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Clinical reactivations of herpes simplex virus or varicella zoster virus occur frequently among patients with malignancies and manifest particularly as herpes simplex stomatitis in patients with acute leukaemia treated with intensive chemotherapy and as herpes zoster in patients with lymphoma or multiple myeloma. In recent years, knowledge on reactivation rates and clinical manifestations has increased for conventional chemotherapeutics as well as for many new antineoplastic agents. This guideline summarizes current evidence on herpesvirus reactivation in patients with solid tumours and hematological malignancies not undergoing allogeneic or autologous hematopoietic stem cell transplantation or other cellular therapy including diagnostic, prophylactic, and therapeutic aspects. Particularly, strategies of risk adapted pharmacological prophylaxis and vaccination are outlined for different patient groups. This guideline updates the guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society for Hematology and Medical Oncology (DGHO) from 2015 "Antiviral prophylaxis in patients with solid tumours and haematological malignancies" focusing on herpes simplex virus and varicella zoster virus., (© 2022. The Author(s).)

Background: Herpes simplex virus type 1 (HSV-1) is frequently detected in the BAL fluid of patients on mechanical ventilation., Research Question: The aim of the study was to investigate whether antiviral therapy is associated with improved overall survival within 30 days., Study Design and Methods: This was a retrospective cohort study in four ICUs between January 2011 and December 2017. All adult patients on mechanical ventilation with a respiratory tract infection with positive polymerase chain reaction testing for HSV-1 in the BAL were included. Patients already receiving antiviral agents on the day BAL was performed were excluded. We performed uni- and multivariable Cox and logistic regression modeling., Results: Overall, 306 patients were included in the analysis. Among them, 177 patients (57.8%) received antiviral therapy (90.9% acyclovir, 6.2% ganciclovir, 2.9% both). The overall 30-day mortality rate was 42.4% (n = 75) in the antiviral treatment group and 50.4% (n = 65) in the control group. The adjusted hazard ratio (HR) for the primary outcome was 0.62 (95% CI, 0.44-0.87; P = .005), indicating better overall survival within 30 days for the antiviral-treated group than for the untreated group. This benefit was also present in the subgroup of patients without immunosuppression (n = 246; adjusted HR, 0.53; 95% CI, 0.36-0.78; P = .001). Overall, the median lengths of hospital stay (31 vs 24 days, P = .002) and ICU stay (24 vs 17 days, P < .001), and the duration of mechanical ventilation (18 vs 11 days, P < .001), were longer for patients with therapy. No evidence for the treatment-related deterioration of renal function was observed., Interpretation: These data suggest that detection of HSV-1 in the BAL of patients on mechanical ventilation may be of clinical significance and that specific antiviral treatment may improve clinical outcomes. However, this needs to be proven in multicenter randomized controlled trials before implementation into the clinical routine., (Copyright © 2020 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.)

Background: Herpes simplex virus type 1 (HSV-1), human cytomegalovirus (HCMV) and Epstein-Barr virus (EBV) have been suspected to play a causal role in periodontitis pathogenesis. The aim of this study was to determine the prevalence of these viruses in subgingival plaque samples of Caucasian patients with generalized aggressive periodontitis compared to periodontally healthy controls., Methods: A total of 65 patients with aggressive periodontitis and 65 unmatched controls from Germany were investigated in the study. Subgingival plaque samples were analysed for the presence of HSV-1, EBV and HCMV by quantitative real-time polymerase chain reaction assays. Viral antibody titres were determined quantitatively by immunosorbent assays., Results: DNA of HSV-1 and HCMV were detected in 1.5% of the patients and controls, whereas EBV DNA was present in 10.8% and 13.9% respectively. Detection rates of serum IgG against HSV-1 (76.1% versus 73.9%), EBV (98.5% versus 96.9%), HCMV (47.7% versus 46.2%) and IgM levels against HSV-1 (6.2% versus 1.5%), EBV (0% versus 0%), HCMV (0% versus 1.5%) did not significantly differ between patients and controls., Conclusion: The data of our study do not suggest any contribution of HSV-1, EBV or HCMV to aggressive periodontitis in a German population. Ethnic and methodological aspects might have caused conflicting results of previous studies., (© 2012 John Wiley & Sons A/S.)

The objective of this study was to genotype 375 clinical herpes simplex virus type 1 (HSV-1) isolates collected from the German Reference Laboratory of HSV and VZV between 1973 and 2010. The method is based on the amplification and the restriction fragment length polymorphism analysis of the glycoprotein G (gG) and gI. 45.1% of isolates were classified as genotype A, 28.5% as B, and 4.3% as C. 22.1% presented different cleavage patterns for gG and gI suggesting intergenic recombinants A/B in 7.7%, A/C in 0.5%, B/A in 9.3%, B/C in 1.9%, C/A in 1.6%, and C/B in 0.5% of isolates. Two isolates from 1982 and 2010 presented atypical gI cleavage pattern consistent with novel intragenic recombination between genotypes A and C. There were no significant differences of the prevalence of genotypes A, B as well as the recombinants A/B, B/A dependent on the age/gender of patients and the time period in which the strains were isolated. Likewise, there were no significant differences in the distribution of the genotypes A and B as etiological agents of eczema herpeticum, herpes labialis, herpes genitalis, and herpetic gingivostomatitis. The number of recombinants was not different significantly in the groups of the distinct herpetic diseases. In conclusion, the study confirms the high prevalence of recombinants in clinical HSV-1 strains. HSV-1 infections result in clinical manifestations which are independent of the gG/gI genotype and recombinants are not associated with special herpetic diseases., (Copyright © 2012 Wiley Periodicals, Inc.)

Background: Recently three different herpes simplex virus type 1 (HSV-1) genotypes (A, B and C) were described on DNA sequence data of the glycoprotein E (gE), G (gG) and I (gI) genes., Objective: To type the circulating HSV-1 wild-type strains in Germany and to monitor potential changes in the molecular epidemiology over the past 10 years., Study Design: A total of 569 clinical HSV-1 isolates from a 10-year survey in Germany were genotyped by a PCR-based restriction fragment length polymorphism analysis of gG and gI. Recombination analysis of the gE gene sequences was performed to reveal intragenic recombinants., Results: Genotypes A and B strains represented 76% of all strains analyzed and showed a stable distribution within all age groups investigated, independently from the gender. Intergenic gG/gI and intragenic gE recombinants were demonstrated to be less prevalent. Interestingly, for one HIV infected patient a gG/gI genotype switch from A/A to C/A was observed within 3 years., Conclusion: The first molecular survey of clinical HSV-1 isolates from Germany demonstrated a stable distribution of two different genotypes and recombinants within age groups and over a period of 10 years. Moreover, homologous recombination seems to be an important feature in the evolution of the HSV-1 genome.

Infections with herpes simplex virus (HSV) types 1 and 2 are widespread in all human populations and result in persistent and latent infections. HSV-1 is commonly responsible for orofacial, HSV-2 more likely causes genital lesions. Herpes genitalis is one of the most important sexually transmitted diseases; furthermore, there are severe diseases associated with HSV (e.g., encephalitis). Over the last years an increase in clinical manifestations of HSV has been reported, and HSV-1 has been increasingly discussed as causative agent of herpes genitalis. We retrospectively evaluated the laboratory results of our routine diagnostic service for HSV infections, looking for changes of HSV epidemiology in recent years. Specimens from 2,678 herpes patients were obtained between 1 January 1996 and 31 March 2002. Using cell culture, the presence of HSV was investigated in swabs taken from different body sites, and clinical data on HSV localization and type were evaluated. We found 345 patients positive for HSV-1 and 212 positive for HSV-2. Clinical data were available from 72.1% of the patients with HSV-1, and 61.3% of those with HSV-2 infection. In genital herpes HSV-1 was the causative agent in 20% of men and in 25% of women. In patients suffering from orofacial herpes HSV-2 was detected in 7% of men and in 4% of women. To evaluate the frequency of neurological HSV diseases, 2,406 cerebrospinal fluid samples (CSF) from 2,121 patients suspected of meningitis or encephalitis were tested for HSV DNA by the polymerase chain reaction. Among those patients, 120 showed CSF positive for HSV DNA. Serum surveys of HSV-1 and HSV-2 infection recently established in our region were compared to similar studies performed in Germany 25 years ago. We found that seroprevalences have not changed over the last 25 years and that neurological HSV diseases are rare. However, as in the USA, a significant percentage of herpes genitalis is caused by HSV-1 in Germany.

This study investigated risk factors for herpes simplex virus type 1 (HSV-1) infection in a population of university students in Germany and Spain. In addition, factors associated with the occurrence of oral lesions were studied. Serum samples were collected from 596 Spanish students from the Navarra Public University in Pamplona and 174 German students from the University of Bielefeld aged 17-41 years and tested by a HSV-1 type-specific immunoassay using monoclonal antibody-selected gG1 as antigen. Information on clinical manifestations and risk factors were obtained by a standardized questionnaire. The rate of HSV-1 infection was 55.3 and 27.4% of these infected students reported having had oral lesions within the last 12 months. Prevalence of HSV-1 infection did not differ between study sites, and did not vary according to gender or age. Students with coitus experience were more likely to be infected with HSV-1 (Odds ratio (OR), 1.88; 95%CI: 1.31-2.69), while other lifestyle factors were not associated with HSV-1 infection. Risk factors for the occurrence of oral lesions included HSV-1 seropositivity (OR: 6.90; 95%CI: 3.84-12.37) and a higher level of perceived stress, as measured by the Cohen scale of perceived stress (OR: 1.79; 95%CI: 1.15-2.78). Drinking alcohol was found to be a protective factor (OR: 0.59; 95%CI: 0.37-0.93). There was no difference in the clinical pattern and course of infection between the young adults in Germany and Spain. We conclude, that lifestyle factors appear to play an important role in the epidemiology and clinical manifestations of HSV-1.