Herpes : the journal of the IHMF
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The consequences of neonatal herpes simplex virus (HSV) infection can be severe. Disease can be localized to skin, eye and mouth (SEM disease), involve the central nervous system (CNS) or manifest as disseminated infection involving multiple organs. Most surviving infants in the latter two categories have neurological sequelae, and the mortality rate in the absence of therapy is very high (80%) for babies in the latter category. ⋯ The neutrophil count for children receiving intravenous aciclovir should be monitored. If the absolute neutrophil count falls below 500/mm3, decreasing the aciclovir dose or administering granulocyte colony stimulating factor (GCSF) should be considered. At the end of therapy in CNS and disseminated disease, PCR assessment of CSF should be used and treatment continued if the child remains PCR positive at this site.
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Post-herpetic neuralgia (PHN) is the most common complication of herpes zoster (HZ, shingles), particularly in the elderly and those with severe acute phase symptoms. Unless or until varicella vaccination reduces the incidence of HZ and attenuates the risk and/or severity of complications, PHN will continue to result in patient suffering and remain a significant cause of healthcare and social support resource consumption. There have been useful advances in PHN management (e.g. use of the anticonvulsant gabapentin and topical local anaesthetic patches), but some cases remain intractable. ⋯ Other acute interventions require further evaluation (nerve blocks, acute phase use of tricyclic antidepressants or anticonvulsants). As prevention of PHN requires early recognition and prompt management of at-risk patients presenting with acute HZ, public education and provision of information to relevant healthcare personnel are important. This article discusses issues relevant to PHN management and prevention, and provides a review of the pertinent literature.
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Randomized Controlled Trial Comparative Study Clinical Trial
No significant analgesic benefit of adding lidocaine 2% to aciclovir 5% cream as treatment of episodes of herpes labialis.