice, aged mice displayed: (i) increased basal level activation of epithelial cells with a decreased expression of TLR3; (ii) increased activation of dendritic cells with increased expression of MHC-1, MHC-II and CD80/86; and (iii) decreased production of type-I interferons upon stimulation; (iv) a delay in cytokines and chemokines production in the lungs; and (v) an impairment in function (CD107 and IFN-g production) of HSV-specific CD8+ T cells. These impairment in innate and adaptive immune responses in aged mice following intranasal HSV-1 inoculation was associated with symptomatic herpes infection. The findings suggest an age-related impairment of both innate and adaptive immune responses which may exacerbate herpes infection and disease in the elderly.

Herpes Vegetans, an atypical herpes lesion in HIV patient: a case report

Herpes vegetans is a rare form of Herpes simplex virus (HSV) infection in immunocompromised patients that clinically presents as a verrucous and hypertrophic lesion. In this case, we present a 36- year-old man with exophytic verrucous masses in the genital area that was initially suspected as a malignancy. Difficulty to properly diagnose the patient resulted in a few failed attempts at treating the lesion. After excluding other differential diagnoses, the atypical lesion proved to be caused by vegetative herpes infection due to a good response to HSV therapy. Reevaluation of biopsy also showed signs of HSV etiology. Atypical presentation of herpes simplex in immunocompromised patients still proves to be a challenge to diagnose and treat. Proper clinical identification and workup are needed to diagnose and to choose proper regiments

Cluster headache due to intranasal herpes simplex: a case report

Cluster headache is characterized by pain in the first division of trigeminal nerve along with autonomic features, with attacks last from 15 minutes to 180, up to eight times a day. Albeit considered as a primary headache, it may be mimicked by structural diseases like infections, inflammatory, tumoral and vascular. Intranasal and sinus infectious were also reported. Herpes simplex infections are quite common in the general population, and the nerve ganglia are the natural reservoir of the virus. Intranasal herpes, on the other hand, is exceedingly rare, with only few cases reported in the literature. Our main objective is to describe a case report of a 49-year-old male who was diagnosed with intranasal herpes infection during a bout of cluster headache, evaluated by an otolaryngologist. He got free of symptoms after using valacyclovir and melatonin. Thus, herpes simplex might be involved in the mechanisms of secondary or primary cluster headache. Further research is necessary to help elucidate this relationship.

Rational use of corticosteroids in the treatment of ophthalmic herpes

The article discusses the issues of rational use of corticosteroid preparations for herpes infection of the eye. On the basis of scientific literature data and our own clinical observations given in the work, corticosteroid preparations are recommended for use in ophthalmic herpes only in the absence of ulceration and violation of the integrity of the cornea. It is advisable to prescribe them in micro doses, mainly in the form of instillations and, less often, parabulbar injections, with caution, under the strict supervision of an ophthalmologist, in the minimum effective concentration and in a short course. Key words: ophthalmic herpes, therapy, rational use corticosteroids.

Challenges in Diagnosis and Therapy of Recurrent Oral Herpes Infection: Study of Two Cases

The symptoms of recurrent oral herpes infection may vary, from mild discomfort to life threatening. Dentists are more likely to be consulted in this oral infection, hence the ability to diagnose and treat this disease is mandatory. This article described manifestation and therapy of recurrent oral herpes infection. In the first case, a 41-year-old woman came with a complaint of painful sore mouth in her lower gingiva. She experienced canker sores for two to three times a year on the tongue, lips and palate. Laboratory results showed positive IgM anti HSV-2, which matched with the primary herpes infection. However, based on the history and clinical manifestations, she was diagnosed with recurrent intra oral herpes infection. In the second case, a 70-year-old man came with a very painful canker sores in his entire mouth. The patient had to be hospitalised for three days and received analgesic, antibiotic and gel containing triamcinolone. After hospitalisation, canker sores did not heal. Extraorally, we found a crust in the vermillion border of the upper lip and intraorally, we found multiple ulceration of keratinised and non-keratinised mucosa. The use of topical steroid in this patient may aggravated ulceration due to its ability to cause rapid spreading of the virus. The first patient was given chlorhexidine gluconate 0.2% and the second patient was prescribed with doxycycline rinse. Both patients received multivitamin containing zinc. Complete history taking, objective and adjunctive examination played a role in establishing the diagnosis and treatment of recurrent oral herpes infections.

Cytokine tatus in patients with recurrent herpes infection

The study of the concentration of the main pro-inflammatory cytokines (IL-1β, IL-6 and TNF) in the blood serum of 48 patients with recurrent chronic herpesvirus infection was carried out. A significant increase of cytokine levels with the maximum values during the height of the disease was established. During the period of clinical symptoms’ subsidence, a decrease in their concentration with incomplete normalization is observed during the period of convalescence. Changes in the level of IL-1β, IL-6 and TNF in the blood serum of patients with recurrent herpesvirus infection depended on the period of the disease and the severity of the pathological process.

Acyclovir as a Potential Adjuvant Therapy in COVID-19 Treatment Regimens

Introduction: There are successful reports of the concomitant management of herpes infection and coronavirus disease 2019 (COVID-19), using both acyclovir (ACV) and COVID-19 treatment regimens. Furthermore, ACV has been proposed to effectively treat COVID-19, through various mechanisms, such as inhibition of viral proteases, multiple viral gene expressions, and RNA-dependent RNA polymerase (RdRP). Therefore, this study aimed to review the reported cases of patients with concomitant herpes infection and COVID-19, receiving concurrent antiviral drugs for herpetic lesions. Methods: A search was done to find the relevant articles, published between December 2019 and December 2020, with no language limitations, in the PubMed database, using the Medical Subject Headings (MeSH) terms related to herpes simplex virus or herpes zoster (namely, shingles) combined with COVID-19. Accordingly, the reports of the concomitant herpes infection and COVID-19, receiving concurrent antiviral drugs for herpetic lesions were included. Results: Out of 90 articles, 11 records reporting the cases of herpes infection and concurrent laboratory-confirmed COVID-19, receiving antiherpetic therapies, were reviewed. There were 28 patients (age range of 7-82 years) with laboratory-confirmed COVID-19, concomitant with reactivation of herpes infection, receiving antiviral drugs alongside candidate COVID-19 treatment regimens, but no mortality. The mean (standard deviation [SD] range) age of these 28 patients during treatment was 56.4 (18.6 [7-82]) years, and the majority were male (n=18, 64.3%). A total number of 20 patients had also received ACV and eight cases had been administered with other two antiviral compounds, including seven cases with valacyclovir, and one case with famciclovir, with no mortality. Conclusion: The potential use of ACV, as an add-on therapy, along with candidate COVID-19 treatment regimens was proposed in this study. However, further clinical trials are recommended to test this hypothetical adjuvant therapy.