informed consent treatment with lysine for herpes virus

Electronic medical records (EMRs) hold great promise for improving the practice of evidence based medicine by facilitating communication between members of the health care team. The most profound influence of EMRs may lie in their ability to encourage clients' involvement in their own pets care.

informed consent treatment with lysine for herpes virus

Postby malernee » Thu Oct 26, 2006 8:14 am

Because treatment with lysine for herpes virus still is an unproven modality of treatment. Clients should avoid taking the advice of any veterinarian who promotes treatment with lysine for herpes virus in the market place. Clients who wish to try treatment with lysine for herpes virus should discuss their situation with a knowledgeable veterinarian who has no commercial interest in making a profit from treatment with lysine for herpes virus.
The use of treatment with lysine for herpes virus in animals and humans should be restricted to appropriate research settings. Licensure of lysine ointments promoted as a herpes treatment should be prohibited or phased out by the govenment because treatment with lysine for herpes virus is an unproven modality of treatment.



At the 1995 ACVO meeting, Keith Collins, Mark Nasisse, et al reported on the in vitro efficacy of lysine against FHV-1. They demonstrated that lysine reduces viral replication in cell culture. No controlled clinical studies have been reported.
However, lysine has been used at least since 1993-4 and some vets have reported they found that it dramatically improved the corneas of herpes-positive cats which had been unresponsive to topical antivirals. Not all patients have responded as convincingly but some boarded internal medicine vets still recommend lifelong supplementation of L-lysine in ocular herpes patients, 500mg PO daily. There are also reports of beneficial lysine therapy in humans with herpes simplex (HSV-1).



Key points
1. the major cause of feline upper respiratory infection are feline calicivirus(FCV)and feline herpesvirus(FHV).
2. The vaccines available for Feline upper respiratory infections do not prevent infection. They tend to reduce the severity of the symptoms. So one could suspect to see FURI symptoms with any vaccination program.
3. Feline URIs are usually transmitted via direct transfer of infectious materials rather than aerosol in spite of the fact that sneezing may occur . Like our colds, they usually get it from contact with infectious secretions and excretions. Therefore, attention to detail when kennel cleaning to avoid cross contamination and thorough disinfection is critical to getting control of these situations.
Kittens should not be housed with adults and obviously all sick cats should be segregated and the healthy ones handled and cleaned first. Entering kennel animals may benefit from intranasal URI vaccine because of more rapid onset of action compared to parenteral vaccines. Kennels where cats are removed from cages and alowed to come in direct contact with other cats should be avoided at all cost if you plan to board <animal>.

FHV was first isolated in 1957 and initially named feline rhinotracheitis virus. Incubation period is about two to six days. Cats become depressed inappetant pyrexic and often develop marked sneezing. Salivation may occur. Ocular and nasal discharge may be serious followed by mucopurulent conjunctivitis. A cough and dyspnea may occur. FHV may be an important cause of morbidity in young animals in breeding colonies. Less often FHV can cause pneumonia or keratitis with desmcemetocele formation. Rarely skin ulceration and neurological signs have also been seen in FHV infected cats. FHV may like FCV produce tongue ulcers but not as frequently as FCV. Abortion most likely is secondary to debilitation and pyrexia has been reported. Damage to nasal turbinates by FHV in acute disease may predispose to chronic rhinosinusitis later in life.
When vaccinating the ability to cause disease must be weighted against ability to produce disease.
Attenuated live calici and herpes vaccinations sold to veterinarians badly need reevaluation. Chronic infections with both FHV and FCV agents are still very common, even in the face of continuous vaccination. acute disease is also seen at times in environments that are being heavily vaccinated, and at least a portion of both acute and chronic disease may be vaccine virus associated. In the case of FCV this high rate of vaccine failure has been blamed on the emergence of vaccine resistant strains in the field. A more likely explanation is the vaccine does not protect against the chronic state and in some cases may be a significant source of both acute and chronic infections. Both FCV and FHV vaccines contain virulence attenuated stains of living virus. However attenuation is marginal and their safety depends largely on their being administered parenterally. If they are given mucosally they cause infection disease. This can occur when <animal> licks the vaccine site and get vaccine virus orally off the skin if 100% is not deposited under the skin. Although immunization with live FHV and FCV vaccine may decrease the frequency and severity of acute disease there is no evidence that they significantly decrease the chronic carrier state. In fact the incidence of FCV carriers is higher today than it was prior to vaccination. We need to reevaluate the use of live FHV and FCV and to consider using killed FHV and FCV vaccinations instead. By using killed FHV and FCV one major source for virus reintroduction and chronic infection can be removed from the environment. However one must weigh the decreased incidence vaccine induced infection against the potential increase in vaccine induced tumors.

>>>Problems with Respiratory Virus Vaccination in Cats

<<<Comp on Cont Ed 15[10]:1347-1354 Oct'93 Review Article 47 Refs
S. Dawson, BVMS, PhD, MRCVS and R. M. Gaskell, BVSc, PhD, MRCVS
Depts. of Veterinary Pathology and Veterinary Clinical Science; University of Liverpool; Veterinary Field Station; Leahurst; Neston, Wirral, UK

-The two main causes of respiratory disease in cats, feline herpesvirus and feline calicivirus, are prevalent despite the availability of vaccines. Both viruses survive interepidemic phases through carriers. With feline herpesvirus, the carrier state is characterized by periods of latency interspersed with episodes of infectious virus shedding, particularly after stress. Shedding is more or less continuous in the feline calicivirus carrier state. In environments where the cat population is dense, infection of kittens is common because of the high incidence of carriers and a possible immunity gap occurring between the time maternally derived antibody loses its effectiveness and vaccinations are commonly given. Vaccine reactions are most likely attributable to field virus, with the kitten incubating the disease at the time of vaccination. Apparent vaccine breakdowns occur because even under ideal conditions, protection is not necessarily complete in all cats. Intercurrent disease can reduce protection afforded by vaccination, and in some cases, levels of virus within a population are so high that clinical disease occurs even in vaccinated cats. (Author Abstract)<<<

>>>Mechanisms for persistence of acute and chronic feline calicivirus infections in the face of vaccination.

<<<Vet Microbiol 1995 Nov;47(1-2):141-56
Pedersen NC ; Hawkins KF
Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis 95616, USA.

-The study was concerned with possible reasons for the persistence of both acute and chronic feline calicivirus (FCV)-induced disease and sustained oral carriage in the field in the face of routine FCV immunization. It was concluded from this study that: 1) the original FCV-F9 strain, which is the basis of most live vaccines, still generates cross-reactive antibodies against almost all field strains in California, 2) vaccine strains derived from
FCV-F9 may not be as broadly cross-protective as the parent strain, 3) whole inactivated FCV-2280 vaccine evokes high virus neutralizing antibody titers with an equally broad spectrum of cross-reactivity as FCV-F9, 4) all vaccine strains of FCV cause acute disease signs and protracted oral shedding when administered orally, 5) strains isolated from the mouth five to ten weeks following oral inoculation can differ from parental virus, usually
appearing more vaccine resistant, 6) cats previously infected with field or vaccine strains develop much less severe acute illness when subsequently infected with heterologous FCV strains but are not protected against the chronic carrier state. Therefore, the persistence of FCV in the field cannot be explained solely by the emergence of vaccine resistant strains and vaccine virus itself may contribute to both acute and chronic infection and
disease. (Author Abstract)<<<

If <animal> would have a upper respiratory infection with corneal ulcers, it's pretty much got to be herpes. Calici and the others don't do that. Herpes may be complicated by some of the others but if eye ulcers occur it's the main offender.
Trying to find the carrier cats is pretty difficult with herpes as the virus is only shed intermittently and so not all carrier cats will be shedding at any one time.
It may be helpful especially if a nested set PCR is run on the samples. See reference below. However, Herpes can still hide out and may be difficult to pick up carriers if they aren't in an actively shedding state unless you test neural tissues or cornea where latent virus can hang out.



Detection Of Feline Herpesvirus 1 DNA By The Nested Polymerase Chain Reaction.
<<Vet Microbiol 1996 Feb;48(3-4):345-52
Hara M ; Fukuyama M ; Suzuki Y ; Kisikawa S ; Ikeda T ; Kiuchi A ; Tabuchi K

-The thymidine kinase region of feline herpesvirus 1 (FHV 1) genome in ocular/nasal swabs from cats with clinical manifestations of upper respiratory disease was amplified by nested polymerase chain reaction (nested PCR). Two primer pairs were prepared for nested PCR. FHV 1 DNA in ocular/nasal swabs was extracted using instaGene-DNA purification matrix. Nested PCR for the FHV 1 culture supernatants was ten times as sensitive as single PCR. On comparing viral isolation with single PCR and nested PCR for the detection of FHV 1 in ocular/nasal secretions, of 5 samples that yielded infectious virus in cell culture, 3 (60%) were positive in single PCR and 5 (100%) were positive in nested PCR. When 22 ocular/nasal swabs that did not yield FHV 1 were assayed, 3 were negative in both single PCR and nested PCR, 2 were positive in both single and nested PCR and 17 were positive in only nested PCR. Thus, FHV 1 was detected in 19/22 (86.4%) by the nested PCR and in 2/22 (9%) by single PCR. These results show that nested PCR is 4.8 (24 positive samples/5 positive samples) times as sensitive as single PCR. (Author Abstract)
Detection of feline herpesvirus-specific antibodies and DNA in aqueous humor from cats with or without uveitis.

<<Am J Vet Res 1999 Aug;60(8):932-6
Maggs DJ, Lappin MR, Nasisse MP
Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri, Columbia 65211, USA.

OBJECTIVE: To determine whether uveitis in cats was associated with intraocular production of feline herpesvirus type 1 (FHV-1)-specific antibodies or with detection of FHV-1 DNA in aqueous humor (AH). ANIMALS: 44 cats with idiopathic uveitis, 29 cats with uveitis attributed to Toxoplasma gondii infection, 13 FHV-1 seropositive cats without uveitis, and 9 FHV-1 seronegative cats without uveitis. PROCEDURE: ELISA were used to detect FHV-1-specific antibodies and total IgG antibodies in serum and AH, and the Goldmann-Witmer coefficient (C-value) for intraocular antibody production was calculated. A polymerase chain reaction assay was used to detect FHV-1 DNA in AH. RESULTS: FHV-1 seroprevalence among cats with uveitis was not significantly different from seroprevalence among cats without uveitis. Intraocular FHV-1 antibodies were never detected in cats without uveitis. Significantly more cats with idiopathic uveitis (22/44) or with toxoplasmic uveitis (11/29) had evidence of intraocular antibody production (C-value > 1) than did cats without uveitis. Only cats with idiopathic uveitis had FHV-1 C-values > 8. Among cats with evidence of intraocular antibody production, cats with idiopathic uveitis had a significantly higher median FHV-1 C-value (9.61) than did cats with toxoplasmic uveitis (2.56). Overall, FHV-1 DNA was detected in AH from 12 cats, 11 of which had uveitis. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that FHV-1 can infect intraocular tissues of cats and that intraocular FHV-1 infection may be associated with uveal inflammation in some
cats

There is a Herpes PCR that can be done on conjunctival swabs, it's probably the best test but since Herpes may only shed intermittently, you can miss it. You can find information about some of these tests at the TAMU website: www.cvm.tamu.edu/clinpath. Go to the "outside labs" page.



.



________________________
____________________________________

1: Am J Vet Res 2003 Jan;64(1):37-42 Related Articles, Links


Efficacy of oral supplementation with L-lysine in cats latently infected
with feline herpesvirus.

Maggs DJ, Nasisse MP, Kass PH.

Department of Veterinary Medicine and Surgery, College of Veterinary
Medicine, University of Missouri, Columbia, MO 65211, USA.

OBJECTIVE: To examine the effects of orally administered L-lysine on
clinical signs of feline herpesvirus type 1 (FHV-1) infection and ocular
shedding of FHV-1 in latently infected cats. ANIMALS: 14 young adult,
FHV-1-naive cats. PROCEDURE: Five months after primary conjunctival
inoculation with FHV-1, cats were rehoused and assigned to receive 400 mg of
L-lysine in food once daily for 30 days or food only. On day 15, all cats
received methylprednisolone to induce viral reactivation. Clinical signs of
infection were graded, and viral shedding was assessed by a polymerase chain
reaction assay throughout our study. Peak and trough plasma amino acid
concentrations were assessed on day 30. RESULTS: Fewer cats and eyes were
affected by conjunctivitis, and onset of clinical signs of infection was
delayed on average by 7 days in cats receiving L-lysine, compared with cats
in the control group; however, significant differences between groups were
not demonstrated. Significantly fewer viral shedding episodes were
identified in the treatment group cats, compared with the control group
cats, after rehousing but not following corticosteroid-induced viral
reactivation. Mean plasma L-lysine concentration was significantly increased
at 3 hours but not at 24 hours after L-lysine administration. Plasma
arginine concentration was not significantly altered. CONCLUSIONS AND
CLINICAL RELEVANCE: Once daily oral administration of 400 mg of L-lysine to
cats latently infected with FHV-1 was associated with reduced viral shedding
following changes in housing and husbandry but not following corticosteroid
administration. This dose caused a significant but short-term increase in
plasma L-lysine concentration without altering plasma arginine concentration
or inducing adverse clinical effects.

PMID: 12518876 [PubMed - indexed for MEDLINE]
***
Does L Lysine prevent Herpes?10-26-06 at 8:48a:



At this point, it appears that some studies show lysine to be helpful in herpes treatment or prevention, but several more studies are needed to confirm or refute these findings before we can make any firm recommendations for the use of lysine in herpes treatment. My overall impression thus far is that if lysine does help a herpes infection or if lysine prevents a herpes infection, its effects are most likely mild. Although the role of lysine in herpes has been studied off an on for quite a number of years, no firm conclusions can yet be made. The ideal dosage of lysine for herpes prevention is not known at this time and the long term side effects of lysine, if any, are also not known. Thus far no significant l lysine side effects have been reported in the medical literature that I can find.



Lysine is not evaluated by the FDA for safety, effectiveness, or purity. All potential risks and/or advantages of lysine may not be known. Additionally, there are no regulated manufacturing standards in place for these compounds. There have been instances where herbal/health supplements have been sold which were contaminated with toxic metals or other drugs.
FDA has a review I found of the herpes/lysine studies submitted for an over the counter claim and why they were not acceptable for a herpes label claim for lysine.
http://www.fda.gov/cder/otcmonographs/F ... 920630.pdf

Pet drug Companies are selling lysine paste to give cats for their types of herpes. A vet boarded in internal medicine on the largest vet newsgroup said it was indicated for treating herpes while at the same time saying that a recent study shows just as many cats asymptomatic for herpes test positive as cats symptomatic for the virus. Cats may have respiratory signs caused by herpes but many cats for many reasons sneeze a lot. So questionable diagnosis and questionable supplement treatment with a product that is a required amino acid in the cats diet promoted by boarded vets is where we are at today using lysine for herpes.
see
1: Am J Vet Res 2003 Jan;64(1):37-42 Related Articles, Links


Efficacy of oral supplementation with L-lysine in cats latently infected
with feline herpesvirus.

Maggs DJ, Nasisse MP, Kass PH.

Department of Veterinary Medicine and Surgery, College of Veterinary
Medicine, University of Missouri, Columbia, MO 65211, USA.

OBJECTIVE: To examine the effects of orally administered L-lysine on
clinical signs of feline herpesvirus type 1 (FHV-1) infection and ocular
shedding of FHV-1 in latently infected cats. ANIMALS: 14 young adult,
FHV-1-naive cats. PROCEDURE: Five months after primary conjunctival
inoculation with FHV-1, cats were rehoused and assigned to receive 400 mg of
L-lysine in food once daily for 30 days or food only. On day 15, all cats
received methylprednisolone to induce viral reactivation. Clinical signs of
infection were graded, and viral shedding was assessed by a polymerase chain
reaction assay throughout our study. Peak and trough plasma amino acid
concentrations were assessed on day 30. RESULTS: Fewer cats and eyes were
affected by conjunctivitis, and onset of clinical signs of infection was
delayed on average by 7 days in cats receiving L-lysine, compared with cats
in the control group; however, significant differences between groups were
not demonstrated. Significantly fewer viral shedding episodes were
identified in the treatment group cats, compared with the control group
cats, after rehousing but not following corticosteroid-induced viral
reactivation. Mean plasma L-lysine concentration was significantly increased
at 3 hours but not at 24 hours after L-lysine administration. Plasma
arginine concentration was not significantly altered. CONCLUSIONS AND
CLINICAL RELEVANCE: Once daily oral administration of 400 mg of L-lysine to
cats latently infected with FHV-1 was associated with reduced viral shedding
following changes in housing and husbandry but not following corticosteroid
administration. This dose caused a significant but short-term increase in
plasma L-lysine concentration without altering plasma arginine concentration
or inducing adverse clinical effects.

PMID: 12518876 [PubMed - indexed for MEDLINE]




Art Malernee dvm
malernee
Site Admin
 
Posts: 462
Joined: Wed Aug 13, 2003 5:56 pm

Return to My Pet Medical Records

Who is online

Users browsing this forum: No registered users and 5 guests

cron