Herpes Treatment and VZV Infections Quiz

Herpes Treatment in HIV+ Patients

• Acyclovir options for acute infection: 400 mg po tid or 200 mg po 5 times/day for 5-10 days; alternatives include Famciclovir 500 mg po bid or Valacyclovir 1 g po bid for similar duration.
• Daily suppressive therapy for HIV+ patients: Acyclovir 400-800 mg po bid-tid; Famciclovir 500 mg po bid; Valacyclovir 500 mg po bid.
• Suspected resistance treatment includes Foscarnet 40 mg/kg IV q8h until resolution or topical Cidofovir 1% gel applied daily for 5 days; resistance to acyclovir affects valacyclovir and famciclovir.

Herpes Encephalitis

• Both HSV-1 and HSV-2 can cause CNS infections; HSV-1 affects adults while HSV-2 is more common in newborns.
• PCR testing is preferred over cultures for diagnosis; early detection is crucial with mortality rates at 50-85%.
• Empirical treatment with Acyclovir 5-10 mg/kg IV every 8 hours for 2-3 weeks; Foscarnet used in cases of resistance.

Neonatal Herpes

• High mortality and morbidity risk for neonates exposed during pregnancy.
• Treatment involves Acyclovir 20-60 mg/kg IV every 8 hours for 21 days for disseminated/CNS infection or 14 days for skin/mucosal infection.

Oral-Facial Herpes

• Herpes labialis treatment varies with immune status; options include topical and oral treatments.
• Topical treatment options: Docosanol (Abreva) applied 5 times daily until healed; Acyclovir Topical (Zovirax) applied 5 times daily for 4 days; Acyclovir Buccal Tablet (Sitavig) as a single 50 mg dose; Penciclovir Topical (Denavir) every 2 hours for 4 days.

Herpes Keratitis

• Eye infection across all age groups; primary cause of corneal blindness in the U.S. and a leading reason for corneal transplants.
• Treatment includes Trifluridine, Idoxuridine, and Vidarabine.

Varicella-Zoster Infections

• Primary manifestation of VZV is Varicella (chickenpox), while secondary manifestation is Herpes Zoster (shingles); risk increases with age.
• Chickenpox characterized by a highly contagious nature, common childhood infection, and fever before rash onset, typically 10-14 days post-exposure.

Chicken Pox Management

• Supportive care includes cool baths and antipruritic treatments; avoid aspirin.
• Varivax vaccine indicated for individuals 12 months and older; 0.5 mL dose subcutaneously, with a second dose at least 3 months later.

Herpes Zoster Infections

• Result from reactivation of latent VZV; common in patients over 40 years old.
• Initial symptoms include mild itch or pain; lesions appear as macules, papules, and grouped vesicles, resolving in 2-4 weeks.
• Treatments include Acyclovir 800 mg po five times a day, Famciclovir 500 mg po TID, and Valacyclovir 1 g po TID for shingles.

Post-Herpetic Neuralgia (PHN)

• Lasts more than 30 days after rash onset; most common manifestation of herpes zoster.
• FDA-approved treatments include topical capsaicin, lidocaine patches, gabapentin, and pregabalin.

Ebola Virus

• Ebola is a zoonotic, enveloped filovirus causing severe hemorrhagic fever with high case fatality rates.
• Major reservoir is likely bats; transmission involves spillover from wild animals to humans and human-to-human spread.

Clinical Management of Ebola

• Focused on addressing hypovolemia, sepsis physiology, and managing electrolyte abnormalities.
• Supportive care essential; avoid NSAIDs, and manage multisystem organ failure with oxygenation, mechanical ventilation, and renal replacement therapy if required.

Investigational Therapies for Ebola

• No FDA-approved specific antiviral treatment; investigational therapies include convalescent serum and antiviral medications like ZMapp and Tekmira.
• Ebola vaccines under development, targeting specific viral genes; some show promise in clinical trials.

Prevention of Ebola

• Ongoing research into Ebola vaccines, indications for development based on outbreak responses, focusing on at-risk populations.

Test your knowledge on the dosing schedule for Penciclovir Topical and explore various aspects of herpes treatments and Varicella-Zoster virus infections. This quiz covers critical topics including Herpes Keratitis and specific treatments for HIV+ patients. Perfect for students or healthcare professionals wanting to reinforce their understanding.