Effective Combined Treatment of Herpes Simplex Recidivans Type I and Type II

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Effective Combined Treatment of Herpes Simplex Recidivans Type I and Type II

Infections of the skin and mucous membranes caused by Herpes Simplex Virus (HSV) are frequently encountered in clinical practice and present various clinical symptoms. Two main groups of infections can be distinguished - primary and secondary (recidive). Both are caused by either HSV type I or HSV type II.

The primary infection develops during the first encounter of the organism with HSV due to the absence of anti-HSV antibody in the serum. In 99% of encounters it does not lead to clinical consequences and can only be demonstrated by the presences of antibody in the serum. Secondary recidive infections are due to reactivation of the HSV, which has been latent, or due to reinfection with HSV while anti-HSV antibody are already present in the serum.

It is accepted that the infection can spread from the primary site through migration of the HSV from one cell to the other, through blood exchange or through nerve endings. Virus genetic material located in nerve ganglia is in the latent state. If immunity becomes supressed or some virus activating factors appear, a secondary recidive infection occurs.

Ceratinocites and langerhans cells produce cytokines (interferon, II-2), which carry out the lymphocyte invasion into the HSV site (Braetnach S. M.). Helper and cytotoxic cell-mediated immunity are important for limiting the HSV infection to the skin and peripheral ganglia (Wildy et al).

The mechanisms through which the HSV infection develops are now clearly understood and they direct the clinicians' attention to the activation of the immune response on a cellular and humoral level.

The treatment of secondary recidive HSV infections is extremely difficult since effective anti-viral drugs to this point have not been developed. The widely used in clinical practice drug based on acycloquanosin (acyclovir, zovirax) has not stood up to expectations - it is toxic and after prolonged use has a mutagenic effect and leads to chromosomal aberrations. There are also, resistant cases (K. Bründel, 1986, Keller and Riva, 1983).

Great hopes for the prophylaxis of the virus infections were placed on the vaccines, but clinical practice has shown that they are not sufficiently effective and are not widely used due to the suspected oncogenic characteristic of the HSV DNA, introduced into the body through the vaccine (Keller and Riva 1983, Zerial 1983).

Our research with HSV began some 12 years ago when we treated a patient suffering from Cheilitis granulomatosa and recidive HSV infection with more than 15 attacks annually. At that time we used only low-level He-Ne therapy, which did not lead to satisfactory clinical results. While searching for the means which would also influence humoral immunity, we applied a combined treatment which included:

Direct irradiation of the herpes lesions with low-level He-Ne laser with power density 150 mW/cm( 2) and with 5 rain duration of the irradiation.
Body acupuncture in the points GV20, LI4, LI11, St36, Sp6.
Daily subcutaneous injections of 1 ml extr. Alloe.
Specific dietary recommendations.
After a treatment course of 2 months the attacks were terminated for a period of 9 months and after a new course of treatment the patient was clinically free of infections for more than 2 years.

This positive therapeutic effect encouraged us to apply the same method to a series of patients suffering from recidive erythema exsudativum multiforme in connection with HSV and also in other, graver forms of HSV infections, both type I and type II.

The current study summarizes the treatment results for 342 patients (162 male and 180 female) suffering from HSV and treated with the proposed original therapeutic method. Patients were aged 17 - 61. 291 patients were suffering from HSV type II and 51 from type I. According to the severity of the disease, the patients were divided into three groups:

- 150 patients with a very serious condition - more than 12 attacks annually.
- 109 patients with a moderately serious condition - 4-12 attacks annually.
- 83 patients with a light condition - 1-3 attacks annually.
For patients of group 1 and 2 we applied the following treatment plan: 15 sessions in the above mentioned acupuncture points, 1 month rest, another 15 sessions, 3 months rest, another 10 sessions, 6 months rest and a final 10 sessions. In patients with deficiency (xu) type, the sessions were carried out 3 times a week (Mon, Wed, Fri) and tonification (bu) method was used and in patients with excess (shi) type, the sessions were carried out daily and a sedation (xie) technique was used.

With patients of group 3 we used 2 courses of 15 session each with 3 months rest in between.

He-Ne laser therapy was performed only if herpetic efflorescence was present.

Subcutaneous alloe injections in patients of group 1 and 2 were carried on in a 3-month course. The first 30 injections were applied daily and the second 30 - every other day. Every 6 months a 30 day course of daily applications was performed.

In group 3 patients only the first 3-month course was performed.

Some of the cases were followed up for more than 5 years and the minimal follow-up period was 18 months.

Results and discussion: In patients of group 1 complete recovery was observed in 113 cases (75%) - for the period of no less than a year no new attacks have been noted. An improvement was observed in 25 patients (17%) - the attacks were reduced to 2-3 attack annually. The treatment had no effect in 12 patients (8%).

In patients of group 2 full clinical recovery was observed in 60 patients (55%), improvement ( 1-2attacks annually) - in 32 patients (29%) and no effect - in 17 patients (16%).

In patients of group 3 complete recovery was observed in 69 patients (83%), improvement - in 5 patients (6%), and no effect or left treatment course for various reasons - 9 patients (11%).

Based on our 12-year experience in the treatment of secondary recidive HSV infections and on the basis of the observed dynamics of a large number of immunologic parameters (E. Iliev, K. Nikolov, L. Durmishev, 1995), we conclude that a very effective method for the treatment of this extremely wide-spread disease has been found. Through the modulation of both protective systems of the organism - cellular and humoral immunity - which defend against infiltrating foreign bodies (in our case viruses), this is the method that has shown the best therapeutic outcomes in our clinical practice.

References:
1. Baringer, J.R. Recovery of HSV from human sacral ganglions. N. Engl. J. Med, 291, 1974, 828-830

2. Baringer, J.R. HSV infections of nervous tissue in man. Progr. Med. Virol. 20, 1975, 1-26

3. Braetnach, S.M. The epidermotropie T cell exist In normal human skin? Evaluation of the SALT hypothesis. Brit. J. Dermat. 105, 1986, 385-392

4. Bründel, K.H. Acyclovir - eine neie scharfe Waffe gegen Herpes simplex - viren und Varicellen-Zoster Viren? Derm.u.Kosmet. 23, 1982, 85. 105.-106

5. Highet, A. S., Kurtz, J. Viral infection. In: Textbook of dermatology. Ed. Rook. Wilkinson and Ebling, Ed. V, 1992, Champion Blackwell.

6. Iliev, E. Soft Laser in der Dermatologie, Edition Svesa, Münich, 1988

7. Iliev, E., Nikolov, K., Durmishev, L., Dynamics of the immunologic parameters in patients with herpes simplex recidivans before and after combined treatment with acupuncture, laser and phytoproducts. Second Bulgarian Acupuncture Congress. 1-5 June 1995, Sofia

8. Nasemaann, Th. Viruskrankheiten der Haut, des Schleimhäte und des Genitales, G. Thieme, Stuttgart, 1974

9. Raab, B. Oral acyclovir for genital herpes - cautious optimism. J. Am. Ac. Derm. 13. 1985, 2. 293-296

10. Söltz-Szöts, J. Generalisierter Herpes simplex übergehend in das Bild der Erythema exsudativum multiforme (Herpetid). Zsohr, Haut geschl. Krkh. 44, 1969. 77-80.

11. Wildy, P. The progression of herpes simplex to the central nervous system of the mouse, J. Hyg, 1967, 65, 173-192

12. Zerial, A. Antiviral hemotherapie. In: Antimicrobal chemotherapie B: II. Ed. G. K. Daikos, J. Jeljaszewics, K.H. Spitzy, H. Umezawa, Stuttgart, G. Thieme, B. II, 1983, 388-411.

Cognizant Communication Corporation.

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By Emil Iliev

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