of patients may develop one or two types of antibody - (I) cold agglutination which agglulinates human group O erylhrocytes

50-75% of patients may develop one or two types of antibody - (I) cold agglutination which agglulinates human group O erylhrocytes at 40-45"F, (ii) an antibody which agglutinates a certain strain of non-hernotytic streptococcus designated MG These antibodes arise coring the 2nd or 3rd week of illness Antiviral agents ACYCLOVIR - is effective and without significant side-effects The specificity is because the phosphorylation required for Its activation occurs only in cells infected with herpes viruses. In case of HSV and VZV, the viral thyrldine kinase enzyme phosphorylates acyclovir Acyclovir monophosphate Is further phosphorylated to the triphosphate by cellular enzymes, the triphosphals becomes incorporated into the growing DNA chain and acrs as an obligate chain Terminator so Inhibiting the DNA polymerase of all herpes viruses. It also inhibits the enzyme directly GANCICLOVIR AND PENCICLQVIR - are activated in a similar manner but have adverse effects Ganckclovir can cause significant bone marrow depression and Is only adwised for life or sight threatening CMF infections Penciclovir Is well tolerated clinically PRODRUGS The bioavailability of the above compounds can be improved by use of prooVugs Farrclclovlr Is the prodrug of penciclovir and valaciclovlr of acyclovir FOSCARNET - Is used Iv for cytomegalovirus relinitis and induction therapy for mucocutaneous HSV unresponsive to acyclovir Side-effects are renal impairment and anemia PURINE ANALOGUES - Rlbavlrln inhibits DNA and RNA viruses, and is active against influenza, respiratory syncytial. herpes simplex. It can Inhibit hepatitis B replication In chronic hepatitis B carriers Aerosol form is indicated for RSV bronchiolilis or pneumonia, severe influenza and among immunocornpromised far parainfluenza and measles IV formulation has been used in lassa fever, and hemorrhagic lever with renal synctoma due to Hanlaan virus. TPICYCLIC AMINES - Rimantadine and Amantadne inhibit Influenza A virus They are not recommended for children below 10 years They can also be used for herpes zostar IMMUNQPQTENTIATORS - (a) Inosine pranobex - has been used In HSV 1 and 2 akin or mucous membrane lesions, subacule sclerosing encephalitis and as atjunctive treatment for genital warts It is not recommended in cnidren (b) Interferons - are a group of highly homologous species specific proteins that act by augmenting cellular resistance to virus and exert a nonspecific antiviral effect Indfcations are chronic active hepatitis with HBV DNA and chronic hepatitis C with raised serum transminases Adverse reactions include influenza-like syndrome, neuro-psychlairlc changes, bone marrow suppression, thyroid dysfunction. VIRUS AND DRUGS DISEASE Herpes sinplex Ocular herpes 3% acyclovir olntment Herpes labialis 5% acyclovir cream or 3% foscarnel cream. Genital Primary Acyclovir 1000 mg/day po. or 5 mg/kg i.d.s l.v Aliernate FCV Recurrent Asyclovir 1000 mg/day p.o. Alternate FCV Prophylaxis Acyclovir 400-1000 mg/day p.o. Encephalitis Aoyclovir . Forschhelmer,s spots - Soil palate lesions In rubella Gram-staining - Common organisms - I Gram-positive cocci - Staph spp. Strap spp. 2 Gram-negative cocci - Gonococcus, menlngococcus. 3 Gram-positive bacilli - Clostrldum spp.. Bacillus spp, C. diphtheriae. Actinomyes israeli Gardenereila vaglnalls, Llsieria monocytogenes 4. Gram-negative bacilli - Enierobacterlaceae (E.