AU: Mattassi, R.M.D., D'Angelo F.,M.D., Franchina A.,M.D., Bassi P.,M.D.
SO: From the Division of Vascular Surgery, Santa Corona Hospital, Milan, Italy
It is known from many researches that ozone has a high antibacterial and antiviral effect and this is utilized in the industrial treatment of drinking water. Authors of this paper tried to utilize this ozone effect in the treatment of some viral diseases of man. 30 patients with herpes zoster and 27 with herpes simplex labialis were treated with injections of an oxygen-ozone mixture. Patients with herpes zoster healed from cutaneous lesions after a minimum of five and a maximum of 12 injections performed once daily. 5 elderly patients complained of postherpetic pain. Herpes simplex healed completely after a minimum of 1 and a maximum of 5 injections. Only 3 recurrence of herpes labialis were observed in 3 years. No side effects were noticed during treatment in all patients.
Herpes virus is a group of DNA-virus that range in size between 120 and 180 nm; they contain a lipid envelope, are sensible to ether and have a cubic symmetry. Virus multiplication is intracellular. After entering the cell by pinocytosis, nucleic acid is stripped from the capsid and specific virus DNA strands are transcribed into specific mRNA, which is, in turn, translated to synthesize virus-specific proteins and enzymes necessary for biosynthesis of virus DNA. Newly formatted complete virions may be released by cell lysis of budding from the cytoplasm (1). Principal routes of infection in man may be respiratory, direct contact, transplacentar (H. Hominis), breast milk and feces (Cytomegalovirus).
The main diseases occurring in man from these agents are:
- Varicella (chickenpox)
- Herpes Zoster
- Herpes Simplex
- Herpes labialis
- Herpes genitalis
- H. Hominis Type 1 and Type 2
- Acute gingivostomatitis
- Eczema herpeticum
- Cytomegalic inclusion disease
Herpes zoster is a disease caused by the same virus as varicella. It has been suggested that it results from reactivation of virus that has lain dormant in spinal nerves since an episode of chickenpox (2). It occurs often in patients with neoplasm, specially lymphomas (3) and in elderly patients. It is characterized by unilateral segmental inflammation of the spinal or cranial nerves and their ganglions and by a painful localized vesicular eruption of the skin along the distribution of the involved nerve. Skin lesions starts with local redness and progress over the next 2 - 3 weeks through red papules, vesicules, pustules and crusts. In young people pain persists only a week or two after healing but in elderly patients it often remains for over two months.
Herpes labialis is a chronic local infection of Herpes virus Hominis type I with clinical recurrences associated with continued virus shedding rather than reactivation of latent infection (4). Often recurrence appears after infective diseases, exposure to sunlight, menstruations and tiredness. Typically the disease is preceded by a brief period of itching and inflammation followed by a vesicular eruption that later collapses and ulcerates leaving a crust. The disease lasts about 8 - 15 days. Local iodoxuridine can shorten pain and morbidity somewhat. No therapy is available to prevent recurrence.
In spite of this excellent antiviral and antibacterial effect, ozone has not been widely utilized in medicine because of the widespread belief that it is toxic to man (13, 14). This opinion varies widely from the fact that researches about ozone effects on animals were done by only observing respiratory tract lesions after long-term inhalation of ozone. In fact, while it is true that ozone is toxic if inhaled (but it is only a local toxicity), it is also true that given in forms other than inhalation (endovenous, intraarterial, intramuscular, subcutaneous, local, transdermal) there is no toxic effect (15,16,17). Injected ozone can be given without risks (if the injection technique is correct) because of the good solubility of ozone in blood. Fundamental is to use a mixture containing medically pure ozone. This can only be obtained utilizing a machine that produces ozone from pure oxygen (and not from air).
To investigate the effect of ozone on some viral diseases we treated a group of patients affected by Herpes Zoster and Herpes Simplex Labialis.
Material and Methods
In the period 1980-1982 we treated 30 patients affected by Herpes Zoster and 27 affected by Herpes simplex labialis. In the Herpes Zoster group 13 were men and 17 women. Age range was from 9 to 76 years and the mean age was 41.4. In the Herpes simplex group, 12 were men and 15 women. Age range was from 15 to 53 and the mean age was 34.5.
Total 30 cases
- Face 5 cases
- Neck 2 cases
- Thorax 12 cases
- Abdomen 8 cases
- Upper limbs 1 case
- Lower limbs 2 cases
Therapy performed in all patients consisted of injections of 20cc of a oxygen-ozone mixture. The concentration of ozone was 20 gamma of ozone per cc (20 ug/ml) of oxygen-ozone mixture. Injections were performed daily and were stopped at complete healing (except in 5 patients of the Herpes Zoster group and in 3 of the Herpes Simplex group which broke up therapy before ending; see below). Special care was taken on the technique of injections: gas mixture must be injected slowly (20 cc in 2-3 minutes). Some patients sometimes noticed a sense of gurgling at the axillary region: 5 patients had a slight cough for about 10 minutes after injections. No other side effect was observed.
Herpes Zoster: in all patients healing of skin lesions were observed after a minimum of 5 and a maximum of 12 ozone injections. In the greater part of patients (21) we had a disappearance of local redness after only 2-3 days of therapy: especially in those patients that started therapy quickly at the beginning of symptoms (fig. I and 2). Contemporaneously vesicules dried up and crusts appeared. After beginning therapy no new vesicules appeared. The disease course was "cut off" and complete healing was very quick. 5 patients broke up therapy because they felt well after a few injections; 2-4 days later new vesicules and pain appeared. Complete healing was achieved after another cycle of therapy. Usually pain regressed contemporaneously with disappearance of local redness; itching persisted for some days while going on with therapy but disappeared at the end of therapy. In the other 5 patients, skin lesions healed but neuritis post-herpetica lasted for over 2 months; all of these patients were elderly (over 70 years) and started therapy late after the beginning of symptoms. The other patients never had neuritis post-herpetica.
Herpes Simplex: all patients healed after 1-5 injections. Best results were reached in patients that began therapy early before vesicules appeared; in these cases the disease healed directly without the appearance of vesicules in 1-2 days. 3 patients with severe herpes labialis stopped therapy after only one injection and observed appearance of new vesicules; a new cycle of treatment allowed complete healing. It was noticed that other patients with slight herpes healed after only one injection. Very interesting that of this group of 27 patients treated, only 3 complained a recurrence of disease and this recurrence were clearly attenuated in comparison with their usual disease. The other 24 patients had no recurrence during period of control (maximum 3 years).
According to these results we can assert that ozone seemed to be very effective in the therapy of herpes zoster and herpes simplex labialis diseases. We observed a clear shortening of the course of disease and, if therapy starts early, also a "cut-off" of the course of disease. It can be possible also that ozone obtains a complete healing of herpes simplex labialis without recurrence after therapy but it is necessary to have a longer time of control. It was important to perform injections daily, to continue therapy till healing was complete and not to stop treatment prematurely because immediate recurrence of the disease is possible. It is interesting to notice the absence of side effects with ozone therapy.
1) JAWETZ E. et al.: Review of Medical Microbiology, 9th ed.; Los Altos, Calif. Langue, 1970.
2) WELLER T.H.: Varicella-Herpes Zoster virus. in "Viral and Rickettsial Infections of Man", ed. F.L. Horsfall Jr., T. Tamm, 4th ed., Philadelphia Lippincott, 1965.
3) GOFFINET D.R. et al.: Herpes zoster-varicella infections and lymphoma. ANN. INTERN. MED. 76: 235, 1972.
4) LERNER M.A.: Infections with herpes virus hominis (Herpes Simplex). in: Harrison's Principles of Internal Medicine. McGraw-Hill 7th ed. 1974.
5) STAEHELIN J., HOIGNI J.: Zur chemischen Reaktionskinetik des ozonzerfa im Wasser. I.0.A. Congress - "Wasser Berlin 1981" p. 623.
6) CANTARELLI G.: Sul trattamento mediante ozono delle acque inquinate. i: "L'ozono nell'aria e nell'acqua. Concentrazioni ottimali". Atti 30 con vegno di: bioclimatologia applicata.. Universita di Milano 1969.
7) LEGERON J.P., GIRARDIN F.: Contribution a l'optimisation de la desinfection par 1'ozone des eaux residuaires domestiques. I.O.A. Congress -"Wasser Berlin 1981" p. 178.
8) VIEBAHN R.: Ergebnisse internationale Ozonforschung - die Inaktivierung von Viren durch Ozon. ERFAHRUNGSHEILKUNDE 5: 197, 1977
9) EWELL A.M.: Researches of UV-light, ozone and their relations as germi-cidal agents. REFRIG. ENG. 41: 331, 1941.
10) SYKES G.: Disinfection and sterilization. 2nd ed. Spon, London 1968.
11) STOVER E.L., JARNIS RN., LONG J.P.: Ozone for high level vastemater disinfection. I.O.A. Congress- "Wasser Berlin 1981" p. 259.
12) D'ELIA P., MEUCCI F., TOSI A.: Experiences d'Italie dans l'emploi de l'ozone. I.Q.A. Congress - "Wasser Berlin 1981" p. 411.
13) MCKENZIE Wh., KNELSSON Jh. et al.: Cytogenetic effects of inhaled ozone in man. MUTAT.RES. 48: 95, 1977.
14) THORP E.: The toxicity of ozone. IND.MED. AND SURG. 19: 45, 1950.
15) PAYR E.: MUNCH.MED.WOCHENSCHR. 1 (22): 858, 1935.
16) MATTASSI R., FRANCHINA A., D'ANGELO F.: Ozontherapie in der gefasschirurgischen Abteilung des Krankenhauses "Santa Corona" in Garbagnate Milanes ERFAHRUNGSHEILKUNDE 12: 974, 1980.
17) WOLFF H.H.: Das Medizinische Ozon. E. Fischer Verlag. Heidelberg, 1979.