Kwon, Jung Ho; Mo, Jong Hyun; Moon, Sung Hee; Lee, Sang Sun; Park, Yang Hee; Lee, Kyung Hee [National Police Hospital, Seoul (Korea, Republic of); Choi, Ik Joon [Sejong General Hospital, Seoul (Korea, Republic of)
To evaluate the MRI findings of acute facial nerve paralysis in Bell's palsy and herpes zoster opticus, and to correlate these with the clinical findings. We retrowspectively reviewed the MRI findings in six cases of BEll's palsy(BP) and two of herpes zoster oticus(HZO), and compared them with the findings for 30 normal facial nerves. This nerve was considered abnormal when its signal intensity was greater than that of brain parenchyma or the contralateral normal side on Gd-enhanced T1-weighted axial and coronal MR images. We analysed the location and degree of contrast enhancement, interval change, and clinical progression in correlation with House-Brackmann(HB) grade and electroneuronography (ENoG) findings. Fifteen of 30 normal facial nerves(50%) seen on Gd-enhanced MRI were mildly enhanced in the geniculate ganglion, the proximal tympanic, and the proximal mastoid segment of the facial nerve. No enhancement of the internal auditory canal(IAC) or labyrinthine segment of the facial nerve was noted, however. In BP and HZO, Gd-enhanced MR images revealed fair to marked enhancement for more than two segments from the internal auditory canal to the mastoid segment of the facial nerve. During follow-up MRI, enhancement of the facial nerve varied in location and signal intensity, though gradually decreased in intensity approximately eight weeks after the onset of facial nerve palsy. No correlation between clinical HB grade, ENoG, and follow up MRI findings was noted. Except in the internal auditory canal and labyrinthine segment, normal facial nevemay show mild and relatively symmetrical enhancement. In BP and HZO, the facial nerve showed diffuse enhancement from the IAC to the mastoid segment.=20.
Herpes zoster causes significant suffering owing to acute and chronic pain or postherpetic neuralgia (PHN). Varicella-zoster virus-induced neuronal destruction and inflammation causes the principal problems of pain, interference with activities of daily living, and reduced quality of life in older adults. The optimal treatment of herpes zoster requires early antiviral therapy and careful pain management. For patients who have PHN, evidence-based pharmacotherapy using topical lidocaine patch, gabapentin, pregabalin, tricyclic antidepressants, or opiates can reduce pain burden. The live attenuated zoster vaccine is effective in reducing pain burden and preventing herpes zoster and PHN in older adults. Copyright © 2016 Elsevier Inc. All rights reserved.
Synopsis Herpes zoster afflicts millions of older adults annually worldwide and causes significant suffering due to acute and chronic pain, or postherpetic neuralgia (PHN). Herpes zoster is caused by the reactivation of varicella-zoster virus (VZV) in sensory ganglia in the setting of age, disease and drug-related decline in cellular immunity to VZV. VZV-induced neuronal destruction and inflammation causes the principal problems of pain, interference with activities of daily living and reduced quality of life in older adults. To address these problems, the optimal treatment of herpes zoster requires early antiviral therapy and careful pain management. For patients who develop PHN, evidence-based pharmacotherapy using topical lidocaine patch, gabapentin, pregabalin, tricyclic antidepressants, and/or opiates can reduce pain burden. The live attenuated zoster vaccine is effective in reducing pain burden and preventing herpes zoster and PHN in older adults. PMID:17631237
Guilherme Cristianini Baldivia
Full Text Available Summary The varicella zoster virus is the causative agent of herpes zoster and varicella. In herpes zoster, the virus dormant within dorsal root ganglia is reactivated, resulting in painful vesicular lesions overlying an erythematous base.
Full Text Available History of present illness: A 26-year-old male presented to the emergency department with a burning rash over his left axilla and chest that started 2 days prior to presentation. The pain had been steadily worsening and was exacerbated by touch and the rubbing of his clothes over it. Patient denied fevers, chills, or weakness. Patient denied any past medical history, past surgical history or medications. He was unsure of his vaccination history and endorsed having chicken pox as a child. Significant findings: The patient was in mild distress, afebrile, with stable vital signs. His physical exam revealed an erythematous, grouped vesicular rash in various stages of progression including erythematous papules, clear vesicles, and pustular vesicles. Few lesions were scabbed over. No signs of crusting or scarring were appreciated. The distribution encompassed the entire left T4 dermatome both posteriorly and anteriorly. No other rashes were appreciated elsewhere on the body. Discussion: Herpes Zoster (HZ, also known as “shingles,” is a result of the reactivation Varicella Zoster Virus (VZV that emerges from latency in the sensory dorsal root ganglion. The reactivation causes the spreading of a classic rash of group vesicular lesions in various stages along the unilateral sensory dermatomal distribution over the first 3 days. Ulceration and crusting begin to occur after 3-5 days.1 The diagnosis is usually made clinically; however PCR testing of skin lesions is also available to differentiate between VZV, HSV1, and HSV2.2 The incidence of HZ increases with age due to immunosenesacence of cell mediated immunity, with the mean age between 43 and 53 years old.3 An immunocompromised state, due to factors like human immunodeficiency virus (HIV, medications, and autoimmune disease, also increases the incidence of HZ.4-6 A routine HIV screening in this patient was negative. He was prescribed oral acyclovir 800 mg, five times per day for five days.
... Center (GARD) National Institute on Deafness and Other Communication Disorders (NIDCD) See all related organizations Publications Order NINDS Publications Definition Herpes zoster oticus, also called Ramsay Hunt Syndrome ...
Herpes zoster (shingles) normally occurs in a limited area that follows a dermatome (see the "dermatome" picture). In individuals with damaged immune systems, herpes zoster may be widespread (disseminated), causing serious illness. ...
Toyama, Nozomu; Daikoku, Tohru; Yajima, Misako
Abstract Background. The incidence of recurrent herpes zoster (HZ) and the relationship between initial and recurrent HZ are not clear. Methods. The Miyazaki Dermatologist Society has surveyed ~5000 patients with HZ annually since 1997. A questionnaire regarding HZ and its recurrence was completed by the dermatologists. Results. A total of 34 877 patients with HZ were registered at 43 clinics between June 2009 and November 2015. Among 16 784 patients seen at 10 of the 43 clinics, 1076 patients (6.41%) experienced recurrence. Herpes zoster was more frequent in female than in male patients (5.27 vs 4.25 in 1000 person-years, P dermatome was observed in 16.3% of patients, and more frequently this occurred in the left side (P = .027). The number of HZ-experienced persons increased with age, and one third of the population had experienced HZ by the age of 80. Conclusions. Recurrent HZ was observed in 6.41% of patients, with a higher incidence in women. Moreover, HZ experience reduced the HZ incidence to 31.7% of the incidence in the HZ-naive population. PMID:28480280
de Jong, M. D.; Weel, J. F.; van Oers, M. H.; Boom, R.; Wertheim-van Dillen, P. M.
Patients with disseminated herpes zoster may present with severe abdominal pain that results from visceral involvement of varicella-zoster-virus infection. In the absence of cutaneous eruptions of herpes zoster, visceral herpes zoster is extremely difficult to diagnose. This diagnostic difficulty
Full Text Available Herpes zoster (HZ is a neurocutaneous disorder due to endogenous reactivation of the varicella-zoster virus (VZV. The typical clinical manifestation is an acute segmental eruption of herpetiform umbilicated vesicles associated with malaise, pain, dysaesthesia, allodynia and probably fever. This review focuses on other possible clinical manifestations of the disease to sensitize physicians not to overlook HZ since only an early antiviral treatment can reduce the risk of post-zosteric neuralgia.
Mar 1, 2013 ... Mustafa MB, Arduino PG, Porter SR. Varicella zoster virus: review of its management. J Oral Pathol Med. 2009;38:673–88. 4. Millar EP, Troulis MJ. Herpes zoster of the trigeminal nerve: the dentists' role in diagnosis and treatment. J Can Dent Assoc. 1994;60:450–3. 5. Ragozziuo MW, Melton LJ, Kudand LT, ...
Wollina, Uwe; Gemmeke, Astrid
Erythema multiforme is a cutaneous reaction that has only rarely been described in varicella zoster virus infection. We describe a 76-year old immunocompetent male patient with thoracic herpes zoster. While treated with oral brivudin he developed a widespread cutaneous erythema multiforme. The lesions completely cleared with two weeks with systemic corticosteroids. Varicella zoster infections are possible triggers of erythema multiforme and this is the oldest patient reported with such an association. Brivudin itself has not been reported to induce erythema multiforme and is an unlikely cause of disease in our patient.
Boateng Wiafe MD MSc
Full Text Available Herpes zoster is a common infection caused by the human herpes virus 3, the same virus that causes chickenpox. It is a member of herpes viridae, the same family as the herpes simplex virus, Epstein- Barr virus, and cytomegalovirus. Herpes zoster ophthalmicus occurs when a latent varicella zoster virus in the trigeminal ganglia involving the ophthalmic division of the nerve is reactivated. Of the three divisions of the fifth cranial nerve, the ophthalmic is involved 20 times more frequently than the other divisions.
Full Text Available Herpes zoster is a common clinical condition involving cranial nerves. We encountered 3 cases in which multiple cranial nerves were involved besides the commoner ones. All the three cases were treated with acyclovir and oral steroids. Recovery of motor function was only partial in all three cases when reviewed 2 months after discharge. The clinical details and a brief review of literature are presented.
Dayan, Roy Rafael; Peleg, Roni
Varicella- zoster virus infection is an intriguing medical entity that involves many medical specialties including infectious diseases, immunology, dermatology, and neurology. It can affect patients from early childhood to old age. Its treatment requires expertise in pain management and psychological support. While varicella is caused by acute viremia, herpes zoster occurs after the dormant viral infection, involving the cranial nerve or sensory root ganglia, is re-activated and spreads orthodromically from the ganglion, via the sensory nerve root, to the innervated target tissue (skin, cornea, auditory canal, etc.). Typically, a single dermatome is involved, although two or three adjacent dermatomes may be affected. The lesions usually do not cross the midline. Herpes zoster can also present with unique or atypical clinical manifestations, such as glioma, zoster sine herpete and bilateral herpes zoster, which can be a challenging diagnosis even for experienced physicians. We discuss the epidemiology, pathophysiology, diagnosis and management of Herpes Zoster, typical and atypical presentations.
Galluzzi, Katherine E
Treatment strategies for herpes zoster infection include limiting viral replication with anti-infective agents as well as limiting associated acute and chronic neuropathic pain with a variety of analgesics...
Muecke, M; Amedee, R G
Herpes zoster oticus (Ramsay Hunt syndrome) is recognized as a polycranial neuritis caused by the DNA virus Herpes zoster and characterized by damage to sensory and motor nerves, including the audio-vestibular apparatus. Common presenting symptoms include cutaneous auricular vesicles, severe otalgia, inflammation of the pinna, and occasionally unilateral sudden facial paralysis. This article reviews the medical management of this disease, including the efficacy of antibiotics, corticosteroids, and acyclovir, along with the role of surgical decompression of the facial nerve.
Kofoed, Kristian; Rønholt, Finn; Gerstoft, Jan
Herpes zoster (HZ) and post-herpetic neuralgia (PHN) are frequently occurring diseases in elderly and in immuno-compromised persons. The live attenuated HZ vaccine boosts an existing immune response, so that the already established varicella-zoster virus infection is kept latent. Vaccination has...
Yoo, Kwang Ho; Park, Ju Hee; Kim, Myeung Nam; Song, Kye Yong
The skin lesion of herpes zoster is classically limited to a single dermatome, and most cases of multi-dermatomal herpes zoster have contiguous skin lesions. Noncontigous multi-dermatomal herpes zoster is very rare in both immunocompetent and immunosuppressed persons. The phenomenon of zoster occurring in two non-contiguous dermatomes has been referred to as zoster duplex unilateralis or bilateralis. We report here on a case of herpes zoster duplex bilateralis in a 49-year-old woman who had previously received chemotherapy for breast cancer treatment. PMID:19688072
Ahu Çiler Çıkım
Full Text Available Varicella zoster virus (VZV is the causing agent of chickenpox which is common in children. Herpes zoster (HZ is a latent infection that is caused by VZV, which is localized in the cells of dorsal root ganglions. HZ is rare in childhood and is especially encountered in immunosuppressed children. Here, an immunocompetent child with HZ is presented and the clinical symptoms, treatment and complications of the infection are reviewed.
S Karthiga Kannan
Full Text Available Ramsay Hunt syndrome (RHS is defined as an acute peripheral facial neuropathy caused by the reactivated latent varicella zoster virus (VZV in the geniculate ganglion; characterized with erythematous vesicular rash of the skin of the ear canal, auricle, facial skin, oral mucosa and facial palsy (also known as herpes zoster oticus. This article reports a case of Ramsay Hunt Syndrome (RHS in a 37-year-old male patient depicting the classical signs.
Full Text Available Varicella zoster virus causes both chicken pox and herpes zoster. The phenomenon of herpes zoster occurring concurrently in two non-contiguous dermatomes involving different halves of the body is termed herpes zoster duplex bilateralis (HZDB. Few cases, reported in the literature, were seen in either an immunosuppressed host or in the older age group. Here we present a case of HZDB in an immunocompetent host, probably the first in India.
Gahalaut, Pratik; Chauhan, Sandhya
Varicella zoster virus causes both chicken pox and herpes zoster. The phenomenon of herpes zoster occurring concurrently in two non-contiguous dermatomes involving different halves of the body is termed herpes zoster duplex bilateralis (HZDB). Few cases, reported in the literature, were seen in either an immunosuppressed host or in the older age group. Here we present a case of HZDB in an immunocompetent host, probably the first in India. PMID:23130258
Herpes zoster (shingles) is caused by reactivation of the latent varicella zoster virus which is present due to an earlier varicella infection (chicken-pox). Herpes Zoster is a less common and endemic disease than varicella, although factors causing reactivation are still not well known, but it occurs in older and/or ...
Herpes zoster is a painful vesiculobullous dermatitis which occurs as a result of previously established varicella zoster virus infection. It is a well established fact that Herpes zoster ophthalmicus is a well known marker of human immune deficiency virus infection even in Africans. The aim of this study is to determine if indeed ...
Full Text Available A case of unilateral herpes zoster ophthalmicus (HZO is reported with ipsilateral involvement of III, IV and VI cranial nerves which led to extra ocular muscles palsy presenting as total ophthalmopegia along with ptosis, cycloplegia and dilated non reactive pupil.
Full Text Available A 32 year old female presented to us with herpes zoster involving the T 8 to T 10 dermatomes. She had a scar involving the same dermatomes on the other half of the body. Investigations revealed that both the patient and her husband were HIV positive with CD4 cell count less than 200.
R A Bumb
Full Text Available A 65 year old, immunocompetent, male patient developed herpes zoster ophthalmicus associated with a generalized varicellifform euption and meningo-encephalitis. Meningo-encephalitis was diagnosed on the basis of CSF picture. The patient responded in seven clays to oral acyclovir (400 mg five times a day
Kofoed, Kristian; Rønholt, Finn; Gerstoft, Jan
Herpes zoster (HZ) is a painful vesicular rash localized to one dermatome. Post-herpetic neuralgia (PHN) is persistent pain three months after the rash started. In recent years several Cochrane reviews and clinical studies on how to treat HZ and PHN have been published. These studies show...
Full Text Available Herpes zoster occurs due to reactivation of the latent varicella zoster virus and is usually a disease of the elderly. Childhood herpes zoster is believed to be rare, though recent studies suggest increasing incidence in children. Here we report ten cases of childhood herpes zoster, seven of which occurred within a short span of six months, at a tertiary care level hospital in Pokhara, Nepal. Only three of the ten children reported previous history of varicella infection and none was immunized against varicella. Though childhood herpes zoster accounted for less than 1% of the total zoster cases in the past, recent reports show an increase in the number of cases in apparently healthy children. So far, no studies have been done linking childhood herpes zoster with HIV, though there are many studies linking it with other immunocompromised conditions.
Full Text Available Herpes zoster oticus also known as Ramsay Hunt syndrome is a rare complication of herpes zoster in which reactivation of latent varicella zoster virus infection in the geniculate ganglion causes otalgia, auricular vesicles, and peripheral facial paralysis. Ramsay Hunt syndrome is rare in children and affects both sexes equally. Incidence and clinical severity increases when host immunity is compromised. Because these symptoms do not always present at the onset, this syndrome can be misdiagnosed. Although secondary to Bell′s palsy in terms of the cause of acute atraumatic peripheral facial paralysis, Ramsay Hunt syndrome, with incidence ranged from 0.3 to 18%, has a worse prognosis. Herpes zoster oticus accounts for about 12% cases of facial palsy, which is usually unilateral and complete and full recovery occurs in only about 20% of untreated patients. The most advisable method to treat Ramsay Hunt syndrome is the combination therapy with acyclovir and prednisone but still not promising, and several prerequisites are required for better results. We present a case of 32-year-old man suffering from Ramsay Hunt syndrome with grade V facial palsy treated effectively with rehabilitation program, after the termination of the combination therapy of acyclovir and prednisone.
Full Text Available Herpes zoster is one of the common dermatological diseases in elderly. It is clinically diagnosed by the presence of vesicles in a zosteriform pattern, appearing along one or two dermatomes. We report a rare presentation of herpes zoster occurring over hard palate. Early recognition of such rare presentations of Herpes zoster and treatment with antivirals at the appropriate time is the most essential step required to decrease the morbidity.
Kofoed, Kristian; Rønholt, Finn; Gerstoft, Jan
Herpes zoster (HZ) and post-herpetic neuralgia (PHN) are frequently occurring diseases in elderly and in immuno-compromised persons. The live attenuated HZ vaccine boosts an existing immune response, so that the already established varicella-zoster virus infection is kept latent. Vaccination has...... been shown to halve the risk of HZ, and the risk of PHN is reduced by two thirds in people = 60 years. The vaccine is approved for persons aged = 50 years. However, the clinical efficacy of the vaccine is best studied in people aged = 60 years. The vaccine has so far not shown any serious side-effects....
Full Text Available Benzalkonium chloride (BAC is a frequently used disinfectant and its most well-known side effect is contact dermatitis. In this report, two children who had vesicular dermatitis, headache, lethargy, fever and encephalopathy mimicking Herpes zoster encephalitis were presented. Their consciousness level improved on the second day. From the medical history it was understood that the mother had applied 20% BAC solution to the scalps of two children. The aim of the presentation of this report is to draw attention to the fact that BAC application to the scalp for treating pediculosis capitis may resemble the herpes encephalitis clinical picture.
Graue, N; Grabbe, S; Dissemond, J
A 71-year old man presented with painful hemorrhagic vesicles and papules over the entire body that had persisted for three days. Type 2 diabetes mellitus type 2 had been diagnosed 20 years ago and had not been treated for the last 5 years. Therapy had been discontinued by the patient. HbA1c (11,9%) and blood glucose levels (up to 360 mg/dl) were abnormal. Varicella-zoster-DNA was replicated by PCR from the vesicle fluid. After the clinical diagnosis of disseminated herpes zoster had been confirmed systemic therapy with aciclovir 10 mg/kg day was started. There was no evidence of malignancy. Insulin therapy was initiated. Dissemination is a rare complication of herpes zoster, aided by immunosuppression. In the presented case there was no evidence of malignancy or other cause of immunosuppression, but the patient also had type 2 diabetes with very high blood glucose levels. The diabetes was thought to be causally related to the ineffective immune response to varicella zoster virus. There has been no previous published report of this relationship.
We describe a 90-year-old woman with right upper limb monoparesis secondary to varicella zoster virus infection as a result of extensive inflammatory involvement of the entire brachial plexus at root level. To our knowledge, this is the first report of entire brachial plexus involvement in a living patient of such advanced age. Despite a delay in presentation and thus initiation of treatment, a favourable clinical response was observed.
Full Text Available One hundred and seven cases (6 children and 101 adults of herpes zoster were recruited over a period of two years. The frequency of herpes zoster amongst skin OPD cases was found to be 0.34 per cent. The male to female ratio was 1.74:1. The most common prodromal symptom seen was paresthesia in 25 (23.36% cases followed by itching in 21 (19.62% cases.Most common presenting complaint was pain in 97 (90.65% cases. Ninety nine cases had classical herpes zoster followed by necrotic / ulcerated herpes zoster in 5 cases and hemorrhagic herpes zoster in 3 cases. Thoracic dermatome was the most common dermatome involved in 64 (59.8% cases followed by cervical in 17 (15.8% cases. Unidermatomal involvement was seen in 81 (75.7% cases, followed by multidermatomal in 18 (16.8% cases and disseminated in 8 (7.4% cases. Forty six cases were screened for HIV, out of them; six cases (4 males, 2 females were seropositive for HIV. Classical herpes zoster was a feature in four cases; however, one case each also had necrotic and hemorrhagic form of herpes zoster. To conclude, herpes zoster commonly occurs in young adults in India with presenting symptoms such as pain, itching and fever.
Ha, Jae Won; Lee, Jin Yong; Her, Young; Kim, Chul Woo; Kim, Sang Seok
Herpes zoster is characterized by unilateral grouped vesicles along the distribution of a dermatome. A global recurrence rate as low as 0.5%∼6.2% has been reported for herpes zoster. The recurrence of herpes zoster is higher in immunocompromised patients and older patients. The purpose of this study is to assess the frequency of herpes zoster recurrence and factors that can influence its recurrence. From January 2005 to December 2015, 14,343 patients with herpes zoster were enrolled in this study. The patients were diagnosed at Hallym University Medical Centers and Kangwon National University Hospital in Seoul, Gyeonggi, and Gangwon. Herpes zoster recurrence and patient characteristics were surveyed by medical record review and a telephonic survey. The overall frequency of herpes zoster recurrence was 1.18%. The frequency of recurrence was higher in women than in men. It was also higher in patients aged 50∼70 years than in patients who were younger or older than this. Additionally, we assessed that the frequency of recurrence was statistically higher in patients with a compromised immune system and in patients who experienced longer lasting pain during their first episode. The frequency of herpes zoster recurrence is more common in women, older age, patient with longer pain duration and immunocompromised patients.
Stiff, Katherine M; Cohen, Philip R
BackgroundHerpes zoster vaccine is currently recommended in the United States for immune competent individuals ≥60 years. The efficacy of the herpes zoster vaccine decreases with age and with time following vaccination.PurposeAn elderly man with herpes zoster following vaccination is described. The guidelines for vaccination and issues regarding re-vaccination are reviewed. PubMed was used to search the following terms: efficacy, elderly, herpes zoster, herpes zoster incidence, herpes zoster recurrence, and vaccination. The papers and relevant citations were reviewed. The clinical features of a patient with post-vaccination herpes zoster skin infection are presented; in addition, vaccine efficacy and guidelines are reviewed.ResultsA 91-year-old man, vaccinated for herpes zoster 10 years earlier, presented with crusted erosions on his face corresponding to the area innervated by the ophthalmic division of the left trigeminal nerve. Evaluation using polymerase chain reaction confirmed the diagnosis of herpes zoster.ConclusionsHerpes zoster vaccine decreases in efficacy with both age and number of years following vaccination. Therefore, booster shots or revaccination in the older population may be of benefit.
Hooi Khee Teo
Full Text Available Herpes zoster is a common presentation in both the community and emergency department; however segmental zoster paresis is a rare complication that can lead to misdiagnosis. We present a case of a 74-year-old Indian gentleman with a background of well controlled diabetes mellitus, hypertension, and ischaemic heart disease who presented with sudden right lower limb weakness. This was preceded by a 5-day history of paraesthesia starting in the right foot and ascending up the right lower limb. On examination, there was a characteristic vesicular rash in the L2/3 region with MRC grading 3/5 in the right hip flexors. The rest of the neurological examination was unremarkable. MRI of the spine did not show any evidence of spinal disease. The patient was initiated on IV acyclovir with improvement of the lower limb weakness to MRC grading 5/5 as the vesicles improved. This is an interesting case as it highlights a rare presentation of zoster: segmental motor paresis that recovered fully with resolution of the rash. It shows the importance of recognizing motor neuropathy as a complication of shingles as it has a very good prognosis with most patients regaining full motor function of the affected limb with treatment.
Melker, Hester E de; Berbers, Guy A M; Hahné, Susan J M; Rümke, Hans; Hof, Susan van den; Wit, G Ardine de; Boot, Hein J
We studied the epidemiology of varicella (chickenpox) and herpes zoster (shingles) in The Netherlands to assess the desirability to implement routine varicella zoster virus vaccination in The Netherlands. Data on seroprevalence of varicella zoster virus in the general population (1995-1996),
de Boer, Pieter; Wilschut, Jan C.; Postma, Maarten J.
Herpes zoster (HZ) is a common disease among elderly, which may develop into a severe pain syndrome labeled postherpetic neuralgia (PHN). A live-attenuated varicella zoster virus vaccine has been shown to be effective in reducing the incidence and burden of illness of HZ and PHN, providing the
Full Text Available A 52-year-old White man presented with a dozen small, well-restricted, punctiform, asymptomatic, blue-gray macules on the left shoulder. A few months earlier, he had been treated with oral acyclovir for herpes zoster (HZ affecting the left C7–C8 dermatomes. All the blue macules appeared over a short period of time and then remained stable. The patient had not experienced any previous trauma or had tattooing in this anatomical region. The clinical diagnosis suggested blue nevi. Dermatoscopy revealed small, well-limited, dark-blue, compact, homogeneous areas evoking dermal blue nevi. An excisional biopsy was performed and the histological examination confirmed a blue nevus. As far as we are aware of, this is the first report of eruptive blue nevi following HZ, and it should be included in the differential diagnosis of zosteriform dermatoses responding to an isotopic pathway. In addition, a brief review concerning eruptive nevi is presented.
Vu, A Q; Radonich, M A; Heald, P W
Noncontiguous multidermatomal herpes zoster is very rare in both immunocompetent and immunocompromised persons. Most of the reported cases have been limited to 2 noncontiguous dermatomes. This unique presentation has been referred to as zoster duplex unilateralis or bilateralis, depending on whether one or both halves of the body are involved. Granulomatous dermatitis at sites of herpes zoster scars, a rare isotopic response, has only been reported in persons with contiguous dermatomes of zoster. We describe an immunocompromised patient who developed herpes zoster in 7 disparate dermatomes. Three months after resolution of the zoster, the patient developed a granulomatous dermatitis in a zosteriform distribution at the sites of previous infection.
Wyman, Marcia J; Stabi, Katie L
To determine whether concomitant administration of zoster vaccine and polysaccharide pneumococcal-23 vaccine (PPV23) provides sufficient protection against herpes zoster infections. Literature was retrieved through the Centers for Disease Control and Prevention (CDC) website, PubMed (inception-February 2013), and Scopus (inception-February 2013) using the key words herpes zoster, pneumococcal, vaccine, concomitant, simultaneous administration, Pneumovax, Zostavax, and barriers. In addition, reference citations from publications were used. All English-language articles identified from the data sources were evaluated. Two studies evaluating concomitant and nonconcomitant administration of zoster vaccine and PPV23 were included. Current product labeling recommends a 4-week interval between zoster vaccine and PPV23 administration; however, the Food and Drug Administration (FDA) and the CDC promote concomitant administration to prevent a missed opportunity to vaccinate. This has caused confusion among health care professionals regarding the appropriate timing of these vaccines. A randomized trial that evaluated the immunogenicity of zoster vaccine and PPV23 given together versus separated by at least 4 weeks demonstrated that the varicella zoster virus (VZV) antibody levels of concomitant versus nonconcomitant vaccination groups did not meet noninferiority requirements. However, a large retrospective cohort trial that compared the incidence of herpes zoster infections following concomitant versus nonconcomitant administration of PPV23 and zoster vaccine did not find a statistically significant between-group difference. Concomitant administration of zoster vaccine and PPV23 is advocated by the CDC and FDA to improve immunization rates among vaccine-eligible individuals. Since there is no direct evidence that simultaneous administration of zoster vaccine and PPV23 puts patients at increased risk of developing herpes zoster, the vaccines should be given during the same
Zografakis, Charalampos; Tiniakos, Dina G; Palaiologou, Marina; Kouloukoussa, Mirsini; Kittas, Christos; Staurianeas, Nikos
Herpes zoster neural injury was assessed by determining cutaneous nerve density in skin biopsies from the affected dermatomes of 35 adult patients with herpes zoster in the acute phase and 3 months...
Full Text Available Objective: Herpes zoster is an acute dermatomal viral infection caused by the reactivation of varicella zoster virus. While it is commonly seen among elderly and immunocompromised individuals, it is rare in healthy children. The aim of this study was to evaluate the clinical features, treatment and complications of healthy children with herpes zoster. Methods: Thirty one patients aged between 0-16 years who were admitted to our clinic with the diagnosis of herpes zoster, between January 2014 and December 2014, were evaluated retrospectively for age, gender, month of admission, complaint, history of chickenpox infection or varicella vaccination, triggering factors, dermatomal involvement, complications and treatment. Results: Among 31 patients with diagnosis of herpes zoster, 19 were boys (61.3% and 12 were girls (38.7%. The mean of age was 9.12±4.4 years. Twenty patients had thoracic (64.5%, six had lumbar (19.4% and five had cervical involvements (16.2%. The most frequent symptoms were pruritus and pain, respectively. Six patients were administered topical treatment and 25 patients were treated with both systemic and topical treatments. Complication was not observed. Conclusion: Herpes zoster is also being encountered increasingly in healthy children nowadays. It is benign and generally no complications are observed. Incidence can vary because of geographic and socioeconomic differences like vaccination programs.
Full Text Available Herpes zoster of the trigeminal nerve branches caused by varicella zoster is a clinical entity consisting of erythematous macules, papules, vesicles, bullae, small ulcers and erythematous plaques, with characteristic short acute/pre-eruptive phases and long herpetic periods with pain. It is caused by reactivation of latent varicella infection. Herpes zoster is a less common endemic disease compared to varicella. During the prodromal stage, the only presenting symptom may be odontalgia, which may prove to be a diagnostic challenge for the dentist. Emergency treatment for a misdiagnosis such as trigeminal neuralgia, odontalgia, and acute pulpitis, as well as complications reported in literature such as tooth resorption, periapical lesions, periodontal destructions, and osteomyelitis may cause an irreversible damage to the patient. Hence, the dentist must be familiar with the presenting signs and symptoms in prodrome of herpes zoster infection of trigeminal nerve. The present article focuses on the pathogenesis, clinical picture, difficulties in diagnosis and management of such cases.
Shishov, A S; Blank, I A; Petrova, I S; Kulagina, M V; Rusanova, S A
To describe rare clinical cases of Herpes zoster with a rash appeared simultaneously in different segmental zones (zoster duplex unilateralis and zoster duplex bilateralis). Brief details of medical histories of 3 patients are presented. A very rare possibility of the complete fusion of bilateral exanthema on the same topographic level with the development of an entire zoster that confirm a historical name of the disease has been demonstrated. A mistaken translation of disease name into Russian as "lishai" is emphasized. Recommendations on the complex, stage-by-stage treatment of patients, including psychotherapeutic treatment of the pain syndrome, are presented.
Ana M. Z. Gagliardi
Full Text Available BACKGROUND:Herpes zoster or, as it is commonly called, 'shingles' is a neurocutaneous disease characterised by the reactivation of varicella zoster virus (VZV, the virus that causes chickenpox, which is latent in the dorsal spinal ganglia when immunity to VZV declines. It is an extremely painful condition which can often last for many weeks or months, impairing the patient's quality of life. The natural aging process is associated with a reduction of cellular immunity which predisposes to herpes zoster. Vaccination with an attenuated form of VZV activates specific T cell production, therefore avoiding viral reactivation. A herpes zoster vaccine with an active virus has been approved for clinical use among older adults by the Food and Drug Administration and has been tested in large populations.OBJECTIVE:To evaluate the effectiveness and safety of vaccination for preventing herpes zoster in older adults.METHODSSearch methods: We searched the following sources for relevant studies: CENTRAL 2012, Issue 7, MEDLINE (1948 to July week 1, 2012, EMBASE (2010 to July 2012, LILACS (1982 to July 2012 and CINAHL (1981 to July 2012. We also reviewed reference lists of identified trials and reviews for additional studies.Selection criteria: Randomised controlled trials (RCTs or quasi-RCTs comparing zoster vaccine with placebo or no vaccine, to prevent herpes zoster in older adults (mean age > 60 years.Data collection and analysis: Two review authors independently collected and analysed data using a data extraction form. They also carried out an assessment of risk of bias.MAIN RESULTS:We identified eight RCTs with a total of 52,269 participants. Three studies were classified at low risk of bias. The main outcomes on effectiveness and safety were extracted from one clinical trial with a low risk of bias. Four studies compared zoster vaccine versus placebo; one study compared high-potency zoster vaccine versus low-potency zoster vaccine; one study compared
Mankesh Lal Gambhir
Full Text Available “Wolf’s isotopic response” describes the occurrence of a new skin disorder at the site of another, unrelated and already healed skin disease. In most cases of isotopic response, the initial dermatosis is herpes zoster, herpes simplex, varicella, thrombophlebitis, scrofuloderma and striae distense. The most frequent second dermatoses are granulomatous reactions, particularly granuloma annulare, and lichenoid diseases. Various etiological reasons including viral, immunologic, neural and vascular have been put forth. We report here a case in which the second disease was herpes zoster that appeared over the same dermatomes of pre-existing segmental vitiligo. The occurrence of vitiligo as first and herpes zoster as second disease in the “Wolf’s isotopic response” has not, to the best of our knowledge, been reported previously.
Veenstra, J.; Krol, A.; van Praag, R. M.; Frissen, P. H.; Schellekens, P. T.; Lange, J. M.; Coutinho, R. A.; van der Meer, J. T.
OBJECTIVE: To study the incidence of herpes zoster, the relationship between herpes zoster and immunological markers, and the prognostic value of herpes zoster for progression of HIV disease. DESIGN AND METHODS: A total of 966 homosexual participants in The Amsterdam Cohort Study were studied.
Jastrzebski, Andre; Brownstein, Seymour; Ziai, Setareh; Saleh, Solin; Lam, Kay; Jackson, W Bruce
We present a case of reactivated herpes zoster keratouveitis of 6 years duration with corneal perforation requiring penetrating keratoplasty shortly after inoculation with herpes zoster vaccine (Zostavax, Merck, Quebec, Canada). Retrospective case report. A 67-year-old woman with a 5-year history of recurrent unilateral herpes zoster keratouveitis in her right eye presented with another recurrence 2 weeks after Zostavax vaccination. Three months later, she developed descemetocele and 2 months afterward, corneal perforation, which was managed by penetrating keratoplasty. Immunohistopathological examination disclosed positive staining for varicella zoster virus in most of the keratocytes adjacent to the descemetocele and perforation, most vividly in the deeper two-thirds of the stroma where the keratocytes were most dense, but not in corneal epithelium or endothelium. Electron microscopic examination showed universally severely degenerated corneal keratocytes in the corneal stroma adjacent to the perforation with variable numbers of herpes virus capsids present in half of these cells. Only a rare normal-appearing keratocyte was identified in the more peripheral corneal stroma. We present a case of reactivation of herpes keratouveitis shortly after vaccination with Zostavax in a patient with previous herpes zoster ophthalmicus. We demonstrate, for the first time, ultrastructural evidence consistent with inactive virus capsids in diffusely degenerated keratocytes in the extracted corneal tissue.
Full Text Available A 12-year-old girl had systemic lupus erythematosus (SLE and type IV lupus nephritis since three-and-a-half years. She was treated with prednisolone and cyclophosphamide. She had first attack of herpes zoster (HZ involving eighth and ninth thoracic segments on right side at the age of nine years. Second attack occurred on the same segments on same side at the age of twelve years. The second attack of herpes zoster was treated with oral acyclovir 400 mg five times a day for seven days plus analgesics and multi-vitamins. Most probably this is the first case of recurrent herpes zoster (RHZ in a child in Indian literature.
Son, Jee Hee; Chung, Bo Young; Kim, Hye One; Cho, Hee Jin
Cases involving dermatomal herpes zoster in two or more locations are rare, especially in immunocompetent patients. When two noncontiguous dermatomes are involved, if affected unilaterally, it is called herpes zoster duplex unilateralis; if bilaterally, bilateralis. Here, we report two cases of herpes zoster duplex unilateralis. A 66-year-old man presented with painful erythematous grouped vesicles on his left scalp, forehead, trunk, and back (left [Lt.] V1, Lt. T8). Histologic findings were consistent with herpetic infection. A 33-year-old woman presented with painful erythematous grouped vesicles and crust on her left forehead and neck (Lt. V1, Lt. C5). Both patients were treated with oral administration of famcyclovir 750 mg/day for seven days. PMID:27904277
Full Text Available Ogilvie’s syndrome due to herpes zoster infection is a rare manifestation of VZV reactivation. The onset of rash of herpes zoster and the symptoms of intestinal obstruction can occur at different time intervals posing a significant diagnostic challenge resulting in avoidable surgical interventions. Herein, we describe a case of 35-year-old male who presented with 6-day history of constipation and colicky abdominal pain along with an exquisitely tender and vesicular skin eruption involving the T8–T11 dermatome. Abdominal X-ray and ultrasound revealed generalized gaseous distention of the large intestine with air up to the rectum consistent with paralytic ileus. Colonoscopy did not show any obstructing lesion. A diagnosis of Ogilvie’s syndrome associated with herpes zoster was made. He was conservatively managed with nasogastric decompression, IV fluids, and acyclovir. The patient had an uneventful recovery and was later discharged.
Grillo, A P; Fraunfelder, F W
The objective of this review was to collect reports of keratitis in association with herpes zoster virus (HZV) or varicella zoster virus (VZV) vaccines. HZV vaccination is intended for at-risk adult populations and VZV vaccination is intended for all pediatric patients. We reviewed the literature and reports of keratitis in association with herpes zoster or varicella vaccine from the National Registry of Drug-Induced Ocular Side Effects and the World Health Organization. Twenty-four cases of unilateral keratitis in association with VZV vaccines were collected from the adverse reaction databases and literature. In most cases, the onset of keratitis occurred within days of vaccination and resolved with topical steroid eye drops and oral acyclovir. Data suggest that keratitis in association with herpes zoster or varicella vaccine is rare, is usually self-limited or resolves with treatment. The mechanism may be the persistence of viral antigens in the cornea after VZV vaccination or herpes zoster ophthalmicus. This reaction is probable, given the plausible biological mechanism, the temporal relationship between vaccination and keratitis, and overall patterns of presentation after vaccination. Copyright 2017 Clarivate Analytics.
Full Text Available Herpes zoster occuring at two different sites in the same individual at the same time, involving more than two segments at each site has rarely been reported. We recently observed two such cases. The first patient was HIV-infected 10 year old haemophiliac who had zoster involving the distribution of the right C4, 5, 6 and left L 2, 3, 4 dermatomes and the second one was a 50 year old renal transplant recipient on immunosuppressive drugs who developed zoster at left C3, 4, 5 and left T 7, 8, 9.
Kotya Naik Maloth
Full Text Available Herpes zoster (HZ is an acute infectious viral disease result from reactivation of the DNA varicella-zoster virus, which occurs more frequently among older adults and immunocompromised persons. The most common complication of HZ is postherpetic neuralgia, a chronic often debilitating pain condition that can last months or even years. Deaths attributable to zoster are common among immunocompromised persons. Prompt treatment with the antiviral drugs, corticosteroids and analgesics decrease the severity and duration of acute pain from HZ. Here, we report a treated case of HZ in 35-year-old male involving all three branches of the trigeminal nerve without any complication.
A. L. Yakubenko
Full Text Available Neopterin is a specific marker of cellular immunity and monocytes/macrophages activation. Correlation between serum neopterin levels and clinical features of herpes zoster is unknown.The objective of the study was to determine the concentration of serum neopterin in patients with herpes zoster.Methods: 55 patients with herpes zoster (30 HIV-positive and 25 HIV-negative were included. Serum neopterin levels were measured three times during the observation period (before onset of treatment with acyclovir, on the 3rd day of treatment and after healing of skin lesions. The clinical course and dynamics of laboratory data were also evaluated.Results: The study showed that elevated serum neopterin levels were found in all patients with herpes zoster. Neopterin concentrations were significantly reduced during acyclovir treatment (from 30 (17; 32 to 12 (11; 27 nmol/L (p = 0,0000001, but remained above the upper limit of normal by the time skin lesions were healed in most patients. Neopterin levels before and after treatment weren’t associated with HIV-status. Neopterin concentration was slightly higher in patients with HIV infection on the third day of observation only, that could reflect the abnormal immunoreactivity of this host. Neopterin levels in patients with varicella zoster viremia were higher compared to patients without viremia on the third day of treatment with acyclovir (23.5 (12,7; 30,0 and 12 (4,2, 24,5 nmol/L, respectively, p = 0,037.Conclusions: These results suggest that the dynamics of serum neopterin could be a marker of effectiveness of immune response in herpes zoster.
Full Text Available Increasing trends in incidence of herpes zoster (HZ have been reported in Australia and internationally. This may reflect the impact of childhood VZV vaccination programs introduced universally in Australia in late 2005. The objective of this study was to evaluate changes in incidence of HZ and PHN in Australia over time, and associated healthcare resource utilisation.Australian data on general practice (GP encounters for HZ, specific antiviral prescribing data from the pharmaceutical benefits scheme, emergency department presentations from the states of NSW and Victoria and national hospitalisation data for HZ were analysed for time trends using regression models. Two time periods (2000-2006 and 2006-2013 were compared which correspond broadly with the pre- and post- universal VZV vaccination period.All data sources showed increasing rates of HZ with age and over time. The GP database showed a significant annual increase in encounters for HZ of 2.5 per 100,000 between 1998 and 2013, and the rates of prescriptions for HZ increased by 4.2% per year between 2002 and 2012. In the 60+ population HZ incidence was estimated to increase from 11.9 to 15.4 per 1,000 persons using GP data or from 12.8 to 14.2 per 1,000 persons using prescription data (p<0.05, between the two periods. Hospitalisation data did not show the same increasing trend over time, except for the age group ≥80 years. Most emergency visits for HZ were not admitted, and showed significant increases over time.The burden of HZ in Australia is substantial, and continues to increase over time. This increase is seen both pre- and post-universal VZV vaccination in 2005, and is most prominent in the older population. The substantial burden of HZ, along with ageing of the Australian population and the importance of healthy ageing, warrants consideration of HZ vaccination for the elderly.
Herpes Zoster is a common viral disorder, occurs due to reactivation of latent Varicella Zoster Virus (VZV) usually in adults or elderly patients, usually confined to a single dermatome. Herpes zoster duplex is a rare but well established entity which is simultaneous, occurring of herpes zoster at two different non contiguous dermatomes, can be unilateralis or bilateralis. Here we are reporting two cases of herpes zoster duplex bilateralis, in case-1 lesions occurs in two different distant dermatomes while in case-2 it appeared in a single dermatome but both sides were involved. Both the patients were healthy immuno-competent male. PMID:26816979
A. Winnifred Christy
Full Text Available Herpes Zoster also known as Shingles is an acute viral infection which is an extremely painful and incapacitating ailment. It results from the reactivation of the varicella zoster virus. The triggering factors for the onset of an attack of Herpes Zoster include some form of immunosuppression. The diagnosis of Herpes Zoster can be made on proper medical history and a thorough clinical examination. Here is the report of a male patient affected by Herpes Zoster infection which followed after extraction of a lower first molar.
Chan, Yumin; Smith, David; Sadlon, Tania; Scott, Julius X; Goldwater, Paul N
A 5-year-old boy was vaccinated with the Oka strain of varicella zoster virus vaccine before cord blood transplant for chronic granulomatous disease in 2005. In 2006, he developed herpes zoster on his left arm. DNA from the vesicular rash confirmed the Oka vaccine strain of varicella zoster virus caused this complication. He responded well to 10 days of aciclovir treatment.
Nigerian Journal of Clinical Practice • Oct-Dec 2011 • Vol 14 • Issue 4. Case Report. African traditional medication and keloid formation in herpes zoster ophthalmicus. OO Komolafe, OT Ogunleye, OO Fasina1, OA Komolafe2. Departments of Ophthalmology, and 2Pharmaceutical Service, Federal Medical Centre, Owo, ...
Jul 26, 2017 ... Herpes zoster ophthalmicus (HZO) is rare in children especially those who are immunocompetent. We reported a case of HZO in a healthy 3- year-old girl with no history of exposure or underlying immune-compromising systemic disease. She developed severe ocular complications after treatment.
Herpes zoster ophthalmicus (HZO) is rare in children especially those who are immunocompetent. We reported a case of HZO in a healthy 3- year-old girl with no history of exposure or underlying immune-compromising systemic disease. She developed severe ocular complications after treatment. Both parents were ...
Two male patients aged 40 and 45 years with HIV infection and paraplegia are presented. The two had sub-acute onset paraplegia with a sensory level, which developed 10 days after herpes zoster dermatomal rash. They both had asymmetrically involvement of the lower limbs. Investigation including imaging of the spinal ...
Herpes zoster ophthalmicus (HZO) is rare in children especially those who are immunocompetent. We reported a case of HZO in a healthy 3- year-old girl with no history of exposure or underlying immune-compromising systemic disease. She developed severe ocular complications after treatment. Both parents were non ...
Corneal involvement in maxillary herpes zoster is very rare. This report presents the case of a 32 years old 7 months pregnant para2+1 female, who presented with vesiculopapular rashes with hyperpigmented crusts over the maxillary area of the face on the left side with periocular oedema, conjunctivitis and mild punctate ...
Winthrop, Kevin L; Lebwohl, Mark; Cohen, Arnon D
BACKGROUND: Tofacitinib is an oral Janus kinase (JAK) inhibitor. Immunomodulatory therapies can increase the risk for herpes zoster (HZ) in patients with psoriasis. OBJECTIVE: To evaluate the relationship between tofacitinib use and HZ risk. METHODS: We used phases 2 and 3 and long-term extension...
Full Text Available Herpes zoster is a common dermatological condition which affects up to 20% of the population, most frequently involving the thoracic and facial dermatomes with sacral lesions occurring rarely and only a few reported cases of penile shingles. Case report: We report two cases of unusual penile clinical presentations of varicella zoster virus infection in immunocompetent men. The patients presented with grouped clusters of vesicles and erythema on the left side of penile shaft and posterior aspect of the left thigh and buttock, involving s2-s4 dermatomes. The lesions resolved quickly upon administration of oral antiviral therapy. Conclusion: Penile herpes zoster should not be overlooked in patients with unilateral vesicular rash.
Kirwan, R P
AIM: To report a case of superior orbital fissure syndrome (SOFS) in a patient with herpes zoster ophthalmicus (HZO). MATERIALS AND METHODS: A case report. RESULTS: A 71-year-old male with HZO presented acutely to accident and emergency complaining of right vision loss, double vision and drowsiness. The right visual acuity was counting fingers. There was no relative afferent pupillary defect. He had interstitial keratitis, ptosis, proptosis and total ophthalmoplaegia. The signs indicated HZO complicated by SOFS. Brain imaging and lumbar puncture confirmed the diagnosis of varicella zoster encephalitis. Systemic acyclovir and prednisolone led to recovery of visual acuity and ocular motility in addition to resolution of his proptosis and ptosis. CONCLUSION: SOFS is a rare complication of herpes zoster infection. With the appropriate treatment and follow-up, patients may be reassured that recovery of their visual acuity and ocular motility will occur.
Kalogeropoulos, Chris D.; Bassukas, Ioannis D.; Moschos, Marilita M.; Tabbara, Khalid F.
Herpes zoster ophthalmicus (HZO) is a clinical manifestation of the reactivation of latent varicella zoster virus (VZV) infection and is more common in people with diminished cell-mediated immunity. Lesions and pain correspond to the affected dermatomes, mostly in first or second trigeminal branch and progress from maculae, papules to vesicles and form pustules, and crusts. Complications are cutaneous, visceral, neurological, ocular, but the most debilitating is post-herpetic neuralgia. Herpes zoster ophthalmicus may affect all the ophthalmic structures, but most severe eye-threatening complications are panuveitis, acute retinal necrosis (ARN) and progressive outer retinal necrosis (PORN) as well. Antiviral medications remain the primary therapy, mainly useful in preventing ocular involvement when begun within 72 hours after the onset of the rash. Timely diagnosis and management of HZO are critical in limiting visual morbidity. Vaccine in adults over 60 was found to be highly effective to boost waning immunity what reduces both the burden of herpes zoster (HZ) disease and the incidence of post-herpetic neuralgia (PHN). PMID:27800502
Hatice Gamze Bayram
Full Text Available Herpes zoster (HZ occurs in older ages with activation of varicella-zoster virus (VZV which persists in a dormant phase within the dorsal root ganglia. The incidence of HZ in immunosuppressed patients is 20-100 times higher and the clinical progress is more severe than in immunocompetent individuals. A 48-year-old man who had been diagnosed with acute myelocytic leukemia type M3 and had been treated with immunosuppressive agents was admitted to our clinic. The patient was clinically diagnosed as having HZ. He was treated with acyclovir 800 mg five times daily for 7 days. In the consecutive three months, he attended our clinic again with similar complaints. The left cervical (C5, C6 dermatomes were involved at the fourth attack of HZ. Multinucleated giant cells were determined on the Tzanck smear. VZV DNA was detected by polymerase chain reaction (PCR. Treatment with valacyclovir 1 g three times daily for 14 days was prescribed and then, prophylactic treatment with valacyclovir 500 mg two times a day was administered. Although immunosuppressive treatment was continued, no new attacks of herpes zoster occurred. We think that prophylactic antiviral therapy should be initiated in immunosuppressive individuals who have recurrent herpes zoster attacks.
Reyes, David P; Brinley, Alaina A; Blue, Rebecca S; Gruschkus, Stephen K; Allen, Andrew T; Parazynski, Scott E
Antarctica is a useful analog for spaceflight, as both environments are remote, isolated, and with limited resources. While previous studies have demonstrated increased asymptomatic viral shedding in both the Antarctic and spaceflight environments, clinical manifestations of reactivated viral disease have been less frequently identified. We sought to identify the incidence of clinical herpes zoster from viral reactivation in the Antarctic winter-over population. Medical records from the 2014 winter season were reviewed for the incidence of zoster in U.S. Antarctic personnel and then compared to the age-matched U.S. Five cases of clinical herpes zoster occurred in the Antarctic Station population of 204 persons, for an incidence of 33.3 per 1000 person-years vs. 3.2 per 1000 person-years in the general population. Four cases were in persons under age 40, yielding an incidence of 106.7 per 1000 person-years in persons ages 30-39 compared to an incidence of 2.0 per 1000 person-years in the same U.S. age group. Immune suppression due to the stressful Antarctic environment may have contributed to the increased incidence of herpes zoster in U.S. Antarctic personnel during the winter of 2014. Working and living in isolated, confined, and extreme environments can cause immune suppression, reactivating latent viruses and increasing viral shedding and symptomatic disease. Such changes have been observed in other austere environments, including spaceflight, suggesting that clinical manifestations of viral reactivation may be seen in future spaceflight.Reyes DP, Brinley AA, Blue RS, Gruschkus SK, Allen AT, Parazynski SE. Clinical herpes zoster in Antarctica as a model for spaceflight. Aerosp Med Hum Perform. 2017; 88(8):784-788.
Levin, Myron J.; Gershon, Anne A.; Dworkin, Robert H.; Brisson, Marc; Stanberry, Lawrence
SUMMARY Impairment of varicella zoster virus (VZV)-specific cell-mediated immunity, including impairment due to immunosenescence, is associated with an increased risk of developing herpes zoster (HZ), whereas levels of anti-VZV antibodies do not correlate with HZ risk. This crucial role of VZV-specific cell-mediated immunity suggests that boosting these responses by vaccination will be an effective strategy for reducing the burden of HZ. Other strategies focus on preventing the major complication of HZ – post-herpetic neuralgia. These strategies include pre-emptive treatment with drugs such as tricyclic antidepressants, anticonvulsants and analgesics. PMID:20510262
Full Text Available Background: Herpes zoster, or shingles, is a skin or mucous infection caused by the reactivation of varicella-zoster virus (VZV. Seasonal pattern of herpes zoster incidence was reported in some countries, indicating that emergence of this disease was caused by the reactivation of latent Varicella-Zoster Virus (VZV rather than new exposures to VZV. On the other hand, the VZV primary infection difference between tropical and temperate zones may have implications for virus reactivation as herpes zoster. The aim of this study was to identify the incidence of herpes zoster in Dr. Hasan Sadikin General Hospital Bandung, West Java related to the change of rainfall, air temperature and humidity from 2009 to 2011. Methods: A descriptive retrospective study was carried out to 341 medical records of herpes zoster patients from Dr. Hasan Sadikin General Hospital Bandung periode 2009 to 2011. Data on climate factors, i.e. rainfall, air temperature, and relative humidity, were obtained from the Indonesian Meteorology, Climatology, and Geophysical Agency. The collected data were presented using tables and figures. Result: The highest number of herpes zoster cases occured during the period when the highest annually total rainfall and annually mean relative humidity occurred. Conclusions: The finding of this study shows that herpes zoster cases have the same pattern with the rainfall and relative humidity. These findings can inform better prevention of herpes zoster. However, further research is needed to get more comprehensive understanding on this relationship.
Kim, Choon Kwan; Choi, Youn Mi; Bae, Eunsin; Jue, Mihn Sook; So, Hyung Seok; Hwang, Eung-Soo
The pathogenesis of herpes zoster is closely linked to reduced varicella-zoster virus-specific cell-mediated immunity. However, little is known about the interplay between natural killer cells and psychological stress in the pathogenesis of herpes zoster. This study aimed to investigate possible associations among natural killer cells, T cells and psychological stress in herpes zoster. Interferon-gamma secretion from natural killer cell, psychological stress events, stress cognition scale scores and cytomegalovirus-specific cell-mediated immunity were compared between 44 patients with herpes zoster and 44 age- and gender-matched control subjects. A significantly lower median level of interferon-gamma secreted by natural killer cells was observed in patients with a recent diagnosis of herpes zoster than in control subjects (582.7 pg/ml vs. 1783 pg/ml; P = 0.004), whereas cytomegalovirus-specific cell-mediated immunity was not associated with herpes zoster. Psychological stress events and high stress cognition scale scores were significantly associated in patients with herpes zoster (Pherpes zoster display reduced interferon-gamma secretion from natural killer cells and frequent previous psychological stress events compared with controls. However, reduced natural killer cell activity is not an immunological mediator between psychological stress and herpes zoster.
Tseng, Hung Fu; Chi, Margaret; Hung, Peggy; Harpaz, Rafael; Schmid, D Scott; LaRussa, Philip; Sy, Lina S; Luo, Yi; Holmquist, Kimberly; Takhar, Harpreet; Jacobsen, Steven J
Studies have investigated a possible association between family history of HZ and the occurrence of HZ. However, the results were inconclusive and susceptible to bias. We evaluated this association in an elderly population. The matched case-control study conducted at Kaiser Permanente Southern California in 2012-2015 included 656 incident HZ patients ≥60 whose skin lesion tested positive for varicella zoster virus by polymerase chain reaction. Half of the HZ patients were vaccinated with zoster vaccine as achieved by stratified sampling. The controls were randomly selected and 1:1 matched to the cases on sex, age (±1year), and zoster vaccination (±3 months of the case's vaccination date). Conditional logistic regression was used to estimate the odds ratio (OR) and 95% confidence interval (CI). Having any blood relative with a history of HZ was associated with a slightly increased risk of HZ (adjusted OR=1.37, 95% CI 1.05-1.79). The adjusted OR associated with having one and two categories of first-degree blood relatives with a history of HZ was 1.30 (95% CI: 0.97-1.73) and 2.53 (95% CI: 1.17-5.44), respectively. Our results suggested a weak association between the development of HZ and a positive family history of HZ among the elderly population. Copyright © 2017. Published by Elsevier Ltd.
Full Text Available Varicella zoster virus infection, which causes chickenpox and herpes zoster (HZ, is not uncommon in the general population. Varicella zoster virus can be latent in cranial nerve or dorsal root ganglia, and reactivate several decades later to produce vesicles with post-herpetic neuralgia. HZ myelitis usually occurs in elderly or immunocompromised patients. We report here a case of HZ myelitis of the cervical spinal cord in a 35-year-old woman who was immunocompetent. Cervical myelitis developed 1 month after the eruption of vesicles. Pure sensation loss was limited initially from the C2 to T1 dermatomes, but later progressed to lower limb sensory loss and sphincter function impairment. The patient's motor function was also mildly affected. Despite the initial rapid neurological deterioration, the symptoms dramatically improved after 5 days of parenteral acyclovir and steroid administration with rehabilitation. We therefore propose that early medical intervention is necessary for better and earlier recovery.
I. N. Nazarova
Full Text Available Recent advances in multiple myeloma (MM treatment associated with new drug use including bortezomib. Experiences in wide ambul atory drug use confirm therapy success for this serious disease, but at the same time reveals the most common side effects. One of th e most significant is the reactivation of Herpes zoster , which leads to decrease MM therapy results because of inability to perform standard therapy in these patients. Literature data and own experiences about reactivation of Herpes zoster during bortezomib therapy as monothe rapy and in combination, which varies from 7 to 34% according to different authors and 25% of own experiences, is presented. Treatment and preventive schedule of this complication are shown.
O'Connor, Mortimer B
Varicella is a self-limiting and relatively mild disease of childhood, although it is frequently more severe and complicated among the immunocompromised rheumatology patients on immunomodulator therapies. In addition, future reactivation of the dormant virus in dorsal root ganglia may cause herpes zoster infection, which can be very debilitating. In this manuscript, we discuss the nature of this infection along with its potential vaccine especially among rheumatology patients.
Full Text Available Cutaneous sarcoidosis presents with a wide range of clinical presentations. An uncommon cutaneous manifestation is infiltration of old cutaneous scars with non-caseating granulomas known as scar sarcoidosis. Most of the patients with this clinical entity have other systemic manifestations, particularly pulmonary changes. We report a case of a 50 years old man, presenting with cutaneous sarcoidosis overlying scars of healed herpes zoster.
Gilmara Franco da Cunha
Full Text Available OBJECTIVES: Herpes zoster has been widely described in the context of different systemic autoimmune diseases but not dermatomyositis/polymyositis. Therefore, we analyzed the prevalence, risk factors and herpes zoster outcomes in this population. METHOD: A retrospective cohort study of herpes zoster infections in dermatomyositis/polymyositis patients was performed. The patients were followed at a tertiary center from 1991 to 2012. For the control group, each patient with herpes zoster was paired with two patients without herpes zoster. Patients were matched by gender and the type of myositis, age at myositis onset and disease duration. RESULTS: Of 230 patients, 24 (10.4% had a histories of herpes zoster (19 with dermatomyositis and five with polymyositis, two-thirds female. The mean age of the patients with herpes zoster was 44.6±16.8 years. No difference between the groups was found regarding cumulative clinical manifestations. Disease activity, autoantibody, muscle and leukogram parameters were also comparable between the groups. No differences in immunosuppressive (alone or in association with other immunosuppressive therapies or glucocorticoid (current use, medium dose and cumulative dose in the last two months therapies were found between patients with and without herpes zoster. However, a higher proportion of patients in the herpes zoster group received chloroquine diphosphate compared to the control group. All of the patients received acyclovir; 58.3% of patients had postherpetic neuralgia and no cases of recurrence were reported. Furthermore, individuals who were taking high prednisone doses at the time of the herpes zoster diagnosis had reduced levels of postherpetic neuralgia. CONCLUSIONS: These data suggest that chloroquine diphosphate could predispose patients with dermatomyositis/polymyositis to developing herpes zoster, particularly women and dermatomyositis patients.
Full Text Available Herpes zoster is a localized, generally painful cutaneous eruption that occurs most frequently among older adults and immunocompromized persons. It is caused by reactivation of latent varicella zoster virus (VZV Approximately one in three persons will develop zoster during their lifetime. A common complication of zoster is postherpetic neuralgia (PHN, a chronic, often debilitating pain condition that can last months or even years. The risk for PHN in patients with zoster is 10 to 18%. Approximately 3% of patients with zoster are hospitalized. Death attributable to zoster are common among immunocompromized persons. Prompt treatment with the oral antiviral agents, corticosteroids and analgesics decreases the severity and duration of acute pain from zoster. This article reviews herpes zoster and reports one such case, which was treated successfully without any complications.
Aim: To study the presentation of herpes zoster (shingles) in self-referral urban primary care setting. Patients and method: During nearly 20 years, patients of Igbo ethnic group presented with herpes zoster, on a self-referral basis, to my urban, week day evening, out patient clinic. The recorded epidemiological parameters ...
Sørensen, Gitte Vrelits; Helgestad, Jon; Rosthøj, Steen
INTRODUCTION: Herpes zoster rarely occurs in healthy children, but may occur frequently and may take a complicated course in children receiving chemotherapy. We aimed to assess morbidity from herpes zoster in children with acute lymphoblastic leukemia (ALL). MATERIAL AND METHODS: Reviewing records...
(0/23. None of the patients had postherpetic neuralgia or bacterial super infection. Immunosuppressive medications were discontinued at the time of diagnosis of Zoster in 19 of 32 patients and all patients received antiviral medications.There were no permanent neurologic deficits or deaths. We conclude that Herpes Zoster infections occur at increased frequency among patients with SLE and carry significant morbidity. Immunosuppressive therapy and severe manifestations of lupus may be risk factors for the development of Herpes Zoster although not necessarily at the time of disease flare or immunosuppressive therapy. Our study suggests that although Herpes Zoster occurs frequently in patients with SLE, it has a relatively benign course.
Zaal, M.J.; Volker-Dieben, H.J.; Wienesen, M.; Amaro, D' J.; Kijlstra, A.
PURPOSE: Longitudinal analysis of varicella-zoster virus DNA on the ocular surface of patients with herpes zoster ophthalmicus. METHODS: Clinical specimens were obtained from the bulbar conjunctival surface with a cotton-tipped swab at weekly intervals for 6 consecutive weeks from 21 patients with
Marin, Mona; Yawn, Barbara P; Hales, Craig M; Wollan, Peter C; Bialek, Stephanie R; Zhang, John; Kurland, Marge J; Harpaz, Rafael
Options for managing herpes zoster (HZ)-related pain and complications have limited effectiveness, making HZ prevention through vaccination an important strategy. Limited data are available on HZ vaccine effectiveness against confirmed HZ and manifestations of HZ among vaccinated persons. We conducted a matched case-control study to assess HZ vaccine effectiveness for prevention of HZ and other HZ-related outcomes and a cohort study of persons with HZ to compare HZ-related outcomes by vaccination status. Cases were identified through active surveillance among persons age ≥60 years with HZ onset and health-care encounters during 2010-2011 in Southeastern Minnesota. Controls were age- and sex-matched to cases. Data were collected by medical record review and from participants via interviews and daily pain diaries. 266 HZ case-patients and 362 matched controls were enrolled in the vaccine effectiveness studies and 303 case-patients in the cohort study of HZ characteristics by vaccination status. Vaccination was associated with 54% (95% CI:32%-69%) reduction in HZ incidence, 58% (95% CI:31%-75%) reduction in HZ prodromal symptoms, and 70% (95% CI:33%-87%) reduction in medically-attended prodrome. HZ vaccine was statistically significant effective at preventing postherpetic neuralgia (PHN) measured at 30 d after rash onset, 61% (95% CI: 22%-80%). Among persons who developed HZ, no differences were found by vaccination status in severity or duration of HZ pain after rash onset. In this population-based study, HZ vaccination was associated with >50% reduction in HZ, HZ prodrome, and medically-attended prodrome. PMID:25806911
Full Text Available Herpes zoster is a reactivated varicella-zoster virus (VZV infection of the sensory nerve ganglion, peripheral nerve, and its branches. Mechanical trauma to the nervous system can reactivate VZV. It is well known that extracorporeal shock wave lithotripsy (SWL can produce mechanical damage to the tissue. We report a rare case of herpes zoster reactivation after SWL for treatment of 1.2 cm size renal stone in a 63-year-old male patient.
Chen, Vincent Chin-Hung; Wu, Shu-I; Huang, Kuo-You; Yang, Yao-Hsu; Kuo, Ting-Yu; Liang, Hsin-Yi; Huang, Kuan-Lun; Gossop, Michael
Some infectious diseases have been found to be associated with cognitive impairment and dementia. However, the relationship between herpes zoster and dementia has received little attention. This study aimed to investigate this association as well as associations of antiviral treatments for herpes zoster and incident dementia using a large national sample. Cases were identified from the Taiwan National Health Insurance Research Database with a new diagnosis of herpes zoster (ICD-9-CM code: 053) between 1997 and 2013. Each identified individual with a case of herpes zoster was compared with 1 sex-, age-, and residence-matched control subject. Both groups were followed until the first diagnosis of dementia (ICD-9-CM codes: 290.0 to 290.4, 294.1, 331.0 to 331.2, and 331.82), withdrawal from the registry, or the end of 2013. Cox regression analyses and competing risk model were applied, adjusting for sex, age, residence, depression, autoimmune disease, ischemic stroke, traumatic brain injury, alcohol use disorder, and antiviral treatments for herpes zoster to evaluate the risk of interest. A total of 39,205 cases with herpes zoster were identified. Of the 78,410 study and comparison subjects, 4,204 were diagnosed as having dementia during a mean (SD) follow-up period of 6.22 (4.05) years. Herpes zoster was associated with a slightly increased risk of dementia in the fully adjusted model (hazard ratio [HR] = 1.11; 95% CI, 1.04-1.17). Prescriptions of antiviral therapy were associated with a reduced risk of developing dementia following the diagnosis of herpes zoster (HR = 0.55; 95% CI, 0.40-0.77). Herpes zoster was associated with an increased risk of dementia, independent of potential confounding factors. Antiviral treatment might be protective in preventing dementia in patients with herpes zoster.
Full Text Available Patients who develop herpes zoster or herpes zoster ophthalmicus may be at risk for cerebrovascular and cardiac complications. We systematically reviewed the published literature to determine the association between herpes zoster and its subtypes with the occurrence of cerebrovascular and cardiac events.Systematic searches of PubMed (MEDLINE, SCOPUS (Embase and Google Scholar were performed in December 2016. Eligible studies were cohort, case-control, and self-controlled case-series examining the association between herpes zoster or subtypes of herpes zoster with the occurrence of cerebrovascular and cardiac events including stroke, transient ischemic attack, coronary heart disease, and myocardial infarction. Data on the occurrence of the examined events were abstracted. Odds ratios and their accompanying confidence intervals were estimated using random and fixed effects models with statistical heterogeneity estimated with the I2 statistic. Twelve studies examining 7.9 million patients up to 28 years after the onset of herpes zoster met our pre-defined eligibility criteria. Random and fixed effects meta-analyses showed that herpes zoster, type unspecified, and herpes zoster ophthalmicus were associated with a significantly increased risk of cerebrovascular events, without any evidence of statistical heterogeneity. Our meta-analysis also found a significantly increased risk of cardiac events associated with herpes zoster, type unspecified.Our results are consistent with the accumulating body of evidence that herpes zoster and herpes zoster ophthalmicus are significantly associated with cerebrovascular and cardiovascular events.
Antia, Camila; Persad, Leah; Alikhan, Ali
Varicella zoster virus (VZV) is an exclusively human, double-stranded DNA virus. Primary infection causes varicella (chickenpox); later the virus becomes dormant in the dorsal root, cranial nerve, and autonomic ganglia along the entire span of the nervous system, retaining the capacity to reactivate and cause a variety of dermal and neurological complications. Recently there has been increasing recognition, both clinically and epidemiologically, of the relationship between VZV and subsequent strokes. Herein, we describe a case of a previously healthy individual with reactivation of VZV causing herpes zoster opthtalmicus along with devastating multifocal vasculopathy. It is crucial for dermatologists to recognize the dermatomal vesicular eruption in this high risk area to aid in prompt diagnosis in an effort to improve clinical prognosis.
Full Text Available Introduction: Herpes Zoster (HZ is rare in infancy and results from reactivation of varicella-zoster virus, latent in the dorsal root ganglia of sensory or cranial nerves after primary infection (chickenpox. Case Report: We describe the case of an healthy infant, three months old, without previous clinical symptoms of chickenpox, in spite of having contacted with the disease at two weeks of life. She was hospitalized for vesicular-papular rash involving unilaterally dermatomes L4 and L5 and was treated with acyclovir with good clinical outcome. Conclusion: The immaturity of the immune system and the interference of maternal antibodies contribute to the manifestation of HZ in the first year of life. In a previously healthy child it is not recommended the exclusion of underlying immunodeficiency or malignant disease.
Koda, Masao; Mannoji, Chikato; Oikawa, Makiko; Murakami, Masazumi; Okamoto, Yuzuru; Kon, Tamiyo; Okawa, Akihiko; Ikeda, Osamu; Yamazaki, Masashi; Furuya, Takeo
Symptom of herpes zoster is sometimes difficult to distinguish from sciatica induced by spinal diseases, including lumbar disc herniation and spinal canal stenosis. Here we report a case of sciatica mimicking lumbar canal stenosis. A 74-year-old Chinese male patient visited our hospital for left-sided sciatic pain upon standing or walking for 5 min of approximately 1 month's duration. At the first visit to our hospital, there were no skin lesions. A magnetic resonance imaging showed spinal canal stenosis between the 4th and 5th lumbar spine. Thus, we diagnosed the patient with sciatica induced by spinal canal stenosis. We considered decompression surgery for the stenosis of 4th and 5th lumbar spine because conservative therapy failed to relieve the patient's symptom. At that time, the patient complained of a skin rash involving his left foot for several days. A vesicular rash and erythema were observed on the dorsal and plantar surfaces of the great toe and lateral malleolus. The patient was diagnosed with herpes zoster in the left 5th lumbar spinal nerve area based on clinical findings, including the characteristics of the pain and vesicular rash and erythema in the 5th lumbar spinal dermatome. The patient was treated with famciclovir (1,500 mg/day) and non-steroidal anti-inflammatory drugs. After 1 week of medication, the skin rash resolved and pain relief was obtained. In conclusion, spinal surgeons should keep in mind herpes zoster infection as one of the possible differential diagnoses of sciatica, even if there is no typical skin rash.
Merino-Iglesias, Alexia; Montero, Javier Antonio; Calabuig-Goena, Maria; Giraldo-Agudelo, Luisa Fernanda
A male patient with herpes zoster ophthalmicus (HZO) presented with left exophthalmos, external and internal ophthalmoplegia and decreased visual acuity. A CT scan revealed myositis without significant compression of the optic nerve. Intravenous acyclovir and oral steroids were started with improvement of the symptoms and eventual complete recovery.Orbital apex syndrome is a rare complication of HZO. Multiple pathogenic mechanisms are involved, including a direct cytopathic effect of the virus as in the present case. Early diagnosis and therapy may lead to complete recovery of visual function. PMID:24614776
García-Rojas, Amós; Gil-Prieto, Ruth; Núñez-Gallo, Domingo Ángel; Matute-Cruz, Petra; Gil-de-Miguel, Angel
Herpes zoster is an important problem of public health especially among the elderly in Spain. A population-based retrospective epidemiological study to estimate the burden of herpes zoster requiring hospitalization in the Canary Islands, Spain was conducted by using data from the national surveillance system for hospital data, Conjunto Mínimo Básico de Datos. Records of all patients admitted to hospital with a diagnosis of herpes zoster in any position and cases of primary diagnosis (ICD-9-MC codes 053.0-053.9) during a 10-year period (2005-2014), were selected. A total of 1088 hospitalizations with a primary or secondary diagnosis of herpes zoster were identified during the study period. Annually there were 6.99 hospitalizations by herpes zoster per 100,000 population. It increases with age reaching a maximum in persons ≥85 years of age (43.98 admissions per 100,000). Average length of hospitalization was 16 days and 73 patients died, with a case-fatality rate of 4.03%. In 22% of the cases hospitalized, herpes zoster was the primary diagnosis. The hospitalization burden of herpes zoster in adults in the Canary Islands was still important during the last decade and justify the implementation of preventive measures, like vaccination in the elderly or other high risk groups to reduce the most severe cases of the disease.
Background The herpes zoster burden of disease in Sweden is not well investigated. There is no Swedish immunization program to prevent varicella zoster virus infections. A vaccine against herpes zoster and its complications is now available. The aim of this study was to estimate the herpes zoster burden of disease and to establish a pre-vaccination baseline of the minimum incidence of herpes zoster. Methods Data were collected from the Swedish National Health Data Registers including the Patient Register, the Pharmacy Register, and the Cause of Death Register. The herpes zoster burden of disease in Sweden was estimated by analyzing the overall, and age and gender differences in the antiviral prescriptions, hospitalizations and complications during 2006-2010 and mortality during 2006-2009. Results Annually, 270 per 100,000 persons received antiviral treatment for herpes zoster, and the prescription rate increased with age. It was approximately 50% higher in females than in males in the age 50+ population (rate ratio 1.39; 95% CI, 1.22 to 1.58). The overall hospitalization rate for herpes zoster was 6.9/100,000 with an approximately three-fold increase for patients over 80 years of age compared to the age 70-79 group. A gender difference in hospitalization rates was observed: 8.1/100,000 in females and 5.6/100,000 in males. Herpes zoster, with a registered complication, was found in about one third of the hospitalized patients and the most common complications involved the peripheral and central nervous systems. Death due to herpes zoster was a rare event. Conclusions The results of this study demonstrate the significant burden of herpes zoster disease in the pre-zoster vaccination era. A strong correlation with age in the herpes zoster- related incidence, hospitalization, complications, and mortality rates was found. In addition, the study provides further evidence of the female predominance in herpes zoster disease. PMID:24330510
Catia Susana Harumi Minami
Full Text Available A distrofia simpática reflexa (DSR é uma síndrome dolorosa pouco entendida que consiste na presença de múltiplos sinais e sintomas incluindo dor, edema, alterações cutâneas distróficas e disfunção autonômica envolvendo uma ou mais extremidades. Nem sempre a DSR pós-herpes zóster é facilmente reconhecida. Poucos relatos dessa complicação foram publicados, o que torna interessante esta descrição. Apresentamos o caso de uma mulher branca, de 65 anos de idade cujos sinais e sintomas característicos de DSR no membro superior direito surgiram após 4 semanas do aparecimento das lesões de herpes zóster envolvendo trajeto dermatomérico. Com o diagnóstico precoce e abordagem terapêutica com calcitonina nasal e fisioterapia houve melhoras funcional e álgica satisfatórias em um mês de tratamento.The reflex sympathetic dystrophy (RSD is a poorly understood, painful syndrome that consists of multiple clinical manifestations, including pain, swelling, dystrophic cutaneous changes and autonomic dysfunction involving one or more extremities. The RSD following herpes zoster is not always easily recognized, and only a few documented cases of this complication have been reported, what makes this report even more interesting. We present the case of a 65 years old white woman, with characteristic signs and symptoms of RSD in the right upper limb observed four weeks after she had had a typical herpes zoster involving the dermatomes. Early diagnosis and treatment with intranasal calcitonin and physiotherapy lead to progressive functional and pain improvements after one month.
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PURPOSE: To report a case of posterior ischemic optic neuropathy (PION following herpes zoster ophthalmicus (HZO. CASE REPORT: A 58-year-old woman with history of recent HZO in her right eye presented with acute painless loss of vision in the same eye to no light perception. Examination revealed a positive relative afferent pupillary defect and a normal appearing optic disc. Inflammatory and infiltrative lesions of the optic nerve were ruled out by laboratory and imaging studies. The patient received systemic acyclovir and prednisolone. Three months later, visual acuity improved to counting fingers, but the optic disc became pale and atrophic leading to a presumptive diagnosis of PION. Considering the positive PCR test for varicella zoster virus and the short time interval between the two presentations, HZO was considered as the most probable cause of the optic neuropathy. CONCLUSION: Herpes zoster ophthalmicus can be associated with PION.
When a patient presents with acute voiding dysfunction without a typical skin rash, it may be difficult to make a diagnosis of herpes zoster. Here, we present a case of scrub typhus in a 25-year-old man with the complication of urinary dysfunction. The patient complained of loss of urinary voiding sensation and constipation. After eight days, he had typical herpes zoster eruptions on the sacral dermatomes and hypalgesia of the S1-S5 dermatomes. No cases of dual infection with varicella zoster virus and Orientia tsutsugamushi were found in the literature. In the described case, scrub typhus probably induced sufficient stress to reactivate the varicella zoster virus. Early recognition of this problem is imperative for prompt and appropriate management, as misdiagnosis can lead to long-term urinary dysfunction. It is important that a diagnosis of herpes zoster be considered, especially in patients with sudden onset urinary retention. PMID:26157595
Conclusion: Herpes zoster ophthalmicus is an uncommon ocular presentation. Managing two concurrent complications; persistent total hyphema and orbital apex syndrome is a challenging clinical situation. Early diagnosis and prompt treatment are essential to prevent potential blinding situation.
Buckingham, Erin M; Foley, Maria A; Grose, Charles; Syed, Nasreen A; Smith, Morton E; Margolis, Todd P; Thurtell, Matthew J; Kardon, Randy
To examine whether herpes zoster antigen (also called varicella-zoster virus antigen) was detectable in temporal artery biopsies taken from individuals with giant cell arteritis (GCA). Retrospective comparative case series. Sections of formalin-fixed paraffin-embedded temporal arteries were examined first by hematoxylin and eosin (H&E) staining to establish the diagnosis of GCA. Adjacent sections of the same biopsy were then examined by immunohistochemistry, using 2 different monoclonal antibodies against a major antigen of varicella-zoster virus called gE. Pathological specimens were obtained from patients cared for at the University of Iowa and Washington University in St. Louis Ophthalmology Clinics. The study included biopsies from 25 patients with symptoms of GCA as well as positive H&E pathology and 25 patients with symptoms compatible with GCA but negative H&E pathology. Among the GCA-positive group, three patients had positive staining for herpes zoster antigen. Among the GCA-negative group, herpes zoster antigen was not detected in any biopsy. In both groups of patients, false positive staining for herpes zoster antigen was detected in the presence of calcifications in the arteries. False-positive staining was also detected on some extra-arterial skeletal muscle and erythrocytes. Herpes zoster antigen was detected in 3/25 temporal arteries from patients with biopsy-proven GCA. One of the three positive cases was noteworthy because the patient had had herpes zoster ophthalmicus diagnosed 3 weeks before the onset of GCA symptoms. False-positive staining for herpes zoster antigen was detected on several temporal artery biopsies. Copyright © 2017. Published by Elsevier Inc.
Mehta, Satish; Pierson, Duane L.
Spaceflight is a uniquely stressful environment with astronauts experiencing a variety of stressors including: isolation and confinement, psychosocial, noise, sleep deprivation, anxiety, variable gravitational forces, and increased radiation. These stressors are manifested through the HPA and SAM axes resulting in increased stress hormones. Diminished T-lymphocyte functions lead to reactivation of latent herpes viruses in astronauts during spaceflight. Herpes simplex virus reactivated with symptoms during spaceflight whereas Epstein-Barr virus (EBV), cytomegalovirus (CMV), and varicella zoster virus (VZV) reactivate and are shed without symptoms. EBV and VZV are shed in saliva and CMV in the urine. The levels of EBV shed in astronauts increased 10-fold during the flight; CMV and VZV are not typically shed in low stressed individuals, but both were shed in astronauts during spaceflight. All herpesviruses were detected by polymerase chain reaction (PCR) assay. Culturing revealed that VZV shed in saliva was infectious virus. The PCR technology was extended to test saliva of 54 shingles patients. All shingles patients shed VZV in their saliva, and the levels followed the course of the disease. Viremia was also found to be common during shingles. The technology may be used before zoster lesions appear allowing for prevention of disease. The technology may be used for rapid detection of VZV in doctors? offices. These studies demonstrated the value of applying technologies designed for astronauts to people on Earth.
Full Text Available Background: Herpes Zoster (HZ is reactivation of latent varicella-zoster virus that involves dermatomes. Aging and immunosupressed states are among the main risk factors. Some investigations showed that HZ is more common in diabetic patients than in normal population. Aim: To determine whether undiagnosed DM is more common in patients with HZ than in those without it. Materials and Methods: In this study 103 patients with HZ (cases and 142 as control participated. They had no history of DM. Both groups were matched according to age, gender and family history of DM. Fasting plasma glucose was checked for all participants. DM was defined when the fasting plasma glucose was equal or more 126 mg/dl. Results: 35.9% of patients with HZ and 19.7% of the control group had DM. There was significant association between HZ and undiagnosed DM (OR = 2.28, 95% CI: 1.28-4.06. Conclusion: Our findings indicate that the prevalence of undiagnosed DM is more common in HZ patients and supports the policy to investigate patients with HZ for the presence of undiagnosed DM.
Cunningham, Anthony L; Heineman, Thomas
Herpes zoster (HZ) causes an often severe and painful rash in older people and may be complicated by prolonged pain (postherpetic neuralgia; PHN) and by dissemination in immune-compromised patients. HZ results from reactivation of latent varicella-zoster virus (VZV) infection, often associated with age-related or other causes of decreased T cell immunity. A live attenuated vaccine boosts this immunity and provides partial protection against HZ, but this decreases with age and declines over 8 years. Areas covered: A new HZ subunit (HZ/su) vaccine combines a key surface VZV glycoprotein (E) with a T cell-boosting adjuvant system (AS01 B ) and is administered by two intramuscular injections two months apart. Expert commentary: HZ/su showed excellent efficacy of ~90% in immunocompetent adults ≥50 and ≥70 years of age, respectively, in the ZOE-50 and ZOE-70 phase III controlled trials. Efficacy was unaffected by advancing age and persisted for >3 years. Approximately 9.5% of subjects had severe, but transient (1-2 days) injection site pain, swelling or redness. Compliance with both vaccine doses was high (95%). The vaccine will have a major impact on HZ management. Phase I-II trials showed safety and immunogenicity in severely immunocompromised patients. Phase III trial results are expected soon.
Full Text Available Herpes zoster is a viral disease caused by the reactivation of varicella-zoster virus (VZV which remained latent in the cranial nerve or dorsal root ganglia. Cell-mediated immunity is known to decline with age as part of immunosenescence and can lead to the reactivation of VZV. Whereas herpes zoster is usually mild in healthy young persons, older patients are at increased risk for complications. In the present study we investigated the serum cytokine profile (IL-17, IL-23, IL-21, IL-4, IL-12, representing cellular and humoral immunity and assessed the level of VZV IgG antibodies in patients with herpes zoster.We investigated the serum concentrations of IL-17, IL-23, IL-21, IL-4, IL-12 and the level of VZV IgG antibodies in 23 patients with herpes zoster who did not develop superinfection. The control group was represented by 21 individuals in similar age with no inflammatory and infectious diseases. Cytokine and antibodies levels were measured by ELISA method. Statistical analysis was performed using the ROC curve (receiver operating characteristic, t-test, Welch's t-test, and nonparametric tests with STATISTICA 10 software.In patients with herpes zoster, the serum level of IL-17, IL-23, IL-21, IL-4 and IL-12 as well as VZV IgG antibodies titer were statistically significantly increased compared to control group.Our results confirm the broad activation of the immune system involving humoral and cell-mediated immunity.
Takao, Yukiko; Miyazaki, Yoshiyuki; Onishi, Fumitake; Kumihashi, Hideaki; Gomi, Yasuyuki; Ishikawa, Toyokazu; Okuno, Yoshinobu; Mori, Yasuko; Asada, Hideo; Yamanishi, Koichi; Iso, Hiroyasu
Background The incidence and risk factors for herpes zoster have been studied in cross-sectional and cohort studies, although most such studies have been conducted in Western countries. Evidence from Asian populations is limited, and no cohort study has been conducted in Asia. We are conducting a 3-year prospective cohort study in Shozu County in Kagawa Prefecture, Japan to determine the incidence and predictive and immunologic factors for herpes zoster among Japanese. Methods The participants are followed for 3 years, and a telephone survey is conducted every 4 weeks. The participants were assigned to 1 of 3 studies. Participants in study A gave information on past history of herpes zoster and completed health questionnaires. Study B participants additionally underwent varicella-zoster virus (VZV) skin testing, and study C participants additionally underwent blood testing. If the participants develop herpes zoster, we evaluate clinical symptoms, measure cell-mediated immunity and humoral immunity using venous blood sampling, photograph skin areas with rash, conduct virus identification testing by polymerase chain reaction (PCR) and virus isolation from crust sampling, and evaluate postherpetic pain. Results We recruited 12 522 participants aged 50 years or older in Shozu County from December 2009 through November 2010. The participation rate was 65.7% of the target population. Conclusions The present study is likely to provide valuable data on the incidence and predictive and immunologic factors for herpes zoster in a defined community-based population of Japanese. PMID:22343323
Dabrowska, Anna; Tarnowska, Czesława; Jałowiński, Robert; Amernik, Katarzyna; Stankiewicz, Jan; Grzelec, Halina
The cephalic zoster is a cranial neuritis, with great tendency to diffusion along the nerves. The objective of this article is both to report a case of cranial polineuritis due to herpes zoster infection with laryngeal involvement and review of the relevant literature. The case of 57-years-old man with unilateral laryngeal mucosal eruptions and complete left vocal paralysis is reported. Laryngeal symptoms, diagnostic criteria and therapeutic result are described. 1. In cases of head and neck herpes zoster, the investigations of all cranial nerves should be carried out, and the larynx must always be examinated; 2. Co-occurrence of the neuralgic pain (radiating especially to the ear or the occipital region) with unilateral laryngeal palsy should raise a suspicion that herpes zoster infection may by the causative factor; 3. The explanation of the etiologic cause of a vocal fold paralysis in idiopathic cases, may yield not only diagnostic, but also therapeutic value.
Full Text Available El herpes zoster (HZ constituye una enfermedad de distribución mundial; sin embargo, existen es casos datos comunicados sobre la misma en países de Latinoamérica. Con el objetivo de evaluar aspectos clínicos y epidemiológicos de esta enfermedad en nuestra población, realizamos un análisis retrospectivo de historias clínicas de un centro privado de referencia en enfermedades infecciosas en Buenos Aires, Argentina (período: 2000-2005. Se realizó un análisis estadístico univariado para evaluar los factores asociados a neuralgia posherpética en este grupo de pacientes. Sobre un total de 302 casos evaluables, el 62% correspondieron a mujeres. La mediana de edad fue de 57 años. El 16.1% de los pacientes presentó condiciones predisponentes al desarrollo de zoster. Las localizaciones más frecuentes fueron la torácica, oftálmica y lumbosacra. El 7.75% presentó compromiso de más de dos metámeras. El 94% de los pacientes recibió medicación antiviral, siendo el aciclovir la droga más utilizada. El 94% recibió alguna medicación coadyuvante (antiinflamatorios no esteroideos, antineuríticos, corticoides. La complicación más frecuente fue la neuralgia posherpética (12% y se encontró estadísticamente asociada a edad mayor de 50 años.Herpes zoster (HZ is a public health problem worldwide. Although, there is paucity of data of this disease from South American countries. The objective of this study was to evaluate clinical and epidemiological aspects of HZ in a population of patients from South America. We underwent a retrospective analysis of clinical charts of an infectious diseases reference center (period: 2000-2005. Univariate analysis was performed to assess variables related to post herpetic neuralgia (PHN. From a total of 302 cases, 62% were in women. The median age was 57 years; 16.1% of the patients had a predisposing condition for the development of HZ. Most frequent dermatomes involved were: thoracic, ophthalmic and
Grace E. Parkins, BDS, FDS.RCPS (Glas., FWACS, FGCS
Full Text Available Herpes zoster ophthalmicus and HIV are serious health problems. We report a case of a 37-year-old woman who presented to the Korle-Bu Teaching Hospital with dyspnea and facial cellulitis, and a diagnosis 5 days prior of dental cellulitis made at a district hospital. Investigations revealed that the facial cellulitis was secondary to herpes zoster infection involving the ophthalmic division of the left trigeminal nerve. The patient responded well to oral acyclovir but developed postherpetic neuralgia. During the course of treatment, she was also diagnosed to be HIV-1 positive and was referred for further management. This case represents a unique report in which the patient presented to the hospital with symptoms of cellulitis suggestive of underlying dental infection but was later diagnosed with both herpes zoster ophthalmicus and an underlying HIV infection. Atypical presentations of herpes zoster can occur in HIV/AIDS. Signs of herpes zoster infection with cellulitis should alert the clinician that the patient may have a possible underlying immunosuppressive disease. The population must be educated regarding the importance of early presentation and careful compliance with treatment as well as regular follow-ups.
A. L. Yakubenko
Full Text Available Interleukin-6 plays a central role in antiviral immunity. However, the function of this cytokine in the pathogenesis of herpes zoster is unknown. The objective of this study was todeterminethe dynamicsof serum interleukin-6 level in HIV-infected patients with herpes zoster. 55 patients with herpes zoster (30 HIV-positive and 25 HIV-negative were included. Serum interleukin-6 levels were measured before acyclovir treatment, on the 3rd day of treatment and after healing of skin lesions. The clinical course and dynamics of laboratory data were also evaluated. The study showed that elevated serum levels of interleukin-6 were associated with HIV-positive status, severity of rash, fever anddecreaseof CD4-lymphocytes. Levels of interleukin-6 in HIV-infected patients were significantly reduced during herpes zoster treatment and reached the level of HIVnegative cohort.Interleukin-6 levels in complicated course of herpes zoster in HIV-infected patients with low CD4-lymphocyte count (less than 350 cells/ml were significantly higher compared to levels in uncomplicated course of the disease.
Khan, Nabeel; Patel, Dhruvan; Trivedi, Chinmay; Shah, Yash; Lichtenstein, Gary; Lewis, James; Yang, Yu-Xiao
Patients with inflammatory bowel disease (IBD) might be at increased risk for herpes zoster infection. We sought to quantify the risk of herpes zoster in patients with IBD and evaluate the effects of IBD and IBD medications on the risk of herpes zoster. We conducted 2 retrospective studies of populations of Veterans, from January 2000 through June 2016. In study 1, we compared the incidence of herpes zoster among patients with IBD receiving 5-ASA alone vs matched patients without IBD. In study 2, we compared the incidence of herpes zoster among patients with IBD treated with only 5-ASA, with thiopurines, with antagonists of tumor necrosis factor (TNF), with a combination of thiopurines and TNF antagonists, and with vedolizumab. We used multivariable Cox regression to estimate the hazard ratios and 95% CIs for herpes zoster associated with IBD in study 1 and with different treatments in study 2. We also estimated the incidence rate of herpes zoster based on age and IBD medication subgroups. Compared to no IBD, ulcerative colitis (UC) and Crohn's disease (CD) were each associated with significantly increased risk of herpes zoster infection. In multivariable Cox regression (compared to no IBD), UC, CD, or IBD treated with 5-ASA treatment alone was associated with significantly increased risk of herpes zoster, with adjusted HRs (AHR) of 1.81 for UC (95% CI, 1.56-2.11), 1.56 for CD (95% CI, 1.28-1.91), and 1.72 for treated IBD (95% CI, 1.51-1.96). In multivariable Cox regression analysis, compared to exposure to 5-ASA alone, exposure to thiopurines (AHR, 1.47; 95% CI, 1.31-1.65) or a combination of thiopurines and TNF antagonists (AHR, 1.65; 95% CI, 1.22-2.23) was associated with increased risk of herpes zoster. However, exposure to TNF antagonists alone (AHR, 1.15; 95% CI, 0.96-1.38) was not associated with increased risk of herpes zoster. The incidence rates of herpes zoster in all age groups and all IBD medication subgroups were substantially higher than that in the
Kim, Koohyun; Jo, Daehyun; Kim, EungDon
Latent varicella zoster virus reactivates mainly in sensory ganglia such as the dorsal root ganglion (DRG) or trigeminal ganglion. The DRG contains many receptor channels and is an important region for pain signal transduction. Sustained abnormal electrical activity to the spinal cord via the DRG in acute herpes zoster can result in neuropathic conditions such as postherpetic neuralgia (PHN). Although the efficacy of pulsed radiofrequency (PRF) application to the DRG in various pain conditions has been previously reported, the application of PRF to the DRG in patients with herpes zoster has not yet been studied. The aim of the present study was to compare the clinical effects of PRF to the DRG in patients with herpes zoster to those of PRF to the DRG in patients with PHN. Retrospective comparative study. University hospital pain center in Korea. The medical records of 58 patients who underwent PRF to the DRG due to zoster related pain (herpes zoster or PHN) were retrospectively analyzed. Patients were divided into 2 groups according to the timing of PRF after zoster onset: an early PRF group (within 90 days) and a PHN PRF group (more than 90 days). The efficacy of PRF was assessed by a numeric rating scale (NRS) and by recording patient medication doses before PRF and at one week, 4 weeks, 8 weeks, and 12 weeks after PRF. Pain intensity was decreased after PRF in all participants. However, the degree of pain reduction was significantly higher in the early PRF group. Moreover, more patients discontinued their medication in the early PRF group, and the PRF success rate was also higher in the early PRF group. The relatively small sample size from a single center, short duration of review of medical records, and the retrospective nature of the study. PRF to the DRG is a useful treatment for treatment-resistant cases of herpes zoster and PHN. Particularly in herpes zoster patients with intractable pain, application of PRF to the DRG should be considered for pain control
Langan, Sinéad M.; Smeeth, Liam; Margolis, David J.; Thomas, Sara L.
Background Herpes zoster is common and has serious consequences, notably post-herpetic neuralgia (PHN). Vaccine efficacy against incident zoster and PHN has been demonstrated in clinical trials, but effectiveness has not been studied in unselected general populations unrestricted by region, full health insurance coverage, or immune status. Our objective was to assess zoster vaccine effectiveness (VE) against incident zoster and PHN in a general population-based setting. Methods and Findings A cohort study of 766,330 fully eligible individuals aged ≥65 years was undertaken in a 5% random sample of Medicare who received and did not receive zoster vaccination between 1st January 2007 and 31st December 2009. Incidence rates and hazard ratios for zoster and PHN were determined in vaccinated and unvaccinated individuals. Analyses were adjusted for age, gender, race, low income, immunosuppression, and important comorbidities associated with zoster, and then stratified by immunosuppression status. Adjusted hazard ratios were estimated using time-updated Cox proportional hazards models. Vaccine uptake was low (3.9%) particularly among black people (0.3%) and those with evidence of low income (0.6%). 13,112 US Medicare beneficiaries developed incident zoster; the overall zoster incidence rate was 10.0 (9.8–10.2) per 1,000 person-years in the unvaccinated group and 5.4 (95% CI 4.6–6.4) per 1,000 person-years in vaccinees, giving an adjusted VE against incident zoster of 0.48 (95% CI 0.39–0.56). In immunosuppressed individuals, VE against zoster was 0.37 (95% CI 0.06–0.58). VE against PHN was 0.59 (95% CI 0.21–0.79). Conclusions Vaccine uptake was low with variation in specific patient groups. In a general population cohort of older individuals, zoster vaccination was associated with reduction in incident zoster, including among those with immunosuppression. Importantly, this study demonstrates that zoster vaccination is associated with a reduction in PHN. Please
Khan, N; Shah, Y; Trivedi, C; Lewis, J D
The risk of herpes zoster (HZ) is elevated in inflammatory bowel disease (IBD) patients treated with anti-TNF medications. While it is optimal to give herpes zoster vaccine prior to initiation of therapy clinical circumstances may not always allow this. To determine the safety of giving herpes zoster vaccine while patients are on anti-TNF therapy. We conducted a retrospective cohort study involving IBD patients who were followed in the Veterans Affairs (VA) healthcare system between 2001 and 2016. Patients who received herpes zoster vaccine while on anti-TNF medication were identified through vaccination codes and confirmed through individual chart review. Our outcome of interest was development of HZ between 0 and 42 days after herpes zoster vaccine administration. Fifty-six thousand four hundred and seventeen patients with IBD were followed in the VA healthcare system. A total of 59 individuals were on anti-TNF medication when they were given herpes zoster vaccine, and amongst them, 12 (20%) were also taking a thiopurine. Median age at the time of herpes zoster vaccine was 64.9 years and 95% of patients had a Charlson Comorbidity Index of ≥2. Median number of encounters within 42 days after receiving herpes zoster vaccine was two. No case of HZ was found within 0-42 days of HZV administration. Our data suggest that co-administering the herpes zoster vaccine to patients who are taking anti-TNF medications is relatively safe. This study significantly expands the evidence supporting the use of herpes zoster vaccine in this population, having included an elderly group of patients with a high Charlson Comorbidity Index who are likely at a much higher risk of developing HZ. © 2017 John Wiley & Sons Ltd.
Full Text Available Seventy-four consecutive patients with herpes zoster (HZ in Mumbai were recruited into the study to determine its natural history. Thirty-five (47.3% with HZ were infected with HIV-1/2. HZ+HIV+ and HZ+HIV- were demographically similar but HZ+HIV+ were clinically different; the latter were characterised by multidermatomal involvement of thoracic dermatomes below T6 or that of trigeminal nerve, recurrent episodes, bullous lesions and 17/35 had associated illnesses such as severe weight loss, recurrent fever, chronic cough, active tuberculosis and oral candidiasis. Significant differences in the course of healing, incidence of secondary bacterial infection and scaring emerged between the two groups after day-10. HZ+HIV+ individuals had vesicles and ulcers persisting for significantly longer time with frequent sequelae of post inflammatory pigmentation and post herpetic neuralgia. In areas where resources are limited for health information, such clinical differences between HZ+HIV+ and HZ+HIV- will serve to identify individuals with HIV infection in dermatologic clinic. These findings will also be helpful for early diagnosis of HIV infection, associated opportunistic infections and prevent their secondary transmission through appropriate interventions.
Full Text Available The purpose of our study was to determine the association of type 1 diabetes mellitus (T1DM and the risk of herpes zoster (HZ.In this cohort study, we selected 4736 patients with T1DM registered in the Catastrophic Illness Patient Database who received insulin therapy before 2003 and 18944 participants without DM who were selected by frequency matched based on sex and age. Cox proportional hazard regression analysis was used to measure the hazard ratios (HRs of HZ in the T1DM group compared with that in the non-T1DM group.Cox proportional hazard regression analysis showed that the adjusted HR of HZ was 2.38 times higher for patients in the T1DM group (95% CI = 1.77-3.19 than for those in the non-T1DM group. According to diabetes severity, mild and serious T1DM patients were associated with a higher risk of HZ (adjusted HR = 2.26, 95% CI = 1.67-3.05; and adjusted HR = 5.08, 95% CI = 2.66-9.71, respectively than subjects without T1DM.Patients with T1DM are at a higher risk of HZ than those without T1DM.
Pinchinat, Sybil; Cebri?n-Cuenca, Ana M; Bricout, H?l?ne; Johnson, Robert W
Background Herpes zoster (HZ) is caused by reactivation of the varicella-zoster virus (VZV) and mainly affects individuals aged ?50?years. The forthcoming European launch of a vaccine against HZ (Zostavax?) prompts the need for a better understanding of the epidemiology of HZ in Europe. Therefore the aim of this systematic review was to summarize the available data on HZ incidence in Europe and to describe age-specific incidence. Methods The Medline database of the National Library of Medicin...
Chankramat Sujatha Vinod
Full Text Available Introduction: Herpes zoster (Hz, which presents as localized, painful cutaneous eruption is a common clinical problem, particularly among adults of above 50 years of age and immunocompromised patients. It results from reactivation of varicella zoster virus. Aim: To analyze the clinical pattern of herpes zoster with special emphasis to the precipitating factors and incidence of post herpetic neuralgia. Material and Methods: 100 clinically diagnosed cases of herpes zoster, attending the Dermatology department of MVJ Medical College and Research Hospital Bangalore, India from a period of June 2010 to May 2012 were included in the study. The clinical pattern of herpes zoster with special emphasis to the precipitating factors and incidence of post herpetic neuralgia were analyzed. Results and Conclusion: The study showed a male preponderance. Age group varied from 8-80 years. 42% of the total patients presented during summer season when the incidence of varicella is also high. Past history of chicken pox was present in 68% of the patients. 11% of the patients were on immunosuppressive treatment. 8% of the patients had associated diabetes mellitus and 7% showed HIV seropositivity. Thoracic dermatomal involvement was seen in majority of patients. Most commonly observed complication was post herpetic neuralgia which was encountered in 36% of the patients and most of these patients were (77% were above the age of 60years.
Lam, A Cy; Chan, M Y; Chou, H Y; Ho, S Y; Li, H L; Lo, C Y; Shek, K F; To, S Y; Yam, K K; Yeung, I
There has been limited research on the knowledge of and attitudes about herpes zoster in the Hong Kong population. This study aimed to investigate the knowledge, attitude, and practice of patients aged 50 years or above towards herpes zoster and its vaccination. This was a cross-sectional study in the format of a structured questionnaire interview carried out in Sai Ying Pun Jockey Club General Outpatient Clinic in Hong Kong. Knowledge of herpes zoster and its vaccination was assessed, and patient attitudes to and concerns about the disease were evaluated. Factors that affected a decision about vaccination against herpes zoster were investigated. A total of 408 Hong Kong citizens aged 50 years or above were interviewed. Multiple regression analysis revealed that number of correct responses regarding knowledge about herpes zoster was positively correlated with educational attainment (B=0.313, P=0.026) and history of herpes zoster (B=0.408, P=0.038), and negatively correlated with age (B= -0.042, Pherpes zoster. Misconceptions about herpes zoster were notable in this study. More health education is needed to improve the understanding and heighten awareness of herpes zoster among the general public. Although the majority of participants indicated that herpes zoster would have a significant impact on their health, a relatively smaller proportion was actually worried about getting the disease. Further studies on this topic should be encouraged to gauge the awareness and knowledge of herpes zoster among broader age-groups.
Full Text Available This retrospective cohort study aimed to examine the relationship between herpes zoster ophthalmicus (HZO and the subsequent risk of dementia using a population-based database. We retrieved the study sample from the Taiwan Longitudinal Health Insurance Database 2005. The study group included 846 patients with HZO, and the comparison group included 2538 patients without HZO. Each patient was individually followed for a 5-year period to identify those patients who subsequently received a diagnosis of dementia. We performed a Cox proportional hazards regression to calculate the hazard ratios (HRs along with 95% confidence intervals (CIs for dementia during the follow-up period between patients with HZO and comparison patients. The respective incidence rates of dementia per 1000 person-years were 10.15 (95% CI: 7.22~13.87 and 3.61 (95% CI: 2.61~4.89 for patients with HZO and comparison patients. The Cox proportional analysis showed that the crude HR of dementia during the 5-year follow-up period was 2.83 (95% CI: 1.83-4.37 for patients with HZO than comparison patients. After adjusting for patients' characteristics and comorbidities, HZO patients were still at a 2.97-fold greater risk than comparison patients for developing dementia. Furthermore, we found that of sampled male patients, the crude HR of dementia for patients with HZO was as high as 3.35 (95% CI = 1.79-6.28 compared to comparison patients. This study demonstrated an association between HZO and dementia. Clinicians must be alert to suspect dementia in patients with cognitive impairment who had prior HZO.
Wi, Chung-Il; Kim, Bong-Seong; Mehra, Sonia; Yawn, Barbara P; Park, Miguel A; Juhn, Young J
There is literature that indicates the association of asthma with an increased risk of common and serious microbial infections. We recently reported an increased risk of vaccine-preventable diseases, e.g., herpes zoster (HZ) among children with asthma, defined by predetermined asthma criteria. Little is known about whether this association is persistent if the asthma status is defined by different asthma criteria, e.g., the Asthma Predictive Index, given the heterogeneity of asthma. To assess the consistency of the association between asthma and the risk of HZ in children. This is a population-based case-control study based on all pediatric patients with HZ between 1996 and 2001 in Olmsted County, Minnesota, and 1:1 age- and sex-matched controls without a history of HZ who were enrolled in our previous study. The original Asthma Predictive Index criteria was operationalized by two or more wheezing episodes in a year for the first 3 years of life plus one of the major (physician-diagnosed asthma for a parent or physician-diagnosed eczema for a patient) or two of the minor criteria (physician-diagnosed allergic rhinitis for a patient, wheezing apart from cold, or eosinophilia [≥4%]). Data were fit to traditional logistic regression models to calculate odds ratios and 95% confident intervals. Of the original cohort (n = 554), 95 (17%) did not meet the enrollment criteria for this study, which left 459. Of the 221 patients, 53% were female, with a mean (standard deviation) age of 9.7 ± 4.2 years. The risk of HZ was increased in children with asthma defined by the API controlling for a varicella vaccine history and atopic status (adjusted odds ratio 2.56 [95% confidence interval, 1.08-6.56]). The association between asthma and increased risk of HZ in children and adolescents is consistent, independent of asthma definitions. Asthma might be an important clinical condition to be considered in HZ vaccine studies.
Yan, Chen; Laguna, Benjamin A; Marlowe, Lauren E; Keller, Michael D; Treat, James R
Simultaneous involvement of herpes zoster in multiple dermatomes is uncommon, and even more so in immunocompetent individuals. We report a case wherein a healthy adolescent boy presented with herpes zoster in two distinct dermatomes, raising concern for immunodeficiency, but he was found to be immunocompetent on further testing. A 14-year-old boy with no significant past medical history developed painless vesicular eruptions in two distinct distributions. Varicella zoster virus polymerase chain reaction was positive from unroofed vesicles in both regions. Initial laboratory studies disclosed abnormalities of unknown significance in natural killer (NK) cell percentage and function. The patient was treated with appropriate antiviral therapy. Repeat studies while healthy were not suggestive of an underlying NK cell defect. There are few case reports describing herpes zoster in two or more dermatomes in children. Previously described presentations most commonly occurred in the context of primary immunodeficiency, acquired immunodeficiency, or immunosuppressive medications. Because of the rarity of this presentation in immunocompetent patients, the authors recommend a thorough immune evaluation of all children presenting with isolated multidermatomal zoster. © 2014 Wiley Periodicals, Inc.
Opstelten, Wim; van Essen, Gerrit A; Hak, Eelko
As part of a series of studies on vaccine acceptance, we assessed determinants of compliance of the community-dwelling elderly with herpes zoster (HZ) vaccination in an existing influenza vaccination program. General practitioners (GPs) sent out a questionnaire to 1778 patients aged > or =65 years,
Wackym, P A
In 1907 J. Ramsay Hunt suggested that herpes zoster oticus resulted from a geniculate ganglionitis; however, many contemporary authors believe that this disorder represents a neuritis or polycranial neuropathy. Herpes varicella-zoster viral (VZV) DNA was identified, using the polymerase chain reaction, in archival celloidin-embedded temporal bone sections from two patients who clinically had Ramsay Hunt syndrome (herpes zoster oticus). The presence of VZV was confirmed by sequencing the PCR products. These experiments demonstrated that VZV genomic DNA was present in the geniculate ganglion of the side with facial paralysis and cutaneous recrudescence in both patients and in the clinically unaffected side in patient 1. In addition, patient 2 had a sudden hearing loss and was found to have VZV genomic DNA in sections from the affected side containing the spiral ganglion, Scarpa's ganglion, organ of Corti, and macula of the saccule. No VZV genomic DNA was identified in temporal bone sections from five patients with Bell's palsy and ten patients without evidence of otologic disease. In this study, the histopathology of these two cases yielded complementary information regarding the role of VZV in herpes zoster oticus. These data suggest that in patients with Ramsay Hunt syndrome, latent VZV is located in the geniculate ganglia and may be present in the auditory and vestibular primary afferent ganglia in some patients.
Krol, Anneke; Lensen, Ruud; Veenstra, Jan; Prins, Maria; Schuitemaker, Hanneke; Coutinho, Roel A.
The association between the presence of CCR5 Delta32 heterozygosity and incidence of clinical herpes zoster was studied among 296 homosexual men from the Amsterdam cohort study (ACS) infected with human immunodeficiency virus type I (HIV-1) with an estimated date of seroconversion. Of them 63 were
Salleras, Luis; Salleras, Montse; Salvador, Patricia; Soldevila, Núria; Prat, Andreu; Garrido, Patricio; Domínguez, Angela
The objective of the study was to analyze the descriptive epidemiology and costs of herpes zoster (HZ) and postherpetic neuralgia (PHN) in people aged ≥50 years in Catalonia (Spain). The incidence of HZ in Catalonia was estimated by extrapolating the incidence data from Navarre (Spain) to the population of Catalonia. The incidence of PHN was estimated according to the proportion of cases of HZ in the case series of the Hospital del Sagrado Corazón de Barcelona that evolved to PHN. Drug costs were obtained directly from the prescriptions included in the medical record (according to official prices published by the General Council of the College of Pharmacists). The cost of care was obtained by applying the tariffs of the Catalan Health Institute to the number of outpatient visits and the number and duration of hospital admissions. The estimated annual incidence of HZ was 31 763, of which 21 532 (67.79%) were in patients aged ≥50 years. The respective figures for PHN were 3194 and 3085 (96.59) per annum, respectively. The mean cost per patient was markedly higher in cases of PHN (916.66 euros per patient) than in cases of HZ alone (301.52 euros per patient). The cost increased with age in both groups of patients. The estimated total annual cost of HZ and its complications in Catalonia was € 9.31 million, of which 6.54 corresponded to HZ and 2.77 to PHN. This is the first Spanish study of the disease burden of HZ in which epidemiological data and costs were collected directly from medical records. The estimated incidence of HZ is probably similar to the real incidence. In contrast, the incidence of PHN may be an underestimate, as around 25% of patients in Catalonia attend private clinics financed by insurance companies. It is also probable that the costs may be an underestimate as the costs derived from the prodromal phase were not included. In Catalonia, HZ and PHN cause an important disease burden (21 532 cases of HZ and 3085 de PHN with an annual cost
Rampakakis, Emmanouil; Pollock, Clare; Vujacich, Claudia; Toniolo Neto, Joao; Ortiz Covarrubias, Alejandro; Monsanto, Homero; Johnson, Kelly D
Herpes zoster (HZ) is characterized by debilitating pain and blistering dermatomal rash. The most common complication of HZ is postherpetic neuralgia (PHN), a persistent pain that can substantially affect patients' quality of life. HZ has significant impact on patients' lives with considerable implications for healthcare systems and society. The purpose of this study was to evaluate the healthcare resource utilization (HCRU) and medical costs associated with HZ in Latin America. We conducted a pooled-analysis of three prospective cohort studies of HZ patients ≥50 years of age in Argentina (n=96); Brazil (n=145) and Mexico (n=142). Patients were recruited at different time-points during their HZ episode and were followed for six months. The incidence of PHN was defined as a worst ZBPI pain score of ≥3, persisting or appearing more than 90 days after the onset of rash. Work effectiveness was measured on a 100-point Likert scale where 100 was described as completely effective (able to work like before HZ began) and 0 as not effective at all. Direct costs included costs due to use of antiviral medications and all medical services used to treat HZ. Indirect cost was based on foregone earnings from patients due to work loss and presenteeism, and work loss by family caretakers. One-way sensitivity analysis was performed to assess the impact on total costs. All costs are reported in 2015 USD currency. 383 HZ patients were included and PHN incidence was 38.6%. The most commonly used resources were visits to the doctor's office (79.1% of patients), the emergency room (48.8%) and a specialist (37.9%); hospitalization was reported for 5.7% of patients. The overall direct cost per case was $763.19 USD, indirect cost was $701.40, for a total of $1,464.59 per HZ episode in Latin America. Total cost associated with HZ in patients with PHN was markedly higher compared to patients without PHN ($2,001.13 vs. $867.72, respectively) with indirect costs accounting for the most part
Ferahta, Nabila; Achek, Imene; Dubourg, Julie; Lang, Pierre-Olivier
A vaccination against herpes zoster and its complication is available in France since June 2015. Its exact benefit for public health is still controversial and its level of protection is not optimal. All those reasons seem to suggest a low acceptation rate from general practitioners. To evaluate the effectiveness, the safety, and the cost/benefit ratio of the vaccination against herpes zoster in people aged 50 year or over. Systematic review in Medline and PubMed with research by key words: "herpes zoster vaccine", "zoster vaccine" and "post herpetic neuralgia vaccine". Randomized and observational studies published in English and French language have been selected by two readers. On 1886 articles identified, 62 studies were included in this systematic review of which 21 randomized trials, 21 observational studies, and 17 medico-economic studies concerned the unadjuvanted vaccine. Considered studies showed an effectiveness of 50% against herpes zoster and 60% on post-herpetic neuralgia incidence of the unadjuvanted vaccine. Five randomized controlled studies were identified for the adjuvanted vaccine. The overall effectiveness of this vaccine was > 90% whatever the age of subjects including those over age 70 and 80. The medico-economic studies conducted in many countries have shown that vaccine policies were beneficial in individuals aged 60 years or over. Most of data of effectiveness, and tolerance result from 2 large controlled studies only (SPS and ZEST) for the unadjuvanted vaccine and only one for the adjuvanted vaccine. Despite controversy and few uncertainties, the vaccine significantly reduces herpes zoster and its complication incidence. In terms of public health objectives, it reduces the burden of the disease and has a positive medico-economic impact. Preliminary data concerning the adjuvanted vaccine, whilst very promising, are still too limited. Up to now, no group of people with particularly high risk of herpes zoster-related complication who will
Chung, Wei-Sheng; Lin, Hsuan-Hung; Cheng, Nan-Cheng
.... Studies on sleep disorders and the risk of herpes zoster (HZ) are scant.We conducted a population-based cohort study to evaluate the risk of HZ in patients with sleep disorders and potential risk factors for HZ development...
Park, Seong Yeon; Kim, Ji Yeun; Kim, Ji-Ae; Kwon, Ji-Soo; Kim, Sun-Mi; Jeon, Na Young; Kim, Min-Chul; Chong, Yong Pil; Lee, Sang-Oh; Choi, Sang-Ho; Kim, Yang Soo; Woo, Jun Hee; Kim, Sung-Han
We evaluated the diagnostic usefulness of polymerase chain reaction (PCR) analysis for detecting varicella-zoster virus (VZV) infection and reactivation of VZV, using DNA extracted from saliva and plasma specimens obtained from subjects with suspected herpes zoster and from healthy volunteers during stressful and nonstressful conditions. There were 52 patients with a diagnosis of herpes zoster (group 1), 30 with a diagnosis of zoster-mimicking disease (group 2), and 27 healthy volunteers (group 3). Saliva and plasma samples were evaluated for VZV DNA by real-time PCR analysis. Among patients with suspected herpes zoster (ie, patients in groups 1 and 2), the sensitivity of PCR analysis of salivary DNA for detecting VZV (88%; 95% confidence interval [CI], 74%-95%) was significantly higher than that of PCR analysis of plasma DNA (28%; 95% CI, 16%-44%; P .99). VZV DNA was not detected in saliva and plasma samples from group 3 (0%; 95% CI, 0%-14%). Real-time PCR analysis of salivary DNA is more sensitive than that of plasma DNA for detecting VZV among patients with suspected herpes zoster. We found no subclinical reactivation of VZV in group 3 following exposure to common stressful conditions.
Gary J Bennett
Full Text Available OBJECTIVES: The history behind the current understanding of the varicella-zoster virus and its relationship to the pain conditions caused by shingles and postherpetic neuralgia are reviewed. The framework for the current conceptualization is Hope-Simpson’s latency hypothesis. Data from recent work in virology, neuroanatomy and epidemiology are reviewed, as is work using varicella-zoster virus-infected animals. The recent data largely confirm Hope-Simpson’s hypothesis and extend it significantly.
Bennett, Gary J.; Watson, C Peter N
OBJECTIVES: The history behind the current understanding of the varicella-zoster virus and its relationship to the pain conditions caused by shingles and postherpetic neuralgia are reviewed. The framework for the current conceptualization is Hope-Simpson’s latency hypothesis. Data from recent work in virology, neuroanatomy and epidemiology are reviewed, as is work using varicella-zoster virus-infected animals. The recent data largely confirm Hope-Simpson’s hypothesis and extend it significant...
Susana Lazarte Heraud
Full Text Available Objetivo: Evaluar la frecuencia de infección por VIH en pacientes que consultan por episodio agudo de herpes zoster. Material y Métodos: Se incluyeron a todos los pacientes entre 18 y 49 años, atendidos entre setiembre del 2001 y enero del 2003 en el Departamento de Enfermedades Infecciosas, Tropicales y Dermatológicas del Hospital Nacional Cayetano Heredia, por un cuadro agudo de herpes zoster, diagnosticado clínicamente. Los criterios de inclusión fueron: status VIH desconocido tanto del paciente como de su pareja; que no presentaran alguna complicación neurológica o presentación atípica de zoster y que no tuvieran signos ni síntomas compatibles con infección por VIH (muguet oral, diarrea crónica, síndrome de desgaste, etc.. Previa firma de consentimiento informado, se tomó muestra de sangre para prueba de ELISA para VIH1. A todos los pacientes con resultado positivo se les realizó western blot. Resultados: Veintiún pacientes cumplieron los criterios del estudio, 14 varones y 7 mujeres. Cinco pacientes (23,8% fueron VIH positivos. De éstos, 4 fueron varones (4/14 y 1 mujer (1/7. No se encontró diferencias significativas en cuanto a la conducta sexual de riesgo. Conclusiones: Se encuentra un porcentaje elevado de infección por VIH en adultos jóvenes que consultan en un hospital general por un cuadro agudo de herpes zoster, sin ningún otro signo ni síntoma de inmunosupresión, independientemente de conductas sexuales de riesgo. Nuestro hallazgo justifica un despistaje de VIH en adultos jóvenes con herpes zoster.
Xie, K Y; Ma, J B; Xu, Q; Huang, B; Yao, M; Ni, H D; Deng, J J; Chen, G D
Objective: To determine the dose-response relationship of ropivacaine for epidural block in early herpes zoster by CT guided. Methods: From January 2015 to February 2017, according to the principle of completely random digital table, 80 patients with early herpes zoster who were prepared for epidural block were divided into 4 groups(each group 20 patients): in group A the concentration of ropivacaine was 0.08%, in group B was 0.10%, in group C was 0.12% and in group D was 0.14%.Under CT guidance, epidural puncture was performed in the relevant section, mixing liquid 5.0 ml (with 10% iodohydrin)were injected into epidural gap.CT scan showed that the mixing liquid covered the relevant spinal nerve segmental.The numeric rating scale(NRS) values before treatment and at 30 minutes, the incidence of adverse reactions were recorded, and the treatment were evaluated. The response to ropivacaine for epidural block in early herpes zoster was defined as positive when the NRS values was less than or equal to one.The ED(50), ED(95) and 95% confidence interval ( CI ) of ropivacaine for epidural block in early herpes zoster guided by CT were calculated by probit analysis. Results: The NRS values before treatment were 5.00(4.00, 6.00), 5.00(4.25, 6.00), 5.50(5.00, 6.00) and 5.00(4.00, 6.00), the difference was no significant( Z =2.576, P =0.462). The NRS values at 30 minutes decreased and the effective rate of the treatment increased(χ(2)=8.371, P =0.004), following ropivacaine dose gradient increasing, they were 1.50(1.00, 2.00), 1.00(1.00, 2.00), 0.50(0.00, 1.00) and 0.00(0.00, 1.00), the difference was statistically significant ( Z =17.421, P =0.001). There was one case in group C and four cases in group D were hypoesthesia, others were no significant adverse reactions occurred. The ED(50) and ED(95) (95% CI ) of ropivacaine for epidural block in early herpes zoster guided by CT were 0.078%(0.015%-0.095%)and 0.157%(0.133%-0.271%), respectively. Conclusion: Ropivacaine for
Full Text Available BACKGROUND AND OBJECTIVE: Varicella zoster virus (VZV is known to cause VZV vasculopathy, which may be associated with stroke. A recent study found an increased risk of stroke within one year of herpes zoster. We aimed to investigate the short and long-term effects of herpes zoster on the risk of stroke. METHODS: Using Danish national registers, we constructed a cohort consisting of all Danish adults ≥18 years old between 1995 and 2008 (n = 4.6 million; person-years of follow-up = 52.9 million. Individual-level information on prescriptions for herpes zoster antiviral treatment and diagnoses of stroke was obtained from national registers. We compared the risk of stroke in persons who had received the specific dosage of acyclovir for herpes zoster with persons who had never received antiviral treatment by Poisson regression. RESULTS: During follow-up, 2.5% received treatment for herpes zoster and 5.0% were diagnosed with stroke. Individuals who had received medication had a 127% (95% CI 83-182% increased risk the first two weeks, 17% (CI 9-24% between two weeks and one year, and 5% (2-9% after the first year. The increased risk was greatest in the youngest age group (<40. To control for healthcare-seeking behaviour, we conducted parallel analyses investigating the risk of selected fractures after herpes zoster and found no similar increased risks. CONCLUSIONS: This large nationwide cohort study found an increased risk of stroke after treatment for herpes zoster. Although the short-term risk was particularly high, we cannot rule out the possibility of a small but important long-term risk.
Berry, James D; Rowbotham, Michael C; Petersen, Karin Lottrup
Complex Regional Pain Syndrome (CRPS) associated with herpes zoster (HZ) was first reported by Sudeck in 1901 (Sudeck, 1901) and is recognized clinically. However, only 13 cases have been published in the literature, and nothing is known about the incidence, prevalence, or natural history (Chester, 1992; Foster et al., 1989; Grosslight et al., 1986; Ketz and Schliack,1968; Kishimoto et al., 1995; Querol and Cisneros, 2001; Sudeck, 1901; Visitsunthorn and Prete, 1981). The aim of the present study was to determine the prevalence of CRPS-like symptoms in a prospectively gathered cohort of subjects with HZ and to follow the natural history of their pain and sensory disturbance during the first 6 months after onset of HZ. Subjects were evaluated at four time points after HZ: 2-6 weeks, 6-8 weeks, 3 months, and 6 months. Only subjects aged 50 or older with pain VAS ratings of >/=20/100 at 2-6 weeks were eligible. The first (screening) visit included a neurological and physical examination that was updated at each subsequent visit. Assessments included ratings of pain intensity, allodynia severity, and rash severity. The neurological exam included determination of presence or absence of the following CRPS-like symptoms: (1) increased sweating, (2) color changes, (3) skin temperature changes, (4) weakness of the affected area based on physical exam, (5) edema, and (6) extension of CRPS-like symptoms outside the affected dermatome. For subjects with HZ in dermatomes that can include the limbs (C4-T2 and L1-S2), extremity involvement was considered present if allodynia or rash extended beyond the neck of the humerus (upper extremity), the inguinal ligament (anterior lower extremity), or gluteal sulcus (posterior lower extremity). Involvement of the extremity was considered proximal if neither HZ rash nor allodynia extended past the elbow (upper extremity) or knee (lower extremity). Of the first 75 subjects recruited, 25 had HZ outbreaks in dermatomes that extended into the
Carlos A. M. Guerreiro
Full Text Available Um caso de acidente vascular cerebral (AVC 14 semanas após a instalação de herpes zoster oftálmico (HZO é apresentado. A tomografia computadorizada craniana documentou comprometimento em território de artéria cerebral média ipsilateral ao HZO. O diagnóstico de probabilidade é o de arterite por herpes zoster com posterior trombose. Os autores reviram a literatura e enfatizam o longo intervalo entre o HZO e a instalação da hemiplegia. Citam as novas drogas antivirais que tornam esta causa de AVC potencialmente passível de ser prevenida.
Ana Isabel Gouveia
Full Text Available Viral infections in renal transplant patients are an important cause of morbidity and mortality. In most cases, the clinical presentation of herpes zoster allows the diagnosis to be made only by history and physical examination. However, patients who are immunosuppressed may have uncommon presentations, and require a high index of suspicion and additional diagnostic testing for proper management. We report a rare presentation of herpes zoster duplex bilateralis involving symmetrical dermatomes over the lower limbs occurring in a woman with a recent history of renal transplantation. The skin lesions were also atypical representing a diagnostic challenge. This infection should be part of differential diagnosis of cutaneous manifestations in organ transplant recipients.
Preeti Chawla Arora
Full Text Available Herpes zoster (HZ infection of the maxillary and mandibular divisions of the trigeminal nerve manifests orally as unilateral vesicular eruption localized to the skin and mucus membrane of the dermatome innervated by the trigeminal nerve. Herpes zoster infection has been observed in immunocompromised states like uncontrolled diabetes, cancer chemotherapy, lymphoproliferative diseases, and recently in HIV-positive patients. There are only a few case reports of osteonecrosis due to HZ in an HIV-positive patient in an Indian population, this being the first in a North Indian population. We propose that osteonecrosis should be considered as a strong indicator of HIV infection, especially in a developing country like India. The present case highlights the complexities which can arise in an HIV-inflicted individual suffering from HZ infection. Early diagnosis of such infections can lead to effective treatment and prevention of complications.
Full Text Available Three hundred patients of different ages were sequentially assigned three therapy groups (100 in each group viz. phenytoin, steroid (prednisolone and carbamazepine. Effect of these drugs on herpes zoster neuralgia and in prevention of post herpetic neuralgia was studied. Phenytoin was found to be superior to both steroid and carbamazepine in relieving the pain of herpes zoster and in reducing the incidence of post herpetic neuralgia. Only 16.1% of the patients in phenytoin treated group developed post herpetic neuralgia lasting for 2-4 weeks while 22.7% and 29.6% of the steroid and carbamazepine treated patients respectively developed post herpetic neuralgia and that too lasting for longer duration. No patient under 40 years developed post herpetic neuralgia.
Sánchez-Guerra, M; Infante, J; Pascual, J; Berciano, J; Polo, J
The neurologic complications associated with herpes zoster are infrequent except for postherpetic neuralgia. The aim of this study was to review the clinical profile and the distribution of these complications in a retrospective series of patients. A retrospective analysis of the last 100 patients admitted with the diagnosis of herpes zoster with neurologic complications to our center from 1992 to 1999 by the Departments of Internal Medicine and Neurology was performed. The characteristics of the complications other than postherpetic neuralgia are reported. Aside from the 88 patients with postherpetic neuralgia, the 12 remaining patients presented other complications: seven different peripheral neuropathies, including three with Ramsay-Hunt syndrome, two meningitis, one encephalitis and one myelitis. In addition, one patient had ophthalmic herpes zoster with cerebral vasculopathy as ipsilateral Wallenberg's syndrome. Nine patients (75%) were males, four (25%) were under the age of 20 years and seven older than 60 years and only three were immunodepressed. The CSF was abnormal in six out of the eight patients in whom it was studied with lymphocytic pleocytosis being shown on analysis without qualitative or quantitative alteration in intrathecal synthesis of IgG. In the immunosuppressed patients the serology in the CSF of the varicela zoster virus was negative. All patients demonstrated regressive evolution following treatment with acyclovir. Neurologic complications other than postherpetic neuralgia occurred in 12% of the patients of this series, there was male predominance and peripheral neuropathies were the most frequent complications. Serology of the varicela zoster virus in immunosuppressed patients may be negative. In this series the prognosis was mainly satisfactory.
Cao, Huijuan; Zhu, Chenjun; Liu, Jianping
Wet cupping is a traditional Chinese medicine therapy commonly used in treating herpes zoster in China, and clinical studies have shown that wet cupping may have beneficial effect on herpes zoster compared with Western medication. We included randomized controlled trials (RCTs) on wet cupping for herpes zoster. We searched PubMed, the Cochrane Library (Issue 3, 2008), China Network Knowledge Infrastructure (CNKI), Chinese Scientific Journals Fulltext Database VIP, and Wan Fang Database. All searches ended in February 2009. Two authors extracted data and assessed the trials' quality independently. RevMan 5.0.18 software (The Cochrane Collaboration, The Nordic Cochrane Centre, Copenhagen, Denmark) was used for data analysis with effect estimate presented as relative risk (RR) and mean difference (MD) with a 95% confidence interval (CI). Eight RCTs involving 651 patients were included, and the methodological quality of trials was generally fair in terms of randomization, blinding, and intention-to-treat analysis. Meta-analyses showed wet cupping was superior to medication in the number of cured patients (RR 2.49, 95% CI 1.91 to 3.24, P cupping plus medication was significantly better than medication alone on number of cured patients (RR 1.93, 95% CI 1.23 to 3.04, P = .005) but demonstrated no difference in symptom improvement (RR 1.00, 95% CI 0.92 to 1.08, P = .98). There were no serious adverse effects related to wet cupping therapy in the included trials. Wet cupping appears to be effective in the treatment of herpes zoster. However, further large, rigorously designed
Cao, Huijuan; Zhu, Chenjun; Liu, Jianping
Background Wet cupping is a traditional Chinese medicine therapy commonly used in treating herpes zoster in China, and clinical studies have shown that wet cupping may have beneficial effect on herpes zoster compared with western medication. Methods We included randomized controlled trials on wet cupping for herpes zoster. We searched PubMed, the Cochrane Library (Issue 3, 2008), China Network Knowledge Infrastructure (CNKI), Chinese Scientific Journal Database (VIP), and Wan Fang Database. All searches ended in February 2009. Two authors extracted data and assessed the trials quality independently. RevMan 5.0.18 software was used for data analysis with effect estimate presented as relative risk (RR) and mean difference (MD) with a 95% confidence interval (CI). Results 8 RCTs involving 651 patients were included, and the methodological quality of trials was generally fair in terms of randomization, blinding and intention-to-treat analysis. Meta-analyses showed wet cupping was superior to medications regarding the number of cured patients (RR 2.49, 95%CI 1.91 to 3.24, pcupping plus medications was significantly better than medications alone on number of cured patients (RR 1.93, 95%CI 1.23 to 3.04, p=0.005), but no difference in symptom improvement (RR 1.00, 95%CI 0.92 to 1.08, p=0.98). There were no serious adverse effects with related to wet cupping therapy in the included trials. Conclusions Wet cupping appears to be effective in treatment of herpes zoster. However, further large, rigorous designed trials are warranted. PMID:21280462
Zografakis, Charalampos; Tiniakos, Dina G; Palaiologou, Marina; Kouloukoussa, Mirsini; Kittas, Christos; Staurianeas, Nikos
Herpes zoster neural injury was assessed by determining cutaneous nerve density in skin biopsies from the affected dermatomes of 35 adult patients with herpes zoster in the acute phase and 3 months post-treatment, using protein gene product 9.5 immunohistochemistry. In contrast to the significant increase in subepidermal nerve fibre density (11.77 ± 4.88/mm vs. 13.29 ± 5.74/mm, p = 0.045) after 3 months, no differences were found in epidermal free nerve endings (2.43 ± 2.35/mm and 2.8 ± 2.86/mm, p = 0.168). Patients with post-herpetic neuralgia had significantly lower subepidermal nerve fibre densities (9.7 ± 2.05/mm vs. 14.72 ± 6.13/mm, p = 0.011) compared with non-post-herpetic neuralgia patients. No differences in cutaneous nerve density were found in relation to antiviral therapy. In conclusion, 3 months after acute infection, no sign of epidermal innervation recovery is observed, while the increased subepidermal nerve fibre density in the affected dermatomes probably reflects nerve regeneration that is not affected by antiviral agent type. Subepidermal nerve fibre density is decreased in patients with post-herpetic neuralgia 3-months post-acute herpes zoster infection.
Herpes zoster most commonly occurs in elderly patients, and usually affects sensory neurons. Therefore, its characteristic symptoms are segmental pain, itching, and sensory changes in the affected areas. A 71-yr-old woman experienced painful herpetic rash on the right cervical 2–4 dermatomes for 16 days. Two days after the onset of the rash, she was diagnosed with herpes zoster, and prescribed 250 mg famciclovir three times a day for 7 days, pregabalin 150 mg twice a day, and tramadol 150 mg once a day for 14 days, by a dermatologist. Despite medication, her pain was rated at an intensity of 6/10 on the numeric rating scale. In addition, she complained of severe itching sensation on the affected dermatomes. Superficial cervical plexus block (SCPB) was performed at the right C4 level with 15 ml 0.5% lidocaine plus triamcinolone 30 mg. Five days after the procedure, pain and itching completely disappeared. SCPB may be an effective option for the treatment of acute pain and itching arising from herpes zoster, and for the prevention of postherpetic neuralgia. PMID:28879287
Ota, Tomohiro; Yamazaki, Mineo; Toda, Yusuke; Ozawa, Akiko; Kimura, Kazumi
A 66-year-old man presented with headache and ophthalmalgia. Diplopia developed, and he was hospitalized. The left eye had abducent paralysis and proptosis. We diagnosed him with Tolosa-Hunt syndrome and administered methylprednisolone at 1 g/day for 3 days. However, the patient did not respond to treatment. No abnormality was found on his MRI or cerebrospinal fluid examination. Tests showed his serum immunoglobulin G4 and antineutrophil cytoplasmic antibody titers were within normal limits. He also had untreated diabetes mellitus (HbA1c 9.2). One week after first presenting with symptoms, herpes zoster appeared on the patient's dorsum nasi, followed by keratitis and a corneal ulcer. Herpes zoster ophthalmicus with ophthalmoplegia was diagnosed. We began treatment with acyclovir (15 mg/kg) and prednisolone (1 mg/kg, decreased gradually). Ophthalmalgia and the eruption improved immediately. The eye movement disorder improved gradually over several months. It is rare that diplopia appears prior to cingulate eruption of herpes zoster ophthalmicus. We speculated that onset of the eruption was inhibited by strong steroid therapy and untreated diabetes mellitus.
Maskew, Mhairi; Ajayi, Toyin; Berhanu, Rebecca; Majuba, Pappie; Sanne, Ian; Fox, Matthew P.
Summary Objectives To describe the characteristics of HIV-infected patients experiencing herpes zoster after antiretroviral therapy (ART) initiation and to describe the incidence and predictors of a herpes zoster diagnosis. Methods Adult patients initiating ART from April 2004 to September 2011 at the Themba Lethu Clinic in Johannesburg, South Africa were included. Patients were followed from ART initiation until the date of first herpes zoster diagnosis, or death, transfer, loss to follow-up, or dataset closure. Herpes zoster is described using incidence rates (IR) and predictors of herpes zoster are presented as subdistribution hazard ratios (sHR) and 95% confidence intervals (95% CI). Results Fifteen thousand and twenty-five patients were included; 62% were female, the median age was 36.6 years, and the median baseline CD4 count was 98 cells/mm3. Three hundred and forty patients (2.3%) experienced herpes zoster in a median of 26.1 weeks after ART initiation. Most (71.5%) occurred within 1 year of initiation, for a 1-year IR of 18.1/1000 person-years. In an adjusted model, patients with low CD4 counts (herpes zoster (sHR: 1.53, 95% CI: 0.97–2.28) were at increased risk of incident herpes zoster. Conclusions While only 2% of patients were diagnosed with herpes zoster in this cohort, patients with low CD4 counts and those with prior episodes of herpes zoster were at higher risk for a herpes zoster diagnosis. PMID:24680820
Full Text Available Herpes zoster infection and stroke are highly prevalent in the general population; however, reports have presented inconsistent findings regarding the relationship between herpes zoster infection and stroke. In this meta-analysis, we aimed to clarify this association.The PubMed and Embase databases were searched for studies published from their inception to January 2016. Two investigators independently extracted the data. The pooled relative risk (RR was calculated using a random effects model.A total of 8 studies met the inclusion criteria. During the first 1 month after herpes zoster infection, the pooled RRs for ischemic stroke and hemorrhagic stroke were 1.55 (95% CI, 1.46-1.65 and 1.70 (95% CI, 0.73-3.96, respectively, and within 3 months after infection, the corresponding RRs were 1.17 (95% CI, 1.12-1.23 and 2.05 (95% CI, 1.17-3.60, respectively. At 1 year and more than 1 year after herpes zoster infection, a significant relationship was not observed between herpes zoster infection and the incidence of ischemic and hemorrhagic stroke. Publication bias was not observed.The accumulated evidence generated from this systematic review indicates that an increased risk for ischemic stroke occurred in the short term after herpes zoster infection, whereas a significant relationship was not observed in the long term after infection. With respect to hemorrhagic stroke, the association was not significant. With respect to hemorrhagic stroke, the association between was not significant except within 3 months after a herpes zoster infection.
Catarina S. Oliveira
Full Text Available A zona resulta da reativação do vírus varicela-zoster, latente na raíz dorsal dos gânglios sensitivos e nos gânglios dos nervos cranianos, após a resolução da varicela. Existem poucos estudos sobre as complicações da zona na população pediátrica. Enquanto que nos adultos está preconizada terapêutica antivírica específica contra o herpes zoster, nas crianças imunocompetentes o tratamento antivírico é questionável.Os adolescentes encontram-se entre estes dois grupos. O aciclovir é o único antivírico aprovado pela FDA para o tratamento da zona em crianças com menos de dois anos de idade. O valaciclovir, que apresenta uma maior biodisponibilidade, encontra-se aprovado como terapêutica contra a zona nos doentes entre os dois e os 17 anos. Descreve-se o caso de um adolescente, com zona, sem antecedentes patológicos de relevo, que sob terapêutica com aciclovir desenvolveu meningite a herpes-zoster. Questiona-se a abordagem clinica mais correta nos adolescentes imunocompetentes com zona.
Full Text Available Tetsu Akimoto, Shigeaki Muto, Daisuke Nagata Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke-Shi, Tochigi, Japan Abstract: Herpes zoster (HZ is caused by the reactivation of a latent varicella-zoster virus (VZV infection within the cranial or dorsal root ganglia. The cutaneous lesions of HZ are typically limited to a single dermatome, while non-contiguous HZ involving two or more dermatomes is a very rare clinical entity. In this report, we describe a case of HZ involving the left and right side of the abdomen corresponding to the T11 dermatome in a 63-year-old man on chronic peritoneal dialysis. The characteristic cutaneous manifestation encouraged us to ascribe the disease to HZ duplex bilateralis, and the patient was given a single dose of oral valacyclovir and achieved a favorable outcome. The therapeutic concerns regarding the reactivation of VZV in patients with end-stage kidney disease are also discussed. Keywords: herpes zoster duplex bilateralis, end-stage kidney disease, peritoneal dialysis, valacyclovir, dermatome
Full Text Available Herpes zoster is a reactivation of the varicella zoster virus (VZV, which may remain dormant in the dorsal root ganglion of the trigeminal nerve for decades after the patient's initial exposure. The ophthalmic branch of the trigeminal nerve, i.e., the innervation to the ocular structures, is one of the most commonly involved dermatomes, giving rise to herpes zoster ophthalmicus (HZO. A 10-year-old indigenous Malaysian girl presented with a complaint of painful blurring of vision in the right eye for one week. It was followed a few days later by cutaneous vesicular eruptions over the right side of her face and nose and drooping of the right upper lid, associated with double vision. In children, the disease usually follows a mild course, resolving without residual damage. However, this child achieved a best corrected visual acuity of only 6/36 in the affected eye due to corneal scarring. The rashes healed by formation of disfiguring keloids over the right nasal area. This is another rarely reported complication of HZO in immunocompetent individuals.
Luis Arthur Brasil Gadelha Farias
Full Text Available A 81-years-old caucasian man presented with acute burning pain in external auricular region and inside the auditory canal of right ear, associated with vesicular lesions on face, jugal and lingual mucosa. Physical examination revealed vesicular lesions in external auricular region and inside the auditory canal. Red blood cell count, leukocytes and platelets were normal. Presented HIV-1 and 2 both negative. Patient denied previous history of Diabetes and Hypertension. Treatment was initiated with Ceftriaxone 2g, Acyclovir 250mg, Prednisone 60mg and Bicarbonate Water for rinsing. After eight days of hospitalization, patient reported hearing loss in the right ear, chewing difficulty and mild pain in face. Auditory hearing loss and hypoacusis may suggest involvement of vestibulocochlear nerve. Figure 1 shows cicatricial crusted lesions following trigeminal nerve mandibular branch trajetory. Figure 2 reveals cicatricial crusted lesions following trigeminal nerve maxilar branch, trigeminal branch and erythematous scarring lesions in tongue, hypoglossal nerve region. Figure 3 reveals small crusted lesions following the trigeminal ophthalmic branch. Herpes zoster is caused by Varicella zoster virus (VZV reactivation in individuals who had Varicella in childhood or who were vaccinated. The presence of more than one dermatome affected is rare in immunocompetent individuals, being more prevalent in immunosuppressed individuals such as HIV positive and transplanted patients.1Disseminated herpes zoster can occur in any immunocompetent patient but predominates in elderly due to factors that compromise cellular immune response. 2,3
Ban, J; Takao, Y; Okuno, Y; Mori, Y; Asada, H; Yamanishi, K; Iso, H
Few studies have examined the impact of cigarette smoking on the risk for herpes zoster. The Shozu Herpes Zoster (SHEZ) Study is a community-based prospective cohort study over 3 years in Japan aiming to clarify the incidence and predictive and immunological factors for herpes zoster. We investigated the associations of smoking status with past history and incidence of herpes zoster. A total of 12 351 participants provided valid information on smoking status and past history of herpes zoster at baseline survey. Smoking status was classified into three categories (current, former, never smoker), and if currently smoking, the number of cigarettes consumed per day was recorded. The participants were under the active surveillance for first-ever incident herpes zoster for 3 years. We used a logistic regression model for the cross-sectional study on the association between smoking status and past history of herpes zoster, and a Cox proportional hazards regression model for the cohort study on the association with risk of incidence. The multivariable adjusted odd ratios (95% CI) of past history of herpes zoster for current vs. never smokers were 0·67 (0·54-0·80) for total subjects, 0·72 (0·56-0·93) for men and 0·65 (0·44-0·96) for women. The multivariable adjusted hazard ratios (95% CI) of incident herpes zoster for current vs. never smokers were 0·52 (0·33-0·81) for total subjects, 0·49 (0·29-0·83) for men and 0·52 (0·19-1·39) for women. Smoking status was inversely associated with the prevalence and incidence of herpes zoster in the general population of men and women aged ⩾50 years.
Sironi, Manuela; Peri, Anna Maria; Cagliani, Rachele; Forni, Diego; Riva, Stefania; Biasin, Mara; Clerici, Mario; Gori, Andrea
Defects in genes of the Toll-like receptor 3 (TLR3) pathway are associated with susceptibility to herpes simplex virus type 1 encephalitis (HSE). We analyzed a cohort of 11 adult Italian patients in whom viral encephalitis developed. We detected 2 rare missense mutations in TLR3: 1 in a patient with HSE (p.Leu297Val) and 1 in a patient with varicella-zoster virus encephalitis (p.Leu199Phe). Both mutations are extremely rare in human populations and have pathogenicity scores highly suggestive of a functional effect. Data herein expand the phenotypic spectrum of TLR3 mutations to varicella-zoster virus encephalitis and support the role of TLR3 genetic defects as risk factors for HSE in adults. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: email@example.com.
Oh, Ha Yeun; Cho, Seong Whi [Dept. of Radiology, Kangwon National University Hospital, Chuncheon (Korea, Republic of); Kim, Sung Hun [Dept. of Neurology, Kangwon National University Hospital, Chuncheon (Korea, Republic of)
Herpes zoster ophthalmicus, in which orbital symptoms and signs appear before the onset of a skin rash, is very rare. We experienced such a case and therefore report on it via magnetic resonance imaging. A 48-year-old man with pain and swelling of left eye and headache presented 2 days before onset of a zoster skin rash. On orbit-al MRI, edematous thickening of the left lateral rectus muscle with high signal intensity was revealed. After contrast injection, the lateral rectus muscle demonstrated heterogenous enhancement. Also, diffuse contrast enhancement was noted at left preseptal space, lacrimal gland and periorbital soft tissue. The man was treated with antiviral agents and prednisolone. Two weeks later, he recovered from the skin manifestations and most of the orbital manifestations except for the diplopia and restricted lateral movement.
Gupta, Amit; Sundaram, Murali [Cleveland Clinic, Section of Musculoskeletal Radiology, Imaging Institute, Cleveland, OH (United States); Winalski, Carl S. [Cleveland Clinic, Section of Musculoskeletal Radiology, Imaging Institute, Cleveland, OH (United States); Cleveland Clinic, Department of Biomedical Engineering, Lerner Research Institute, Cleveland, OH (United States)
Herpes zoster is a common disorder characterized by a painful rash along a dermatome caused by reactivation of the varicella zoster virus (VZV). Muscle denervation injury from motor involvement is an uncommon phenomenon. Discordant distribution of the skin rash and motor nerve involvement, presenting as a skin rash in one body part and muscle weakness or pain from nerve involvement in another body part is an even more uncommonly reported finding. We present an unusual case of muscle denervation injury resulting from motor involvement of a peripheral nerve by VZV diagnosed by magnetic resonance imaging with cutaneous manifestations in a different dermatomal distribution. To the best of our knowledge, there has been no similar case reported in the English radiology literature. We suggest that whenever a radiologist notices MRI findings suggesting denervation injury and a cause not readily identified, VZV-related denervation injury should be included in the differential diagnosis, especially in an older immunocompromised patient. (orig.)
de Juan, Victoria; Martín, Raúl; Rodríguez, Guadalupe
Empirical fitting of a bitoric rigid gas permeable contact lens for the management of a scarred irregular cornea caused by herpes zoster ophthalmicus is described. Two corneal scars, which affect the pupil axis, caused an irregular cornea and produced low visual acuity and anisometropia. Two contact lenses were necessary to complete the fitting. Visual acuity improved from 0.2 to 1.0. The rigid gas permeable lenses can be a good alternative in the management of patients with irregular corneas caused by herpes zoster ophthalmicus. © 2011 The Authors. Clinical and Experimental Optometry © 2011 Optometrists Association Australia.
Full Text Available Herpes zoster (HZ is often associated with painful erythematous vesicular eruptions of the skin or mucous membranes. Approximately 10% to 30% of the population will suffer from HZ during their lifetime. HZ is infrequent in healthy children. However, diminished cellular immunity seems to increase risk of reactivation because incidence increases with age and in immunocompromised states. We report a 7-year-old girl with acute myeloblastic leukemia HZ infection on the right palmar, elbow and forearm region (C7, C8 and T1 dermatomes. We want to indicate unusual localization of HZ on the acute myeloblastic leukemia child patient.
A 62-year-old-man treated for nephrotic syndrome with steroid developed acute pain of herpes zoster after immobility of the shoulder. Steroids might have suppressed the first symptoms of pain. But immobility probably appeared as VZV infection developing to spinal ventral root. Suprascapular nerve block was effective for severe pain of the right arm. Sympathetic nerve contained in suprascapular nerve might have been blocked. Sympathetically maintained pain may occur when primary afferent neurons are excited by inflammation due to VZV infection. Pain was abolished 17 weeks after the onset of rash using blocks three times and amitriptyrin and valproic acid. Immobility was resolved seven months after the onset of rash.
Sato, Keiko; Adachi, Koichi; Nakamura, Hiroyuki; Asano, Kazuhiro; Watanabe, Akihiro; Adachi, Riri; Kiuchi, Mariko; Kobayashi, Keiju; Matsuki, Taizo; Kaise, Toshihiko; Gopala, Kusuma; Holl, Katsiaryna
Approximately one in three persons will develop herpes zoster during their lifetime, and it can lead to serious complications such as postherpetic neuralgia. However, evidence on burden of herpes zoster and postherpetic neuralgia in Japan is limited. This prospective, observational, multicenter, physician practice-based cohort study was conducted in Kushiro, Hokkaido, Japan (Clinicaltrials.gov identifier NCT01873365) to assess the incidence and hospitalization rates of herpes zoster, and the proportion, clinical burden and risk factors for postherpetic neuralgia in adults aged 60 years or more. Within the study area, 800 subjects developed herpes zoster and 412 were eligible for the study. Herpes zoster incidence was 10.2/1000 person-years and higher among women and older subjects. Subjects with herpes zoster required on average 5.7 outpatient consultations. Herpes zoster-associated hospitalization rate was 3.4% (27/800). The proportion of postherpetic neuralgia and other complications was 9.2% (38/412) and 26.5% (109/412), respectively. Statistically significant association with the development of postherpetic neuralgia was male sex (odds ratio [OR], 2.51; 95% confidence interval [CI], 1.17-5.38), age of 70-74 years (OR, 3.51; 95% CI, 1.09-11.3), immunosuppressive therapy (OR, 6.44; 95% CI, 1.26-32.9), severe herpes zoster pain at first consultation (OR, 3.08; 95% CI, 1.10-8.62) and rash on upper arms (vs no rash on upper arms; OR, 3.46; 95% CI, 1.10-10.9). Considerable herpes zoster and postherpetic neuralgia burden exists among elderly in Japan, and there may be predictive factors at the first visit which could be indicative of the risk of developing postherpetic neuralgia. © 2016 The Authors. The Journal of Dermatology published by John Wiley & Sons Australia, Ltd on behalf of Japanese Dermatological Association.
Full Text Available Herpes zoster (HZ (shingles results due to reactivation of varicella-zoster virus. Unusual dental complications like osteonecrosis, exfoliation of teeth, periodontitis, and calcified and devitalized pulps, periapical lesions, and resorption of roots as well as developmental anomalies such as irregular short roots and missing teeth may arise secondary to involvement of 2 nd or 3 rd division of trigeminal nerve by HZ. Such cases pose both a diagnostic as well as a therapeutic challenge. We report two such rare dental complications of HZ-spontaneous tooth exfoliation and osteonecrosis of the maxilla in a 70-year-old female patient; and multiple periapical pathoses affecting right half of the mandibular teeth in a 45-year-old female patient. Both the patients did not have any associated systemic illness. The aim of this paper was to compare the present cases with all the 46 cases of osteonecrosis and 6 cases of multiple periapical pathoses secondary to trigeminal zoster reported in literature till date The article also throws light that the occurrence of such dental complications of HZ is not entirely dependent on the immune status of the host.
Irwin, Michael R.; Levin, Myron J.; Laudenslager, Mark L.; Olmstead, Richard; Lucko, Anne; Lang, Nancy; Carrillo, Carmen; Stanley, Harold A.; Caulfield, Michael J.; Weinberg, Adriana; Chan, Ivan S. F.; Clair, Jim; Smith, Jeff G.; Marchese, R. D.; Williams, Heather M.; Beck, Danielle J.; McCook, Patricia T.; Zhang, Jane H.; Johnson, Gary; Oxman, Michael N.
Background. The Depression Substudy of the Shingles Prevention Study (SPS) was designed to evaluate the association between major depression and immune responses to a high-titer live attenuated varicella zoster virus (VZV) vaccine (zoster vaccine), which boosts cell-mediated immunity (CMI) to VZV and decreases the incidence and severity of herpes zoster (HZ). The Depression Substudy was a 2-year longitudinal cohort study in 92 community-dwelling adults ≥60 years of age who were enrolled in the SPS, a large, double-blind, placebo-controlled Veterans Affairs Cooperative zoster vaccine efficacy study. Methods. Forty subjects with major depressive disorder, stratified by use of antidepressant medications, and 52 age- and sex-matched controls with no history of depression or other mental illness had their VZV-CMI measured prior to vaccination with zoster vaccine or placebo and at 6 weeks, 1 year, and 2 years postvaccination. Results. Depressed subjects who were not treated with antidepressant medications had lower levels of VZV-CMI following administration of zoster vaccine than nondepressed controls or depressed subjects receiving antidepressants even when antidepressant medications failed to alter depressive symptom severity (P depression and use of antidepressant medications, as well as changes in depressive symptoms, during the postvaccination period. Conclusions. Depressed patients have diminished VZV-CMI responses to zoster vaccine, and treatment with antidepressant medication is associated with normalization of these responses. Because higher levels of VZV-CMI correlate with lower risk and severity of HZ, untreated depression may increase the risk and severity of HZ and reduce the efficacy of zoster vaccine. PMID:23413415
Full Text Available Abstract Background: Acute viral infections such as cytomegalovirus, Rubella, Herpes simplex and varicella zoster virus in pregnant women can cause congenital infection with increased risk of developing congenital anomalies and morbidity. We aimed to identify young women susceptible to these viral infections in Bushehr. Materials and Methods: In 2009, 180 female were randomly selected from high schools and college students who were been assisted in marriage consulting clinics. In this cross sectional study, IgG antibodies against varicella zoster virus (VZV, Herpes simplex virus I,II (HSV I,II , Rubella & cytomegalovirus (CMV were determined by indirect enzyme immunoassay (ELISA technique. Results: Mean age of the participants was 18.72 years old. %99.4 and %95 of sera were positive for cytomegalovirus & Rubella respectively and also Antibodies against VZV & HSV were detected in %74.5 & %69.4 of samples. There were no significant correlation between antibody seropositivity and education level, living places (rural or urban and occupation. (P<0/05. Conclusion: Although, The findings of this study indicated that high prevalence rate of VZV &HSV 1,2 in child bearing age women, but 1/3 -1/4 of them, are still susceptible to these infections, so routine screening of these viruses is suggested in antenatal care.
Lier, A. van; Lugner, A.K.; Opstelten, W.; Jochemsen, P.; Wallinga, J.; Schellevis, F.; Sanders, E.; Melker, H. de; Boven, M. van
Background: Herpes zoster (HZ) is a painful disease affecting a considerable part of the elderly. Programmatic HZ vaccination of elderly people may considerably reduce HZ morbidity and its related costs, but the extent of these effects is unknown. In this article, the potential effects and
Jacobs, J.J.L.; Folkers, E.; Vreeswijk, J.
Varicella-zoster virus (VZV) and herpes simplex virus (HSV) are human pathogens of significance involved in multiple diseases with either typical or atypical clinical features. In neonates and immunocompromised patients these alphaherpesviruses may cause life-threatening diseases such as
Full Text Available Background: Oral candidosis is an infection caused by mainly Candida albicans. Candida species are common normal flora in the oral cavity and have been reported to be present in 40% to 60% of the population. Candida is predominantly an opportunistic infectious agent. Infection frequency has increased because of the presence of both local and systemic risk factors. The elderly age and diabetes mellitus may decrease the amount of saliva (xerostomia and potentially increase the risk of colonization and secondary infection by Candida. Herpes Zoster (HZ is a manifestation of the reactivation of latent varicella zoster virus. It is characterized by unilateral, painful, vesicular rash with a dermatomal distribution. The clinical manifestations of this disease can erupt to the skin and mucous membrane. If maxillary nerve is involved, the lesion can appear on unilateral facial skin and oral mucous membrane. Purpose: The purpose of this paper is to report and discuss the difficulties in managing the oral candidosis in elderly patient (57 year old male who suffered from maxillary Herpes Zoster and diabetes mellitus. Case management: At first, the patient was treated with 2% chlorhexidine gluconate and mycostatin oral suspension as topical antimycotic and reffered to dermathology clinic for viral infection treatment, however the oral candidosis did not improved. Subsequently, ketokonazole tablet was given three times daily for three weeks and regulated blood glucose level. In systemic antifungi (ketokonazole treatment the oral candidosis disappeared. Conclusion: In this case, it is conclude that the management of oral candidosis are adequate, antiviral, blood glucose level regulating and systemic antifungal therapy.
Full Text Available Uwe Wollina,1 Gesina Hansel,1 Anja Baunacke,1 Georgi Tchernev2 1Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt, Dresden, Germany; 2Department of Dermatology and Dermatologic Surgery, Medical Institute of Ministry of Interior (MVR, Sofia, Bulgaria Abstract: Herpes zoster is a common disease caused due to varicella zoster virus (VZV infection with increasing incidence by age. If the patient has a severe, extended, or treatment-recalcitrant course of herpes zoster, this must be a red flag to search for underlying pathologies. Here, we report about a 64-year-old male patient with diabetes, who came to our emergency department because of general malaise, fever, chills, and a pronounced nuchal and facial swelling on the left side. Based on herpetiform-grouped vesicles and yellowish crusts, an impetiginized facial herpes zoster was diagnosed, and combined antiviral and antibiotic treatment was initiated. He was HIV negative. Despite intensified treatment, his situation worsened. We observed blasts in peripheral blood, but bone marrow biopsy was initially denied. Some days later after deterioration of his disease, he accepted further diagnostics. A myelodysplastic syndrome with blast excess (refractory anemia and blast excess II, RAEB II could be confirmed. The following translocations were detected: t(2;12(p13; q13 and t(6;9(p22;q34. REAB II has an unfortunate prognosis. Cytoreductive treatment was initiated by the hemato-oncologist. Unfortunately, the patient deceased due to septic shock. Keywords: herpes zoster, varicella zoster virus, myelodysplastic syndrome, sepsis, emergency
Grupping, Katrijn; Campora, Laura; Douha, Martine; Heineman, Thomas C; Klein, Nicola P; Lal, Himal; Peterson, James; Vastiau, Ilse; Oostvogels, Lidia
Protection against herpes zoster (HZ) induced by the live attenuated zoster vaccine Zostavax (ZVL) wanes within 3-7 years. Revaccination may renew protection. We assessed whether (re)vaccination with the adjuvanted HZ subunit vaccine candidate (HZ/su) induced comparable immune responses in previous ZVL recipients and ZVL-naive individuals (HZ-NonVac). In an open-label, multicenter study, adults ≥65 years of age, vaccinated with ZVL ≥5 years previously (HZ-PreVac), were matched to ZVL-naive adults (HZ-NonVac). Participants received 2 doses of HZ/su 2 months apart. The primary objective of noninferiority of the humoral immune response 1 month post-dose 2 was considered demonstrated if the upper limit of the 95% confidence interval (CI) of the adjusted anti-glycoprotein E geometric mean concentration (GMC) ratio of HZ-NonVac over HZ-PreVac was <1.5. HZ/su cellular immunogenicity, reactogenicity, and safety were also assessed. In 430 participants, humoral immune response to HZ/su was noninferior in HZ-PreVac compared with HZ-NonVac (adjusted GMC ratio, 1.04 [95% CI, .92-1.17]). Cellular immunogenicity, reactogenicity, and safety appeared to be comparable between groups. HZ/su was well-tolerated, with no safety concerns raised within 1 month post-dose 2. HZ/su induces a strong immune response irrespective of prior vaccination with ZVL, and may be an attractive option to revaccinate prior ZVL recipients. NCT02581410.
Więdłocha, Magdalena; Marcinowicz, Piotr; Stańczykiewicz, Bartłomiej
The psychopathological symptoms occurring in the course of diseases associated with infections are often initially isolated and non-characteristic, and may cause diagnostic difficulties. Moreover, such disorders tend to be less responsive to psychiatric management. Among possible causes such as trauma, neoplasm and vascular changes, inflammatory changes of the brain as a result of a viral infection should also be considered. There were 452 registered cases of viral encephalitis in Poland in 2010, and although not very prevalent they remain a severe and life-threatening condition. What is more, the frequently occurring neurological and psychiatric complications of viral encephalitis often result in permanent disabilities, causing a significant decrease in the quality of life. This article presents the three types of encephalitis that are most prevalent among immunocompetent patients in Poland, i.e. herpes simplex encephalitis (HSE), tick-borne encephalitis (TBE) and herpes zoster encephalitis (HZE). The psychopathology of the acute phase of the infection, the residual symptoms, features apparent in imaging studies and some neuropathological aspects are also presented. The paper also focuses on psychiatric aspects of the diagnostics and treatment of the described conditions. The clinical pictures of these infections are quite specific, although they cover a wide range of symptoms, and these characteristic features are described. The aim of this review is also to show the significance of thorough diagnostics and a multidisciplinary approach to patients with viral CNS infections.
Rampakakis, Emmanouil; Stutz, Melissa; Kawai, Kosuke; Tsai, Tsen-Fang; Cheong, Hee Jin; Dhitavat, Jittima; Ortiz-Covarrubias, Alejandro; Cashat-Cruz, Miguel; Monsanto, Homero; Johnson, Kelly D; Sampalis, John S; Acosta, Camilo J
Background Herpes zoster (HZ) has a significant negative effect on the productive work life of individuals, and has been shown to be responsible for cases of absenteeism, presenteeism and decreased work effectiveness...
Préaud, Emmanuelle; Uhart, Mathieu; Böhm, Katharina; Aidelsburger, Pamela; Anger, Delphine; Bianic, Florence; Largeron, Nathalie
Herpes zoster (HZ; shingles) is a common viral disease that affects the nerves and surrounding skin causing a painful dermatomal rash and leading to debilitating complications such as, mainly, post-herpetic neuralgia (PHN...
Full Text Available Armando Stefanati, Nicoletta Valente, Silvia Lupi, Sara Previato, Matilde Giordani, Giovanni Gabutti Department of Medical Sciences, University of Ferrara, Ferrara, Italy Abstract: Herpes zoster (HZ is a common disease in adults and older subjects solely related to the reactivation of latent varicella zoster virus in ganglia. The incidence of the disease increases with aging and the decline of varicella zoster virus-specific cell-mediated immunity. HZ has a significant impact on the quality of life of subjects during the acute phase. Besides, pain can persist even for a long time becoming chronic. The chronic pain following HZ is called postherpetic neuralgia, and it is a debilitating long-lasting condition, characterized by metameric pain, allodynia, and hyperalgesia. Therapeutic options against HZ and postherpetic neuralgia are often suboptimal and the impact of the disease and its complications on daily living activities is significant, especially in older subjects. Nowadays, a preventive approach to the disease is possible; as a matter of fact, a high-antigen content live vaccine is available. This vaccine has a good profile in terms of immunogenicity, efficacy, effectiveness, and safety and its use may prevent both HZ and postherpetic neuralgia. Nevertheless, the evaluation of the issues raised in countries that introduced this immunization show that both provider and patient barriers could have prevented a more robust uptake of HZ vaccination. In the USA, HZ immunization storage was expensive, reimbursement was cumbersome, and supply shortages may have limited promotion by the interests of the manufacturer and provider. The doctors did not actively recommend HZ vaccination; on the other hand, subjects were mostly unaware of the HZ vaccine. Several demographic factors, including sex and educational level, could have negatively affected the coverage rates; besides, the clinicians who treat adults focus less on vaccination than those taking
Full Text Available Reactivated varicella-zoster virus (VZV, which lies latent in the dorsal root ganglions and cranial nerves before its reactivation, is capable of causing herpes zoster (HZ, but the specific mechanism of virus reactivation and latency remains unknown. It was proposed that circulating microRNAs (miRNAs in body fluids could potentially indicate infection. However, the connection between herpes zoster and circulating miRNAs has not been demonstrated. In this study, 41 HZ patients without superinfection were selected. The serum miRNA levels were analyzed by TaqMan low density array (TLDA and confirmed individually by quantitative reverse transcription PCR (RT-qPCR analysis. Thirty-five age-matched subjects without any infectious diseases or inflammation were selected as controls. The results showed that the serum miRNA expression profiles in 41 HZ patients were different from those of control subjects. Specifically, 18 miRNAs were up-regulated and 126 were down-regulated more than two-fold in HZ patients compared with controls. The subsequent confirmation of these results by qRT-PCR, as well as receiver operating characteristic (ROC curve analysis, revealed that six kinds of miRNAs, including miR-190b, miR-571, miR-1276, miR-1303, miR-943, and miR-661, exhibited statistically significant enhanced expression levels (more than four-fold in HZ patients, compared with those of healthy controls and herpes simplex virus (HSV patients. Subsequently, it is proposed that these circulating miRNAs are capable of regulating numerous pathways and some may even participate in the inflammatory response or nervous system activity. This study has initially demonstrated that the serum miRNA expression profiles in HZ patients were different from those of uninfected individuals. Additionally, these findings also suggest that six of the altered miRNA could be potentially used as biomarkers to test for latent HZ infection.
Horn, Johannes; Karch, André; Damm, Oliver; Kretzschmar, Mirjam|info:eu-repo/dai/nl/075187981; Siedler, Anette; Ultsch, Bernhard; Weidemann, Felix; Wichmann, Ole; Hengel, Hartmut; Greiner, Wolfgang; Mikolajczyk, Rafael T
Varicella zoster virus (VZV) is primarily known for causing varicella in childhood, but can reactivate again as herpes zoster (HZ) after a period of latency, mainly in persons older than 50 years. Universal varicella vaccination was introduced in Germany in 2004, while HZ vaccination has not been
Vora, Rita V; Anjaneyan, Gopikrishnan; Kota, Rahul Krishna S; Pilani, Abhishek P; Diwan, Nilofar G; Patel, Nidhi N
Herpes zoster usually presents with typically grouped vesicles on erythematous base involving single dermatome with self-limiting nature in immunocompetent individuals while it may present in extensive form involving multiple dermatomes involvement or disseminated form in immunocompromised, especially in human immunodeficiency virus (HIV). The aim of this study was to study the prevalence of HIV in patients of herpes zoster, to compare the clinical presentation of herpes zoster in HIV-infected and noninfected patient. The study was carried out in the Department of Dermatology in a Teaching Institute of Gujarat, from June 2008 to May 2014 after ethical clearance. The study population included all the patients with a clinical diagnosis of herpes zoster. All the patients were investigated for HIV infection after written consent. Out of total 688 patients of herpes zoster, 35 (5.1%) were HIV-positive, 26 (74.3%) were males and 9 (25.7%) were females. Among HIV-positive patients, 29 (82.85%) patients had localized dermatomal involvement, 4 (11.42%) patients had multiple dermatomal involvement, and only 2 (5.71%) had disseminated zoster while among HIV-negative, 636 (97.40%) had localized dermatomal involvement, 14 (2.14%) patients had multiple dermatomal involvement, and 3 (0.45%) had disseminated zoster. Cervical dermatome was most commonly involved dermatome in patients of HIV. Disseminated and multiple dermatomal involvement was more commonly involved among HIV-positive patients when compared to HIV-negative patients.
Yang, Sheng-Ye; Li, Hong-Xing; Yi, Xin-Hao; Han, Guang-Liang; Zong, Qiang; Wang, Ming-Xing; Peng, Xiao-Xiao
Several observational studies suggest that herpes zoster (HZ) may increase the risk of stroke, but the results are inconsistent. Our study was designed to assess the association between HZ and the risk of stroke through a meta-analysis of cohort studies. The electronic databases PubMed and EMBASE were searched from inception to May 31, 2016 to identify relevant cohort studies that assess the risk of stroke in patients with HZ. Reference lists were also reviewed to identify potential studies. The random-effects model and fixed-effects model were used to calculate the summary relative risks (RRs) with 95% confidence intervals (CIs). Six cohort studies (251,076 HZ patients and 8462 cases of stroke) were identified in the study. The result showed that HZ was significantly correlated with increased risk of stroke, and the pooled RR was 1.36 (95% confidence interval [CI]: 1.10, 1.67) (P = .004). In the subgroup analysis, the significant association was observed except for stroke type (hemorrhage group). In the sensitivity analysis, excluding 1 study, the pooled RR was 1.45 (95% CI: 1.17, 1.80) (P = .001) for HZ, and 4.42 (95% CI: 2.75, 7.11) (P = .000) for herpes zoster ophthalmicus. Considerable heterogeneity was observed in our study. Our study furnishes evidence of a positive association between HZ and the risk of stroke. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.
Bollea-Garlatti, M L; Bollea-Garlatti, L A; Vacas, A S; Torre, A C; Kowalczuk, A M; Galimberti, R L; Ferreyro, B L
Shingles is the cutaneous expression of the reactivation of latent varicella zoster virus infection in sensory ganglia. It presents as vesicles in the corresponding dermatome. The condition is called disseminated herpes zoster (DHZ) when more than 2 contiguous dermatomes are affected, more than 20 vesicles are observed outside the initial dermatome, or involvement is systemic. DHZ is rare and most frequently occurs in immunocompromised patients. To describe the epidemiology, predisposing factors, clinical presentation, laboratory findings, and clinical course of patients with DHZ, and to compare the findings in immunocompromised and immunocompetent patients. We analyzed a retrospective case series of adults hospitalized between February 2010 and October 2015. Forty-one patients with virologically confirmed manifestations of DHZ were included. Stress as a trigger factor was detected in 39% and immunodepression in 58.5%. Immunocompromised patients were younger than the immunocompetent patients (mean ages, 60.5 vs 82 years, P.01). Six patients died; there was no difference in mortality between the 2 groups. This study provides evidence on the relationship between DHZ, the presence of underlying immunodepression, and complications. Immunosenescence may play an important role in the onset of this disease in older immunocompetent patients. Copyright © 2016 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.
Full Text Available Herpes zoster (HZ is caused by reactivation of the varicella zoster virus. Its main risk factor is increasing age and comorbidities. There are limited data on the characteristics of HZ in South America, especially in the elderly. We analyzed epidemiological and clinical characteristics of 340 patients over 60 years assisted for HZ, between June 2013 and May 2014. The average age was 74 years (60-100, 62% (210 had thoracic location; 75% (255 of the initial consultations were held in guards; 68% (143 had pain and vesicles, and 4% (14 only pain at baseline. Pain persisted after finishing the episode in 41% (139. The diagnosis was made between 1 and 3 days from the beginning of the episode in 53% (180 patients. Average number of visits per episode was 3.6 (1-24. Antiviral treatment was supplied to 91% (309; however it was inadequate in dose or time in 49.1% (167 cases. Pain treatment was indicated in 66% (224. Most frequently used drugs (alone or in combination were non-steroidal painkillers (43%, 146, pregabalin (30%, 102, opiates (24%, 82, and steroids (12%, 41; 9% (31 presented comorbidities; 27% (126 experienced pain after the ending of the episode, with an average duration of 138.7 days. In general, diagnosis was done late, making it difficult to use antivirals correctly. The presence of pain was more frequent than reported in other publications, however there are few data in this age group
Schmader Kenneth E
Full Text Available Abstract Background The potentially serious nature of herpes zoster (HZ and the long-term complication post-herpetic neuralgia (PHN are often underestimated. One in four people will contract herpes zoster in their lifetime, with this risk rising markedly after the age of 50 years, and affecting one in two in elderly individuals. Pain is the predominant symptom in all phases of HZ disease, being reported by up to 90% of patients. In the acute phase, pain is usually moderate or severe, with patients ranking HZ pain as more intense than post-surgical or labour pains. Up to 20% of patients with HZ develop PHN, which is moderate-to-severe chronic pain persisting for months or years after the acute phase. We review the available data on the effect of HZ and PHN on patients' quality-of-life. Discussion Findings show that HZ, and particularly PHN, have a major impact on patients' lives across all four health domains - physical, psychological, functional and social. There is a clear correlation between increasing severity of pain and greater interference with daily activities. Non-pain complications such as HZ ophthalmicus can increase the risk of permanent physical impairment. Some elderly individuals may experience a permanent loss of independence after an acute episode of HZ. Current challenges in the management of HZ and PHN are highlighted, including the difficulty in administering antiviral agents before pain becomes established and the limited efficacy of pain treatments in many patients. We discuss the clinical rationale for the HZ vaccine and evidence demonstrating that the vaccine reduces the burden of the disease. The Shingles Prevention Study, conducted among >38,000 people aged ≥60 years old, showed that the HZ vaccine significantly reduces the burden of illness and the incidence of both HZ and PHN. In the entire study population, zoster vaccination reduced the severity of interference of HZ and PHN with activities of daily living by two
Kaewpoowat, Quanhathai; Salazar, Lucrecia; Aguilera, Elizabeth; Wootton, Susan H; Hasbun, Rodrigo
To describe the clinical manifestations, cerebrospinal fluid (CSF) characteristics, imaging studies and prognostic factors of adverse clinical outcomes (ACO) among adults with herpes simplex virus (HSV) or varicella zoster virus (VZV) CNS infections. Retrospective review of adult patients with positive HSV or VZV polymerase chain reaction on CSF from an observational study of meningitis or encephalitis in Houston, TX (2004-2014), and New Orleans, LA (1999-2008). Ninety-eight adults patients were identified; 25 had encephalitis [20 (20.4 %) HSV, 5 (5.1 %) VZV], and 73 had meningitis [60 (61.1 %) HSV and 13 (13.3 %) VZV]. HSV and VZV had similar presentations except for nausea (P 1 and an encephalitis presentation were independently associated with an ACO. The treatment for HSV meningitis was variable, and all patients had a good clinical outcome. Alpha herpes CNS infections due to HSV and VZV infections have similar clinical and laboratory manifestations. ACO was observed more frequently in those patients with comorbidities and an encephalitis presentation.
van Lier, Alies; Lugnér, Anna; Opstelten, Wim; Jochemsen, Petra; Wallinga, Jacco; Schellevis, François; Sanders, Elisabeth; de Melker, Hester; van Boven, Michiel
Background: Herpes zoster (HZ) is a painful disease affecting a considerable part of the elderly. Programmatic HZ vaccination of elderly people may considerably reduce HZ morbidity and its related costs, but the extent of these effects is unknown. In this article, the potential effects and cost-effectiveness of programmatic HZ vaccination of elderly in the Netherlands have been assessed according to a framework that was developed to support evidence-based decision making regarding inclusion o...
Kennedy, Peter G E; Rovnak, Joel; Badani, Hussain; Cohrs, Randall J
Herpes simplex virus type 1 (HSV-1; human herpesvirus 1) and varicella-zoster virus (VZV; human herpesvirus 3) are human neurotropic alphaherpesviruses that cause lifelong infections in ganglia. Following primary infection and establishment of latency, HSV-1 reactivation typically results in herpes labialis (cold sores), but can occur frequently elsewhere on the body at the site of primary infection (e.g. whitlow), particularly at the genitals. Rarely, HSV-1 reactivation can cause encephalitis; however, a third of the cases of HSV-1 encephalitis are associated with HSV-1 primary infection. Primary VZV infection causes varicella (chickenpox) following which latent virus may reactivate decades later to produce herpes zoster (shingles), as well as an increasingly recognized number of subacute, acute and chronic neurological conditions. Following primary infection, both viruses establish a latent infection in neuronal cells in human peripheral ganglia. However, the detailed mechanisms of viral latency and reactivation have yet to be unravelled. In both cases latent viral DNA exists in an 'end-less' state where the ends of the virus genome are joined to form structures consistent with unit length episomes and concatemers, from which viral gene transcription is restricted. In latently infected ganglia, the most abundantly detected HSV-1 RNAs are the spliced products originating from the primary latency associated transcript (LAT). This primary LAT is an 8.3 kb unstable transcript from which two stable (1.5 and 2.0 kb) introns are spliced. Transcripts mapping to 12 VZV genes have been detected in human ganglia removed at autopsy; however, it is difficult to ascribe these as transcripts present during latent infection as early-stage virus reactivation may have transpired in the post-mortem time period in the ganglia. Nonetheless, low-level transcription of VZV ORF63 has been repeatedly detected in multiple ganglia removed as close to death as possible. There is increasing
Kennedy, Peter G. E.; Rovnak, Joel; Badani, Hussain
Herpes simplex virus type 1 (HSV-1; human herpesvirus 1) and varicella-zoster virus (VZV; human herpesvirus 3) are human neurotropic alphaherpesviruses that cause lifelong infections in ganglia. Following primary infection and establishment of latency, HSV-1 reactivation typically results in herpes labialis (cold sores), but can occur frequently elsewhere on the body at the site of primary infection (e.g. whitlow), particularly at the genitals. Rarely, HSV-1 reactivation can cause encephalitis; however, a third of the cases of HSV-1 encephalitis are associated with HSV-1 primary infection. Primary VZV infection causes varicella (chickenpox) following which latent virus may reactivate decades later to produce herpes zoster (shingles), as well as an increasingly recognized number of subacute, acute and chronic neurological conditions. Following primary infection, both viruses establish a latent infection in neuronal cells in human peripheral ganglia. However, the detailed mechanisms of viral latency and reactivation have yet to be unravelled. In both cases latent viral DNA exists in an ‘end-less’ state where the ends of the virus genome are joined to form structures consistent with unit length episomes and concatemers, from which viral gene transcription is restricted. In latently infected ganglia, the most abundantly detected HSV-1 RNAs are the spliced products originating from the primary latency associated transcript (LAT). This primary LAT is an 8.3 kb unstable transcript from which two stable (1.5 and 2.0 kb) introns are spliced. Transcripts mapping to 12 VZV genes have been detected in human ganglia removed at autopsy; however, it is difficult to ascribe these as transcripts present during latent infection as early-stage virus reactivation may have transpired in the post-mortem time period in the ganglia. Nonetheless, low-level transcription of VZV ORF63 has been repeatedly detected in multiple ganglia removed as close to death as possible. There is
McDonald, Elissa M; Patel, Dipika V; McGhee, Charles N J
To identify the demographic and clinical associations of patients presenting with herpetic keratitis in New Zealand compared with presentations of presumed microbial keratitis. A prospective, 6-month, observational case series of presumed microbial keratitis (including marginal keratitis), specifically identifying all cases of herpes simplex and varicella zoster keratitis attending an emergency eye clinic was conducted. Main outcome measures included demographics, presenting signs and symptoms, and medical, ocular, and drug history. A total of 140 cases of herpetic keratitis were identified, which comprised 125 cases of herpes simplex virus (89%) and 15 cases of varicella zoster virus (11%). Herpes simplex keratitis was associated with a history of keratitis (n = 58, phi = 0.24, P herpes simplex keratitis and ocular surface disease (n = 8, phi = -0.16, P herpes simplex as a possible cause of keratitis. Clinicians prescribing inhaled corticosteroids or topical corticosteroid creams should be aware of possible association with herpes simplex keratitis.
Full Text Available AIM: To explore the effects of oral acyclovir combined with sodium hyaluronate and fluorometholone eye drops on the treatment of herpes zoster keratitis. METHODS:Forty patients with ocular herpes zoster were divided into two groups, 20 cases in the observation group, 20 cases in the control group. Observation group was treated with 200mg oral acyclovir for 5 times a day and sodium hyaluronate eye drops for 4 times a day. When stromal keratitis, disciform keratitis or corneal endotheliitis occurred, fluorometholone was used for 4 times a day. The control group was treated with ganciclovir ophthalmic gel for 4 times a day. The efficacy of two groups was observed, patients were followed up for 3-4wk. RESULTS:The observation group of local pain and photophobia in remission time and corneal damage healing time were better than control group, and there were significant differences(PCONCLUSION: Effects of oral acyclovir combined with sodium hyaluronate and fluorometholone eye drops on the treatment of herpes zoster keratitis are satisfactory.
Ye, Guoping; Su, Meiling; Zhu, Dingyu; Zhang, Linyun; Lin, Wang; Huang, Li; Wu, Mingxia
To observe the effects of conventional western medication and joss stick moxibustion combined with pricking and cupping for herpes zoster in acute stage, and to explore its analgesic mechanism. Seventy patients with acute herpes zoster were randomized into an observation group (33 cases after 2 dropping) and a control group (34 cases after 1 dropping). Patients in the observation group were treated with joss stick moxibustion combined with pricking and cupping at local ashi points for 7 times, once every other day. Oral acyclovir, vitamin B1 and mecobalamin tablets were applied in the control group for continuous 14 days, and interferon injection was used for continuous 6 days, etc. The herpes evaluation indexes of blister stopping time, scab time and decrustation time as well as pain intensity were observed before and after treatment. Peripheral serum substance P (SP) content of herpes local situation was detected. The comprehensive effects were evaluated. The blister stopping time, scab time and decrustation time in the observation group were shorter than those in the control group (all P0.05). The pain beginning to ease time and duration time in the observation group were better than those in the control group (both P0.05). The cured rate of the observation group was better than that of the control group [66.7% (22/33) vs 58.8% (20/34), Pcupping are effective for herpes zoster, which have quicker and good analgesic effects than conventional western medication. Its mechanism may be related to reducing the content of SP more fast and to a larger degree.
Full Text Available Objective: To study the correlation of serum inflammatory cytokine and immunoglobulin content with post-herpetic neuralgia in patients with acute herpes zoster. Methods: Patients diagnosed with herpes zoster in our hospital between May 2012 and October 2015 were selected and divided into herpes zoster-post-herpetic neuralgia group (VZV-PHN group and herpes zoster-control group (VZV-Con group according to the incidence of post-herpetic neuralgia (PHN; healthy volunteers receiving physical examination in our hospital during the same period were selected as normal control group (Con group. Results: Serum β-EP, NT, IFN-γ and IL-2 levels of VZV-PHN group and VZV-Con group were significantly lower than those of Con group (P<0.05, while SP, VGF, CGRP, IL-4, IL-6, IL-17, IL-21, TNF-α, IL-10, TGF-β1, IgG, IgM and IgA levels were significantly higher than those of Con group (P<0.05; serum β-EP, NT, IFN-γ, IL-2, IgG, IgM and IgA levels of VZV-PHN group were significantly lower than those of VZV-Con group (P<0.05 while SP, VGF, CGRP, IL-4, IL-6, IL-17, IL- 21, TNF-α, IL-10 and TGF-β1 levels were significantly higher than those of VZV-Con group (P<0.05; β-EP and NT were positively correlated with IFN-γ, IL-2, IgG, IgM and IgA, and negatively correlated with IL-4, IL-6, IL-17, IL-21, TNF-α, IL-10 and TGF-β1; SP, VGF and CGRP were negatively correlated with IFN-γ, IL-2, IgG, IgM and IgA, and positively correlated with IL-4, IL-6, IL-17, IL-21, TNF-α, IL-10 and TGF-β1. Conclusions: Abnormal secretion of inflammatory cytokines and immunoglobulin caused by humoral immune and cellular immune response disorder is associated with the occurrence of post-herpetic neuralgia in patients with acute herpes zoster.
Full Text Available Abstract Background Acute herpes zoster is a prevalent condition. One of its major symptoms is pain, which can highly influence patient's quality of life. Pain therapy is limited. Acupuncture is supposed to soften neuropathic pain conditions and might therefore act as a therapeutic alternative. Objective of the present study is to investigate whether a 4 week semi-standardised acupuncture is non-inferior to sham laser acupuncture and the anticonvulsive drug gabapentine in the treatment of pain associated with herpes zoster. Methods/Design Three-armed, randomised, placebo-controlled trial with a total follow-up time of 6 months. Up to estimated 336 patients (interim analyses with acute herpes zoster pain (VAS > 30 mm will be randomised to one of three groups (a semi-standardised acupuncture (168 patients; (b gabapentine with individualised dosage between 900–3600 mg/d (84 patients; (c sham laser acupuncture. Intervention takes place over 4 weeks, all patients will receive analgesic therapy (non-opioid analgesics: metamizol or paracetamol and opioids: tramadol or morphine. Therapy phase includes 4 weeks in which group (a and (c consist of 12 sessions per patient, (b visits depend on patients needs. Main outcome measure is to assess the alteration of pain intensity before and 1 week after treatment sessions (visual analogue scale VAS 0–100 mm. Secondary outcome measure are: alteration of pain intensity and frequency of pain attacks; alteration of different aspects of pain evaluated by standardised pain questionnaires (NPI, PDI, SES; effects on quality of life (SF 36; analgesic demand; alteration of sensoric perception by systematic quantitative sensory testing (QST; incidence of postherpetic neuralgia; side effects and cost effectiveness. Credibility of treatments will be assessed. Discussion This study is the first large-scale randomised placebo controlled trial to evaluate the efficacy of acupuncture compared to gabapentine and sham treatment
Yi Chun Lai
Full Text Available Background: Herpes zoster (HZ results from the reactivation of latent varicella zoster virus (VZV residing in dorsal root and cranial nerve ganglia. Advanced age and dysfunctional cell-mediated immune responses are well-established risk factors for VZV reactivation. There have been recent interests in whether there is an increased risk of the disease associated with a positive family history. Aims and Objectives: We aimed to conduct a meta-analysis to evaluate the association between HZ infection and family history. In addition, we investigated the dose-response relationship between HZ infection and the number of relatives with a history of HZ. Materials and Methods: Observational studies were searched from MEDLINE, EMBASE, and Cochrane Central Register from inception to April 15, 2015. The Meta-analysis of Observational Studies in Epidemiology guidelines were followed in conducting this study. To estimate the pooled odds ratio, random-effects model of DerSimonian and Laird was used. Heterogeneity between studies was assessed using the I2 statistic. A dose-response meta-analysis with studies that reported appropriate data were done using the generalized least squares for trend method. Results: Five studies, yielding a total of 4169 subjects, were identified for meta-analysis. Cases with HZ were 3.03 (95% confidence interval [CI]: 1.86–4.94, P < 0.001 and 3.27 (95% CI: 1.75–6.10, P < 0.001 times more likely to report the first-degree relatives and total relatives with a history of HZ, respectively. A significant positive dose-response relationship between the risk of HZ infection and the number of relatives with a history of HZ was also demonstrated (P < 0.001. Conclusions: This meta-analysis demonstrated that family history is a significant risk factor for HZ infection. This risk has a dose-response relationship with the number of relatives with a history of HZ.
Paula da Silva Neves
Full Text Available Infecção pelo vírus varicela zoster (VVZ em pacientes com lúpus eritematoso sistêmico juvenil (LESJ tem sido pouco descrita. Durante um período de 12 anos, ocorreram 195 internações em 77 pacientes com LESJ e estas foram acompanhadas pela Unidade de Reumatologia Pediátrica do Instituto da Criança do Hospital das Clínicas da Universidade de São Paulo. Onze pacientes (14%, dez do sexo feminino, apresentaram 14 internações (7,1% pelo VVZ. Nesses pacientes, a média de idade foi de 16 anos e 5 meses e a média do tempo de duração do LESJ até a primeira infecção devido ao VVZ foi de 4 anos. Todos os episódios das infecções estavam associados com atividade da doença, que se apresentaram como lesões vesicobolhosas seguindo trajeto nervoso. As regiões do tórax e membros foram mais comumente afetadas. Todos haviam utilizado prednisona e quatro usaram ciclofosfamida EV. Todos receberam aciclovir EV por 7 a 10 dias. Nenhum paciente apresentou neuralgia pós-herpética, infecção bacteriana secundária ou evoluiu para óbito. Entretanto, uma paciente em uso de aciclovir apresentou amaurose aguda por vasculite necrosante retiniana bilateral associado ao VVZ, necessitando de duas aplicações de ganciclovir intravítreo e gamaglobulina EV (2 g/kg/dose, com recuperação parcial da acuidade visual. Assim sendo, infecção por VVZ em pacientes com LESJ foi infreqüente, habitualmente associada à atividade da doença e à corticoterapia. Essa infecção foi controlada com aciclovir, e os pacientes raramente apresentaram complicações.Varicella zoster virus (VZV infection in patients with juvenile systemic lupus erythematosus (JSLE has been rarely described. 195 hospitalizations of 77 JSLE patients occurred in a period of 12 years and were followed at the Pediatric Rheumatology Unity of the Instituto da Criança - Hospital das Clínicas - Universidade de São Paulo. Eleven patients (14%, 10 female, had 14 hospitalizations (7.1% due to
Shirane, Risako; Tang, Huamin; Hayashi, Kenichi; Okuno, Yoshinobu; Iso, Hiroyasu; Asada, Hideo; Yamanishi, Koichi; Mori, Yasuko
Age-related declines in cell-mediated immunity (CMI) are associated with the incidence and severity of Herpes Zoster (HZ) infection. However, the level of Varicella-Zoster virus (VZV)-specific CMI associated with disease onset is unclear. This study aimed to examine factors associated with VZV-specific CMI, as measured by an interferon-gamma (IFN-γ) enzyme-linked immunospot (ELISPOT) assay, in a Japanese cohort. The study enrolled 365 subjects aged 60 years and over, all of whom were taking part in the Shozu Herpes Zoster (SHEZ) study and had undergone four sets of blood and intradermal reaction tests during a 3 year follow-up period. The VZV-specific immunity profile of each subject was assessed, and linear mixed effects models were constructed to analyze IFN-γ ELISPOT results in association with a combination of factors. The model that best explained the IFN-γ ELISPOT results was selected using the Akaike Information Criteria. The best-fit model consisted of age group as the only explanatory fixed-effect variable. The model showed that VZV-specific CMI, quantified as numbers of spots on the ELISPOT assay, among subjects aged 70-79 was on average 10.30 points lower than that among subjects aged 60-69. There was no statistically significant difference between subjects aged 70-79 and those aged 80-89. Age was the only factor significantly associated with the level of VZV-specific CMI, as measured by the IFN-γ ELISPOT assay. These results may represent an important step towards quantifying the relationship between VZV-specific CMI and the onset of HZ. J. Med. Virol. 89:313-317, 2017. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.
Schaftenaar, Erik; Meenken, Christina; Baarsma, G Seerp; McIntyre, James A; Verjans, Georges M G M; Peters, Remco P H
To describe the spectrum of ocular complications of herpes zoster ophthalmicus (HZO) in rural South Africa. Patients presenting with visual complaints and active or healed HZO at the ophthalmology outpatient department of three hospitals in rural South Africa were included in this study. Demographic and clinical data were collected, and HIV status was determined for all participants. Forty-eight patients were included, and 81% were HIV infected. Poor vision was reported by 94% of patients, painful eye by 79% and photophobia by 63%. A diverse spectrum of ocular complications was observed with corneal inflammation and opacification in 77% followed by anterior uveitis in 65%. The majority (65%) presented with late-stage ocular complications associated with irreversible loss of vision whereas early-stage complications, such as punctate epithelial keratitis and anterior uveitis, were less common. Blindness of the affected eye was observed in 68% of patients with late-stage complications. There was a considerable delay between onset of symptoms and first presentation to the ophthalmology outpatient department (median time 35 days; range 1-2500 days), and longer delay was associated with late-stage ocular complications (P = 0.02). HZO patients present with relatively late-stage ocular complications, and blindness among these patients is common. The delayed presentation to the ophthalmology outpatient department of hospitals in our rural setting is of concern, and efforts to improve ocular outcomes of HZO are urgently needed. © 2015 John Wiley & Sons Ltd.
Opstelten, Wim; van Essen, Gerrit A; Hak, Eelko
As part of a series of studies on vaccine acceptance, we assessed determinants of compliance of the community-dwelling elderly with herpes zoster (HZ) vaccination in an existing influenza vaccination program. General practitioners (GPs) sent out a questionnaire to 1778 patients aged > or =65 years, and offered them free HZ vaccination simultaneously with the yearly influenza vaccination. In all, 690 patients (39%) were vaccinated against HZ; 1349 patients (76%) accepted influenza vaccination. Determinants of non-compliance with HZ vaccination were perceived lack of recommendation by the GP, unwillingness to comply with the doctor's advice, perception of low risk of contracting HZ, perception of short pain duration of HZ, and the opinion that vaccinations weaken one's natural defenses. The same determinants were associated with non-compliance with both vaccinations, but objections in general towards vaccination, a high education and difficulties to visit GPs were also important. Uptake of HZ vaccination was rather low and more data on (cost-)effectiveness might encourage GPs to offer HZ vaccination to their patients.
Antoine Wadih, MD
Full Text Available We report a patient with history of Hodgkin lymphoma. Six months after treatment, 2-deoxy-2-[18F]fluoro-d-glucose positron emission tomography and/or computed tomography ([18F] FDG PET/CT scan showed abnormal uptake in right axillary lymph nodes concerning for recurrence. In addition, PET/CT showed a new hypermetabolic skin lesion overlying the right scapula. Clinical evaluation was consistent with shingles, and the patient was treated with valacyclovir. Subsequent PET/CT scan was normal with no evidence of lymphoma. Although there have been reported cases of abnormal FDG in nodes or in skin due to herpes zoster, our case is unique in the literature in that the PET/CT demonstrates abnormalities involving both the skin and associated lymph nodes. The possibility of false positive uptake, not because of recurrent malignancy, must always be considered when abnormal FDG uptake is noted in the follow-up of oncology patients. Careful review of the scan and correlation with clinical findings can avoid false positive interpretation and facilitate patient management.
Piret, Jocelyne; Boivin, Guy
Aciclovir (ACV) is the first-line drug for the management of herpes simplex virus (HSV) and varicella-zoster virus (VZV) infections. Long-term administration of ACV for the treatment of severe infections in immunocompromised patients can lead to the development of drug resistance. Furthermore, the emergence of isolates resistant to ACV is increasingly recognized in immunocompetent individuals with herpetic keratitis. This review describes the mechanisms involved in drug resistance for HSV and VZV, the laboratory diagnosis and management of patients with infections refractory to ACV therapy. Genotypic testing is more frequently performed for the diagnosis of infections caused by drug-resistant HSV or VZV isolates. Molecular biology-based systems for the generation of recombinant viruses have been developed to link unknown mutations with their drug phenotypes. Fast and sensitive methods based on next-generation sequencing will improve the detection of heterogeneous viral populations of drug-resistant viruses and their temporal changes during antiviral therapy, which could allow better patient management. Novel promising compounds acting on targets that differ from the viral DNA polymerase are under clinical development. Antiviral drug resistance monitoring for HSV and VZV is required for a rational use of antiviral therapy in high-risk populations.
Aggarwal, Shruti; Cavalcanti, Bernardo M; Pavan-Langston, Deborah
There is no standard of treatment for epithelial pseudodendrites in herpes zoster ophthalmicus (HZO). The purpose of this study is to report the topical antiviral drug, 0.15% ganciclovir for treatment of these lesions. This is a retrospective, interventional case series of 4 patients who were diagnosed with HZO epithelial pseudodendrites despite being given oral antiviral treatment and who underwent 0.15% ganciclovir gel topical treatment. Main outcome measures included epithelial healing time, visual acuity, and corneal sensation. All 4 patients were immunocompetent and had epithelial lesions unresponsive to antiviral treatment with oral valacyclovir. Treatment with topical 0.15% ganciclovir gel 5 times a day resulted in the lesions healing successfully within 7 days with improved visual acuity in 3 patients and an increase in corneal sensation in 2 of the 4 patients. Topical 0.15% ganciclovir gel, 5 times a day until pseudodendritic lesion healing and tapering to bid for 2 to 4 weeks thereafter, is an effective treatment for pseudodendrites in HZO-affected cases that are often a challenge to manage with other oral or topical antivirals.
Hedden, Megan A; Kuehl, Peggy G; Liu, Yifei
To examine the economic impact of providing herpes zoster vaccine (ZOS) in 19 affiliated supermarket pharmacies in a midwestern metropolitan area from the perspective of the pharmacy and to identify factors associated with greater rates of vaccine delivery and profitability. 19 affiliated supermarket pharmacies in the Kansas City metropolitan area. Immunizations with ZOS were expanded from 2 pharmacies to all 19 affiliated pharmacies. Various methods to promote the vaccine were used, including personal selling, store signage, and circular ads. In addition to a broad perspective pharmacoeconomic model, a localized perspective model is proposed to determine profitability for the service. Factors associated with greater success in vaccine delivery and profitability were identified. Net financial gains or losses were calculated for each vaccine administered for each of the 19 pharmacies and for the entire supermarket chain. 662 vaccines were given during the study period, accounting for 6.7% of all eligible patients. The profit per vaccine averaged $9.60 (5.7%) and $28.37 (18.9%) using the broad and localized perspective models, respectively. Success of the ZOS program was demonstrated using both models. Certain factors correlated with greater profits when using the localized perspective model.
Johnson, Robert W.; Alvarez-Pasquin, Marie-José; Bijl, Marc; Franco, Elisabetta; Gaillat, Jacques; Clara, João G.; Labetoulle, Marc; Michel, Jean-Pierre; Naldi, Luigi; Sanmarti, Luis S.; Weinke, Thomas
Herpes zoster (HZ) is primarily a disease of nerve tissue but the acute and longer-term manifestations require multidisciplinary knowledge and involvement in their management. Complications may be dermatological (e.g. secondary bacterial infection), neurological (e.g. long-term pain, segmental paresis, stroke), ophthalmological (e.g. keratitis, iridocyclitis, secondary glaucoma) or visceral (e.g. pneumonia, hepatitis). The age-related increased incidence of HZ and its complications is thought to be a result of the decline in cell-mediated immunity (immunosenescence), higher incidence of comorbidities with age and social-environmental changes. Individuals who are immunocompromised as a result of disease or therapy are also at increased risk, independent of age. HZ and its complications (particularly postherpetic neuralgia) create a significant burden for the patient, carers, healthcare systems and employers. Prevention and treatment of HZ complications remain a therapeutic challenge despite recent advances. This is an overview of the multidisciplinary implications and management of HZ in which the potential contribution of vaccination to reducing the incidence HZ and its complications are also discussed. PMID:26478818
Clements Karen M
Full Text Available Abstract Background The authors sought to monitor the impact of widespread varicella vaccination on the epidemiology of varicella and herpes zoster. While varicella incidence would be expected to decrease, mathematical models predict an initial increase in herpes zoster incidence if re-exposure to varicella protects against reactivation of the varicella zoster virus. Methods In 1998–2003, as varicella vaccine uptake increased, incidence of varicella and herpes zoster in Massachusetts was monitored using the random-digit-dial Behavioral Risk Factor Surveillance System. Results Between 1998 and 2003, varicella incidence declined from 16.5/1,000 to 3.5/1,000 (79% overall with ≥66% decreases for all age groups except adults (27% decrease. Age-standardized estimates of overall herpes zoster occurrence increased from 2.77/1,000 to 5.25/1,000 (90% in the period 1999–2003, and the trend in both crude and adjusted rates was highly significant (p Conclusion As varicella vaccine coverage in children increased, the incidence of varicella decreased and the occurrence of herpes zoster increased. If the observed increase in herpes zoster incidence is real, widespread vaccination of children is only one of several possible explanations. Further studies are needed to understand secular trends in herpes zoster before and after use of varicella vaccine in the United States and other countries.
Amirthalingam, Gayatri; Andrews, Nick; Keel, Philip; Mullett, David; Correa, Ana; de Lusignan, Simon; Ramsay, Mary
In 2013, a herpes zoster vaccination programme was introduced in England for adults aged 70 years with a phased catch-up programme for those aged 71-79 years. We aimed to evaluate the effect of the first 3 years of the vaccination programme on incidence of herpes zoster and postherpetic neuralgia in this population. In this population-based study, we extracted data from the Royal College of General Practitioners sentinel primary care network on consultations with patients aged 60-89 years for herpes zoster and postherpetic neuralgia occurring between Oct 1, 2005, and Sept 30, 2016, obtaining data from 164 practices. We identified individual data on herpes zoster vaccinations administered and consultations for herpes zoster and postherpetic neuralgia, and aggregated these data to estimate vaccine coverage and incidence of herpes zoster and postherpetic neuralgia consultations. We defined age cohorts to identify participants targeted in each year of the programme, and as part of the routine or catch-up programme. We modelled incidence according to age, region, gender, time period, and vaccine eligibility using multivariable Poisson regression with an offset for person-years. Our analysis included 3·36 million person-years of data, corresponding to an average of 310 001 patients aged 60-89 years who were registered at an RCGP practice each year. By Aug 31, 2016, uptake of the vaccine varied between 58% for the recently targeted cohorts and 72% for the first routine cohort. Across the first 3 years of vaccination for the three routine cohorts, incidence of herpes zoster fell by 35% (incidence rate ratio 0·65 [95% 0·60-0·72]) and of postherpetic neuralgia fell by 50% (0·50 [0·38-0·67]). The equivalent reduction for the four catch-up cohorts was 33% for herpes zoster (incidence rate ratio 0·67 [0·61-0·74]) and 38% for postherpetic neuralgia (0·62 [0·50-0·79]). These reductions are consistent with a vaccine effectiveness of about 62% against herpes zoster
Boccalini, Sara; Alicino, Cristiano; Martinelli, Domenico; Bechini, Angela; Tiscione, Emilia; Pellizzari, Barbara; Prato, Rosa; Icardi, Giancarlo; Iannazzo, Stefania; Bonanni, Paolo
Herpes zoster (HZ) is a very relevant pathology among elderly people (≥ 60 years of age), with a considerable disease burden and loss of quality of life. In the last years a new vaccine against HZ became available in Italy. Therefore, the Italian decision makers are now confronted with the decision whether that vaccination should be implemented. Pharmaco-economic analyses represent useful tools to value the feasibility of new immunization programs and their sustainability. To this aim, an ad hoc population model was developed in order to value the clinical and economic impact of HZ vaccination program for the elderly in Italy. Particularly, different immunization scenarios were modeled: vaccination of 60 years-old subjects (single cohort strategy), simultaneous vaccination of people aged 60 and 65 years (double cohort strategy) and, lastly, immunization of people aged 60, 65 and 70 years (triple cohort strategy), thus leading to the vaccination of 5, 10 and 15 cohorts during the first 5 years of the program. The mathematical model valued the clinical impact of vaccination on the number of HZ, post-herpetic neuralgia (PHN) and ophthalmic HZ. The results of the analysis show that, in Italy, a cohort-based HZ vaccination program in elderly could have a relevant impact on the reduction of clinical cases and a favorable economic profile for the National Health Service (NHS), as already foreseen in other countries. In addition, further benefits could be obtained when extending the study period beyond the 5-year horizon of our analysis.
Varghese, Lijoy; Standaert, Baudouin; Olivieri, Antonio; Curran, Desmond
The risk of Herpes Zoster (HZ) increases with age and various studies have also demonstrated an increasing HZ incidence globally. Simultaneously, the global trend of an aging population has placed a greater burden on the healthcare system. This study aims to estimate the potential burden of HZ over time accounting for the increasing trends of both HZ incidence and global aging. A recent systematic review on HZ incidence identified studies that evaluated the temporal effects of HZ incidence. Data from the identified studies were extracted to estimate the trend of HZ incidence in the ≥65-year-old age cohort. The incidence rates were estimated up to the year 2030 using two scenarios: a linear extrapolation and a last observation carried forward. Three countries were chosen to perform the analysis on: Australia, Japan and the United States. The incidence data from the three countries showed an average annual increase between 2.35 and 3.74% over the time period of the studies selected. The elderly population for the US, Japan and Australia are expected to increase by 55, 10 and 53% respectively by the year 2030 compared to the levels in 2015. Under the first scenario between 2001 and 2030, the number of annual incident cases of HZ in those aged ≥65 years is expected to increase by +343% (293,785 to 1,303,328), +176% (158,616 to 437,867) and +376% (18,105 to 86,268) in the US, Japan and Australia respectively while those for the second scenario are +150%, +83% and +223% respectively. In the US alone, the estimated annual cost of HZ-related cases in the ≥65 age cohort is approximately 4.74 Billion US$ in 2030. The increasing incidence of HZ coupled with the demographic trends (i.e., aging population and greater life expectancy) in many countries are likely to imply a rising economic burden of HZ on already constrained healthcare budgets.
He, Yan; de Melo Franco, Rafael; Kron-Gray, Michelle M; Musch, David C; Soong, H Kaz
To report the outcomes of cataract surgery in eyes with previous herpes zoster ophthalmicus (HZO). Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, USA. Retrospective case series. Eyes with a history of HZO that had phacoemulsification and intraocular lens implantation were reviewed. The information analyzed included the ophthalmologic history, visual acuity, preoperative and postoperative adjunct treatments, and complications. Analysis of the mean corrected distance visual acuity (CDVA) at 1 month, 1 year, and the last follow-up was performed. Twenty-four eyes were evaluated. The mean CDVA improved from 20/112 (0.75 logMAR ± 0.63 [SD]) preoperatively to 20/53 (0.42 ± 0.56 logMAR) 1 month postoperatively (P = .007) and 20/44 (0.34 ± 0.55 logMAR) at 1 year (P = .052) but decreased to 20/71 (0.55 ± 0.72 logMAR) by last follow-up (P = .605 versus preoperative CDVA). Eleven patients (45.8%) had recurrent keratouveitis after the first episode, 5 before cataract surgery and 6 after cataract surgery. Three had penetrating keratoplasty for worsening corneal opacification. Two patients had tractional retinal detachment from chronic uveitis and required vitrectomy and retinal repair. Visual recovery after cataract surgery in HZO might be compromised by chronic factors such as ocular surface disease and keratouveitis. Despite long quiescent waiting periods before surgery and aggressive preoperative and postoperative maintenance therapy, visual improvement might be hindered by the inherent pathology associated with HZO. Nevertheless, with careful patient selection, reasonable visual improvement can be achieved. No author has a financial or proprietary interest in any material or method mentioned. Copyright © 2015 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.
Nakamura, Hiroyuki; Mizukami, Akiko; Adachi, Koichi; Matthews, Sean; Holl, Katsiaryna; Asano, Kazuhiro; Watanabe, Akihiro; Adachi, Riri; Kiuchi, Mariko; Kobayashi, Keiju; Sato, Keiko; Matsuki, Taizo; Kaise, Toshihiko; Curran, Desmond
Herpes zoster has a high incidence rate among people aged ≥ 60 years and can lead to serious complications such as post-herpetic neuralgia. There are currently no data on the economic burden of herpes zoster and post-herpetic neuralgia in Japan, and the objective of this study was to address this gap. A total of 412 patients aged ≥ 60 years diagnosed with herpes zoster were recruited. Demographic, clinical, and healthcare resource utilization data on patients with herpes zoster or post-herpetic neuralgia collected via case report forms were used to estimate direct medical cost. Data obtained from a questionnaire survey among patients with herpes zoster/post-herpetic neuralgia were used to estimate transportation cost and productivity loss. The mean number of outpatient visits was 5.7. Prescription medications were the main cost driver accounting for 60% of the direct medical cost. The mean direct medical and total herpes zoster-related costs per patient were ¥43,925 and ¥57,112, respectively, and were higher in patients with post-herpetic neuralgia than in those with herpes zoster without complications. Direct medical cost represented 77%, productivity loss 19%, and transportation cost 4% of the total. This is the first study of the economic burden of herpes zoster and post-herpetic neuralgia in Japan and it demonstrated substantial direct medical cost as a result of the multiple outpatient visits and prescription medications required. These findings provide baseline data for possible future economic evaluations of new herpes zoster/post-herpetic neuralgia interventions. This cost analysis is part of a prospective, physician practice-based cohort study conducted between June 2013 and February 2015 in Kushiro, Japan (Clinicaltrials.gov identifier NCT01873365, registered on 6 June, 2013).
Zhang, Yanting; Luo, Ganfeng; Huang, Yuanwei; Yu, Qiuyan; Wang, Li; Li, Ke
Accumulating evidence indicates that herpes zoster (HZ) may increase the risk of stroke/transient ischemic attack (TIA) or myocardial infarction (MI), but the results are inconsistent. We aim to explore the relationship between HZ and risk of stroke/TIA or MI and between herpes zoster ophthalmicus (HZO) and stroke. We estimated the relative risk (RR) and 95% confidence intervals (CIs) with the meta-analysis. Cochran's Q test and Higgins I 2 statistic were used to check for heterogeneity. HZ infection was significantly associated with increased risk of stroke/TIA (RR = 1.30, 95% CI: 1.17-1.46) or MI (RR = 1.18, 95% CI: 1.07-1.30). The risk of stroke after HZO was 1.91 (95% CI 1.32-2.76), higher than that after HZ. Subgroup analyses revealed increased risk of ischemic stroke after HZ infection but not hemorrhagic stroke. The risk of stroke was increased more at 1 month after HZ infection than at 1-3 months, with a gradual reduced risk with time. The risk of stroke after HZ infection was greater with age less than 40 years than 40-59 years and more than 60 years. Risk of stroke with HZ infection was greater without treatment than with treatment and was greater in Asia than Europe and America but did not differ by sex. Our study indicated that HZ infection was associated with increased risk of stroke/TIA or MI, and HZO infection was the most marked risk factor for stroke. Further studies are needed to explore whether zoster vaccination could reduce the risk of stoke/TIA or MI. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.
Cao, Song; Qin, Bangyong; Zhang, Yi; Yuan, Jie; Fu, Bao; Xie, Peng; Song, Ganjun; Li, Ying; Yu, Tian
Objective: Herpes zoster (HZ) can develop into postherpetic neuralgia (PHN), which is a chronic neuropathic pain (NP). Whether the chronification from HZ to PHN induced brain functional or structural change is unknown and no study compared the changes of the same brains of patients who transited from HZ to PHN. We minimized individual differences and observed whether the chronification of HZ to PHN induces functional and pain duration dependent grey matter volume (GMV) change in HZ-PHN patients. Methods: To minimize individual differences induced error, we enrolled 12 patients with a transition from HZ to PHN. The functional and structural changes of their brains between the two states were identified with resting-state functional MRI (rs-fMRI) technique (i.e., the regional homogeneity (ReHo) and fractional aptitude of low-frequency fluctuation (fALFF) method) and the voxel based morphometry (VBM) technology respectively. The correlations between MRI parameters (i.e., ΔReHo, ΔfALFF and ΔVBM) and Δpain duration were analyzed too. Results: Compared with HZ brains, PHN brains exhibited abnormal ReHo, fALFF and VBM values in pain matrix (the frontal lobe, parietal lobe, thalamus, limbic lobe and cerebellum) as well as the occipital lobe and temporal lobe. Nevertheless, the activity of vast area of cerebellum and frontal lobe significantly increased while that of occipital lobe and limbic lobe showed apparent decrease when HZ developed to PHN. In addition, PHN brain showed decreased GMV in the frontal lobe, the parietal lobe and the occipital lobe but increased in the cerebellum and the temporal lobe. Correlation analyses showed that some of the ReHo, fALFF and VBM differential areas (such as the cerebellum posterior lobe, the thalamus extra-nuclear and the middle temporal gyrus) correlated well with Δpain duration. Conclusions: HZ chronification induced functional and structural change in cerebellum, occipital lobe, temporal lobe, parietal lobe and limbic lobe
Winthrop, Kevin L; Curtis, Jeffrey R; Lindsey, Stephen; Tanaka, Yoshiya; Yamaoka, Kunihiro; Valdez, Hernan; Hirose, Tomohiro; Nduaka, Chudy I; Wang, Lisy; Mendelsohn, Alan M; Fan, Haiyun; Chen, Connie; Bananis, Eustratios
Patients with rheumatoid arthritis (RA) are at increased risk of herpes zoster (HZ), and the risk appears to be increased in patients treated with tofacitinib. The aim of this study was to evaluate whether concomitant treatment with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) or glucocorticoids (GCs) contributes to the increased risk of HZ in RA patients treated with tofacitinib. HZ cases were identified from the databases of 2 phase I, 9 phase II, 6 phase III, and 2 long-term extension studies of tofacitinib in RA patients. Crude incidence rates (IRs) of all HZ events (serious and nonserious) per 100 patient-years (with 95% confidence intervals [95% CIs]) were calculated for unique patients. Within phase III studies, we described HZ rates according to concomitant csDMARD treatment and baseline GC use. A multivariable Cox proportional hazards regression model was used to evaluate HZ risk factors across studies. Across all studies (6,192 patients; 16,839 patient-years), HZ was reported in 636 tofacitinib-treated patients (IR 4.0, 95% CI 3.7-4.4). In most cases (93%), HZ was classified as nonserious, and the majority of patients (94%) had involvement of only 1 dermatome. HZ IRs varied across regions, from 2.4 (95% CI 2.0-2.9) in Eastern Europe to 8.0 (95% CI 6.6-9.6) in Japan and 8.4 (95% CI 6.4-10.9) in Korea. Within phase III studies, HZ IRs varied according to tofacitinib dose, background csDMARD treatment, and baseline use of GCs. The IRs were numerically lowest for monotherapy with tofacitinib 5 mg twice daily without GCs (IR 0.56 [95% CI 0.07-2.01]) and highest for tofacitinib 10 mg twice daily with csDMARDs and GCs (IR 5.44 [95% CI 3.72-7.68]). Age, GC use, tofacitinib dose, and enrollment within Asia were independent risk factors for HZ. Patients receiving treatment with tofacitinib and GCs appear to have a greater risk of developing HZ compared with patients receiving tofacitinib monotherapy without GCs. © 2017 The Authors
Full Text Available The risk of herpes zoster (HZ between patients with psoriasis receiving and not receiving systemic therapy has received increasing attention. This study investigated the association of psoriasis with the risk of HZ.We conducted a population-based retrospective cohort study by using the Taiwan National Health Insurance Research Database. The psoriasis cohort consisted of 4077 patients with newly diagnosed psoriasis between 2000 and 2006. Each patient with psoriasis was frequency-matched with four people without psoriasis, by sex, age and index year. (nonpsoriasis cohort; 16308 subjects. Patients who received systemic therapy were classified as having severe psoriasis, whereas those who did not receive systemic therapy were classified as having mild psoriasis. The Cox proportional hazards regression analysis was conducted to estimate the association between psoriasis and HZ risk.The overall incidence density rate of HZ in the psoriasis cohort than in the nonpsoriasis cohort (4.50 vs. 3.44 per 1,000 person-years, with a multivariable Cox proportional hazards model measured adjusted HR of 1.29 [95% confidence interval (CI = 1.07-1.56]. In additional, compared with the nonpsoriasis cohort, the risk of HZ was higher in the severe psoriasis cohort than in the nonpsoriasis cohort (adjusted hazard ratio [HR], 1.61; 95% confidence interval [CI], 1.15-2.27. The comparison between psoriasis and nonpsoriasis cohorts revealed a greatest magnitude risk of HZ in women (adjusted HR, 1.36; 95% CI, 1.04-1.79, study participants in the age group of 20-39 years (adjusted HR, 1.77; 95% CI, 1.17-2.66, and study participants without any comorbidities (adjusted HR, 1.37; 95% CI, 1.02-1.84.Our results suggest that psoriasis is associated with an increased risk of HZ, which involves differences in sex and age. Although systemic therapy may have a major role in the risk of HZ, the intrinsic factors of psoriasis cannot be excluded.
Ferreira, J C O A; Marques, H H; Ferriani, M P L; Gormezano, N W S; Terreri, M T; Pereira, R M; Magalhães, C S; Campos, L M; Bugni, V; Okuda, E M; Marini, R; Pileggi, G S; Barbosa, C M; Bonfá, E; Silva, C A
The aim of this multicenter study in a large childhood-onset systemic lupus erythematosus (cSLE) population was to assess the herpes zoster infection (HZI) prevalence, demographic data, clinical manifestations, laboratory findings, treatment, and outcome. A retrospective multicenter cohort study (Brazilian cSLE group) was performed in ten Pediatric Rheumatology services in São Paulo State, Brazil, and included 852 cSLE patients. HZI was defined according to the presence of acute vesicular-bullous lesions on erythematous/edematous base, in a dermatomal distribution. Post-herpetic neuralgia was defined as persistent pain after one month of resolution of lesions in the same dermatome. Patients were divided in two groups for the assessment of current lupus manifestations, laboratory findings, and treatment: patients with HZI (evaluated at the first HZI) and patients without HZI (evaluated at the last visit). The frequency of HZI in cSLE patients was 120/852 (14%). Hospitalization occurred in 73 (61%) and overlap bacterial infection in 16 (13%). Intravenous or oral aciclovir was administered in 113/120 (94%) cSLE patients at HZI diagnosis. None of them had ophthalmic complication or death. Post-herpetic neuralgia occurred in 6/120 (5%). After Holm-Bonferroni correction for multiple comparisons, disease duration (1.58 vs 4.41 years, p < 0.0001) was significantly lower in HZI cSLE patients compared to those without HZI. Nephritis (37% vs 18%, p < 0.0001), lymphopenia (32% vs 17%, p < 0.0001) prednisone (97% vs 77%, p < 0.0001), cyclophosphamide (20% vs 5%, p < 0.0001) and SLE Disease Activity Index 2000 (6.0 (0-35) vs 2 (0-45), p < 0.0001) were significantly higher in the former group. The logistic regression model showed that four independent variables were associated with HZI: disease duration < 1 year (OR 2.893 (CI 1.821-4.597), p < 0.0001), lymphopenia <1500/mm(3) (OR 1.931 (CI 1.183-3.153), p = 0.009), prednisone (OR 6.723 (CI 2
Rapid quantitative PCR assays for the simultaneous detection of herpes simplex virus, varicella zoster virus, cytomegalovirus, Epstein-Barr virus, and human herpesvirus 6 DNA in blood and other clinical specimens
Engelmann, I.; Petzold, D. R.; Kosinska, A.; Hepkema, B. G.; Schulz, T. F.; Heim, A.
Rapid diagnosis of human herpesvirus primary infections or reactivations is facilitated by quantitative PCRs. Quantitative PCR assays with a standard thermal cycling profile permitting simultaneous detection of herpes simplex virus (HSV), varicella zoster virus (VZV), cytomegalovirus (CMV),
Takase, Hiroshi; Kubono, Reo; Terada, Yukiko; Imai, Ayano; Fukuda, Shoko; Tomita, Makoto; Miyanaga, Masaru; Kamoi, Koju; Sugita, Sunao; Miyata, Kazunori; Mochizuki, Manabu
To compare the clinical characteristics of anterior uveitis (AU) caused by herpes simplex virus (HSV), varicella-zoster virus (VZV), or cytomegalovirus (CMV). The medical records were reviewed of 46 patients whose diagnoses were based on their clinical characteristics [e.g., unilateral involvement, presence of keratic precipitates (KPs), and elevation of intraocular pressure (IOP)] and on PCR detection of herpes virus DNA in the aqueous humor. The demographics, chief complaints, and clinical characteristics of the three types of herpetic AU were compared. Of the 46 patients with AU, eight had HSV-AU, 20 had VZV-AU, and 18 had CMV-AU. HSV-AU and VZV-AU shared common features, i.e., a relatively acute disease process and the presence of large KPs. Among the three groups of patients, the characteristic features of those with VZV-AU were severe intraocular inflammation, as shown by severe aqueous flare, highest viral load in the aqueous humor, and presence of segmental iris atrophy. In comparison, patients with CMV-AU had the mildest intraocular inflammation, lowest corneal endothelial cell density, and highest IOP. Although the AU caused by each of the three types of herpes viruses has a number of common features, each disease also has distinct features that should facilitate an accurate diagnosis.
El-Safadi, Louay; Arngrim, Nanna; Amin, Faisal Mohammad
of viral meningitis and rapidly progressing symptoms of myelitis. Lumbar puncture showed increased levels of monocytes and varicella zoster virus DNA. Despite a negative MRI, based on a few previous case reports and because of lack of progress on antiviral treatment, treatment with steroids was established...... early, recovering the patient dramatically. This supports that a combination of antiviral treatment and steroids may be a more efficient treatment of zoster myelitis and reminds us that the diagnosis cannot be excluded by a negative MRI....
Cui, Ji-Zheng; Zhang, Jin-Wei; Zhang, Yun; Ma, Zheng-Liang
To evaluate the clinical efficacy of intradermal injection of methylene blue for treatment of moderate to severe acute thoracic herpes zoster and prevention of postherpetica neuralgia in elderly patients. Sixty-four elderly patients with herpes zoster were randomized to receive a 10-day course of intradermal injection of methylene blue and lidocaine plus oral valaciclovir (group A, 32 cases) and intradermal injection of lidocaine plus oral valaciclovir (group B).Herpes evaluation index, pain rating index, incidence of postherpetic neuralgia, and comprehensive therapeutic effect were compared between the two groups at 11, 30 and 60 days after the treatment. The baseline characteristics were comparable between the two groups (all P>0.05). Compared with that in group B, the time for no new blister formation, blister incrustation and decrustation, and pain relief was significantly shortened in group A (Pmethylene blue can effectively shorten the disease course, reduce the pain intensity and prevent the development of postherpetic neuralgia in elderly patients with herpes zoster.
Enrique Arce Morera
Full Text Available Se presentó el caso remitido a nuestro servicio de rehabilitación de la especialidad de oftalmología, con el diagnóstico de herpes zóster oftálmico, por presentar dolor y lesiones maculares, vesículas sobre una base eritematosa en la región periorbitaria y frontal derecha, acompañado de intenso edema. Tratado, además, en primera instancia, por dermatología con: aciclovir, antiinflamatorios (prednisona, vitaminoterapia y colirios. A los 7 días comenzó tratamiento de fisioterapia con radiación láser durante 15 sesiones, y continuó con 20 aplicaciones del campo magnético continuo, lo cual garantizó, con la interrelación de varias especialidades médicas y un enfoque multidisciplinario, la evolución satisfactoria del pacientePresent case was referred to our rehabilitation service of Ophthalmology specialty diagnosed with ophthalmic herpes zoster, pain and macular lesions, vesicles on an erythematous basis in right frontal periorbital region, accompanied of intense edema. The first treatment was applied in the Dermatology service with acyclovir, anti-inflammatory drugs (Prednisone, vitamin-therapy and eyedrops. At 17 days was treated with physiotherapy with laser radiation for 15 sessions continuing 20 applications of continuous magnetic field guarantying with the interrelation of some medical specialties and a multidisciplinary approach, the satisfactory evolution of patient.
Full Text Available Herpes zoster (shingles is an acute, painful, vesicular, and cutaneous eruption caused by varicella zoster virus, the same virus which causes chicken pox. It is due to the reactivation of the virus which remains dormant in sensory ganglions following chicken pox. It is usually confined to a single dermatome but may involve 2-3 dermatomes. Typically, it is a unilateral lesion which can affect both cranial and peripheral nerves. It is usually a self-limiting disease; however, it may cause significant morbidity especially in the elderly. It is more common in older people and individuals with immunocompromised conditions. Antiviral drugs can shorten the duration and the severity of the illness and need to be started as soon as possible after the appearance of the rash. Gabapentin and tricyclic antidepressant are effective in postherpetic neuralgia. Vaccine can reduce the risk of infection and its associated pain. Typically, it occurs once in a lifetime, but some individuals may have more than one episode.
Full Text Available We use age-structured models for VZV transmission and reactivation to reconstruct the natural history of VZV in Norway based on available pre-vaccination serological data, contact matrices, and herpes zoster incidence data. Depending on the hypotheses on contact and transmission patterns, the basic reproduction number of varicella in Norway ranges between 3.7 and 5.0, implying a vaccine coverage between 73 and 80% to effectively interrupt transmission with a 100% vaccine efficacy against infection. The varicella force of infection peaks during early childhood (3-5 yrs and shows a prolonged phase of higher risk during the childbearing period, though quantitative variations can occur depending on contact patterns. By expressing the magnitude of exogenous boosting as a proportion of the force of infection, it is shown that reactivation is well described by a progressive immunity mechanism sustained by a large, though possibly below 100%, degree of exogenous boosting, in agreement with findings from other Nordic countries, implying large reproduction numbers of boosting. Moreover, magnitudes of exogenous boosting below 40% are robustly disconfirmed by data. These results bring further insight on the magnitude of immunity boosting and its relationship with reactivation.
Schmidt, Sigrun A J; Langan, Sinéad M; Pedersen, Henrik S
We examined the association between mood disorders and risk of herpes zoster in two case-control studies using data from nationwide Danish registries and practices in the UK Clinical Practice Research Datalink. We included incident zoster cases diagnosed in general practice (using systemic......) for previous mood disorder among cases vs. controls were 1.15 (99% confidence interval (CI): 1.12, 1.19; prevalence 7.1% vs. 6.0%) in Denmark and 1.12 (99% CI: 1.11, 1.14; prevalence 31.6% vs. 29.2%) in the UK. In Denmark, ORs were higher for anxiety (1.23; 99% CI: 1.17, 1.30) and severe stress and adjustment....... In conclusion, mood disorders were associated with an increased risk of zoster....
Bardach, Ariel; Cafferata, María Luisa; Klein, Karen; Cormick, Gabriela; Gibbons, Luz; Ruvinsky, Silvina
Varicella-zoster virus causes chickenpox and herpes zoster. More than 90% of varicella cases occur in childhood. The aim of this study was to gather all relevant information on epidemiology and resource use in Latin America and the Caribbean since 2000. Epidemiologic studies published since 2000 with at least 50 cases of varicella or herpes zoster, or at least 10 cases of congenital disease were included. Gray literature was also searched. Outcomes included incidence, admission rate, mortality and case-fatality ratio. Use of resources and both direct and indirect costs associated were extracted. From the 495 records identified, 23 were included in the meta-analysis to report varicella-zoster virus outcomes and 3 in the herpes zoster analysis. The global pooled varicella incidence in subjects under 15 years of age was 42.9 cases per 1000 individuals per year (95% confidence interval: 26.9-58.9); children under 5 years of age were the most affected. Pooled general admission rate was 3.5 per 100,000 population (95% confidence interval: 2.9-4.1) and median hospitalization was 5-9 days. The most common varicella complications reported in studies were skin infections (3-61%), followed by respiratory infections (0-15%) and neurologic problems (1-5%). Direct costs averaged (2011/international dollar [I$]) $2040 per admission (range, I$ 298-5369) and I$70 per clinical visit (range, 11-188 I$). Limited information was available on the outcomes studied. Improvements in the surveillance of ambulatory cases are required to obtain a better epidemiologic picture. As of 2011, only 2 countries introduced the vaccine in national immunization programs in Latin America and the Caribbean.
Ajith P. Kannangara
Full Text Available The term isotopic response was coined by Wolf et al. in 1995 to describe the occurrence of a new skin disease at the site of a previous, unrelated and already healed cutaneous disorder . Dermatome/s that have been infected by herpes zoster virus become breading sites for a subsequent development of heterogeneous skin disorders, the occurrence of which generate the well-defined ‘Wolf’s post-herpetic isotopic response’ [2,3].
Temps moyen concernant la cessation de la formation d'un vésicle nouveau, la coûte, et la resolution de la douleur de Zoster liée ont été également remarquablement prolongée chez des patients avec VIH positif. Il n' y avait aucun difference importante dans l'incidence de la neurlgie post-herpetique, kéloides, et bectériel ...
Full Text Available The introduction of mass vaccination against Varicella-Zoster-Virus (VZV is being delayed in many European countries because of, among other factors, the possibility of a large increase in Herpes Zoster (HZ incidence in the first decades after the initiation of vaccination, due to the expected decline of the boosting of Cell Mediated Immunity caused by the reduced varicella circulation. A multi-country model of VZV transmission and reactivation, is used to evaluate the possible impact of varicella vaccination on HZ epidemiology in Italy, Finland and the UK. Despite the large uncertainty surrounding HZ and vaccine-related parameters, surprisingly robust medium-term predictions are provided, indicating that an increase in HZ incidence is likely to occur in countries where the incidence rate is lower in absence of immunization, possibly due to a higher force of boosting (e.g. Finland, whereas increases in HZ incidence might be minor where the force of boosting is milder (e.g. the UK. Moreover, a convergence of HZ post vaccination incidence levels in the examined countries is predicted despite different initial degrees of success of immunization policies. Unlike previous model-based evaluations, our investigation shows that after varicella immunization an increase of HZ incidence is not a certain fact, rather depends on the presence or absence of factors promoting a strong boosting intensity and which might or not be heavily affected by changes in varicella circulation due to mass immunization. These findings might explain the opposed empirical evidences observed about the increases of HZ in sites where mass varicella vaccination is ongoing.
Catarina Carrusca; Raquel Machado; Carolina Albuquerque; Florbela Cunha
O herpes zoster (HZ) resulta da reativação do vírus varicela- -zoster (VVZ). A incidência aumenta com a idade, sendo raro em crianças saudáveis. Descrevemos um caso de HZ oftálmico numa menina de 29 meses, previamente saudável. Apresentava febre e erupção cutânea vesicular dolorosa no território oftálmico do nervo trigémio. Sem história de varicela ou vacinação anti-varicela prévias. Teve contacto intrafamiliar com varicela aos dois meses de idade. A pesquisa do vírus nas...
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Wang, Kaiyi; Coyle, Meaghan E; Mansu, Suzi; Zhang, Anthony Lin; Xue, Charlie Changli
This study reviewed the biological action of key herbs and evaluated systematically the efficacy and safety of oral Gentiana formula for herpes zoster (HZ). Experimental studies relevant to HZ were identified in PubMed. Randomized controlled trials using Gentiana formula for HZ were identified from nine English and Chinese databases. The primary outcome was evaluation of pain. Potential risk of bias was assessed. Meta-analysis was conducted using mean difference or risk ratio with 95% confidence intervals. Key herbs Gentiana scabra Bunge, Gentiana triflora Pall, Scutellaria baicalensis Georgi, and Gardenia jasminoides Ellis have shown antiinflammatory actions through inhibition of inflammatory cytokines and pro-inflammatory enzymes. Twenty-six clinical studies, involving 2955 participants, were included. Modified Gentiana formula resolved pain earlier than pharmacotherapy when used alone or combined with topical Chinese herbal medicine. Incidence of postherpetic neuralgia was lower (risk ratio 0.14, 95% confidence interval 0.03 to 0.74) with modified Gentiana formula plus topical Chinese herbal medicine. Mild adverse events were reported. Antiinflammatory actions of key herbs of Gentiana formula may explain clinical benefit in hastening pain relief and decreasing postherpetic neuralgia. Few adverse events were reported. Findings were limited by study quality and diversity in intervention and comparator dosage. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.
Peng, Yi-Hao; Fang, Hsin-Yu; Wu, Biing-Ru; Kao, Chia-Hung; Chen, Hsuan-Ju; Hsia, Te-Chun; Liao, Wei-Chih
The objective of this study was to determine whether a new diagnosis of asthma is associated with a later diagnosis of herpes zoster (HZ) in a nationwide, retrospective, non-age limited, population-based cohort. We used data from the National Health Insurance Research Database in Taiwan. The asthma group consisted of all 40 069 patients in the database with newly diagnosed asthma and using asthma medications from 2000 through 2005. The nonasthma group comprised 40 069 age- and sex-matched patients without any asthma diagnosis. Cox proportional hazards regression analysis was applied to calculate the hazard ratio of HZ in the patients with asthma relative to those without asthma. During a mean follow-up period of 8.77 years, the risk of HZ was 1.48-fold higher in the asthma group compared with that in the nonasthma group after adjustment for sex, age, comorbidities, inhaled and systemic corticosteroid use, and annual outpatient department visits to dermatologists. Additional stratified analyses revealed that the risk of HZ was significantly higher in patients of both sexes and those aged older than 21 years. Newly diagnosed adult patients with asthma have a significantly higher risk of developing HZ than do those without asthma.
To compare the differences of curative effects of herpes zoster treated with acupuncture based on syndrome differentiation combined with pricking and cupping and simple pricking and cupping. Eighty-six cases were randomly divided into an observation group (43 cases) and a control group (43 cases). In observation group, acupoints selection based on syndrome differentiation i.e. Quchi (LI 11), Zusanli (ST 36), Sanyinjiao (SP 6), etc. were selected and pricking and cupping at affected parts were applied, and the cases were classified into damp heat in liver and gallbladder, damp retention and spleen deficiency, and qi deficiency and blood stasis. In control group, all the cases were simplely treated with pricking and cupping at affected parts. The treatment was given once a day, and seven days were made one session. The curative effect was evaluated after 2 courses, and the follow-up was carried on after 1 month. The cured and markedly effective rate was 93.0% (40/43) in observation group, superior to that of 67.4% (29/43) in control group (P 0.05). The cured and markedly effective rate of damp retention and spleen deficiency: 93.8% (15/16) in observation group, superior to that of 60.0% (9/15) in control group (P cupping therapy is high pertinent and effective, the postherpetic neuralgia can be reduced significantly and the curative effect is superior to that of simple pricking and cupping.
Full Text Available Background. Herpes zoster infection is a painful worldwide disease. Inappropriate and delayed treatment causes prolongation of the disease with debilitating symptoms and postherpetic neuralgia. Method. A cross-sectional study evaluated shingles cases admitted in a teaching hospital with one-year followup in north of Iran from 2007 to 2013. Results. From 132 patients, 60.4% were male. Head and neck involvement occurred in 78 people (59.1%, thoracoabdominal region in 37 cases (28%, and extremities in 16 cases (12.1%, and one case (0.8% got multisites involvement. 54 cases (40.9% had predisposing factors including diabetes mellitus in 26 cases (19.7%, malignancy in 15 (11.4%, immunosuppressive medication in 7 (5.03%, HIV infection in 3 (2.3%, radiotherapy in 2 (1.5%, and tuberculosis in one patient (0.8%. The most common symptoms were pain (95.5%, weakness (56%, fever (31.1%, headache (30.3%, ocular complaints (27.3%, itching (24.2%, and dizziness (5.3%. 21 cases (15.9% had bacterial superinfection on blistering areas and overall 18 cases (13.6% had opium addiction. 4 cases (3.03% died during admission because of comorbidities. Postherpetic neuralgia was reported in 56 patients (42.5% after three months and seven cases (5% in one-year followup. Conclusion. Shortening interval between skin lesion manifestation and starting medication can accelerate lesion improvement and decrease disease course, extension, and complication.
Horn, Johannes; Damm, Oliver; Greiner, Wolfgang; Hengel, Hartmut; Kretzschmar, Mirjam E; Siedler, Anette; Ultsch, Bernhard; Weidemann, Felix; Wichmann, Ole; Karch, André; Mikolajczyk, Rafael T
Epidemiological studies suggest that reduced exposure to varicella might lead to an increased risk for herpes zoster (HZ). Reduction of exposure to varicella is a consequence of varicella vaccination but also of demographic changes. We analyzed how the combination of vaccination programs and demographic dynamics will affect the epidemiology of varicella and HZ in Germany over the next 50 years. We used a deterministic dynamic compartmental model to assess the impact of different varicella and HZ vaccination strategies on varicella and HZ epidemiology in three demographic scenarios, namely the projected population for Germany, the projected population additionally accounting for increased immigration as observed in 2015/2016, and a stationary population. Projected demographic changes alone result in an increase of annual HZ cases by 18.3% and a decrease of varicella cases by 45.7% between 1990 and 2060. Independently of the demographic scenario, varicella vaccination reduces the cumulative number of varicella cases until 2060 by approximately 70%, but also increases HZ cases by 10%. Unlike the currently licensed live attenuated HZ vaccine, the new subunit vaccine candidate might completely counteract this effect. Relative vaccine effects were consistent across all demographic scenarios. Demographic dynamics will be a major determinant of HZ epidemiology in the next 50 years. While stationary population models are appropriate for assessing vaccination impact, models incorporating realistic population structures allow a direct comparison to surveillance data and can thus provide additional input for immunization decision-making and resource planning.
Kangath, Raghesh Varot; Lindeman, Tracey Einem; Brust, Karen
A 30-year-old Caucasian woman, without significant medical history or immunosuppression, presented with a 7-day history of severe headache and neck pain. The patient was presumed to have tension headache versus migraine, but was admitted because her symptoms did not resolve. A lumbar puncture was performed showing lymphocytic pleocytosis suggestive of aseptic meningitis and the patient was started on broad-spectrum antibiotics and acyclovir. After admission, a rash was discovered on her left lumbar region with vesicles on top of an erythematous base. Varicella PCR was conducted on the patient's cerebrospinal fluid which was positive. Upon further history, patient was found to have previous varicella infection as a child, but no prior episodes of dermatomal zoster. Therefore, this patient was found to have aseptic meningitis and cutaneous manifestation of disseminated varicella-zoster despite immunocompetence. Antibacterial treatment was discontinued and she was continued on acyclovir for 7 days with transition to valacyclovir for 2 additional weeks with good treatment response and symptom resolution.
Nov 2, 2012 ... Varicella zoster virus (VZV) of the human herpes virus family causes childhood chickenpox, becomes latent in sensory ganglia and re-activates years later in immunocompromised and elderly persons to produce shingles (herpes zoster). The annual incidence of herpes zoster in children aged <10 years is ...
Hao, Pengliang; Yang, Yiling; Guan, Ling
To observe the effects of bloodletting pricking, cupping and surrounding acupuncture on blood inflammation-related indices in patients with acute herpes zoster (HZ), and to explore the mechanism of pain control and treatment. A total of 60 patients were randomly divided into an observation group and a control group, 30 cases in each one. In the observation group, the patients were treated with bloodletting pricking at herpes, followed by cupping treatment; also the surrounding acupuncture was performed at injured skin. The treatment was given once a day and once every other day after the first 3 days; totally one-week treatment was given. In the control group, the patients were treated with intravenous drip of acyclovir and oral administration of vitamin B1 and B12, once a day for total one week. The visual analogue scale (VAS) and percentages of neutrophil, lymphocyte in peripheral and local blood were observed before and after treatment in the two groups. After treatment, the score of VAS was significantly reduced in both groups (both P treatment, the percentages of lymphocyte in peripheral and local blood were reduced after treatment (both P treatment in the control group (P cupping and surrounding acupuncture on acute herpes zoster is positive, and it can significantly lower the number of lymphocytes in the local blood and increase the number of neutrophil, which is likely to be one of the anti-virus mechanisms.
Full Text Available In Italy a specific surveillance system for zoster does not exist, and thus updated and complete epidemiological data are lacking. The objective of this study was to retrospectively review the national hospital discharge forms database for the period 1999-2005 using the code ICD9-CM053. In the period 1999-2005, 35,328 hospital admissions have been registered with annual means of 4,503 hospitalizations and 543 day-hospital admissions. The great part of hospitalizations (61.9% involved subjects older than 65 years; the mean duration of stay was 8 days. These data, even if restricted to hospitalizations registered at national level, confirm the epidemiological impact of shingles and of its complications.
Immunogenicity and safety of an adjuvanted herpes zoster subunit candidate vaccine in adults ≥ 50 years of age with a prior history of herpes zoster: A phase III, non-randomized, open-label clinical trial.
Godeaux, Olivier; Kovac, Martina; Shu, Daniel; Grupping, Katrijn; Campora, Laura; Douha, Martine; Heineman, Thomas C; Lal, Himal
This phase III, non-randomized, open-label, multi-center study (NCT01827839) evaluated the immunogenicity and safety of an adjuvanted recombinant subunit herpes zoster (HZ) vaccine (HZ/su) in adults aged ≥ 50 y with prior physician-documented history of HZ. Participants (stratified by age: 50-59, 60-69 and ≥ 70 y) received 2 doses of HZ/su 2 months apart and were followed-up for another 12 months. Anti-glycoprotein E (gE) antibodies were measured by enzyme-linked immunosorbent assay before vaccination and 1 month after the second dose (Month 3). Solicited local and general adverse events (AEs) were recorded for 7 d and unsolicited AEs for 30 d after each vaccination. Serious AEs were recorded until study end. The primary immunogenicity objective was met if the lower limit of the 95% confidence interval (CI) of the vaccine response rate (VRR), defined as a 4-fold increase in anti-gE over baseline, at Month 3 was ≥ 60%. 96 participants (32/age group) were enrolled. The primary immunogenicity objective was met, as the VRR at Month 3 was 90.2% (95% CI: 81.7-95.7). Geometric mean anti-gE antibody concentrations at Month 3 were similar across age groups. 77.9% and 71.6% of participants reported local and general solicited AEs, respectively. The most frequent solicited AEs were pain at injection site, fatigue, headache, myalgia and shivering. The HZ/su vaccine was immunogenic in adults aged ≥ 50 y with a physician-documented history of HZ, and no safety concerns were identified.
Full Text Available O herpes zoster (HZ resulta da reativação do vírus varicela-zoster (VVZ. A incidência aumenta com a idade, sendo raro em crianças saudáveis. Descrevemos um caso de HZ oftálmico numa menina de 29 meses, previamente saudável. Apresentava febre e erupção cutânea vesicular dolorosa no território oftálmico do nervo trigémio. Sem história de varicela ou vacinação anti-varicela prévias. Teve contacto intrafamiliar com varicela aos dois meses de idade. A pesquisa do vírus nas vesículas por polimerase chain reaction foi positiva. Os títulos de IgG e IgM anti-vírus varicela-zoster foram inicialmente negativos, tendo ocorrido seroconversão oito semanas depois. Medicada com aciclovir endovenoso, recuperou sem sequelas. O HZ pode ocorrer em crianças previamente saudáveis, sem evidência de varicela anterior e com serologia para VVZ negativa. Tal pode ser explicado pela imaturidade do sistema imunológico, assim como pela transferência transplacentária de anticorpos maternos, aquando da infeção primária precoce.
Pérez Escuredo, Jhudit; Llorente, José Luis; Melón, Santiago; de Oña, María; García Martínez, Jorge; Alvarez Marcos, César; Hermsen, Mario
Several types of virus have been implicated in the development of head and neck tumors. However, until now sinonasal adenocarcinomas (ACN) have not been studied. The aim of this study is to screen a series of ACN for the presence of a number of viruses known to play a role in cancer. Viral DNA sequences of herpes simplex virus, Epstein-Barr, varicela zoster, human papilloma, cytomegalovirus, and adenovirus were analysed by PCR in 37 primary ACN. Three tumors (8.1%) were positive for Epstein-Barr virus and 1 case (2.7%) for cytomegalovirus. Viral infections do not seem to play a role in the etiology of ACN.
Schmidt, Sigrun A J; Vestergaard, Mogens; Pedersen, Henrik S; Schønheyder, Henrik C; Thomas, Sara L; Smeeth, Liam; Mansfield, Kathryn E; Sørensen, Henrik T; Forbes, Harriet J; Langan, Sinéad M
Psychological stress is commonly thought to increase the risk of herpes zoster by causing immunosuppression. However, epidemiological studies on the topic are sparse and inconsistent. We conducted 2 parallel case-control studies of the association between partner bereavement and risk of zoster using electronic healthcare data covering the entire Danish population and general practices in the UK Clinical Practice Research Datalink. We included patients with a zoster diagnosis from the primary care or hospital-based setting in 1997-2013 in Denmark (n = 190671) and 2000-2013 in the United Kingdom (n = 150207). We matched up to 4 controls to each case patient by age, sex, and general practice (United Kingdom only) using risk-set sampling. The date of diagnosis was the index date for case patients and their controls. We computed adjusted odds ratios with 99% confidence intervals for previous bereavement among case patients versus controls using conditional logistic regression with results from the 2 settings pooled using random-effects meta-analysis. Overall, the adjusted odds ratios for the association between partner bereavement and zoster were 1.05 (99% confidence interval, 1.03-1.07) in Denmark and 1.01 (.98-1.05) in the United Kingdom. The pooled estimates were 0.72, 0.90, 1.10, 1.08, 1.02, 1.04, and 1.03 for bereavement within 0-7, 8-14, 15-30, 31-90, 91-365, 366-1095, and >1095 days before the index date, respectively. We found no consistent evidence of an increased risk of zoster after partner death. Initial fluctuations in estimates may be explained by delayed healthcare contact due to the loss.
Suo, Luodan; Lu, Li; Li, Juan; Sun, Mu; Wang, Haihong; Peng, Xinhui; Yang, Fan; Pang, Xinghuo; Marin, Mona; Wang, Chengbin
Hospital-based case control studies have found family history of herpes zoster (HZ) was associated with risk of HZ, but the role of family history is not fully examined for other HZ-associated outcomes such as recurrent HZ, occurrence of postherpetic neuralgia (PHN), and HZ with different pain severities. We conducted a population-based matched case control study. HZ cases that occurred during December 1, 2011 to November 30, 2012 were identified by face-to-face interview with all residents of eight selected communities/villages from three districts of Beijing, China. Medical records were reviewed for those who sought healthcare for HZ. For each case-patient, three, age-matched controls (±5 years) without HZ were enrolled from the same community/village of the matched case. Data on family history of HZ were collected by interview and only defined among first-degree relatives. A total of 227 case-patients and 678 matched controls were enrolled. Case-patients were more likely to report a family history of HZ [odds ratio (OR) =2.4, P = 0.002]. Compared with controls, association of family history decreased from HZ with PHN to HZ without PHN (OR = 6.0 and 2.3, respectively; P = 0.002 for trend), from recurrent HZ to primary HZ (OR = 9.4 and 2.2, respectively; P = 0.005 for trend), and from HZ with moderate or severe pain to HZ with mild or no pain (OR = 3.2 and 0.8, respectively; P Family history of HZ was associated with HZ occurrence and was more likely in HZ case-patients with PHN, recurrences, and painful HZ.
Lionis Christos D
Full Text Available Abstract Background Research has indicated that general practitioners (GPs have good clinical judgment in regards to diagnosing and managing herpes zoster (HZ within clinical practice in a country with limited resources for primary care and general practice. The objective of the current study was to assess the burden of HZ and post herpetic neuralgia (PHN within rural general practices in Crete, Greece. Methods The current study took place within a rural setting in Crete, Greece during the period of November 2007 to November 2009 within the catchment area in which the Cretan Rural Practice-based Research Network is operating. In total 19 GP's from 14 health care units in rural Crete were invited to participate, covering a total turnover patient population of approximately 25, 000 subjects. For the purpose of this study an electronic record database was constructed and used as the main tool for monitoring HZ and PHN incidence. Stress related data was also collected with the use of the Short Anxiety Screening Test (SAST. Results The crude incidence rate of HZ was 1.4/1000 patients/year throughout the entire network of health centers and satellite practices, while among satellite practices alone it was calculated at 1.3/1000 patients/year. Additionally, the standardised incidence density within satellite practices was calculated at 1.6/1000 patients/year. In regards to the stress associated with HZ and PHN, the latter were found to have lower levels of anxiety, as assessed through the SAST score (17.4 ± 3.9 vs. 21.1 ± 5.7; p = 0.029. Conclusions The implementation of an electronic surveillance system was feasible so as to measure the burden of HZ and PHN within the rural general practice setting in Crete.
Background Research has indicated that general practitioners (GPs) have good clinical judgment in regards to diagnosing and managing herpes zoster (HZ) within clinical practice in a country with limited resources for primary care and general practice. The objective of the current study was to assess the burden of HZ and post herpetic neuralgia (PHN) within rural general practices in Crete, Greece. Methods The current study took place within a rural setting in Crete, Greece during the period of November 2007 to November 2009 within the catchment area in which the Cretan Rural Practice-based Research Network is operating. In total 19 GP's from 14 health care units in rural Crete were invited to participate, covering a total turnover patient population of approximately 25, 000 subjects. For the purpose of this study an electronic record database was constructed and used as the main tool for monitoring HZ and PHN incidence. Stress related data was also collected with the use of the Short Anxiety Screening Test (SAST). Results The crude incidence rate of HZ was 1.4/1000 patients/year throughout the entire network of health centers and satellite practices, while among satellite practices alone it was calculated at 1.3/1000 patients/year. Additionally, the standardised incidence density within satellite practices was calculated at 1.6/1000 patients/year. In regards to the stress associated with HZ and PHN, the latter were found to have lower levels of anxiety, as assessed through the SAST score (17.4 ± 3.9 vs. 21.1 ± 5.7; p = 0.029). Conclusions The implementation of an electronic surveillance system was feasible so as to measure the burden of HZ and PHN within the rural general practice setting in Crete. PMID:22145678
Conde-Glez, Carlos; Lazcano-Ponce, Eduardo; Rojas, Rosalba; DeAntonio, Rodrigo; Romano-Mazzotti, Luis; Cervantes, Yolanda; Ortega-Barria, Eduardo
We estimated the seroprevalences of varicella-zoster virus (VZV), herpes simplex virus (HSV) and cytomegalovirus (CMV) in this cross-sectional database study. Serum samples collected during the National Health and Nutrition survey (ENSANUT 2006) were obtained from subjects aged 1-70 years between January and October 2010. Serological assays for the determination of antibodies against VZV, HSV and CMV were performed. The overall seroprevalences of VZV, HSV-1, HSV-2 and CMV were 85.8%, 80.9%, 9.9% and 89.2%, respectively. Seroprevalences of VZV, HSV-1 and CMV were comparable between males and females. For HSV-2, although the seroprevalence rate was higher in females when compared to males, this difference in seroprevalence was not statistically significant. Seroprevalence rates for VZV, HSV-1, HSV-2 and CMV increased with age (p-value<.0001). Differences in seroprevalence rate for VZV by socioeconomic status (SES) were significant (p-value<0001). Results of the serological analyses reported high VZV seroprevalence, indicating high transmission in the Mexican population with children and adolescents at risk of acquiring VZV. Global HSV-1 seroprevalence was high, especially in adults. HSV-1 and HSV-2 seroprevalences were consistently higher in women than men, particularly for HSV-2. CMV seroprevalence was higher in Mexico when compared to developed countries. Seroepidemiological data on VZV supports the fact that varicella vaccination may serve as an alternative effective solution to reduce transmission in the Mexican population. For CMV and HSV, since no vaccines are available, activities to reduce transmission are important to reduce the risk of complications and therefore need to be considered. Copyright © 2013 Elsevier Ltd. All rights reserved.
Full Text Available Purpose: To evaluate the diagnostic usefulness of enzyme linked immuno-sorbent assay (ELISA in single serum samples to associate herpes simplex virus (HSV, varicella zoster virus (VZV or cytomegalovirus (CMV with viral retinitis as against polymerase chain reaction (PCR on intraocular specimens. It was also designed to study the seroprevalence in normal healthy individuals, and the genomic prevalence of HSV, VZV and CMV in patients without an active viral inflammatory process. Methods: PCR for the detection of HSV, VZV and CMV genomes was done on 33 and 90 intraocular fluids from viral retinal patients and non-viral controls respectively. ELISA was done on 30 and 100 serum samples from viral retinitis patients and normal healthy controls respectively. Results: PCR did not detect HSV, VZV and CMV genomes except one, in which VZV-DNA was detected. ELISA showed prevalence rates of 28%, 83% and 90% for antibodies against HSV, VZV and CMV respectively in the normal population. In the 30 viral retinitis patients, PCR detected HSV-DNA in 2 (6.7%, VZV-DNA in 7 (23.3% and CMV-DNA in 6 (20.0% patients, while ELISA detected antibodies against HSV, VZV and CMV in 13 (43.3%, 24 (80.0% and 23 (76.7% patients respectively. ELISA was of value in indirect diagnosis only in 6 (20.0% as compared to 15 (50.0% of 30 patients by PCR, this difference was statistically significant (McNemar test, P value = 0.005. Conclusion: Serology by ELISA is no longer a useful diagnostic tool to associate HSV, VZV and CMV viruses with viral retinitis.
Heywood, Anita E; Wang, Han; Macartney, Kristine K; McIntyre, Peter
To examine trends in varicella and herpes zoster (HZ) hospitalization following the availability and subsequent National Immunization Programme funding of one-dose varicella vaccination in Australia. Varicella vaccination coverage for children born between 2001 and 2009 was obtained from the Australian Childhood Immunization Register. Principal or any coded varicella or HZ hospitalizations were retrieved from the national hospital morbidity database from 1998 to 2010. Trends in hospitalization rates in different age groups and indigenous status were assessed. Incidence rate ratios (IRR) were calculated between periods before and after implementation of immunization programme funding. In the first year of the funded immunization programme, varicella vaccine coverage reached 75% in children aged 24 months and more than 80% in children aged 60 months. Compared with the pre-vaccine period, varicella hospitalization rates during the funded programme were significantly lower for age groups younger than 40 years; with the greatest reduction in children aged 18-59 months (IRR: 0.25; 95% confidence interval, CI: 0.22-0.29). Indigenous children had a higher varicella hospitalization rate compared with non-indigenous children before vaccine implementation (IRR: 1.9; 95% CI: 1.4-2.7), but afterwards reached equivalence (IRR: 1.1; 95% CI: 0.7-1.6). The age-standardized HZ hospitalization rate declined between the periods (IRR: 0.95; 95% CI: 0.92-0.97). Rapid attainment of high coverage reduced varicella hospitalizations in the targeted age group, particularly for indigenous children, but also in non-targeted age groups, with no increase in HZ hospitalizations. This suggests high one-dose varicella vaccine coverage can have a substantial impact on severe disease.
Ko, E J; No, Y A; Park, K Y; Li, K; Seo, S J; Hong, C K
Infrared thermography is a non-invasive diagnostic tool that provides information for damage to the nerve, there was some reports that thermal asymmetry of acute Herpes zoster (HZ) patients was significantly related to development of PHN. To identify whether infrared thermography is useful as a predictor for the development of postherpetic neuralgia (PHN) and as an objective assessment tool of subjective pain in acute HZ patients. Infrared thermography was performed on the affected body regions of 112 patients who had been diagnosed with an acute stage of HZ. Demographic and clinical data were recorded. Differences >0.5°C for the mean temperature across the face and trunk were considered abnormal. According to whether PHN developed or not, we analyzed the correlation of risk factors. The study consisted of a total of 112 subjects (46 males and 66 females) with an age range of 9-93 years. The following summarizes the analysis results. (1) As pain severity increased, the occurrence of PHN increased significantly. (2) In older patients, the occurrence of PHN was significantly higher. (3) As the temperature difference between the affected and contralateral dermatome (ΔT) increased, the occurrence of PHN increased significantly. (4) There is a statically significant association between diabetes mellitus and the occurrence of PHN. (5) There is no correlation between pain intensity and ΔT. In this study, we showed that infrared thermography is useful as a predictor of PHN development in acute HZ patients but is not useful as an objective assessment tool for indicating subjective pain. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Full Text Available Abstract Introduction We present a case of herpes zoster infection (shingles precipitated by surgical manipulation of the trigeminal nerve root during an attempted microvascular decompression procedure. The pathogenesis of this phenomenon, as well as the importance and role of prophylactic acyclovir in its management, are discussed. Case presentation A 54-year-old Caucasian man with a classical long-standing left-sided V2 and V3 division primary trigeminal neuralgia refractory to medical management, underwent posterior fossa exploration for microvascular decompression via a standard retromastoid craniectomy. The patient had immediate and complete relief from pain. Three days after the operation, he developed severely painful vesicles with V2 and V3 dermatomal distribution. Rather than the classical paroxysmal, lancinating type of trigeminal neuralgia, the pain experienced by the patient was of a constant burning nature. A clinical diagnosis of herpes zoster (shingles was made after smear confirmation from microbiological testing. The patient was commenced on antiviral treatment with acyclovir. His vesicular rash and pain gradually subsided over the next two weeks. He remains asymptomatic one year later. Conclusions Postoperative shingles precipitated by trigeminal nerve manipulation during surgery for trigeminal neuralgia can be a distressing and demoralizing experience for the patient. A careful preoperative history, early recognition, and prompt antiviral therapy is necessary.
Izurieta, Hector S; Wernecke, Michael; Kelman, Jeffrey; Wong, Sarah; Forshee, Richard; Pratt, Douglas; Lu, Yun; Sun, Qin; Jankosky, Christopher; Krause, Philip; Worrall, Chris; MaCurdy, Tom; Harpaz, Rafael
Tens of millions of seniors are at risk of herpes zoster (HZ) and its complications. Live attenuated herpes zoster vaccine (HZV) reduces that risk, although questions regarding effectiveness and durability of protection in routine clinical practice remain. We used Medicare data to investigate HZV effectiveness (VE) and its durability. This retrospective cohort study included beneficiaries ages ≥65 years during January 2007 through July 2014. Multiple adjustments to account for potential bias were made. HZV-vaccinated beneficiaries were matched to unvaccinated beneficiaries (primary analysis) and to HZV-unvaccinated beneficiaries who had received pneumococcal vaccination (secondary analysis). HZ outcomes in community and hospital settings were analyzed, including ophthalmic zoster (OZ) and postherpetic neuralgia (PHN). Among eligible beneficiaries (average age 77 years), the primary analysis found VE for community HZ of 33% (95% CI: 32%-35%) and 19% (95% CI: 17%-22%), for the first 3, and subsequent 4+ years postvaccination, respectively. In the secondary analysis, VE was, respectively, 37% (95% CI: 36%-39%) and 22% (95% CI: 20%-25%). In the primary analysis, VE for PHN was 57% (95% CI: 52%-61%) and 45% (95% CI: 36%-53%) in the first 3 and subsequent 4+ years, respectively; VE for hospitalized HZ was, respectively, 74% (95% CI: 67%-79%) and 55% (95% CI: 39%-67%). Differences in VE by age group were not significant. In both the primary and secondary analyses, HZV provided protection against HZ across all ages, but effectiveness declined over time. VE was higher and better preserved over time for PHN and HZ-associated hospitalizations than for community HZ.
Full Text Available Kevin J Friesen,1 Jamie Falk,1 Silvia Alessi-Severini,1 Dan Chateau,2 Shawn Bugden1 1College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; 2Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada Background: Pain is a main symptom of herpes zoster (HZ, and postherpetic neuralgia (PHN is a frequent complication occurring in 5% to 15% of cases, causing moderate to severe neuropathic pain. A population-based observational study was conducted to evaluate the treatment patterns and economic burden of prescription drug treatment of HZ and PHN pain in the province of Manitoba (Canada over a period of 15 years. Methods: Administrative health care data, including medical and hospital separation records, were examined to identify episodes of HZ using International Classification of Diseases-9/10 codes between April 1, 1997 and March 31, 2014. Episodes of PHN were identified using medical and prescription claims. Incident use of analgesic, antidepressant, or anticonvulsant drugs was used to determine prescription pain costs. Results: The age-adjusted incidence of HZ increased from 4.7 episodes/1,000 person-years in 1997/98 to 5.7/1,000 person-years in 2013/14. PHN occurred in 9.2% of HZ cases, a rate that did not change over the study period (P=0.57. The annual cost to treat HZ pain rose by 174% from 1997/98, reaching CAD $332,981 in 2011/12, 82.8% (95% confidence interval [CI] 81.2%, 84.3% of which was related to PHN. The per episode cost of HZ rose by 111% from $31.59 (95% CI $25.35, $37.84 to $66.81 (95% CI $56.84, $76.78 and by 94% for PHN from $292 (95% CI $225, $358 to $566 (95% CI $478, $655. These increases were driven by increasing use of anticonvulsants, primarily gabapentin, which accounted for 57% of the increase in cost. Conclusion: There has been an increase in the incidence of HZ and PHN and in the average cost associated with the
Chen, Liang-Kung; Arai, Hidenori; Chen, Liang-Yu; Chou, Ming-Yueh; Djauzi, Samsuridjal; Dong, Birong; Kojima, Taro; Kwon, Ki Tae; Leong, Hoe Nam; Leung, Edward M F; Liang, Chih-Kuang; Liu, Xiaohong; Mathai, Dilip; Pan, Jiun Yit; Peng, Li-Ning; Poblete, Eduardo Rommel S; Poi, Philip J H; Reid, Stewart; Tantawichien, Terapong; Won, Chang Won
Herpes zoster (HZ) is a prevalent viral disease that inflicts substantial morbidity and associated healthcare and socioeconomic burdens. Current treatments are not fully effective, especially among the most vulnerable patients. Although widely recommended, vaccination against HZ is not routine; barriers in Asia-Pacific include long-standing neglect of adult immunisation and sparse local data. To address knowledge gaps, raise awareness, and disseminate best practice, we reviewed recent data and guidelines on HZ from the Asia-Pacific region. We searched PubMed, Scopus, and World Health Organization databases for articles about HZ published from 1994 to 2014 by authors from Australia, China, Hong Kong, India, Indonesia, Japan, Korea, Malaysia, New Zealand, the Philippines, Singapore, Taiwan, Thailand, and Vietnam. We selected articles about epidemiology, burden, complications, comorbidities, management, prevention, and recommendations/guidelines. Internet searches retrieved additional HZ immunisation guidelines. From 4007 retrieved articles, we screened-out 1501 duplicates and excluded 1264 extraneous articles, leaving 1242 unique articles. We found guidelines on adult immunisation from Australia, India, Indonesia, Malaysia, New Zealand, the Philippines, South Korea, and Thailand. HZ epidemiology in Asia-Pacific is similar to elsewhere; incidence rises with age and peaks at around 70 years - lifetime risk is approximately one-third. Average incidence of 3-10/1000 person-years is rising at around 5% per year. The principal risk factors are immunosenescence and immunosuppression. HZ almost always causes pain, and post-herpetic neuralgia is its most common complication. Half or more of hospitalised HZ patients have post-herpetic neuralgia, secondary infections, or inflammatory sequelae that are occasionally fatal. These disease burdens severely diminish patients' quality of life and incur heavy healthcare utilisation. Several countries have abundant data on HZ, but
Nascimento, Heloisa; Watanabe, Aripuanã; Vieira, Ana Carolina Cabreira; Pelegrini, Andrea; Yu, Maria Cecília; Bispo, Paulo José Martins; Granato, Celso Francisco Hernandes; Höfling-Lima, Ana Luisa
Bacterial keratitis occurs worldwide, and despite recent developments, it remains a potentially blinding condition. This study assesses the presence of herpes simplex virus (HSV-1 and -2) and varicella zoster virus (VZV) by quantitative real-time polymerase chain reaction (qPCR) in corneal scrapings from patients with bacterial keratitis. A total of 65 patients with clinical diagnoses of infectious corneal ulcers prospectively underwent clinical eye examinations. Corneal scrapings were investigated by Gram staining, Giemsa staining, culture, and qPCR (the study group). Risk factors and epidemiological data were recorded. The control group comprising 25 eyes with typical herpes dendritic keratitis was also analyzed by qPCR. From the study group (n=65), nine patients (13.8%) had negative smears, cultures, and qPCR findings. Fifty-six (86.2%) patients had positive cultures: 51 for bacteria, 4 for fungi, and 1 for amoebae. Of the patients who had positive bacterial cultures, qPCR identified 10 patients who were also positive for virus: one for VZV and nine for HSV-1. Of the 25 patients in the control group, 21 tested positive for HSV-1 by qPCR analysis. Herpes may be present in patients with bacterial corneal ulcers, and qPCR may be useful in its detection.
Huleihel, Mahmoud; Shufan, Elad; Zeiri, Leila; Salman, Ahmad
Of the eight members of the herpes family of viruses, HSV1, HSV2, and varicella zoster are the most common and are mainly involved in cutaneous disorders. These viruses usually are not life-threatening, but in some cases they might cause serious infections to the eyes and the brain that can lead to blindness and possibly death. An effective drug (acyclovir and its derivatives) is available against these viruses. Therefore, early detection and identification of these viral infections is highly important for an effective treatment. Raman spectroscopy, which has been widely used in the past years in medicine and biology, was used as a powerful spectroscopic tool for the detection and identification of these viral infections in cell culture, due to its sensitivity, rapidity and reliability. Our results showed that it was possible to differentiate, with a 97% identification success rate, the uninfected Vero cells that served as a control, from the Vero cells that were infected with HSV-1, HSV-2, and VZV. For that, linear discriminant analysis (LDA) was performed on the Raman spectra after principal component analysis (PCA) with a leave one out (LOO) approach. Raman spectroscopy in tandem with PCA and LDA enable to differentiate among the different herpes viral infections of Vero cells in time span of few minutes with high accuracy rate. Understanding cell molecular changes due to herpes viral infections using Raman spectroscopy may help in early detection and effective treatment.
Lehmann, Birthe A; Eilers, Renske; Mollema, Liesbeth; Ferreira, José; de Melker, Hester E
Increasing life expectancy results in a larger proportion of older people susceptible to vaccine preventable diseases (VPDs). In the Netherlands, influenza vaccination is routinely offered to people aged 60 years and older. Vaccination against pneumococcal disease, herpes zoster and pertussis is rarely used. These vaccines will be evaluated by the Dutch Health Council and might be routinely offered to older people in the near future. Possible expansion of the program depends partly on the willingness of general practitioners (GPs) to endorse additional vaccinations. In this study, we assessed predictors of GPs' attitude and intention to vaccinate people aged 60 years and older. GPs (N = 12.194) were invited to fill in an online questionnaire consisting of questions about social cognitive factors that can influence the willingness of GPs to vaccinate people aged 60 years and older, including underlying beliefs, practical considerations of adding more vaccines to the national program, demographics, and GPs' patient population characteristics. The questionnaire was filled in by 732 GPs. GPs were positive both about vaccination as a preventive tool and the influenza vaccination program, but somewhat less positive about expanding the current program. Prediction analysis showed that the intention of GPs to offer additional vaccination was predicted by their attitude towards offering additional vaccination, towards vaccination as a preventive tool, towards offering vaccination during an outbreak and on GPs opinion regarding suitability to offer additional vaccination (R 2 = 0.60). The attitude of GPs towards offering additional vaccination was predicted by the perceived severity of herpes zoster and pneumonia, as well as the perceived incidence of herpes zoster. Severity of diseases was ranked as important argument to recommend vaccination, followed by effectiveness and health benefits of vaccines. Providing GPs with evidence-based information about the severity
Rondaan, Christien; van der Geest, Kornelis S. M.; Eelsing, Elisabeth; Boots, Annemieke M. H.; Bos, Nicolaas A.; Westra, Johanna; Brouwer, Elisabeth
Introduction: Herpes zoster, which can have a major impact on quality of life, results from reactivation of a latent varicella zoster virus (VZV) infection. We hypothesized that giant cell arteritis (GCA) patients are at increased risk of herpes zoster because of treatment with high-dose
Civen, Rachel; Marin, Mona; Zhang, John; Abraham, Amanuel; Harpaz, Rafael; Mascola, Laurene; Bialek, Stephanie R
Changes in herpes zoster (HZ) epidemiology are expected with childhood varicella vaccination. We reported previously that during 2000 to 2006 HZ incidence decreased 55% in children vaccinations, disease histories and clinical information. We calculated HZ incidence for 2007 to 2010 and assessed trends since 2000. Among children children compared with 41.6 cases/100,000 children during 2000 to 2006, a 69% decline (P children compared with 68.0 cases/100,000 children during 2000 to 2006, a 13% increase (P = 0.123), with substantial fluctuation in annual rates throughout the 11 years of surveillance. During the mature varicella vaccination program, declines in HZ incidence among children vaccine could reduce HZ incidence among vaccinated populations. Ongoing monitoring of HZ incidence is needed to detect and understand changes in HZ epidemiology in the varicella vaccine era.
Schwarz, Tino F; Aggarwal, Naresh; Moeckesch, Beate; Schenkenberger, Isabelle; Claeys, Carine; Douha, Martine; Godeaux, Olivier; Grupping, Katrijn; Heineman, Thomas C; Fauqued, Marta Lopez; Oostvogels, Lidia; Van den Steen, Peter; Lal, Himal
The immunogenicity and safety of an adjuvanted herpes zoster subunit (HZ/su) vaccine when coadministered with a quadrivalent seasonal inactivated influenza vaccine (IIV4) was investigated in a phase 3, open-label, randomized clinical trial in adults aged ≥50 years. Subjects were randomized 1:1 to receive either HZ/su (varicella zoster virus glycoprotein E; AS01B Adjuvant System) and IIV4 at day 0 followed by a second HZ/su dose at month 2 (coadministration group), or IIV4 at month 0 and HZ/su at months 2 and 4 (control group). The primary objectives were the HZ/su vaccine response rate in the coadministration group and the noninferiority of the antibody responses to HZ/su and IIV4 in the coadministration compared with the control group. Safety information was collected throughout the duration of the study. A total of 413 subjects were vaccinated in the coadministration group and 415 in the control group. The HZ/su vaccine response rate in the coadministration group was 95.8% (95% confidence interval, 93.3%-97.6%) and the anti-glycoprotein E GMCControl/Coadmin ratio was 1.08 (.97-1.20). The primary noninferiority objectives were met. No safety concerns were observed. No interference in the immune responses to either vaccine was observed when the vaccines were coadministered, and no safety concerns were identified. NCT01954251.
To examine the current seroepidemiology of immunoglobulin (Ig)G for herpes simplex virus types 1 and 2 (HSV 1-2), varicella zoster virus (VZV), and cytomegalovirus (CMV) among university females of childbearing age in Syria. A cross-sectional study was conducted to examine the female students of the Pharmacy College, Kalamoon University, Deratiah, Syria, where 316 sera were collected from October 2009 to November 2010, and subjected to HSV 1-2, VZV, and CMV IgG screening and titration using enzyme-linked immunosorbent assay-based techniques in the Microbiology Laboratory. A total of 164 participants were positive for HSV 1-2 IgG giving a prevalence of 52%, leaving a relatively high proportion of susceptibility among the tested group. For VZV, 91% of the participants (n=287) were positive for its specific IgG, while, regarding CMV, 74.5% (n=235) were positive, and 25.5% were negative for CMV specific IgG. Although most participants were seropositive for herpes viruses IgG, suggesting a natural virus circulation within the community, screening for protective immunity is suggested against HSV, since a relatively high proportion of tested females are still susceptible. In addition, and because of its nasty outcomes during pregnancy, IgG against CMV should also be tested. High percentage of positivity towards VZV could be explained due to introduction of the new vaccine program, and therefore, further analysis during pregnancy is not recommended.
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Cárdenas, Ana María; Edelstein, Paul H; Alby, Kevin
We transitioned laboratory-developed PCR assays for herpes simplex virus 1 (HSV-1), HSV-2, and varicella-zoster virus (VZV) to the BD Max system by using BD Max open system reagents. After optimization, the agreement with the reference PCR assay was 100% (123/123) for HSV-1, 96.7% (119/123) for HSV-2, and 100% (60/60) for VZV using retrospective clinical samples. Copyright © 2014, American Society for Microbiology. All Rights Reserved.
Cruzat, Andrea; Hamrah, Pedram; Cavalcanti, Bernardo M.; Zheng, Lixin; Colby, Kathryn; Pavan-Langston, Deborah
Purpose To study corneal reinnervation and sensation recovery in Herpes zoster Ophthalmicus (HZO). Methods Two patients with HZO were studied over time with serial corneal esthesiometry and laser in vivo confocal microscopy (IVCM). A Boston keratoprosthesis (B-KPro) type 1 was implanted and the explanted corneal tissues were examined by immunofluorescence histochemistry for βIII-tubulin to stain for corneal nerves. Results The initial central corneal IVCM performed in each patient, showed a complete lack of the subbasal nerve plexus, which was in accordance with severe loss of sensation (0 of 6 cm) measured by esthesiometry. When IVCM was repeated 2 years later prior to undergoing surgery, Case 1 showed a persistent lack of central subbasal nerves and sensation (0 of 6). In contrast, Case 2 showed regeneration of the central subbasal nerves (4,786 µm/mm2) with partial recovery of corneal sensation (2.5 of 6 cm). Immunostaining of the explanted corneal button in Case 1 showed no corneal nerves while Case 2, showed central and peripheral corneal nerves. Eight months after surgery, IVCM was again repeated in the donor tissue around the B-KPro in both patients, to study innervation of the corneal transplant. Case 1 showed no nerves, while Case 2 showed new nerves growing from the periphery into the corneal graft. Conclusions We demonstrate that regaining corneal innervation and function is possible in patients with HZO as shown by corneal sensation, IVCM, and ex-vivo immunostaining, indicating zoster neural damage is not always permanent and it may recover over an extended period of time. PMID:26989956
Tyring, Stephen K; Lee, Patricia; Hill, Gordon T; Silverfield, Joel C; Moore, Angela Yen; Matkovits, Theresa; Sullivan-Bolyai, John
This prospective, parallel-group, randomized, double-blind, multicenter study compared the efficacy and safety of FV-100 with valacyclovir for reducing pain associated with acute herpes zoster (HZ). Patients, ≥50 years of age, diagnosed with HZ within 72 h of lesion appearance who had HZ-associated pain, were randomized 1:1:1 to a 7-day course of either FV-100 200 mg QD (n = 117), FV-100 400 mg QD (n = 116), or valacyclovir 1000 mg TID (n =117). Efficacy was evaluated on the basis of the burden of illness (BOI; Zoster Brief Pain Inventory scores); incidence and duration of clinically significant pain (CSP); pain scores; incidence and severity of post-herpetic neuralgia (PHN); and times to full lesion crusting and to lesion healing. Safety was evaluated on the basis of adverse event (AE)/SAE profiles, changes in laboratory and vital signs values, and results of electrocardiograms. The burden of illness scores for pain through 30 days were 114.5, 110.3, and 118.0 for FV-100 200 mg, FV-100 400 mg, and valacyclovir 3000 mg, respectively. The incidences of PHN at 90 days for FV-100 200 mg, FV-100 400 mg, and valacyclovir 3000 mg were 17.8%, 12.4%, and 20.2%, respectively. Adverse event and SAE profiles of the two FV-100 and the valacyclovir groups were similar and no untoward signals or trends were evident. These results demonstrate a potential for FV-100 as an antiviral for the treatment of shingles that could both reduce the pain burden of the acute episode and reduce the incidence of PHN compared with available treatments. © 2016 Wiley Periodicals, Inc.
Schuster, Larissa Cristina; Buss, Ceres
Tema: herpes e audiologia. Objetivo: realizar revisao teorica principalmente sobre os virus herpes simples tipo 1, herpes simples tipo 2 e varicela-zoster, bem como sobre seus efeitos na audicao humana...
Ke, Chi-Chen; Lai, Hui-Chin; Lin, Ching-Heng; Hung, Chih-Jen; Chen, Der-Yuan; Sheu, Wayne H-H; Lui, Ping-Wing
We investigated the association between the risk of herpes zoster (HZ) and diabetes-related macrovascular comorbidities and microvascular disorders in diabetic patients. This retrospective study included 25,345 patients with newly identified HZ and age- and gender-matched controls retrieved from the National Health Insurance Research Database in Taiwan during the period of 2005 to 2011. Multivariate logistic regression analyses were used to calculate the odds ratios (OR) and to assess the risk factors for HZ in diabetic patients with associated macrovascular or microvascular disorders. Risk factors for HZ were significantly increased in cases of diabetes mellitus (DM) compared with those in cases of non-DM controls (20.2% vs. 17.0%, OR = 1.24, pcoronary artery disease (CAD) (adjusted OR = 1.21, pmicrovascular disorders (aOR = 1.32, pmicrovascular disorders. Patients who took thiazolidinedione, alpha-glucosidase inhibitors and insulin had a higher HZ risk than those taking metformin or sulphonylureas alone (aOR = 1.11, 1.14 and 1.18, pcoronary artery disease and associated microvascular disorders had an increased risk of HZ occurrence.
Takao, Yukiko; Okuno, Yoshinobu; Mori, Yasuko; Asada, Hideo; Yamanishi, Koichi; Iso, Hiroyasu
This population-based prospective study examined the relationships of perceived mental stress, sense of purpose in life, and negative life events to the incidence of herpes zoster (HZ) and postherpetic neuralgia (PHN). The data were collected from 12,359 participants (aged ≥50 years old in Shozu County, Kagawa Prefecture, Japan) who answered a self-completed health questionnaire. During a 3-year follow-up between December 2008 and November 2012, HZ and PHN were diagnosed in 400 and 79 subjects, respectively. We used Cox regression analysis to estimate hazard ratios of incident HZ and PHN according to psychosocial factors, adjusting for age, sex, history of HZ, cancer, and diabetes, smoking and drinking habits and the period from the onset to treatment. Men who felt their mental stress very high versus low had twice the risk of incident HZ. The risk of incident HZ was approximately 60% lower among men and women confirming very high versus low sense of purpose in life. Women who experienced negative life events, especially changes in their work and living environments and human relations, had two to three fold higher risk of incident PHN. Psychosocial factors may contribute to the development of HZ and PHN in the general population. © The Author(s) 2017. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: firstname.lastname@example.org.
Liu, Zhen-wei; Mo, Jin-hua; Pang, Jun; Deng, Xin
To observe the efficacy of thread-moxa in Zhuang folk medicine (TM) combined with acupuncture and external application drugs for AIDS patients with herpes zoster (AHZ). A randomized, controlled clinical trial was conducted in 60 patients with AHZ. They were randomly assigned to the treatment group (treated with TM combined with acupuncture and Jingwanhong Scald Ointment) and the control group (treated with Famciclovir Tablet, nimesulide dispersible tablet, vitamin B1, ribavirin ointment). The treatment course was 14 days for both groups.The clinical efficacy, significant efficiency visual analog scale score (VAS), sleep quality score (QS), the postherpetic neuralgia rate in 1 year after treatment were observed. The markedly effective rate was significantly higher in the treatment group than in the control group (86.7% vs. 53.3%, P vs. 80.0%, P > 0.05). The post-treatment VAS, QS, the time for pain disappearance, skin repair, crusting, and 1-year postherpetic neuralgia incidence rate were significantly lower in the treatment group than in the control group (P acupuncture and Jingwanhong Scald Ointment was effective for treating AHZ patients. It relieved pain quickly, shortened their course of disease, and improved their quality of sleep.
Hu, Stephen Chu-Sung; Yen, Feng-Lin; Wang, Tsu-Nai; Lin, Yu-Chih; Lin, Chi-Ling; Chen, Gwo-Shing
The association between immunosuppressive medication use and herpes zoster (HZ) in patients with systemic lupus erythematosus (SLE) has not been clearly defined. We evaluated the risk of HZ in patients with SLE treated with different immunosuppressants. A nationwide population-based case-control study was conducted using the Taiwanese National Health Insurance Research Database. Cases (1555 patients with SLE who developed HZ) and controls (3049 age- and sex-matched patients with SLE but without HZ) were analyzed for use of various immunosuppressive medications in the preceding 3-month period, and dose-response relationships were determined. Logistic regression was performed to estimate the adjusted odds ratio for HZ development. Medications associated with greater HZ risk in patients with SLE included oral corticosteroids, intravenous methylprednisolone, hydroxychloroquine, oral cyclophosphamide, intravenous cyclophosphamide, azathioprine, methotrexate, and mycophenolate mofetil. Combination immunosuppressive therapy was common in patients with SLE and was associated with greatly increased HZ risk. For oral corticosteroids and hydroxychloroquine, the risk of HZ was strongly dependent on the medication dose. This study is retrospective in nature. Recent immunosuppressive medication use is associated with increased HZ risk in patients with SLE, particularly those receiving high-dose oral corticosteroids and multiagent immunosuppressive therapy. Copyright © 2016 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.
Lim, Doo-Ho; Kim, Ye-Jee; Kim, Seon Ok; Hong, Seokchan; Lee, Chang-Keun; Yoo, Bin; Kim, Yong-Gil
The aims of our study were to determine whether the use of conventional disease-modifying antirheumatic drugs (cDMARDs) or tumor necrosis factor α (TNFα) inhibitors increase the risk of herpes zoster (HZ) in patients with ankylosing spondylitis (AS). We searched the South Korean National Health Insurance Service - National Sample Cohort Database for relevant patient records between 2002 and 2013. We evaluated the incidence of HZ by categorizing patients into in three treatment groups: disease-modifying antirheumatic drug (DMARD) nonusers, cDMARD users and TNFα inhibitor users. Incidence rates of HZ was 11.0 per 1000 person-years in patients with AS. The adjusted hazard ratio of HZ was higher in cDMARD and TNFα inhibitor users than in DMARD nonusers. In subgroup analyses, current treatment with a TNFα inhibitor increased the risk of HZ significantly both in female patients and in patients aged 50 years or older, but not in patients taking steroids, compared to DMARD nonusers. Treatment with either TNFα inhibitors or cDMARDs is associated with a higher risk of HZ, especially in female patients and older patients, and these two patient groups could therefore benefit from HZ vaccination.
Full Text Available Several prokaryotic and eukaryotic expression systems have been used for in vitro production of viruses’ proteins. However eukaryotic expression system was always the first choice for production of proteins that undergo post-translational modification such as glycosylation. Recombinant baculoviruses have been widely used as safe vectors to express heterologous genes in the culture of insect cells, but the manipulation involved in creating, titrating, and amplifying viral stocks make it time consuming and laborious. Therefore, to facilitate rapid expression in insect cell, a plasmid based expression system was used to express herpes simplex type 1 glycoprotein D (HSV-1 gD and varicella zoster glycoprotein E (VZV gE. Recombinant plasmids were generated, transfected into insect cells (SF9, and both glycoproteins were expressed 48 h post-infection. A protein with approximately molecular weight of 64-kDa and 98-kDa for HSV-1 gD and VZV gE respectively was expressed and confirmed by SDS. Proteins were detected in insect cells cytoplasm and outer membrane by immunofluorescence. The antigenicity and immunoreactivity of each protein were confirmed by immunoblot and ELISA. Results suggest that this system can be an alternative to the traditional baculovirus expression for small scale expression system in insect cells.
Sloutskin, Anna; Yee, Michael B; Kinchington, Paul R; Goldstein, Ronald S
The two human neurotropic alphaherpesviruses varicella-zoster virus (VZV) and herpes simplex virus type 1 (HSV1) both establish latency in sensory ganglia. Human trigeminal ganglia are known to frequently harbor both viruses, and there is evidence to suggest the presence of both VZV and HSV1 DNA in the same neuron. We ask here whether VZV and HSV1 can exclude themselves and each other and whether they can productively infect the same cells in human neurons and human foreskin fibroblasts (HFF). Simultaneous infection (coinfection) or consecutive infection (superinfection) was assessed using cell-free HSV1 and VZV expressing fluorescent reporter proteins. Automated analysis was carried out to detect singly and dually infected cells. We demonstrate that VZV and HSV1 both display efficient superinfection exclusion (SE) in HFF, with each virus excluding either itself or the other virus. While SE also occurred in neurons, it was with much lower efficiency. Both alphaherpesviruses productively infected the same neurons, whether applied simultaneously or even consecutively, albeit at lower frequencies. Superinfection exclusion by VZV for itself or the related neurotropic alphaherpesvirus HSV1 has been studied here for the first time. We find that while these viruses display classic SE in fibroblasts, SE is less efficient for both HSV1 and VZV in human neurons. The ability of multiple VZV strains to productively infect the same neurons has important implications in terms of recombination of both wild-type and vaccine strains in patients.
Cebrián-Cuenca Ana M
Full Text Available Abstract Background Data on the epidemiology and costs related to herpes zoster (HZ and postherpetic neuralgia (PHN in Spain are scarce; therefore, studies are needed to evaluate the epidemiological and economic impact of HZ and its most common complication, PHN. The present study aimed to estimate the clinical and economic burden of HZ and PHN in Valencia (Spain. Methods We prospectively analyzed the burden of HZ and PHN and their attributable costs in patients from 25 general practices in the Autonomous Community of Valencia serving 36,030 persons aged > 14 years. All patients with a clinical diagnosis of HZ who attended these centers between December 1st 2006 and November 30th 2007 were asked to participate. Patients included were followed for 1 year. Results Of the 130 cases of HZ followed up, continued pain was experienced by 47.6% (95% confidence interval (CI = 35.6-56.7% at 1 month after rash onset, by 14.5% (95% CI = 7.8-1.2% at 3 months, by 9.0% (95% CI = 3.7-14.3% at 6 months, and by 5.9% (95% CI = 1.5-10.3% at 12 months. The percentage of patients with PHN increased with age, from 21.4% (95% CI = 8.3-40 in patients Conclusions This study shows that PHN is a relatively common complication of HZ and that both conditions combined give rise to a significant clinical and economic burden for patients and providers.
Ihekwaba, Ugo K; Kudesia, Goura; McKendrick, Michael W
In this retrospective study, our objective was to review the epidemiology of viral meningitis and to compare clinical features associated with enterovirus, herpes simplex virus (HSV), and varicella zoster virus (VZV) infections in immunocompetent adults. Data on cerebrospinal fluid (CSF) samples submitted to the Trust Virology Laboratory (Sheffield, UK) from April 2004 through April 2007 were reviewed. Notes on immunocompetent adults who were polymerase chain reaction (PCR) positive for enterovirus, HSV type 2, or VZV and who had presented to local clinical departments were scrutinized (4 patients were positive for HSV type 1 and did not meet the inclusion criteria). A total of 2045 samples were analyzed for viral pathogens during the 3-year period. Of the 109 PCR-positive samples, 38 (35%) were from immunocompetent adults, of whom 22 were infected with enterovirus, 8 were infected with HSV type 2, and 8 were infected with VZV. The median ages were 32 years (range, 16-39 years), 39 years (range, 22-53 years), and 47.5 years (range, 26-80 years), respectively. Rash occurred after the meningitis symptoms in 5 patients infected with VZV (median time from meningitis symptoms to rash, 6 days). Protein levels were significantly higher in CSF samples from patients infected with HSV type 2 (median, 1205 mg/L) and in samples from those infected with VZV (median, 974 mg/L) than in samples from those infected with enterovirus (median, 640 mg/L; P = .001 and P = .01, respectively). White blood cell counts were significantly higher in CSF samples from patients infected with HSV type 2 (median, 240 x 10(6) cells/L) than in samples from those infected with enterovirus (median, 51 x 10(6) cells/L; P = .01). Enterovirus infection was the most common cause of viral meningitis in immunocompetent adults in this study. White blood cell counts and protein levels were significantly higher in CSF samples from patients infected with HSV type 2 than in samples from patients with enterovirus
Full Text Available We investigated the association between the risk of herpes zoster (HZ and diabetes-related macrovascular comorbidities and microvascular disorders in diabetic patients. This retrospective study included 25,345 patients with newly identified HZ and age- and gender-matched controls retrieved from the National Health Insurance Research Database in Taiwan during the period of 2005 to 2011. Multivariate logistic regression analyses were used to calculate the odds ratios (OR and to assess the risk factors for HZ in diabetic patients with associated macrovascular or microvascular disorders. Risk factors for HZ were significantly increased in cases of diabetes mellitus (DM compared with those in cases of non-DM controls (20.2% vs. 17.0%, OR = 1.24, p<0.001. Results of age- and gender-adjusted analyses demonstrated a significantly higher risk of HZ in DM patients with accompanying coronary artery disease (CAD (adjusted OR = 1.21, p<0.001 and microvascular disorders (aOR = 1.32, p<0.001 than in DM patients with other comorbidities but no microvascular disorders. Patients who took thiazolidinedione, alpha-glucosidase inhibitors and insulin had a higher HZ risk than those taking metformin or sulphonylureas alone (aOR = 1.11, 1.14 and 1.18, p<0.001, respectively. Patients who took insulin alone or in combination with other antidiabetic agents had a significantly higher risk of HZ (aOR = 1.25, p<0.001 than those who received monotherapy. Diabetic patients comorbid with coronary artery disease and associated microvascular disorders had an increased risk of HZ occurrence.
Nithyanandam, S; Joseph, M; Stephen, J
The aim of the work is to describe the occurrence of ocular complications and loss of vision due to herpes zoster ophthalmicus (HZO) in HIV-positive patients who received early antiviral therapy for HZO.This is a post hoc analysis of prospectively collected data.Twenty-four HIV-positive patients with HZO were included in this report; male to female ratio was 3.8:1; mean age was 33.5 (±14.9) years. The visual outcome was good, with 14/24 patients having 6/6 vision; severe vision loss (≤6/60) occurred in only 2/24. There was no statistical difference in the visual outcome between the HIV-positive and -negative patients (P = 0.69), although severe vision loss was more likely in HIV-infected patients. The ocular complications of HZO in HIV-infected patients were: reduced corneal sensation (17/24), corneal epithelial lesions (14/24), uveitis (12/24), elevated intraocular pressure (10/24) and extra-ocular muscle palsy (3/24). The severity of rash was similar in the two groups but multidermatomal rash occurred only in HIV-infected patients (4/24). There was no difference in the occurrence of ocular complications of HZO between HIV-positive and HIV-negative patients. HZO associated ocular complications and visual loss is low in HIV-infected patients if treated with HZO antiviral therapy and was comparable with HIV-negative patients. Early institution of HZO antiviral therapy is recommended to reduce ocular complication and vision loss.
Full Text Available Abstract Background Data on the potential efficacy of acupuncture (AC in controlling intense or very intense pain in patients with Herpes Zoster (HZ has not been so far adequately assessed in comparison with standard pharmacological treatment (ST by a controlled trial design. Methods Within the VZV Pescara study, pain was assessed in HZ patients on a Visual Analogue Scale (VAS and by the McGill Pain Questionnaire (MPQ both at the beginning and at the end of treatment. Response rates, mean changes in pain intensity, differences in total pain burden with an area-under-the-curve (AUC method over a 1-year follow-up and differences in the incidence of Post-Herpetic Neuralgia (PHN were evaluated. Results One hundred and two patients were randomized to receive either AC (n = 52 or ST (n = 50 for 4 weeks. Groups were comparable regarding age, sex, pain intensity at presentation and missed antiviral prescription. Both interventions were largely effective. No significant differences were observed in response rates (81.6% vs 89.2%, p = 0.8, mean reduction of VAS (4.1 +/- 2.3 vs 4.9 +/- 1.9, p = 0.12 and MPQ scores (1.3 +/- 0.9 vs 1.3 +/- 0.9, p = 0.9, incidence of PHN after 3 months (48.4% vs 46.8%, p = 0.5, and mean AUC during follow-up (199 +/- 136 vs 173 +/- 141, p = 0.4. No serious treatment-related adverse event was observed in both groups. Conclusions This controlled and randomized trial provides the first evidence of a potential role of AC for the treatment of acute herpetic pain. Trial registration ChiCTR-TRC-10001146.
Choi, Rihwa; Kim, Gyeong-Moon; Jo, Ik Joon; Sim, Min Seob; Song, Keun Jeong; Kim, Byoung Joon; Na, Duk L; Huh, Hee Jae; Kim, Jong-Won; Ki, Chang-Seok; Lee, Nam Yong
Since there are limited data on the incidence and clinical findings of central nervous system (CNS) infection by three α-herpesviruses including human herpes simplex virus 1 (HSV-1), HSV-2 and varicella-zoster virus (VZV) in Korea, a retrospective analysis of clinical data and polymerase chain reaction (PCR) results was performed in patients who presented with suspicion of acute viral meningitis and/or encephalitis at the emergency department of a tertiary referral hospital in Seoul, Korea. During the 3-year study period, a total of 224 cerebrospinal fluid (CSF) samples from 224 patients were examined. Among the 224 patients, 135 (60.3%) patients were identified as having aseptic meningitis (n = 70, 51.9%), encephalitis (n = 41, 30.4%) or meningoencephalitis (n = 24, 17.8%) at discharge. Twenty-four (17.8%) patients were identified as having VZV meningitis (n = 16, 11.9%), VZV meningoencephalitis (n = 2, 1.5%), HSV-2 meningitis (n = 4, 3.0%), or HSV-1 encephalitis (n = 2, 1.5%). Of the 24 patients infected with the three herpesviruses, immunocompromised patients accounted for 33.3% (n = 8). Skin rashes were observed in half (n = 9) of the patients with VZV, and none with HSV-1 or HSV-2. One patient with VZV meningitis and four patients with brain parenchymal involvement had neurologic sequelae. In conclusion, three herpesviruses are important causative agents of CNS infectious disease with significant morbidity in adults, regardless of the immunologic status. Therefore, CSF should be examined for HSV-1, HSV-2, and VZV using sensitive diagnostic methods in all cases of adult patients with clinical manifestations of CNS disease in order to identify the correct etiology and to determine appropriate therapy. © 2014 Wiley Periodicals, Inc.
Full Text Available OHerpes Zoster Oftálmico (HZO decorre da infecção pelo vírus da varicela-zoster que permanece latente no gânglio de Gasser até que seja reativado e comprometa a divisão oftálmica do nervo trigêmeo. HZO freqüentemente causa manifestações oftalmológicas como lesões vesiculares palpebrais, ceratoconjuntivite, esclerite, uveíte, paralisia oculomotora, miosite orbitária e neurite óptica. Raramente o acometimento do ápice da órbita pode ser a manifestação inicial desta grave afecção. Este trabalho relata um caso de síndrome do ápice orbitário associado à meningite, causado por HZO e que foi tratado com corticosteróide e aciclovir sistêmicos.Herpes Zoster ophthalmicus (HZO is caused by a varicella-zoster virus infection which remains latent in the ganglion of Gasser until it is reactivated and compromise the ophthalmic division of the trigeminal nerve. HZO commonly causes neuro-ophthalmic complications such as vesicular lesions in the eyelids, keratoconjunctivitis, sclertis, uveitis, ocular palsy, orbital miositis and optic neuritis. HZO rarely presents as an orbital apex syndrome. This paper describes a patient with of orbital apex syndrome associate and meningitis caused by HZO which was treated with systemic steroids and acyclovir.
A Real-Time PCR Assay to Identify and Discriminate Among Wild-Type and Vaccine Strains of Varicella-Zoster Virus and Herpes Simplex Virus in Clinical Specimens, and Comparison With the Clinical Diagnoses
Harbecke, Ruth; Oxman, Michael N.; Arnold, Beth A.; Ip, Charlotte; Johnson, Gary R.; Levin, Myron J.; Gelb, Lawrence D.; Schmader, Kenneth E.; Straus, Stephen E.; Wang, Hui; Wright, Peter F.; Pachucki, Constance T.; Gershon, Anne A.; Arbeit, Robert D.; Davis, Larry E.; Simberkoff, Michael S.; Weinberg, Adriana; Williams, Heather M.; Cheney, Carol; Petrukhin, Luba; Abraham, Katalin G.; Shaw, Alan; Manoff, Susan; Antonello, Joseph M.; Green, Tina; Wang, Yue; Tan, Charles; Keller, Paul M.
A real-time PCR assay was developed to identify varicella-zoster virus (VZV) and herpes simplex virus (HSV) DNA in clinical specimens from subjects with suspected herpes zoster (HZ; shingles). Three sets of primers and probes were used in separate PCR reactions to detect and discriminate among wild-type VZV (VZV-WT), Oka vaccine strain VZV (VZV-Oka), and HSV DNA, and the reaction for each virus DNA was multiplexed with primers and probe specific for the human β-globin gene to assess specimen adequacy. Discrimination of all VZV-WT strains, including Japanese isolates and the Oka parent strain, from VZV-Oka was based upon a single nucleotide polymorphism at position 106262 in ORF 62, resulting in preferential amplification by the homologous primer pair. The assay was highly sensitive and specific for the target virus DNA, and no cross-reactions were detected with any other infectious agent. With the PCR assay as the gold standard, the sensitivity of virus culture was 53% for VZV and 77% for HSV. There was 92% agreement between the clinical diagnosis of HZ by the Clinical Evaluation Committee and the PCR assay results. PMID:19475609
Incidencia de la varicela y el herpes zóster antes de la introducción de la vacunación sistemática infantil en Navarra, 2005-2006 Varicella and herpes zoster incidence prior to the introduction of systematic child vaccination in Navarre, 2005-2006
M. García Cenoz; J. Castilla; Y. Montes; J. Morán; A. Salaberri; F. Elía; Y. Floristán; I. Rodrigo; F. Irisarri; M. Arriazu; A. Zabala; A. Barricarte
La varicela es una enfermedad aguda muy contagiosa producida por el virus varicela-zoster, que deja inmunidad duradera. El herpes zóster se produce por reactivación de una infección latente por el mismo virus. La introducción de la vacunación sistemática y gratuita frente a la varicela en niños de 15 meses de Navarra desde 2007, previsiblemente producirá cambios epidemiológicos importantes. Por ello, describimos la situación epidemiológica previa, en el periodo 2005-2006. Se han analizado los...
Full Text Available The aims of this study were to estimate the incidences of herpes zoster (HZ and postherpetic neuralgia (PHN in patients after traumatic brain injury (TBI. Furthermore, we aimed to explore the risk factors of the development of HZ and PHN in patients after TBI. This population-based, longitudinal analysis was conducted using the Taiwan National Health Insurance Research Database (consisting of 1,000,000 beneficiaries from 1996 to 2010. Using the longitudinal National Health Insurance Research Database, we conducted a retrospective population-based cohort study to evaluate the incidence of HZ and PHN in adult TBI patients and controls. Kaplan-Meier analysis and Cox regression were used to compare differences in the development of HZ and PHN. The effects of gender, comorbidity and surgery on the risk of HZ and PHN development were assessed by subgroup analyses. Over a 15-year follow-up, the cumulative incidence of HZ in 28,234 TBI patients (604.00/100,000 person-years was significantly higher than 34,085 controls (322.21/100,000 person-years (P<0.0001, by log-rank test. Females showed a significantly higher incidence of HZ than males (p for interaction = 0.0010. The time to HZ development in the follow-up period was 5.9 years in TBI patients compared to 9.9 years in the control set (p <0.0001. TBI patients were 2.93 and 2.11 times likely to develop HZ and PHN, respectively, than the general population. The incidences of HZ and PHN in TBI patients were also significantly greater than for controls in the CCI = 0 subgroup. To our knowledge, this is the first population-based cohort study to reveal that TBI is an independent risk factor for HZ and PHN in TBI patients, especially in females. Physician should pay attention to the possibility of HZ and PHN in TBI patients and be aware that HZ vaccination early after brain trauma may lower the incidence of HZ and PHN.
Lier, E.A. van; Suijkerbuijk, A.W.M.; Nielen, M.; Jochemsen, P.; Luytjes, W.; Melker, H.E. de
• The VZV epidemiology (incidence of GP consultations, hospitalisations and deaths) is comparable to previous years. • For the prevention of herpes zoster (HZ), HZ/su (or Shingrix®) might be a promising alternative for Zostavax® due to the higher sustained vaccine efficacy. It is now being submitted
Mar 1, 2013 ... prove to be a diagnostic challenge for the dentist, since many diseases can cause orofacial pain, and the diagnosis must be ... Diagnostic assessment in patients with orofacial pain may be ..... blind, placebo-controlled trial.
Conclusions: In addition to older age and severe acute pain, this study suggests that impaired physical and social functioning from acute zoster pain may play a role in the development of PHN in this prospective cohort study of HZ patients from North and Latin America and Asia.
Canadian Pain Society Study Day participants
Full Text Available The Canadian Pain Society (CPS hosted its first Study Day in Toronto in July 2014, attended by experts in various fields of pain management and research (listed below. The aim was to review the National Advisory Committee on Immunization guidelines and to prepare a CPS position statement concerning the use of the zoster vaccine in Canada.
Pupillary paralysis and paresis of the peripheral facial nerve on the left side was found in a 68-year-old man with concussion and herpes zoster ophthalmicus on the left eye. Post mortem examination showed no sign of intracranial hemorrhage. The cause of death was pulmonary oedema and aspiration....... The neurological signs were probably caused by herpes zoster affection of the oculomotor and optic nerves in association with the facial nerve paresis induced by zoster....
Galetta, Kristin M.; Gilden, Don
While herpes zoster infection has been recognized since antiquity, chickenpox (varicella) was confused with smallpox until the 1800s, when both illnesses became better understood. In the 20th century, varicella zoster virus (VZV) was shown to cause varicella upon primary (first-time) infection and herpes zoster (shingles) after reactivation of latent VZV. Scientific progress over the past 50 years has rapidly advanced the understanding and prevention of disease produced by VZV. Combined imagi...
Sch?nrich, G?nther; Raftery, Martin J.
Varicella zoster virus (VZV), a human alphaherpesvirus, causes varicella and subsequently establishes latency within sensory nerve ganglia. Later in life VZV can reactivate to cause herpes zoster. A reduced frequency of VZV-specific T cells is strongly associated with herpes zoster illustrating that these immune cells are central to control latency. Dendritic cells (DCs) are required for the generation of VZV-specific T cells. However, DCs can also be infected in vitro and in vivo allowing VZ...
Günther eSchönrich; Martin J. Raftery
Varicella zoster virus (VZV), a human alphaherpesvirus, causes varicella and subsequently estab-lishes latency within sensory nerve ganglia. Later in life VZV can reactivate to cause herpes zoster. A reduced frequency of VZV-specific T cells is strongly associated with herpes zoster illustrating that these immune cells are central to control latency. Dendritic cells (DCs) are required for the generation of VZV-specific T cells. However, DCs can also be infected in vitro and in vivo allowing V...
Barros, Andrea Barbieri; Rodrigues, Alex Miranda; Batista, Mariane Pereira; Munhoz Junior, Sidney; Hueb, Marcia; Fontes, Cor Jesus
Antimony compounds are the cornerstone treatments for tegumentary leishmaniasis. The reactivation of herpes virus is a side effect described in few reports. We conducted an observational study to describe the incidence of herpes zoster reactivation during treatment with antimony compounds. The global incidence of herpes zoster is approximately 2.5 cases per 1,000 persons per month (or 30 cases per 1,000 persons per year). The estimated incidence of herpes zoster in patients undergoing antimony therapy is higher than previously reported.
Andrea Barbieri Barros
Full Text Available Antimony compounds are the cornerstone treatments for tegumentary leishmaniasis. The reactivation of herpes virus is a side effect described in few reports. We conducted an observational study to describe the incidence of herpes zoster reactivation during treatment with antimony compounds. The global incidence of herpes zoster is approximately 2.5 cases per 1,000 persons per month (or 30 cases per 1,000 persons per year. The estimated incidence of herpes zoster in patients undergoing antimony therapy is higher than previously reported.
Biesiada, Grazyna; Czepiel, Jacek; Sobczyk-Krupiarz, Iwona; Mach, Tomasz; Garlicki, Aleksander
Herpes zoster is an infectious disease caused by varicella zoster virus (VZV). After replication at the place of entry, VZV spreads via the blood into the skin and mucosa, causing the varicella. From these regions VZV migrates into the sensory ganglia where it establishes a latent infection. The aim of our study was to analyze the localization of the skin changes and correlations of neurological complications among patient with zoster. We have reviewed medical documentation of the 67 patients with herpes zoster, hospitalized in our Department during the years 2001-2006. We have studied localization of the herpes zoster changes and frequency of neurological complications among these patients. Neuralgia was less intensive and last shorter time, when antiviral treatment had been started earlier. Neuralgia, meningitis, encephalitis and complications of the eye zoster were present more often among patients over 65 years old.
Kusawake, Tomohiro; Kowalski, Donna; Takada, Akitsugu; Kato, Kota; Katashima, Masataka; Keirns, James J; Lewand, Michaelene; Lasseter, Kenneth C; Marbury, Thomas C; Preston, Richard A
Amenamevir (ASP2151) is a nonnucleoside human herpesvirus helicase-primase inhibitor that was approved in Japan for the treatment of herpes zoster (shingles) in 2017. This article reports the results of two clinical trials that investigated the effects of renal and hepatic impairment on the pharmacokinetics of amenamevir. These studies were phase 1, open-label, single-dose (oral 400 mg), parallel-group studies evaluating the pharmacokinetics, safety, and tolerability of amenamevir in healthy participants and participants with moderate hepatic impairment and mild, moderate, and severe renal impairment. In the hepatic impairment study, the pharmacokinetic profile of amenamevir in participants with moderate hepatic impairment was generally similar to that of participants with normal hepatic function. In the renal impairment study, the area under the amenamevir concentration versus time curve from the time of dosing up to the time of the last sample with extrapolation to infinity of the terminal phase was increased by 78.1% in participants with severe renal impairment. There was a positive relationship between creatinine clearance and oral and renal clearance for amenamevir in the renal impairment study. In both studies, amenamevir was safe and well tolerated. The findings of the hepatic impairment study indicate that no dosing adjustment is required in patients with moderate hepatic impairment. In the renal impairment study, systemic amenamevir exposure was increased by renal impairment. However, it is unlikely that renal impairment will have a significant effect on the safety of amenamevir given that in previous pharmacokinetic and safety studies in healthy individuals amenamevir was safe and well tolerated after a single dose (5-2400 mg, fasted condition) and repeated doses for 7 days (300 or 600 mg, fed condition), and the amount of amenamevir exposure in the renal impairment study was covered by those studies. These findings suggest that amenamevir does not
European consensus-based (S2k) Guideline on the Management of Herpes Zoster - guided by the European Dermatology Forum (EDF) in cooperation with the European Academy of Dermatology and Venereology (EADV), Part 1: Diagnosis.
Werner, R N; Nikkels, A F; Marinović, B; Schäfer, M; Czarnecka-Operacz, M; Agius, A M; Bata-Csörgő, Z; Breuer, J; Girolomoni, G; Gross, G E; Langan, S; Lapid-Gortzak, R; Lesser, T H; Pleyer, U; Sellner, J; Verjans, G M; Wutzler, P; Dressler, C; Erdmann, R; Rosumeck, S; Nast, A
Herpes zoster (HZ, shingles) is a frequent medical condition which may severely impact the quality of life of affected patients. Different therapeutic approaches to treat acute HZ are available. The aim of this European project was the elaboration of a consensus-based guideline on the management of patients who present with HZ, considering different patient populations and different localizations. This interdisciplinary guideline aims at an improvement of the outcomes of the acute HZ management concerning disease duration, acute pain and quality of life of the affected patients and at a reduction of the incidence of postherpetic neuralgia and other complications. The guideline development followed a structured and predefined process, considering the quality criteria for guidelines development as suggested by the AGREE II instrument. The steering group was responsible for the planning and the organization of the guideline development process (Division of Evidence based Medicine, dEBM). The expert panel was nominated by virtue of clinical expertise and/or scientific experience and included experts from the fields of dermatology, virology/infectiology, ophthalmology, otolaryngology, neurology and anaesthesiology. Recommendations for clinical practice were formally consented during the consensus conference, explicitly considering different relevant aspects. The guideline was approved by the commissioning societies after an extensive internal and external review process. In this first part of the guideline, diagnostic means have been evaluated. The expert panel formally consented recommendations for the management of patients with (suspected) HZ, referring to the assessment of HZ patients, considering various specific clinical situations. Users of the guideline must carefully check whether the recommendations are appropriate for the context of intended application. In the setting of an international guideline, it is generally important to consider different national
European consensus-based (S2k) Guideline on the Management of Herpes Zoster - guided by the European Dermatology Forum (EDF) in cooperation with the European Academy of Dermatology and Venereology (EADV), Part 2: Treatment.
Werner, R N; Nikkels, A F; Marinović, B; Schäfer, M; Czarnecka-Operacz, M; Agius, A M; Bata-Csörgő, Z; Breuer, J; Girolomoni, G; Gross, G E; Langan, S; Lapid-Gortzak, R; Lesser, T H; Pleyer, U; Sellner, J; Verjans, G M; Wutzler, P; Dressler, C; Erdmann, R; Rosumeck, S; Nast, A
Herpes zoster (HZ, shingles) is a frequent medical condition which may severely impact the quality of life of affected patients. Different therapeutic approaches to treat acute HZ are available. The aim of this European project was the elaboration of a consensus-based guideline on the management of patients who present with HZ, considering different patient populations and different localizations. This interdisciplinary guideline aims at an improvement of the outcomes of the acute HZ management concerning disease duration, acute pain and quality of life of the affected patients and at a reduction in the incidence of postherpetic neuralgia (PHN) and other complications. The guideline development followed a structured and pre-defined process, considering the quality criteria for guidelines development as suggested by the AGREE II instrument. The steering group was responsible for the planning and the organization of the guideline development process (Division of Evidence-Based Medicine, dEBM). The expert panel was nominated by virtue of clinical expertise and/or scientific experience and included experts from the fields of dermatology, virology/infectiology, ophthalmology, otolaryngology, neurology and anaesthesiology. Recommendations for clinical practice were formally consented during the consensus conference, explicitly considering different relevant aspects. The guideline was approved by the commissioning societies after an extensive internal and external review process. In this second part of the guideline, therapeutic interventions have been evaluated. The expert panel formally consented recommendations for the treatment of patients with HZ (antiviral medication, pain management, local therapy), considering various clinical situations. Users of the guideline must carefully check whether the recommendations are appropriate for the context of intended application. In the setting of an international guideline, it is generally important to consider different
Meenken, C.; van den Horn, G. J.; de Smet, M. D.; van der Meer, J. T.
We report on a 29-year-old severely compromised acquired immunodeficiency syndrome patient who developed retrobulbar optic neuritis 5 weeks after an episode of cutaneous herpes zoster infection. During the optic neuritis, varicella zoster virus could be demonstrated in the cerebrospinal fluid. The
Snel, Bart Jorrit; Visconti, Giuseppe; Grabietz, Patrice D.; Werker, Paul M. N.
Varicella zoster virus (VZV) is the causal agent of varicella (chickenpox) and herpes zoster (shingles). Primary VZV infection is a common childhood disease, but elderly patients and those having a compromised immune system are also at risk. We present the case of progressive necrosis of the nose
Genital herpes - resources; Resources - genital herpes ... following organizations are good resources for information on genital herpes : March of Dimes -- www.marchofdimes.com/pregnancy/complications- ...
Goodwin, T. J.; McCarthy, M.; Albrecht, T.; Cohrs, R.
The old adage we are our own worst enemies may perhaps be the most profound statement ever made when applied to man s desire for extraterrestrial exploration and habitation of Space. Consider the immune system protects the integrity of the entire human physiology and is comprised of two basic elements the adaptive or circulating and the innate immune system. Failure of the components of the adaptive system leads to venerability of the innate system from opportunistic microbes; viral, bacteria, and fungal, which surround us, are transported on our skin, and commonly inhabit the human physiology as normal and imunosuppressed parasites. The fine balance which is maintained for the preponderance of our normal lives, save immune disorders and disease, is deregulated in microgravity. Thus analogue systems to study these potential Risks are essential for our progress in conquering Space exploration and habitation. In this study we employed two known physiological target tissues in which the reactivation of hCMV and VZV occurs, human neural and lung systems created for the study and interaction of these herpes viruses independently and simultaneously on the innate immune system. Normal human neural and lung tissue analogues called tissue like assemblies (TLAs) were infected with low MOIs of approximately 2 x 10(exp -5) pfu hCMV or VZV and established active but prolonged low grade infections which spanned .7-1.5 months in length. These infections were characterized by the ability to continuously produce each of the viruses without expiration of the host cultures. Verification and quantification of viral replication was confirmed via RT_PCR, IHC, and confocal spectral analyses of the respective essential viral genomes. All host TLAs maintained the ability to actively proliferate throughout the entire duration of the experiments as is analogous to normal in vivo physiological conditions. These data represent a significant advance in the ability to study the triggering
Webster, A; Grint, P; Brenner, M K; Prentice, H G; Griffiths, P D
Serum antibodies to varicella zoster virus (VZV) were measured in 77 patients about to undergo allogeneic bone marrow transplantation, and in 65 of their donors. Ten patients developed zoster within the first 6 months following transplant. There was no significant difference in the mean pretransplant antibody titre between those patients who did or did not subsequently develop zoster. Likewise, the level of antibody to VZV amongst donors had no effect on the subsequent development of zoster. We conclude that the pretransplant level of antibody to VZV is not predictive of subsequent zoster infection, and would not be helpful in identifying patients for trials of antiviral prophylaxis. These results contrast with those previously found for another herpesvirus, herpes simplex (HSV), where antibody level pretransplant is predictive of future HSV recurrence.
... Dry Mouth Burning Mouth Tooth Decay See All Oral Complications of Systemic Diseases Cancer Treatment Developmental Disabilities ... care. NIDCR > Image Gallery > Oral Health > Oral Herpes Oral Herpes Main Content Title: Oral Herpes Description: Herpes ( ...
... skin diseases Athlete's foot Chickenpox Cold sores Genital herpes Genital warts Head lice Herpes simplex Impetigo Molluscum contagiosum ... swollen lymph nodes (glands) in the neck (oral herpes) or groin (genital herpes) are possible. Problems urinating . People (most often ...
Galetta, Kristin M; Gilden, Don
While herpes zoster infection has been recognized since antiquity, chickenpox (varicella) was confused with smallpox until the 1800s, when both illnesses became better understood. In the 20th century, varicella zoster virus (VZV) was shown to cause varicella upon primary (first-time) infection and herpes zoster (shingles) after reactivation of latent VZV. Scientific progress over the past 50 years has rapidly advanced the understanding and prevention of disease produced by VZV. Combined imaging and virological studies continue to reveal the protean neurological, ocular and visceral disorders produced by VZV. Copyright © 2015 Elsevier B.V. All rights reserved.
... Stories Español Eye Health / Eye Health A-Z Herpes Keratitis Sections What is Herpes Keratitis? Herpes Keratitis ... Herpes Keratitis Symptoms Herpes Keratitis Treatment What is Herpes Keratitis? Leer en Español: ¿Qué es la queratitis ...
Full Text Available Abstract Introduction Simultaneous involvements of multiple cranial nerve ganglia (geniculate ganglion and peripheral ganglia of cranial nerves VIII, IX and X by varicella-zoster virus and its subsequent activation may result in the characteristic eruptions of herpes zoster cephalicus. Coexistence of facial palsy and involvement of upper cervical dermatomes by varicella-zoster virus is quite rare. Case presentation Here, we report a 71-year-old Iranian man with involvement of multiple sensory ganglia (geniculate ganglion and upper dorsal root ganglia by varicella-zoster virus. He presented with right-sided facial weakness along with vesicular eruptions on the right side of his neck, and second and third cervical dermatomes. Conclusion The present case is an example of herpes zoster cephalicus with cervical nerve involvement. Although resembling Ramsay Hunt syndrome with presence of facial nerve paralysis and accompanying vesicles, involvement of cervical dermatomes is not a feature of the classic Ramsay Hunt syndrome.
Introduction Simultaneous involvements of multiple cranial nerve ganglia (geniculate ganglion and peripheral ganglia of cranial nerves VIII, IX and X) by varicella-zoster virus and its subsequent activation may result in the characteristic eruptions of herpes zoster cephalicus. Coexistence of facial palsy and involvement of upper cervical dermatomes by varicella-zoster virus is quite rare. Case presentation Here, we report a 71-year-old Iranian man with involvement of multiple sensory ganglia (geniculate ganglion and upper dorsal root ganglia) by varicella-zoster virus. He presented with right-sided facial weakness along with vesicular eruptions on the right side of his neck, and second and third cervical dermatomes. Conclusion The present case is an example of herpes zoster cephalicus with cervical nerve involvement. Although resembling Ramsay Hunt syndrome with presence of facial nerve paralysis and accompanying vesicles, involvement of cervical dermatomes is not a feature of the classic Ramsay Hunt syndrome. PMID:19918290
Ruocco, Vincenzo; Sangiuliano, Sonia; Brunetti, Giampiero; Ruocco, Eleonora
Neuroepidermal tropism of varicella-zoster virus accounts for cutaneous and nerve lesions following herpes zoster. Skin lesions heal in a few weeks and may or may not leave visible scars. Nerve lesions involve peripheral sensory fibres, sometimes causing permanent damage that results in partial denervation of the affected dermatome. The effects of the nerve injury involve the sensibility function, thus causing neuralgia, itch, allodynia, hypo- or anaesthesia, as well as the immune function that is related to neuropeptide release, thus altering immune control in the affected dermatome. The neuro-immune destabilization in the zoster-infected site paves the way for the onset of many and various immunity-related disorders along the affected dermatome.
pesviruses — herpes simplex virus (HSV), varicella zoster virus (VZV) ... virus infections. Herpesviruses are commonly seen in clinical practice. This article discusses their management in some detail. MAIN TOPIC. 332 C M E June 2003 Vol.21 No.6. After primary infection, ... A typical primary attack lasts about 10 - 14 days.
Genital herpes is a sexually transmitted disease (STD) caused by a herpes simplex virus (HSV). It can cause sores on ... also infect their babies during childbirth. Symptoms of herpes are called outbreaks. You usually get sores near ...
Full Text Available Jamie Zussman, Lorraine YoungDepartment of Medicine, Dermatology Division, David Geffen School of Medicine at the University of California, Los Angeles, CaliforniaAbstract: Shingles, also known as herpes zoster, is a common disease in the elderly population that is caused by reactivation of latent varicella zoster virus. Its manifestations and complications can lead to significant short- and long-term morbidity. In 2006, the United States Food and Drug Administration approved Zoster Vaccine Live (Zostavax® for the prevention of herpes zoster in immunocompetent adults age 60 and over. The approval was based on the results of a large, multi-center clinical trial, the Shingles Prevention Study. This study showed that vaccination significantly decreased shingles incidence, burden of illness due to disease, and the development of, and severity of postherpetic neuralgia. This review offers an overview of varicella zoster virus infection and complications, a summary of the Shingles Prevention Study, and a critical analysis designed to aid the practicing physician who has questions about vaccine administration.Keywords: zoster vaccine, shingles, herpes zoster, postherpetic neuralgia, zostavax
Kofoed, Kristian; Rønholt, Finn; Gerstoft, Jan
that early recognition and treatment can reduce acute symptoms, that antiviral therapy and corticosteroids shorten the acute illness period, that opioids and anticonvulsants have effect on acute HZ pain and, finally, that tricyclic antidepressants, opioids and anticonvulsants all have proven efficiency...
Full Text Available A large number of oral mucosal lesions result in severe post-affliction deficits. One such defect is neurological fall out. Herpes zoster is a condition that occasionally results in a dreadful post-infection neuralgic pain. Although shingles is generally regarded as a self-limited condition, it can take several weeks to resolve and has the potential for development of complications. To identify this as well as appropriate management is required. Patients affected are in such severe distress that alleviation of pain and successful treatment protocol should be the primary consideration. We report one such case, which was successfully treated, and also intend to highlight the current concepts in the management of such cases.
Schott, G D
The term 'zoster' is nowadays associated with 'herpes zoster', the condition resulting from reactivation of the latent varicella-zoster virus which causes shingles. But in antiquity the meaning of 'zoster', a Latin word originating from the Greek for a belt or girdle, was variously associated in men with a form of body armour which could enclose just one half of the body; in women with a garment worn around the waist and sometimes called a 'zona'; and with a place, Zoster, linked mythologically then with the goddess Leto and her zona. Around 48 AD, the Roman physician Scribonius Largus became the first to associate 'zona' with 'herpes', and to attribute a medical meaning to 'zona', here an abbreviation of 'zona ignea' ('fiery girdle'). Although in the past the terms 'zoster' and 'zona' were sometimes used interchangeably, today only 'zoster' remains-even when etymologically illogical in those patients whose zoster rash occurs in body areas other than the trunk. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
Salleras, Luis; Salleras, Montserrat; Soldevila, Nuria; Prat, Andreu; Garrido, Patricio; Domínguez, Ángela
In Western countries, two attenuated varicella vaccines derived from the OKA strain are licensed: Varilrix® GlaxoSmithKline (OKA/RIT strain) and Varivax® Merck Sharp and Dohme (OKA/Merck strain). Currently, in Spain, varicella vaccination is only included in the Ministry of Health, Social Services and Equality official vaccination calendar for administration in adolescents who have not had the disease. Given the good results obtained in Navarra and Madrid with universal administration of the vaccine in children, it would be desirable to include the vaccine in the routine immunization schedule, with the administration of two doses at 15-18 months of age in the future. The protective efficacy of the attenuated herpes zoster vaccine was evaluated in the Shingles Prevention Study, which showed that in the short term (0-4 years) the vaccine reduced the incidence of herpes zoster by 53%, post-herpetic neuralgia by 66%, and the disease burden in immunocompetent persons aged ≥60 years by 61%. Another study demonstrated protective efficacy in persons aged 50-59 years. Over time, the protective efficacy decreases, but remains at acceptable levels, especially for post-herpetic neuralgia and the disease burden. Recently, the results of a controlled clinical trial (phase III) conducted in 18 countries to assess the protective efficacy of the inactivated subunit vaccine (glycoprotein E) adjuvanted with the adjuvant AS01B were published. The study inferred that the vaccine significantly reduced the incidence of herpes zoster in the short term (3.2 years) in people aged ≥50 years. Vaccine protection did not decrease with age at vaccination, ranging between 96.8% and 97.9% in all age groups. Copyright © 2015. Published by Elsevier España, S.L.U.
... percent) women in the United States has genital herpes. Can genital herpes cause complications during pregnancy? Yes. Genital herpes ... sex Having your period Stress How does genital herpes spread? Genital herpes is caused by two viruses called herpes ...
HSV; Congenital herpes; Herpes - congenital; Birth-acquired herpes; Herpes during pregnancy ... Newborn infants can become infected with herpes virus: In the uterus (this is ... herpes, the most common method of infection) Right ...
Charles, R E; Katz, R L; Ordóñez, N G; MacKay, B
Cytologic evidence of herpes viral infection within cells from body cavity effusions is extremely uncommon. The authors report the case of a 57-year-old woman who was treated with chemotherapy and irradiation for malignant lymphoma and subsequently developed disseminated varicella-zoster infection with pleural involvement. Cytologic examination of pleural fluid revealed cytopathic changes caused by the varicella-zoster virus, which were confirmed by electron microscopy and viral culture of the effusion. The cytologic and ultrastructural features of the virus-infected cells are described, and the pathogenesis of the effusion and sequence of events in varicella-zoster virus-cell interaction are discussed.
Mesar, Ines; Basić-Jukić, Nikolina; Hudolin, Tvrtko; Katalinić, Lea; Kes, Petar
Varicella zoster virus reactivation often occurs in the setting of impaired immunity, which is generally present in patients with end-stage renal disease (ESRD). Therapy for variceIla zoster virus infection is well established. However, it is often been forgotten that acyclovir dosage should be adjusted to renal function. We point to the problem encountered in clinical practice when ESRD patient presents with cutaneous herpes zoster and neurological symptoms. Clinical findings alone may prove inadequate to determine whether neurological deficit is caused by infection of the central nervous system or is a consequence of acyclovir induced neurotoxicity.
Davidson Ribeiro Costa
Full Text Available O herpes-zóster facial é definida como uma doença infecciosa, que durante seu desenvolvimento apresenta lesões dolorosas na região orofacial. A Neuralgia pós-herpética é uma complicação da herpes-zóster facial que é caracteriza pela sintomatologia extremamente dolorosa. Tanto a herpes-zóster facial como a Neuralgia pós-herpética diminuem drasticamente a qualidade de vida de seus portadores. A terapia com laser de baixa intensidade (TLBI tem sido amplamente divulgada nos meios científicos, devido o seu efeito positivo no tratamento de uma série de condições. Nesse contexto, o presente estudo objetivou analisar os principais efeitos da TLBI de forma a apresentar uma nova abordagem terapêutica, que pode ser empregada no tratamento da HZ facial e NPHT, salientando as doses e os possíveis locais para a irradiação em cada fase. A TLBI é uma terapia não invasiva, que não apresenta efeitos adversos, quando empregada de maneira correta. Essa terapia apresenta efeitos antiálgico, anti-inflamatório, de reparo tecidual e neuronal, o que justifica a sua utilização no tratamento da HZ facial e NPHT.
Full Text Available We report the case of an 86-year-old man with acute left shoulder pain, followed by left limb monoparesis and a herpetic rash on the left upper limb and thoracic region. This situation presented a diagnostic challenge because of the simultaneity of symptoms attributable to Parsonage-Turner syndrome and herpes zoster neuropathy. A detailed clinical history, physical examination and electroneuromyography were essential to distinguish the neurological structures involved and to ascertain the diagnosis.
Yamashita, Yukiko; Kusakabe, Shinsuke; Toda, Jun; Ohshima, Kenji; Masaie, Hiroaki; Yagi, Toshinari; Yoshida, Hitoshi; Ishikawa, Jun
Here, we describe a case of sequential varicella-zoster virus encephalomeningitis and progressive multifocal leukoencephalopathy following an allogeneic hematopoietic stem cell transplant procedure. A 37-year-old male patient presented with fever, incomplete paralysis of bilateral legs, and bullous eruptions 8 months after allogeneic transplant. Polymerase chain reaction assays of cerebrospinal fluid samples for varicella-zoster virus were positive. Bullous eruptions and incomplete paralysis of bilateral legs improved after administration of acyclovir. However, higher brain dysfunction was present and getting worse. We detected no herpes simplex virus, varicella-zoster virus, Cytomegalovirus, human herpes virus 6, Epstein-Barr virus, or JC virus in cerebrospinal fluid samples with polymerase chain reaction assays. Pathologic findings and polymerase chain reaction assays with brain biopsy samples revealed that the patient had progressive multifocal leukoencephalopathy. This is the first report of a case showing dual central nervous system infections due to varicella-zoster virus and JC virus after allogeneic stem cell transplant.
Stinson, Crystal; Deng, Mohong; Yee, Michael B; Bellinger, Larry L; Kinchington, Paul R; Kramer, Phillip R
Most people are initially infected with varicella zoster virus (VZV) at a young age and this infection results in chickenpox. VZV then becomes latent and reactivates later in life resulting in herpes zoster (HZ) or "shingles". Often VZV infects neurons of the trigeminal ganglia to cause ocular problems, orofacial disease and occasionally a chronic pain condition termed post-herpetic neuralgia (PHN). To date, no model has been developed to study orofacial pain related to varicella zoster. Importantly, the incidence of zoster associated pain and PHN is known to be higher in women, although reasons for this sex difference remain unclear. Prior to this work, no animal model was available to study these sex-differences. Our goal was to develop an orofacial animal model for zoster associated pain which could be utilized to study the mechanisms contributing to this sex difference. To develop this model VZV was injected into the whisker pad of rats resulting in IE62 protein expression in the trigeminal ganglia; IE62 is an immediate early gene in the VZV replication program. Similar to PHN patients, rats showed retraction of neurites after VZV infection. Treatment of rats with gabapentin, an agent often used to combat PHN, ameliorated the pain response after whisker pad injection. Aversive behavior was significantly greater for up to 7 weeks in VZV injected rats over control inoculated rats. Sex differences were also seen such that ovariectomized and intact female rats given the lower dose of VZV showed a longer affective response than male rats. The phase of the estrous cycle also affected the aversive response suggesting a role for sex steroids in modulating VZV pain. These results suggest that this rat model can be utilized to study the mechanisms of 1) orofacial zoster associated pain and 2) the sex differences underlying zoster associated pain.
Pupillary paralysis and paresis of the peripheral facial nerve on the left side was found in a 68-year-old man with concussion and herpes zoster ophthalmicus on the left eye. Post mortem examination showed no sign of intracranial hemorrhage. The cause of death was pulmonary oedema and aspiration....
Gücüyener, Kivilcim; Citak, Elvan Cağlar; Elli, Murat; Serdaroğlu, Ayse; Citak, Funda Erkasar
Primary infection with varicella zoster is characterzed by a generalized vesicular rash usually without significant systemic illness. Encephalitis, pneumonitis, pancreatitis, nephritis, Reye and Guillan-Barre syndrome transvers myelitis, myocarditis have been reported before, but there is not any case having all these system to be involved during the same infection in a sequential manner ending up with multiorgan failure. We wanted to represent 21-month-old boy had a multiorgan failure due to varicella zoster infection.
van der Eb, Marjolijn M.; Geutskens, Sacha B.; van Kuilenburg, André B. P.; van Lenthe, Henk; van Dierendonck, Jan-Hein; Kuppen, Peter J. K.; van Ormondt, Hans; van de Velde, Cornelis J. H.; Wanders, Ronald J. A.; van Gennip, Albert H.; Hoeben, Rob C.
BACKGROUND: Ganciclovir exhibits broad-spectrum activity against DNA viruses such as cytomegaloviruses, herpes simplex viruses, varicella-zoster virus, Epstein-Barr virus and human herpes virus-6. Ganciclovir is widely applied for anti-herpetic treatment, cytomegalovirus prophylaxis after organ
Genital herpes is an infection with herpes simplex virus type 1 (HSV-1) or type 2 (HSV-2). The typical clinical features include painful shallow anogenital ulceration. It is among the most common sexually transmitted diseases, with up to 23% of adults in the UK and US having antibodies to HSV-2.
Carla Ferreira Santos
Full Text Available A varicela é uma doença infecto contagiosa comum na infância, ocorrendo pouco mais de 2% dos casos em adultos. Desde a década de 80 que a sua incidência nos adultos tem vindo a aumentar, dos quais apenas 7% são seronegativos¹. A pneumonia a Varicella zoster, se bem que rara, constitui a complicação mais grave e mais frequente no adulto. Os autores apresentam um caso clínico ilustrativo de pneumonia a Varicella zoster num adulto fumador e imunocompetente e fazem uma breve revisão teórica sobre o tema.Varicella (chickenpox is a common contagious infection of childhood, with fewer than 2% of the cases occurring in adults. Since the early 1980s the incidence of chickenpox in adults has been increasing and only 7% of them are seronegative for Varicella zoster antibodies. Pneumonia, although rare, is the most common and serious complication of chickenpox infection in adults. The authors present an illustrative case of varicella pneumonia in an immunocompetent adult with smoking habits and make a brief thematic review.
Full Text Available Abstract Introduction We present a case of an unusual clinical manifestation of Guillain-Barre syndrome following a pre-existing herpes virus infection. Although there have been several reports describing the co-existence of herpes virus infection and Guillain-Barre syndrome, we undertook a more in-depth study of the cross-reactivity between herpes viruses and recommend a follow-up study based on serology tests. Case presentation A 39-year-old healthy Caucasian man with Guillain-Barre syndrome presented to our facility initially with sensory disturbance, followed by an atypical descending pattern of clinical progression. On physical examination, our patient showed hot and cold temperature sensory disturbance under the T4 vertebrae level, symmetrically diminished muscle power mainly to his lower limbs, blurred vision, a loss of taste and paresis and diminished reflexes of his lower limbs. Serology test results for common viruses on hospital admission were positive for cytomegalovirus immunoglobulin M, cytomegalovirus immunoglobulin G, herpes simplex virus immunoglobulin M, herpes simplex virus immunoglobulin G, Epstein-Barr virus immunoglobulin M, and varicella zoster virus immunoglobulin G, borderline for Epstein-Barr virus immunoglobulin G and negative for varicella zoster virus immunoglobulin M. At one month after hospital admission his test results were positive for cytomegalovirus immunoglobulin M, cytomegalovirus immunoglobulin G, herpes simplex virus immunoglobulin G, Epstein-Barr virus immunoglobulin G, varicella zoster virus immunoglobulin G, borderline for herpes simplex virus immunoglobulin M and negative for Epstein-Barr virus immunoglobulin M and varicella zoster virus immunoglobulin M. At his six month follow-up, tests were positive for cytomegalovirus immunoglobulin G, herpes simplex virus immunoglobulin M, herpes simplex virus immunoglobulin G, Epstein-Barr virus immunoglobulin G and varicella zoster virus immunoglobulin G and
Pierik Jorien GJ
Full Text Available Abstract Background Varicella and herpes zoster are both caused by varicella zoster virus (VZV infection or reactivation and may lead to complications associated with a (severe societal burden. Because the epidemiology of VZV-related diseases in the Netherlands remains largely unknown or incomplete, the main objective of this study was to study the primary care incidence, associated complications and health care resource use. Methods We investigated the incidence of VZV complications in the Dutch general practitioner (GP practices and pharmacies in a retrospective population-based cohort study (2004–2008 based on longitudinal GP data including free text fields, hospital referral and discharge letters from approximately 165,000 patients. Results The average annual incidence of varicella GP-consultations was 51.5 per 10,000 (95% CI 44.4-58.7 overall; 465.5 per 10,000 for 0–1 year-olds; 610.8 per 10,000 for 1–4 year-olds; 153.5 per 10,000 for 5–9 year-olds; 8,3 per 10,000 for >10 year olds. When only ICPC coded diagnoses were analyzed the incidence was 27% lower. The proportion of complications among varicella patients was 34.9%. Most frequently complications were upper respiratory tract infections. Almost half of the varicella patients received medication. The referral rate based on GP consultations was 1.7%. The average annual incidence of herpes zoster GP-consultations was 47.5 per 10,000 (95% CI 40.6-54.4. The incidence increased with age; 32.8 per 10,000 for 65 year olds. When estimating herpes zoster incidence only on ICPC coded information, the incidence was 28% lower. The complication rate of herpes zoster was 32.9%. Post herpetic neuralgia was seen most often. Of patients diagnosed with herpes zoster 67.8% received medication. The referral rate based on GP consultations was 3.5%. Conclusions For varicella the highest incidence of GP-consultations was found in 1–4 year-olds, for herpes zoster in the >65 years olds
Anne L.Y. Lecluse
Full Text Available Immunodeficient patients are at risk of developing extended or atypical herpes simplex virus infections, which can be easily misdiagnosed. We present the case of a 79-year-old, treatment-induced (oral corticosteroid, immunocompromised female with an extensive atypical herpes simplex virus infection. This patient presented with multiple erosions and vesicles on the trunk with a subacute onset. The clinical differential diagnosis was herpes simplex infection, herpes zoster infection, pemphigus vulgaris or bullous pemphigoid. Due to the atypical clinical presentation and negative Tzanck test, suspicion of viral infection was low. High-dose steroid treatment was initiated. Subsequent histopathology, however, showed a herpes simplex virus infection. After discontinuing steroid treatment and initiating antiviral treatment, the patient recovered within a week. Emphasis must be placed on the importance of clinical awareness of extended and clinically atypical herpes simplex infections in immunocompromised patients. A negative Tzanck test does not rule out the possibility of a herpes infection.
... causes cold sores (oral herpes). HSV-2 causes genital herpes. How the Test is Performed A blood sample ... person has ever been infected with oral or genital herpes . It looks for antibodies to herpes simplex virus ...
Duda, Jose F; Castro, Jose G
To report on a case of bilateral retrobulbar optic neuritis in a patient with acquired immune deficiency syndrome (AIDS) caused by varicella-zoster virus (VZV); and to review the literature focusing on: cases reported, epidemiology, pathophysiology, diagnosis and treatment. A 38-year-old woman with AIDS presented with a 10-day history of progressive bilateral visual loss and ocular pain. She had bilateral dilated pupils with no light perception; the fundoscopic examination was normal. Facial herpes zoster lesions appeared on the second day of hospitalization Magnetic resonance imaging (MRI) findings were compatible with a bilateral optic neuritis; the cerebrospinal fluid (CSF) showed pleocytosis, increased proteins and a positive VZV-DNA PCR. She was treated with intravenous acyclovir and corticosteroids and was able, when discharged 2 weeks after admission, to carry out activities of daily living. VZV retrobulbar optic neuritis has previously been reported in 12 patients with AIDS, more than half of the cases had concomitant herpes zoster and an associated retinopathy. A positive VZV-DNA in the CSF is indicative of VZV infection, initial use of intravenous acyclovir is recommended, and the concomitant use of corticosteroids would be a prudent choice; the duration of antiviral therapy remains undefined. VZV retrobulbar optic neuritis in AIDS patients can occur with or without herpes zoster. It is a sight-threatening infectious and inflammatory process requiring the advice of specialists in infectious diseases, ophthalmology, neurology and viral microbiology.
Lara El Hayderi
Full Text Available Varicella zoster virus (VZV cutaneous infection occurs predominantly in epidermal and infundibular keratinocytes and accessorily in dermal dendritic cells. These latter cells play a role in cicatricial processes. Two patients are presented with localized alopecia after VZV infection. A 4-year-old girl presented localized hair loss affecting about 20% of her upper right eyelash immediately following the resolution of the varicella skin lesions. No regrowth was observed after 3 months. An 80-year-old woman with a prior history of localized alopecia areata of the left occipital area presented severe left herpes zoster affecting the V1 and V2 dermatomes. At precisely the same site of the previous episode, a localized plaque of alopecia areata recurred. After topical corticosteroid therapy, a progressive hair regrowth occurred after about 3 months. These case reports are the first relating cutaneous VZV infection as the origin for permanent cicatricial alopecia and transitory alopecia areata. Localized hair loss should be added to the cutaneous complications of VZV skin infection.
Full Text Available Primary infection with varicella zoster virus (VZV results in varicella (chickenpox followed by the establishment of latency in sensory ganglia. Declining T cell immunity due to aging or immune suppressive treatments can lead to VZV reactivation and the development of herpes zoster (HZ, shingles. HZ is often associated with significant morbidity and occasionally mortality in elderly and immune compromised patients. There are currently two FDA-approved vaccines for the prevention of VZV: Varivax® (for varicella and Zostavax® (for HZ. Both vaccines contain the live-attenuated Oka strain of VZV. Although highly immunogenic, a two-dose regimen is required to achieve a 99% seroconversion rate. Zostavax vaccination reduces the incidence of HZ by 51% within a 3-year period, but a significant reduction in vaccine-induced immunity is observed within the first year after vaccination. Developing more efficacious vaccines and therapeutics requires a better understanding of the host response to VZV. These studies have been hampered by the scarcity of animal models that recapitulate all aspects of VZV infections in humans. In this review, we describe different animal models of VZV infection as well as an alternative animal model that leverages the infection of Old World macaques with the highly related simian varicella virus (SVV and discuss their contributions to our understanding of pathogenesis and immunity during VZV infection.
... after an outbreak. Using male latex condoms (or polyurethane for those allergic to latex) may reduce your ... with an HIV-infected partner. Taking suppressive therapy does not decrease this risk. How can the herpes ...
Full Text Available The association of mumps with peripheral facial paralysis has been suggested, but its pathogenesis remains unclear. An 8-year-old girl simultaneously developed left peripheral facial paralysis, ipsilateral cervical herpes zoster, and bilateral mumps sialadenitis. Elevated anti-mumps and anti-varicella zoster virus IgM antibodies in serological testing indicated recent infection of mumps and reactivation of VZV. Molecular studies have provided mounting evidence that the mumps virus dysregulates the host’s immune system and enables the virus to proliferate in the infected host cells. This dysregulation of the immune system by mumps virus may have occurred in our patient, enabling the latent VZV infection to reactivate.
Mathiasen, Victor Dahl; Wejse, Christian
Primary infection with varicella zoster virus (VZV) in neonates, adults and in pregnancy may lead to severe disease and embryopathy. On the Northern hemisphere varicella is a mild childhood disease, but in tropical regions it typically occurs at later age and is more frequently observed among...... adolescents and adults. Disease presents with fever, malaise and a characteristic vesiculopapular rash (chickenpox) after an incubation period of 14 days on average. VZV is very contagious and transmission occurs mainly airborne. After infection, virus persists latent and prompts herpes zoster on reactivation...
Ferreira Santos, Carla; Gomes, Ana; Garrido, António; Albuquerque, Ana; Melo, Eduardo; Barros, Inês; Marques, António; Saraiva, José Pedro
Varicella (chickenpox) is a common contagious infection of childhood, with fewer than 2% of the cases occurring in adults. Since the early 1980s the incidence of chickenpox in adults has been increasing and only 7% of them are seronegative for Varicella zoster antibodies. Pneumonia, although rare, is the most common and serious complication of chickenpox infection in adults. The authors present an illustrative case of varicella pneumonia in an immunocompetent adult with smoking habits and make a brief thematic review.
Carla Ferreira Santos
Full Text Available Resumo: A varicela Ã© uma doenÃ§a infectocontagiosa comum na infÃ¢ncia, ocorrendo pouco mais de 2% dos casos em adultos. Desde a dÃ©cada de 80 que a sua incidÃªncia nos adultos tem vindo a aumentar, dos quais apenas 7% sÃ£o seronegativos1. A pneumonia a Varicella zoster, se bem que rara, constitui a complicaÃ§Ã£o mais grave e mais frequente no adulto.Os autores apresentam um caso clÃnico ilustrativo de pneumonia a Varicella zoster num adulto fumador e imunocompetente e fazem uma breve revisÃ£o teÃ³rica sobre o tema.Rev Port Pneumol 2010; XVI (3: 493-505 Abstract: Varicella (chickenpox is a common contagious infection of childhood, with fewer than 2% of the cases occurring in adults. Since the early 1980s the incidence of chickenpox in adults has been increasing and only 7% of them are seronegative for Varicella zoster antibodies. Pneumonia, although rare, is the most common and serious complication of chickenpox infection in adults.The authors present an illustrative case of varicella pneumonia in an immunocompetent adult with smoking habits and make a brief thematic review.Rev Port Pneumol 2010; XVI (3: 493-505 Palavras-chave: Varicela, pneumonia, ARDS, Key-words: Chickenpox, pneumonia, ARDS
Carla Ferreira Santos
Full Text Available Resumo: A varicela Ã© uma doenÃ§a infecto contagiosa comum na infÃ¢ncia, ocorrendo pouco mais de 2% dos casos em adultos. Desde a dÃ©cada de 80 que a sua incidÃªncia nos adultos tem vindo a aumentar, dos quais apenas 7% sÃ£o seronegativos1. A pneumonia a Varicella zoster, se bem que rara, constitui a complicaÃ§Ã£o mais grave e mais frequente no adulto.Os autores apresentam um caso clÃnico ilustrativo de pneumonia a Varicella zoster num adulto fumador e imunocompetente e fazem uma breve revisÃ£o teÃ³rica sobre o tema. Abstract: Varicella (chickenpox is a common contagious infection of childhood, with fewer than 2% of the cases occurring in adults. Since the early 1980s the incidence of chickenpox in adults has been increasing and only 7% of them are seronegative for Varicella zoster antibodies. Pneumonia, although rare, is the most common and serious complication of chickenpox infection in adults.The authors present an illustrative case of varicella pneumonia in an immunocompetent adult with smoking habits and make a brief thematic review. Palavras-chave: Varicela, pneumonia, ARDS, Key-words: Chickenpox, pneumonia, ARDS
Gershon, Anne A., E-mail: email@example.com [Department of Pediatrics, Columbia University College of Physicians and Surgeons, 620W. 168th Street, NY, NY 10032 (United States)
Live attenuated vaccines to prevent varicella and zoster have been available in the US for the past 17 years, with a resultant dramatic decrease in varicella incidence and a predicted future decrease in the incidence of zoster. The pathogenesis and immune responses to varicella zoster virus (VZV) as well as the safety and effectiveness of VZV vaccines are reviewed. The lack of sterilizing immunity provided by VZV vaccines has not prevented them from being safe and effective. Virological and pathological information concerning parallels and differences between VZV and herpes simplex virus (HSV) are highlighted. Although VZV and HSV are distinct pathogens, they appear to have similarities in target organs and immunity that provide an expectation of a high likelihood for the success of vaccination against HSV, and predicted to be similar to that of VZV.
I. H. Belyaletdinova
Full Text Available To describe the spectrum of neurological complications in children with varicella and against the background of herpes zoster. The study included children at the age of 0—16 years (n = 84, who recovered from exanthematous form of the disease not longer than 21 day before the appearance of neurological symptoms (n = 82 or presented with herpes zoster (n = 2. Results: Clinical syndromes included acute cerebellar ataxia (n = 37, meningoencephalitis (n = 34, meningitis (n = 7, polyradiculoneuropathy (n = 4, acute disseminated encephalomyelitis (n = 1, and ischemic stroke (n = 1. The period from varicella onset to the appearance of neurological symptoms was 6 [5;8] days. We have not lethal cases. Аcute cerebellar ataxia is most common postvaricella complication in children.
... best way to prevent genital herpes is abstinence. Teens who do have sex must properly use a latex condom every time ... Date reviewed: February 2016 previous ... Boyfriend Has an STD Before We Have Sex? Telling Your Partner You Have an STD Contact ...
... to determine if you have herpes is a culture of the sore. A cotton swab is used to collect some of the fluid in the blister or cells on the sore, and this sample is grown in the laboratory. The sores must be fresh. A culture may not grow if the sores are dried ...
... condom. 28,29 The surest way to avoid transmission of STDs, including genital herpes, is to abstain from sexual contact, or to be in a long-term ... therapy as part of a strategy to prevent transmission, in addition to consistent condom use and ... recurrences. Health care providers with STD ...
L. Remeijer (Lies); R. Duan (Rui); J.M. van Dun (Jessica); M.A.W. Bettink; A.D.M.E. Osterhaus (Albert); G.M.G.M. Verjans (George)
textabstractBackground. We determined the prevalence and clinical consequences of herpes simplex virus (HSV) type 1 (HSV-1), HSV type 2 (HSV-2), and varicella-zoster virus (VZV) in cornea tissues obtained after penetrating keratoplasty (PKP) was performed. Methods. The excised corneas of 83 patients
... a Kidney Transplant Vision Facts and Myths Genital Herpes KidsHealth > For Parents > Genital Herpes Print A A A What's in this article? Symptoms Contagiousness Treatment Prevention Getting Help Genital herpes is a sexually transmitted disease (STD) that's usually ...
Hügler, Peter; Siebrecht, Peter; Hoffmann, Klaus; Stücker, Markus; Windeler, Jürgen; Altmeyer, Peter; Laubenthal, Heinz
Recovery after an acute attack of herpes zoster is followed by postherpetic neuralgia (PHN) in 9-14% of all patients. Depending on the patient's age, the severity of the acute attack of herpes zoster and the dermatome involved, the incidence of PHN may be as high as 65%. The purpose of our study was to ascertain the incidence of PHN after a prophylactic intravenous injection of varicella-zoster hyperimmune globulin (VZV-IG) (Varitect Biotest Pharma). For this double-blind placebo-controlled randomised investigation we defined PHN as pain confined to the dermatome previously affected by herpes zoster, and we required a pain intensity of at least 15% points on a visual analogue scale (VAS) for this dermatome. The inclusion criteria were the dermatological diagnosis of herpes zoster together with age over 50 years. On Day 1, 20 patients received a single intravenous infusion of VZV-IG in a dose of 2mL/kg body weight, 20 patients (control group) received a single infusion of human albumin 5% in a dose of 2mL/kg body weight. All patients received acyclovir intravenously in a dose of 15mg/kg body weight per 24h for 5 days. The patients were followed up for a total of 42 days. The incidence of PHN at Day 42 was selected as the main outcome criterion for assessing the efficacy of prophylaxis. On reaching a significant difference between the groups (t test; alphaVAS and a NAS. As auxiliary outcome criteria, we used the McGill Pain-Rating Questionnaire in its German version, the revised multidimensional pain scale (RMSS) and the Freiburg symptom list (FBL). All results were assessed by the t test (alpha<0.05). The frequency of PHN in the placebo group was 70% (14/20), in the active treatment group it was 35% (7/20) at Day 42. The results of the McGill test showed the variability of the perception of pain in the placebo group significantly greater. No significant group differences were found in the FBL. Being tested with the RMSS, the patients of the placebo group assessed
Ronald Albert Benton Carey
Full Text Available Introduction: Varicella zoster virus is an exclusively human neurotrophic virus. The primary infection with the virus causes varicella. The virus remains latent in nervous tissue and upon secondary activation causes a variety of syndromes involving the central nervous system (CNS including meningoencephalitis and cerebellitis. Materials and Methods: In this study, we looked at the epidemiology, clinical and laboratory features, and outcomes of patients who were admitted with varicella zoster of the CNS from 2005 to 2014. Results: There were 17 patients. Fever was present in 13 patients, seizures in 9 patients and headache and vomiting in 4 patients each. A generalized varicella rash was present in 8 out of 17 patients. A single dermatomal herpes zoster was present in seven patients. Two patients had no rash. Varicella zoster polymerase chain reaction (PCR in cerebrospinal fluid (CSF was done in 5 patients of which 4 were positive and 1 was negative. Nine patients had diabetes with an average glycated hemoglobin of 8.6%. Total number of deaths was five. Conclusions: Patients with diabetes who develop varicella or herpes zoster may be at risk for CNS complications. The diagnosis of varicella encephalitis has to rest on a combination of clinical findings and CSF PCR, as neither the rash nor the PCR is sensitive enough to diagnose all the cases with varicella encephalitis.
Beals, Chan R; Railkar, Radha A; Schaeffer, Andrea K; Levin, Yotam; Kochba, Efrat; Meyer, Brian K; Evans, Robert K; Sheldon, Eric A; Lasseter, Kenneth; Lang, Nancy; Weinberg, Adriana; Canniff, Jennifer; Levin, Myron J
The licensed live, attenuated varicella-zoster virus vaccine prevents herpes zoster in adults older than 50 years. We aimed to determine whether intradermal administration of zoster vaccine could enhance vaccine immunogenicity compared with conventional needle subcutaneous administration. In this randomised, dose-ranging study, adults aged 50 years or older who had a history of varicella or who had resided in a country with endemic varicella-zoster virus infection for 30 years or more were eligible. Participants received the approved full or a 1/3 dose of zoster vaccine given subcutaneously or one of four intradermal doses (full, 1/3, 1/10, or 1/27 dose) using the MicronJet600 device. The two subcutaneous doses and the four intradermal doses were randomised (1·5:1:1:1:1:1) by computer generated sequence with randomisation stratified by age (50-59 years or 60 years or older). The primary immunogenicity endpoint was the change from baseline in IgG antibody to varicella-zoster virus-specific glycoproteins (gpELISA) measured at 6 weeks. All patients were included in the primary and safety analyses. This study is registered with ClinicalTrials.gov, number NCT01385566. Between Sept 2, 2011, and Jan 13, 2012, 224 participants were enrolled from three clinics in the USA and 223 were randomly assigned: 52 to receive the full dose subcutaneous zoster vaccine, 34 to receive the 1/3 dose subcutaneous zoster vaccine, 34 to receive the full dose intradermal zoster vaccine, 35 to receive the 1/3 dose intradermal zoster vaccine, 34 to receive the 1/10 dose intradermal zoster vaccine, and 34 to receive the 1/27 dose intradermal zoster vaccine. Full dose zoster vaccine given subcutaneously resulted in a gpELISA geometric mean fold-rise (GMFR) of 1·74 (90% CI 1·48-2·04) at 6 weeks post-vaccination compared with intradermal administration which resulted in a significantly higher gpELISA GMFR of 3·25 (2·68-3·94; pvaricella-zoster virus gpELISA antibody compared with subcutaneous
Larissa Cristina Schuster
Full Text Available TEMA: herpes e audiologia. OBJETIVO: realizar revisão teórica principalmente sobre os vírus herpes simples tipo 1, herpes simples tipo 2 e varicela-zoster, bem como sobre seus efeitos na audição humana. Esses se constituem nos tipos de vírus herpéticos humanos de maior relevância para a área da Audiologia dentro da ciência da Fonoaudiologia e, no entanto, são pouco conhecidos e estudados, especialmente no Brasil. MÉTODOS: realizou-se pesquisa em bases de dados eletrônicas nacionais e internacionais, incluindo SciELO, MEDLINE e LILACS, a partir da seguinte combinação de descritores: herpes simplex/zoster X hearing loss ou deafness. Foram selecionados estudos publicados desde a década de 90 até os dias atuais, relevando-se aqueles que contivessem maior valor informativo, contribuindo para os objetivos do presente trabalho. CONCLUSÃO: os vírus herpéticos estudados apresentam estreita relação com distúrbios auditivos, independentemente da idade em que o sujeito é acometido.BACKGROUND: herpes and audiology. PURPOSE: to promote a theoretical approach mainly on herpes simplex virus type 1, herpes simplex virus type 2 and varicella zoster virus, and their effects on human hearing. Although representing the most relevant human herpetic viruses for the area of Audiology within the Speech and Language Pathology Science, these viruses are little studied and known, especially in Brazil. METHODS: a research was carried out in national and international electronic databases, including SciELO, MEDLINE and LILACS, and using the following keyword combinations: herpes simplex/zoster X hearing loss or deafness. Studies published from the 90's until today were selected, revealing those that would contain the highest informative value, which would thus contribute for the objectives of this work. CONCLUSION: the studied herpetic viruses show strict relation with hearing disorders, regardless of the age in which the patient is affected.
Kwak, Byung Ok; Lee, Hoan Jong; Kang, Hyun Mi; Oh, Chi Eun; Choi, Eun Hwa
This study was performed to differentiate vaccine-type strains from wild-type strains and determine the genotype of varicella-zoster virus (VZV) in 51 Korean children. A sequencing analysis of ORF 62 identified two cases of herpes zoster caused by the vaccine-type virus, without a previous history of varicella, 22 months and 5 months after VZV vaccination. The wild-type strain was identified in the remaining children. A genotype analysis of ORF 22 amino acids revealed genotype J in all children except one. Genotype E was identified in an infant with varicella imported from Egypt.
Weinberg, Adriana; Canniff, Jennifer; Rouphael, Nadine; Mehta, Aneesh; Mulligan, Mark; Whitaker, Jennifer A; Levin, Myron J
The incidence and severity of herpes zoster (HZ) increases with age. The live attenuated zoster vaccine generates immune responses similar to HZ. We compared the immune responses to zoster vaccine in young and older to adults to increase our understanding of the immune characteristics that may contribute to the increased susceptibility to HZ in older adults. Young (25-40 y; n = 25) and older (60-80 y; n = 33) adults had similar magnitude memory responses to varicella-zoster virus (VZV) ex vivo restimulation measured by responder cell-frequency and flow cytometry, but the responses were delayed in older compared with young adults. Only young adults had an increase in dual-function VZV-specific CD4+ and CD8+ T cell effectors defined by coexpression of IFN-γ, IL-2, and CD107a after vaccination. In contrast, older adults showed marginal increases in VZV-specific CD8+CD57+ senescent T cells after vaccination, which were already higher than those of young adults before vaccination. An increase in VZV-stimulated CD4+CD69+CD57+PD1+ and CD8+CD69+CD57+PD1+ T cells from baseline to postvaccination was associated with concurrent decreased VZV-memory and CD8+ effector responses, respectively, in older adults. Blocking the PD1 pathway during ex vivo VZV restimulation increased the CD4+ and CD8+ proliferation, but not the effector cytokine production, which modestly increased with TIM-3 blockade. We conclude that high proportions of senescent and exhausted VZV-specific T cells in the older adults contribute to their poor effector responses to a VZV challenge. This may underlie their inability to contain VZV reactivation and prevent the development of HZ. Copyright © 2017 by The American Association of Immunologists, Inc.
De Paschale, Massimo; Clerici, Pierangelo
Varicella-zoster virus, which is responsible for varicella (chickenpox) and herpes zoster (shingles), is ubiquitous and causes an acute infection among children, especially those aged less than six years. As 90% of adults have had varicella in childhood, it is unusual to encounter an infected pregnant woman but, if the disease does appear, it can lead to complications for both the mother and fetus or newborn. The major maternal complications include pneumonia, which can lead to death if not treated. If the virus passes to the fetus, congenital varicella syndrome, neonatal varicella (particularly serious if maternal rash appears in the days immediately before or after childbirth) or herpes zoster in the early years of life may occur depending on the time of infection. A Microbiology laboratory can help in the diagnosis and management of mother-child infection at four main times: (1) when a pregnant woman has been exposed to varicella or herpes zoster, a prompt search for specific antibodies can determine whether she is susceptible to, or protected against infection; (2) when a pregnant woman develops clinical symptoms consistent with varicella, the diagnosis is usually clinical, but a laboratory can be crucial if the symptoms are doubtful or otherwise unclear (atypical patterns in immunocompromised subjects, patients with post-vaccination varicella, or subjects who have received immunoglobulins), or if there is a need for a differential diagnosis between varicella and other types of dermatoses with vesicle formation; (3) when a prenatal diagnosis of uterine infection is required in order to detect cases of congenital varicella syndrome after the onset of varicella in the mother; and (4) when the baby is born and it is necessary to confirm a diagnosis of varicella (and its complications), make a differential diagnosis between varicella and other diseases with similar symptoms, or confirm a causal relationship between maternal varicella and malformations in a newborn
De Paschale, Massimo; Clerici, Pierangelo
Varicella-zoster virus, which is responsible for varicella (chickenpox) and herpes zoster (shingles), is ubiquitous and causes an acute infection among children, especially those aged less than six years. As 90% of adults have had varicella in childhood, it is unusual to encounter an infected pregnant woman but, if the disease does appear, it can lead to complications for both the mother and fetus or newborn. The major maternal complications include pneumonia, which can lead to death if not treated. If the virus passes to the fetus, congenital varicella syndrome, neonatal varicella (particularly serious if maternal rash appears in the days immediately before or after childbirth) or herpes zoster in the early years of life may occur depending on the time of infection. A Microbiology laboratory can help in the diagnosis and management of mother-child infection at four main times: (1) when a pregnant woman has been exposed to varicella or herpes zoster, a prompt search for specific antibodies can determine whether she is susceptible to, or protected against infection; (2) when a pregnant woman develops clinical symptoms consistent with varicella, the diagnosis is usually clinical, but a laboratory can be crucial if the symptoms are doubtful or otherwise unclear (atypical patterns in immunocompromised subjects, patients with post-vaccination varicella, or subjects who have received immunoglobulins), or if there is a need for a differential diagnosis between varicella and other types of dermatoses with vesicle formation; (3) when a prenatal diagnosis of uterine infection is required in order to detect cases of congenital varicella syndrome after the onset of varicella in the mother; and (4) when the baby is born and it is necessary to confirm a diagnosis of varicella (and its complications), make a differential diagnosis between varicella and other diseases with similar symptoms, or confirm a causal relationship between maternal varicella and malformations in a newborn.
Grahn, Anna; Studahl, Marie
Both varicella and herpes zoster that are caused by varicella-zoster virus (VZV), are associated with central nervous system disease. Since the introduction of polymerase chain reaction, the opportunity to detect the virus in cerebrospinal fluid (CSF) has improved dramatically. As a result VZV is diagnosed as one of the most common viruses causing CNS disease and it has become evident that this disease includes a wide spectrum of different CNS manifestations. The most evaluated CNS manifestations are encephalitis which is associated with both varicella and herpes zoster and, cerebellitis which occurs predominantly in children with varicella. Other manifestations have been less widely investigated. The incidence of cerebrovascular disease caused by VZV has been only scarcely studied and, in addition, some data indicate that vasculitis might also be involved in other VZV CNS manifestations such as herpes zoster-associated encephalitis. For this reason, VZV CNS infection must be suspected in several CNS syndromes and diagnostics should be based on CSF analysis for detection of VZV DNA by PCR and/or intrathecal antibody production. The prognosis is reported as favourable in children but few follow-up studies are available. Moreover, in adults, the prognosis is reported to be good in overall terms, but later studies indicate more serious neurological sequelae including cognition. Despite considerable mortality and morbidity, so far also in vaccinating countries, few treatment studies are available. Further treatment studies including assessments of neurological and cognitive sequelae, are warranted. Copyright © 2015 The British Infection Association. Published by Elsevier Ltd. All rights reserved.
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Markus, Amos; Golani, Linoy; Ojha, Nishant Kumar; Borodiansky-Shteinberg, Tatiana; Kinchington, Paul R; Goldstein, Ronald S
Many herpesviruses express small noncoding RNAs (sncRNAs), including microRNAs (miRNAs), that may play roles in regulating lytic and latent infections. None have yet been reported in varicella-zoster virus (VZV; also known as human herpesvirus 3 [HHV-3]). Here we analyzed next-generation sequencing (NGS) data for small RNAs in VZV-infected fibroblasts and human embryonic stem cell-derived (hESC) neurons. Two independent bioinformatics analyses identified more than 20 VZV-encoded 20- to 24-nucleotide RNAs, some of which are predicted to have stem-loop precursors potentially representing miRNAs. These sequences are perfectly conserved between viruses from three clades of VZV. One NGS-identified sequence common to both bioinformatics analyses mapped to the repeat regions of the VZV genome, upstream of the predicted promoter of the immediate early gene open reading frame 63 (ORF63). This miRNA candidate was detected in each of 3 independent biological repetitions of NGS of RNA from fibroblasts and neurons productively infected with VZV using TaqMan quantitative PCR (qPCR). Importantly, transfected synthetic RNA oligonucleotides antagonistic to the miRNA candidate significantly enhanced VZV plaque growth rates. The presence of 6 additional small noncoding RNAs was also verified by TaqMan qPCR in productively infected fibroblasts and ARPE19 cells. Our results show VZV, like other human herpesviruses, encodes several sncRNAs and miRNAs, and some may regulate infection of host cells. IMPORTANCE Varicella-zoster virus is an important human pathogen, with herpes zoster being a major health issue in the aging and immunocompromised populations. Small noncoding RNAs (sncRNAs) are recognized as important actors in modulating gene expression, and this study demonstrates the first reported VZV-encoded sncRNAs. Many are clustered to a small genomic region, as seen in other human herpesviruses. At least one VZV sncRNA was expressed in productive infection of neurons and fibroblasts
Sotelo, Julio; Ordoñez, Graciela; Pineda, Benjamín; Flores, José
Recent studies have documented the apparent participation of varicella zoster virus (VZV) in the etiopathogenesis of multiple sclerosis (MS). The present study aimed to corroborate the possible presence of VZV during exacerbations of MS. Fifty-three patients with definite MS were included; of them, 31 were studied during the first week of a clinical relapse, whereas 16 were studied during remission; 6 patients with progressive MS were also studied. Genes from 5 herpes viruses: varicella zoster, herpes simplex 1 and 2, Epstein-Barr and herpes 6 were studied by polymerase chain reaction in cerebrospinal fluid and in peripheral blood mononuclear cells (PBMC). As controls 21 patients with inflammatory or functional neurological disorders were included. DNA from varicella zoster virus was found in the CSF from all MS patients studied during relapse (100%) and in the PBMC from 28 of them (90%). However, VZV DNA was found in the CSF only in 5 MS patients studied during remission (31%) and in the PBMC from 3 of them (19%). VZV DNA was also found, but in lower amounts, in the CSF (83%) and PBMC (33%) from patients with progressive MS. In contrast, VZV was not found either in CSF or in PBMC from controls. Results from the other herpes viruses tested were similar in MS patients and in controls. Our results corroborate the conspicuous, but ephemeral presence of VZV during relapses of MS and support the idea of VZV involvement in the etiopathogenesis of MS. Recent epidemiological and molecular studies as well as reports of severe VZV infections triggered by specifically induced immunosuppression during therapy of MS give additional support to this potential association. Copyright © 2014 Elsevier B.V. All rights reserved.
Full Text Available Herpes gestationis, also known as pemphigoidgestationis (PG is an extremely rare autoimmune bullous dermatosis of the gestation and postpartum period. The disease was originally named herpes gestationis on the basis of the morphological herpetiform feature of the blisters. We report a 21-year-old woman, pregnant in the third trimester, who presented with a pruritic bullous cutaneous eruption of two weeks duration. The disease started with a red plaque in the abdominal area accompanied by mild itching. Soonafter, blisters appeared and affected almost the entire body. Physical examination revealed a primiparous woman in good general state, pregnant in 36 weeks of gestation. The skin changes affected the abdomen, back of the trunk, upper and lower extremities, hands and feet. They were manifested by a polymorphous eruption, consisting of erythematous urticaria-like plaques, small tense vesicles and multiple excoriations. Mucous membranes were not affected. Routine laboratory examinations were within normal limits. Direct immunofluorescence (DIF on perilesional skin showed linear deposition of IgG (++ and C3 (++ at the cutaneous basement membrane zone (BMZ. Indirect immunofluorescence (IIF on human esophagus substrate revealed circulating IgG anti-BMZ antibodies at a titer of 1:80. ELISABP180 NC16A was strongly positive. The diagnosis of PG was confirmed and a treatment with systemic methylprednisolone 60 mg/day was initiated, later gradually tapered to 20 mg/day, together with topical corticosteroids. As a result on the 10th day of the treatment we already achieved significant improvement with reduction of erythema and itching, absence of new skin lesions. The pregnancy ended in term with successful childbirth. No flare of the skin disease was observed in the puerperal period.
Schönrich, Günther; Raftery, Martin J
Varicella zoster virus (VZV), a human alphaherpesvirus, causes varicella and subsequently establishes latency within sensory nerve ganglia. Later in life VZV can reactivate to cause herpes zoster. A reduced frequency of VZV-specific T cells is strongly associated with herpes zoster illustrating that these immune cells are central to control latency. Dendritic cells (DCs) are required for the generation of VZV-specific T cells. However, DCs can also be infected in vitro and in vivo allowing VZV to evade the antiviral immune response. Thus, DCs represent the immune systems' Achilles heel. Uniquely among the human herpesviruses, VZV infects both DCs and T cells, and exploits both as Trojan horses. During primary infection VZV-infected DCs traffic to the draining lymph nodes and tonsils, where the virus is transferred to T cells. VZV-infected T cells subsequently spread infection throughout the body to give the typical varicella skin rash. The delicate interplay between VZV and DCs and its consequences for viral immune evasion and viral dissemination will be discussed in this article.
Full Text Available Varicella zoster virus (VZV, a human alphaherpesvirus, causes varicella and subsequently estab-lishes latency within sensory nerve ganglia. Later in life VZV can reactivate to cause herpes zoster. A reduced frequency of VZV-specific T cells is strongly associated with herpes zoster illustrating that these immune cells are central to control latency. Dendritic cells (DCs are required for the generation of VZV-specific T cells. However, DCs can also be infected in vitro and in vivo allowing VZV to evade the antiviral immune response. Thus, DCs represent the immune systems’ Achilles heel. Uniquely among the human herpesviruses, VZV infects both DCs and T cells, and exploits both as Trojan horses. During primary infection VZV-infected DCs traffic to the draining lymph nodes and tonsils, where the virus is transferred to T cells. VZV-infected T cells subsequently spread infection throughout the body to give the typical varicella skin rash. The delicate interplay between VZV and DCs and its consequences for viral immune evasion and viral dissemination will be discussed in this article.
Norberg, Peter; Depledge, Daniel P; Kundu, Samit; Atkinson, Claire; Brown, Julianne; Haque, Tanzina; Hussaini, Yusuf; MacMahon, Eithne; Molyneaux, Pamela; Papaevangelou, Vassiliki; Sengupta, Nitu; Koay, Evelyn S C; Tang, Julian W; Underhill, Gillian S; Grahn, Anna; Studahl, Marie; Breuer, Judith; Bergström, Tomas
Varicella-zoster virus (VZV) is a human herpesvirus, which during primary infection typically causes varicella (chicken pox) and establishes lifelong latency in sensory and autonomic ganglia. Later in life, the virus may reactivate to cause herpes zoster (HZ; also known as shingles). To prevent these diseases, a live-attenuated heterogeneous vaccine preparation, vOka, is used routinely in many countries worldwide. Recent studies of another alphaherpes virus, infectious laryngotracheitis virus, demonstrate that live-attenuated vaccine strains can recombine in vivo, creating virulent progeny. These findings raised concerns about using attenuated herpesvirus vaccines under conditions that favor recombination. To investigate whether VZV may undergo recombination, which is a prerequisite for VZV vaccination to create such conditions, we here analyzed 115 complete VZV genomes. Our results demonstrate that recombination occurs frequently for VZV. It thus seems that VZV is fully capable of recombination if given the opportunity, which may have important implications for continued VZV vaccination. Although no interclade vaccine wild-type recombinant strains were found, intraclade recombinants were frequently detected in clade 2, which harbors the vaccine strains, suggesting that the vaccine strains have already been involved in recombination events, either in vivo or in vitro during passages in cell culture. Finally, previous partial and complete genomic studies have described strains that do not cluster phylogenetically to any of the five established clades. The additional VZV strains sequenced here, in combination with those previously published, have enabled us to formally define a novel sixth VZV clade. Although genetic recombination has been demonstrated to frequently occur for other human alphaherpesviruses, herpes simplex viruses 1 and 2, only a few ancient and isolated recent recombination events have hitherto been demonstrated for VZV. In the present study, we
Full Text Available Introduction: VZV is an exclusively human pathogen. The primary infection typically occurs during childhood and causes varicella. As with other members of the herpes viruses’ family, VZV is noninfectious in its latent form but can reactivate at a later time to form intact virions in the involved sensory neurons. These virions then migrate to the skin through axons, spread from cell to cell, and penetrate the epidermis.Case Report: In this case a 72 years old woman with history of diabetes mellitus and hypertension is reported hospitalized because of urinary retention, weakness and parestesia in the right leg, complicated with vesiculoulcerative lesions in sacral area with distribution to the right buttock and vagina. L.P was done to confirm inflammatory radicopathy that showed aseptic meningitis and therapy started with acyclovir and prednisolone. Patient got well and discharged from the hospital.Conclusion: Motor weakness in noncranial nerve is one of the zoster complications known as zoster paresis. Weakness begins suddenly 2-3 weeks after rash and progresses to extremities. In this case 3 weeks after rash, nerve complications were observed. We recommend to do paresthesia examination of skin for eruption in all patients presented with paresis.
Sotelo, Julio; Corona, Teresa
Multiple sclerosis (MS) is an immune-mediated disorder; however, little is known about the triggering factors of the abnormal immune response. Different viruses from the herpes family have been mentioned as potential participants. Here, we review the evidences that support the association of varicella zoster virus (VZV) with MS. Epidemiological studies from geographical areas, where incidence of MS has increased in recent decades, pointed out a high frequency of varicella and zoster in the clinical antecedents of MS patients, and also laboratory investigations have found large quantities of DNA from VZV in leucocytes and cerebrospinal fluid of MS patients restricted to the ephemeral period of MS relapse, followed by disappearance of the virus during remission. The above observations and the peculiar features of VZV, mainly characterized by its neurotropism and long periods of latency followed by viral reactivation, support the idea on the participation of VZV in the etiology of MS. However, as with reports from studies with other viruses, particularly Epstein Barr virus, conflicting results on confirmatory studies about the presence of viral gene products in brain tissue indicate the need for further research on the potential participation of VZV in the etiology of MS. PMID:22096629
Full Text Available Among persistent intracellular agents, a group of herpesviruses occupies the leading place after the prevalence. The World Health Organization (WHO warns the international community of the danger of latent herpes infection pandemic. According to the WHO, 70 to 90 % of the world population is infected with one or more types of herpes virus, and in 50 % of them, due to the absence of stable immunity, disease relapses occur annually. The family of herpes viruses found in humans includes herpes simplex virus type 1 and 2, Zoster virus, cytomegalovirus, Epstein-Barr virus, human herpes type 6, 7, 8. Thus, in the pathogenesis of herpes infection type 1 and 2, there are four main phases: the penetration of the epithelial cells → penetration into the nerve endings and paravertebral ganglia → elimination of the virus from tissues and organs → reactivation of herpes simplex virus and moving it to the port of infection. Herpetic and cytomegalovirus infection that belongs to the group of TORCH infections is the most common cause fetal infection, which can lead to the birth of a child with disabilities. Herpesvirus infections are considered as a group of infections associated with human immunodeficiency syndrome, and is a common cause of damage to the central nervous system and internal organs in patients with secondary immunodeficiency. Almost all known now human herpesviruses can cause damage to the nervous system. In this regard, herpes infections have become one of the leading medical and social problems and acquire national importance.
Tugal-Tutkun, Ilknur; Cimino, Luca; Akova, Yonca Aydin
Varicella zoster virus (VZV)-induced anterior uveitis (AU) may complicate the course of primary varicella infection typically seen in children. In adults, especially with advanced age, VZV AU is more commonly associated with herpes zoster ophthalmicus (HZO) with or without skin rash affecting the distribution of the ophthalmic nerve due to reactivation of the latent VZV in the trigeminal ganglion. While it is typically a mild self-limiting AU in primary infection, HZO AU is often accompanied by keratitis, may have a chronic recurrent course, and lead to sectoral iris atrophy, pupillary distortion, and ocular hypertension. Diagnosis is often clinical and proven by analysis of aqueous humor for viral genome or antiviral antibodies. Systemic antiviral agents and topical steroids are the mainstay of treatment. Visual prognosis is favorable with timely diagnosis and appropriate treatment.
Gupta, Meenakashi; Jardeleza, Maria Stephanie R; Kim, Ivana; Durand, Marlene L; Kim, Leo; Lobo, Ann-Marie
Progressive outer retinal necrosis (PORN) associated with varicella zoster virus (VZV) is usually diagnosed in HIV positive or immunosuppressed patients. We report two cases of immunocompetent patients with necrotizing viral retinitis found to have idiopathic CD4 lymphocytopenia. Clinical presentation, examination, imaging, and laboratory testing of two patients with VZV retinitis are presented. An HIV negative patient with history of herpes zoster presented with rapid loss of vision and examination consistent with PORN. PCR testing confirmed VZV. Lymphocytopenia was noted with a CD4 count of 25/mm(3). A second HIV negative patient presented with blurred vision and lid swelling and was found to have peripheral VZV retinitis confirmed by PCR. Laboratory workup revealed lymphocytopenia with a CD4 count of 133/mm(3). VZV necrotizing retinitis classic for PORN can occur in HIV negative patients. Idiopathic CD4 lymphocytopenia should be considered healthy patients who develop ocular infections seen in the immunocompromised.
Full Text Available Varicella zoster virus (VZV is a ubiquitous, exclusively human alphaherpesvirus. Primary infection usually results in varicella (chickenpox, after which VZV becomes latent in ganglionic neurons along the entire neuraxis. As VZV-specific cell-mediated immunity declines in elderly and immunocompromised individuals, VZV reactivates and causes herpes zoster (shingles, frequently complicated by postherpetic neuralgia. VZV reactivation also produces multiple serious neurological and ocular diseases, such as cranial nerve palsies, meningoencephalitis, myelopathy, and VZV vasculopathy, including giant cell arteritis, with or without associated rash. Herein, we review the clinical, laboratory, imaging, and pathological features of neurological complications of VZV reactivation as well as diagnostic tests to verify VZV infection of the nervous system. Updates on the physical state of VZV DNA and viral gene expression in latently infected ganglia, neuronal, and primate models to study varicella pathogenesis and immunity are presented along with innovations in the immunization of elderly individuals to prevent VZV reactivation.
Halling, Geoffrey; Giannini, Caterina; Britton, Jeffrey W; Lee, Ricky W; Watson, Robert E; Terrell, Christine L; Parney, Ian F; Buckingham, Erin M; Carpenter, John E; Grose, Charles
Herein we describe an episode of focal varicella-zoster virus (VZV) encephalitis in a healthy young man with neither rash nor radicular pain. The symptoms began with headaches and seizures, after which magnetic resonance imaging detected a single hyperintense lesion in the left temporal lobe. Because of the provisional diagnosis of a brain tumor, the lesion was excised and submitted for pathological examination. No tumor was found. But the tissue immunostained positively for VZV antigens, and wild-type VZV sequences were detected. In short, this case represents VZV reactivation, most likely in the trigeminal ganglion, in the absence of clinical herpes zoster. © The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: firstname.lastname@example.org.
Luyten, Jeroen; Ogunjimi, Benson; Beutels, Philippe
The varicella-zoster virus (VZV) causes two diseases: varicella ('chickenpox') and herpes zoster ('shingles'). VZV vaccination of children reduces exposure to chickenpox in the population and it has been hypothesized that this could increase the prevalence of shingles. This 'exogenous boosting' effect of VZV raises an important equity concern: introducing a vaccination program could advance the health of one population group (children) at the expense of another (adults and elderly). We discuss the program's justifiability from two ethical perspectives, classic utilitarianism and contractualism. Whereas the former framework might offer a foundation for the case against introducing this vaccination, the latter offers a basis to justify it. Copyright © 2014 Elsevier Ltd. All rights reserved.
Min, Bo Mi; Kim, Jong Hae
Continuous epidural analgesia has been used for decades to treat acute herpes zoster pain and to prevent postherpetic neuralgia. However, many technical problems can arise during chronic treatment with epidural medications. These complications include catheter dislodgement, infection, injection pain, leakage, and occlusion. Epidural catheter placement utilizing subcutaneous injection port implantation has gained widespread acceptance as a method to overcome such complications. The technique r...
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Full Text Available Kaposi′s varicelliform eruption (KVE or eczema herpeticum is characterized by disseminated papulovesicular eruption caused by a number of viruses like Herpes simplex virus I and II, Coxsackie virus, and Vaccinia and Small pox viruses in patients with pre-existing skin disease. The occurrence of KVE with psoriasis has been reported recently as a new entity psoriasis herpeticum. The rare causation of psoriasis herpeticum due to Varicella zoster virus in a patient with underlying psoriasis is being reported for the first time.
Levin, Myron J
Varicella-zoster virus (VZV) can be detected in the blood from approximately 5 days before to 4 days after varicella. VZV DNA, primarily in T-lymphocytes, is detected as early as 8-10 days prior to rash and can persist for a week. The duration and magnitude of VZV DNAemia correlates with immune status and the efficacy of antiviral therapy. VZV DNA is also readily detected in the oropharynx just prior to rash and for 1-2 weeks thereafter. Detection of VZV DNA in blood and saliva has been useful for diagnosis and prognosis in atypical cases of varicella. Herpes zoster (HZ) is also characterized by VZV DNAemia at onset and for many weeks thereafter, and VZV DNA is present in the oropharynx shortly after HZ onset. Detection of VZV DNA in blood and saliva facilitates the diagnosis of zoster sine herpete and other atypical manifestations of VZV reactivation, such as neurologic syndromes when cerebrospinal fluid is not available, Bell's palsy, and atypical pain syndromes. VZV DNA is sometimes present in the blood and saliva of asymptomatic individuals. In total these observations extend understanding of the pathophysiology and epidemiology of VZV, and increasingly contribute to the clinical management of VZV infections. Copyright © 2014 Elsevier B.V. All rights reserved.
K A Kamala; L Ashok; Rajeshwari G Annigeri
Erythema multiforme is an acute and a self-limiting mucocutaneous hypersensitivity reaction triggered by certain infections and medications. One of the most common predisposing factors for erythema multiforme is infection with herpes simplex virus. Herpes associated erythema multiforme (HAEM) is an acute exudative dermatic and mucosal disease caused by the infecting herpes simplex virus. It has recurrence and idiorestriction, characterized by increasing of CD4+T leukomonocyte. This article re...
Kamala, K A; Ashok, L; Annigeri, Rajeshwari G
Erythema multiforme is an acute and a self-limiting mucocutaneous hypersensitivity reaction triggered by certain infections and medications. One of the most common predisposing factors for erythema multiforme is infection with herpes simplex virus. Herpes associated erythema multiforme (HAEM) is an acute exudative dermatic and mucosal disease caused by the infecting herpes simplex virus. It has recurrence and idiorestriction, characterized by increasing of CD4+T leukomonocyte. This article reports a case of HAEM in a 9-year-old girl, with a review of relevant literature, and discusses the pathophysiology and treatment of erythema multiforme triggered by herpes simplex virus.
K A Kamala
Full Text Available Erythema multiforme is an acute and a self-limiting mucocutaneous hypersensitivity reaction triggered by certain infections and medications. One of the most common predisposing factors for erythema multiforme is infection with herpes simplex virus. Herpes associated erythema multiforme (HAEM is an acute exudative dermatic and mucosal disease caused by the infecting herpes simplex virus. It has recurrence and idiorestriction, characterized by increasing of CD4+T leukomonocyte. This article reports a case of HAEM in a 9-year-old girl, with a review of relevant literature, and discusses the pathophysiology and treatment of erythema multiforme triggered by herpes simplex virus
Full Text Available Studies into the impact of vaccination against the varicella zoster virus (VZV have increasingly focused on herpes zoster (HZ, which is believed to be increasing in vaccinated populations with decreasing infection pressure. This idea can be traced back to Hope-Simpson's hypothesis, in which a person's immune status determines the likelihood that he/she will develop HZ. Immunity decreases over time, and can be boosted by contact with a person experiencing varicella (exogenous boosting or by a reactivation attempt of the virus (endogenous boosting. Here we use transmission models to estimate age-specific rates of reactivation and immune boosting, exogenous as well as endogenous, using zoster incidence data from the Netherlands (2002–2011, n = 7026. The boosting and reactivation rates are estimated with splines, enabling these quantities to be optimally informed by the data. The analyses show that models with high levels of exogenous boosting and estimated or zero endogenous boosting, constant rate of loss of immunity, and reactivation rate increasing with age (to more than 5% per year in the elderly give the best fit to the data. Estimates of the rates of immune boosting and reactivation are strongly correlated. This has important implications as these parameters determine the fraction of the population with waned immunity. We conclude that independent evidence on rates of immune boosting and reactivation in persons with waned immunity are needed to robustly predict the impact of varicella vaccination on the incidence of HZ.
Helweg-Larsen, J; Tarp, B; Obel, N
using the polymerase chain reaction (PCR). METHODS: Thirty temporal artery biopsies from 30 patients suspected of having GCA within a period of 1 yr were examined. Thirteen patients had classical GCA, two had biopsy-negative GCA, 10 patients had polymyalgia rheumatica and five patients had other...... conditions. DNA was extracted from frozen biopsies and PCR was used to amplify genes from Chlamydia pneumoniae, parvovirus B19 and each of the eight human herpes viruses: herpes simplex viruses HSV-1 and 2, Epstein-Barr virus, cytomegalovirus, varicella zoster virus and human herpes viruses HHV-6, -7 and -8....... RESULTS: In all 30 biopsies, PCR was negative for DNAs of parvovirus B19, each of the eight human herpes viruses and C. pneumoniae. CONCLUSIONS: We found no evidence of DNA from parvovirus B19, human herpes virus or C. pneumoniae in any of the temporal arteries. These agents do not seem to play a unique...
Kohlmann, Rebekka; Salmen, Anke; Chan, Andrew; Knabbe, Cornelius; Diekmann, Jürgen; Brockmeyer, Norbert; Skaletz-Rorowski, Adriane; Michalik, Claudia; Gold, Ralf; Überla, Klaus
Serious adverse drug reactions of disease-modifying drugs in multiple sclerosis (MS) therapy may include enhanced susceptibility to reactivation of neurotropic herpes viruses like varicella-zoster virus (VZV) and the John Cunningham (JC) polyomavirus. Because symptomatic reactivation of these viruses are rare events, we determined the incidence of rises in anti-VZV IgG antibody levels as a potential marker for enhanced susceptibility to subclinical and symptomatic reactivation of neurotropic viruses. Anti-VZV IgG levels were measured in paired serum samples taken 6-8 months apart from natalizumab-treated MS patients, healthy blood donors and human immunodeficiency virus (HIV) infected patients. The incidence of significant rises in anti-VZV IgG levels in natalizumab-treated MS patients was 4.26 per 100 person-years, which was significantly higher than in healthy blood donors. Retrospective evaluation of the available medical records of patients with rises of anti-VZV IgG levels did not reveal herpes zoster (i.e. shingles) manifestations. The increased incidence of significant rises of anti-VZV IgG levels in natalizumab-treated MS patients might indicate an association of natalizumab treatment of MS with an elevated risk of a subclinical VZV reactivation and/or reinfection events. Whether this is predictive of an increased risk of herpes zoster or even symptomatic reactivation of other neurotropic viruses remains to be determined in larger prospective studies. © The Author(s), 2015.
Irwin, Michael R.; Levin, Myron J.; Carrillo, Carmen; Olmstead, Richard; Lucko, Anne; Lang, Nancy; Caulfield, Michael J; Weinberg, Adriana; Chan, Ivan S. F.; Clair, Jim; Smith, Jeff G.; Marchese, R.D.; Williams, Heather M.; Beck, Danielle J.; McCook, Patricia T.; Johnson, Gary; Oxman, Michael N.
Major depressive disorder has been associated with activation of inflammatory processes as well as with reductions in innate, adaptive and non-specific immune responses. The objective of this study was to evaluate the association between major depression and a disease-relevant immunologic response, namely varicella-zoster virus (VZV)-specific immunity, in elderly adults. A cross-sectional cohort study was conducted in 104 elderly community dwelling adults ≥ 60 years of age who were enrolled in the Depression Substudy of the Shingles Prevention Study, a double blind, placebo-controlled vaccine efficacy trial. Fifty-two subjects had a current major depressive disorder, and 52 age- and sex-matched controls had no history of depression or any mental illness. VZV-specific cell-mediated immunity (VZV-CMI) was measured by VZV responder cell frequency (VZV-RCF) and interferon-γ enzyme-linked immunospot (ELISPOT) assays, and antibody to VZV was measured by an enzyme-linked immunosorbent assay against affinity-purified VZV glycoproteins (gpELISA). VZV-CMI, measured by VZV-RCF, was significantly lower in the depressed group than in the controls (p<0.001), and VZV-RCF was inversely correlated with the severity of depressive symptoms in the depressed patients. In addition, an age-related reduction in VZV-RCF was observed in the depressed patients, but not in the controls. Furthermore, there was a trend for depressive symptom severity to be associated with lower ELISPOT counts. Finally, VZV-RCF was higher in depressed patients treated with antidepressant medications as compared to untreated depressed patients. Since lower levels of VZV-RCF appear to explain the increased risk and severity of herpes zoster observed in older adults, these findings suggest that, in addition to increasing age, depression may increase the risk and severity of herpes zoster. PMID:21329753
Mizuta, K; Urahashi, T; Ihara, Y; Sanada, Y; Wakiya, T; Yamada, N; Okada, N; Egami, S; Kawarasaki, H
The aim of this study was to evaluate patients who developed varicella zoster virus (VZV) disease after pediatric living donor liver transplantation (PLDLT). Two hundred fifty-five patients who underwent PLDLT between 1995 and 2010 were included in this study. Pretransplantation vaccination of VZV was performed for all recipients except emergency PLDLTs. Posttransplantation VZV vaccination was administered to the patients with a low VZV antibody titer 2 years or more after transplantation. The clinical course and outcomes of VZV disease in cases were reviewed with the transplant database and hospital medical records. Sixty-three patients developed VZV disease (chicken pox in 61, herpes zoster in 2) at a median onset of 36 months after PLDLT and at a median age of 4 years old, with a cumulative incidence of 25%. All chicken pox occurred in VZV antibody-negative patients. The onset of herpes zoster in the two patients occurred within 3 months after PLDLT; in addition, these patients were VZV antibody-positive patients. The clinical presentations of most patients were not serious and there were no disseminated infections. Although only 3 patients (5%) were hospitalized, the other 60 patients (95%) all showed a good response to oral antiviral therapy. Although VZV disease is an infectious disease with a high morbidity rate after PLDLT, it can normally be successfully managed on an outpatient basis at home. Pre- and posttransplantation vaccinations are effective for delaying the onset of chicken pox after PLDLT and to prevent it from developing into a serious illness. Copyright © 2012 Elsevier Inc. All rights reserved.
Grahn, Anna; Bergström, Tomas; Runesson, Jim; Studahl, Marie
Varicella-zoster virus (VZV) is a common viral agent causing central nervous system (CNS) infections, normally diagnosed by detection of VZV DNA in cerebrospinal fluid (CSF). Our aim was to investigate trends in VZV DNAemia in VZV CNS infections, which could potentially contribute to diagnosis and secondly, correlate the amount of VZV DNA in serum to severity of disease. Seventy-two patients with VZV CNS infections diagnosed by detection of VZV DNA in CSF and concomitant neurological symptoms were included. The amount of VZV DNA was measured by real-time PCR in paired serum and CSF samples and compared to a control group of herpes zoster (n = 36). An increased amount of VZV DNA was detected in serum in patients with encephalitis compared to patients with meningitis or Ramsay-Hunt syndrome, respectively (p = 0.003 and p = 0.024). A greater proportion of patients with VZV CNS infections and detectable VZV DNA in serum had ongoing rash compared to those without detectable VZV DNA in serum (p ≤ 0.001). The viral load in serum of patients with neurological symptoms was lower compared to in patients with herpes zoster without neurological symptoms (p ≤ 0.001) and only 32/72 of the patients with VZV CNS disease had VZV DNA detected in serum. Increased amount of VZV DNA in serum of patients with VZV CNS infections seems associated with encephalitis and ongoing rash. Additionally, viral DNA analysis by PCR in serum may be a helpful diagnostic tool although viral DNA analysis by PCR in CSF is the method of choice for diagnosis. Copyright © 2016 The British Infection Association. Published by Elsevier Ltd. All rights reserved.
Irwin, Michael R; Levin, Myron J; Carrillo, Carmen; Olmstead, Richard; Lucko, Anne; Lang, Nancy; Caulfield, Michael J; Weinberg, Adriana; Chan, Ivan S F; Clair, Jim; Smith, Jeff G; Marchese, R D; Williams, Heather M; Beck, Danielle J; McCook, Patricia T; Johnson, Gary; Oxman, Michael N
Major depressive disorder has been associated with activation of inflammatory processes as well as with reductions in innate, adaptive and non-specific immune responses. The objective of this study was to evaluate the association between major depression and a disease-relevant immunologic response, namely varicella-zoster virus (VZV)-specific immunity, in elderly adults. A cross-sectional cohort study was conducted in 104 elderly community dwelling adults ≥ 60years of age who were enrolled in the depression substudy of the shingles prevention study, a double blind, placebo-controlled vaccine efficacy trial. Fifty-two subjects had a current major depressive disorder, and 52 age- and sex-matched controls had no history of depression or any mental illness. VZV-specific cell-mediated immunity (VZV-CMI) was measured by VZV responder cell frequency (VZV-RCF) and interferon-γ enzyme-linked immunospot (ELISPOT) assays, and antibody to VZV was measured by an enzyme-linked immunosorbent assay against affinity-purified VZV glycoproteins (gpELISA). VZV-CMI, measured by VZV-RCF, was significantly lower in the depressed group than in the controls (pdepressive symptoms in the depressed patients. In addition, an age-related reduction in VZV-RCF was observed in the depressed patients, but not in the controls. Furthermore, there was a trend for depressive symptom severity to be associated with lower ELISPOT counts. Finally, VZV-RCF was higher in depressed patients treated with antidepressant medications as compared to untreated depressed patients. Since lower levels of VZV-RCF appear to explain the increased risk and severity of herpes zoster observed in older adults, these findings suggest that, in addition to increasing age, depression may increase the risk and severity of herpes zoster. Copyright © 2011 Elsevier Inc. All rights reserved.
Mesar, Ines; Bašić-Jukić, Nikolina; Hudolin, Tvrtko; Katalinić, Lea; Kes, Petar
Do reaktiviranja varicella zoster virusa dolazi u bolesnika s narušenim imunim sustavom, što je gotovo univerzalna pojava u bolesnika sa završnim stadijem kronične bubrežne bolesti. Iako je liječenje infekcije varicella zoster virusom dobro poznato, često se zaboravlja da je potrebna prilagodba doze aciklovira s obzirom na bubrežnu funkciju. Želimo naglasiti problem pojave kožnog oblika herpes zostera u kombinaciji s neurološkim simptomima. Na osnovi kliničkog nalaza ponekad nije moguće jasno...
Leung, Alexander K C; Barankin, Benjamin
Herpes labialis is characterized by recurrent vesicular eruptions primarily on the lips and perioral skin. The condition is contagious, can cause significant discomfort/pain, and can have an adverse effect on the quality of life. To update the evaluation and treatment of herpes labialis. A PubMed search was completed in Clinical Queries using the key term "herpes labialis". Patents were searched using the key term "herpes labialis" from www.freepatentsonline.com. The diagnosis of herpes labialis is mainly clinical based on classic grouped lesions (papules, vesicles, ulcers) on the lip. Antiviral therapy shortens the duration of pain and discomfort, hastens healing, and reduces viral shedding. Thus, episodic treatment is warranted, especially if the patient desires treatment for cosmetic purposes or for relief of pain. Such treatment needs to be initiated promptly, ideally in the prodromal stage and no later than 48 hours from the onset of lesions to achieve optimal results. Chronic suppressive therapy with oral antiviral agents should be considered for patients with severe or frequent (six or more episodes per year) recurrences. Recent patents related to the management of herpes labialis are also discussed. For episodic treatment, oral antiviral agents, such as acyclovir (Zovirax), valacyclovir (Valtrex) and famciclovir (Famvir), are superior to topical antiviral therapy. Valacyclovir and famciclovir have greater oral bioavailability and are better absorbed than acyclovir, require less frequent dosing, but are more expensive and are not approved for children. Topical antiviral agents such as 5% acyclovir cream/ointment (Zovirax) ± hydrocortisone (Xerese), 1% penciclovir (Denavir) cream, and 50 mg Buccal Adhesive Tablet (ABT-50 mg) can also be used for episodic treatment of herpes labialis. These topical agents are not effective in the prevention of recurrent herpes labialis. For chronic daily suppressive therapy, oral antivirals are the treatment of choice
Alessandra de Martino Mota
Full Text Available Abstract Objective: To characterize varicella zoster virus-related deaths and hospitalizations in Brazil before universal vaccination with the tetravalent (measles, mumps, rubella, and varicella vaccine, attempting to collect baseline data on varicella morbidity and mortality in order to evaluate the impact of the varicella vaccination program. Methods: Varicella-associated mortality data were evaluated between 1996 and 2011 and varicella zoster virus-associated hospitalizations between 1998 and 2013. Data were gathered from the Informatics Department of the Unified Health System, considering the International Classification of Diseases, 10th Revision, code B01. All age groups were assessed. Varicella-specific mortality rates were calculated and seasonality of varicella-zoster virus-associated hospitalizations was described. Results: There were 2334 varicella deaths between 1996 and 2011, 19.3% in infants aged less than 1 year and 36% in children from 1 to 4 years. In infants under 1 year, varicella mortality rates reached 3.2/100,000/year. In children aged 1–4 years, varicella mortality rates reach 1.64/100,000/year. Average annual mortality rates for varicella in Brazil are 0.88/100,000 in infants under 1 year and 0.40/100,000 in children aged 1–4 years. The total number of hospitalizations associated with varicella zoster virus was 62,246 from 2008 to 2013. Varicella-associated hospitalizations have a seasonal distribution in children, peaking in November. In the elderly, monthly averages of herpes zoster-associated hospitalizations present no significant seasonal variation. Conclusions: Varicella is associated, in the pre-vaccine period, to significant morbidity and mortality in Brazil. The universal vaccination program is expected to decrease the disease burden from varicella.
de Martino Mota, Alessandra; Carvalho-Costa, Filipe Anibal
To characterize varicella zoster virus-related deaths and hospitalizations in Brazil before universal vaccination with the tetravalent (measles, mumps, rubella, and varicella) vaccine, attempting to collect baseline data on varicella morbidity and mortality in order to evaluate the impact of the varicella vaccination program. Varicella-associated mortality data were evaluated between 1996 and 2011 and varicella zoster virus-associated hospitalizations between 1998 and 2013. Data were gathered from the Informatics Department of the Unified Health System, considering the International Classification of Diseases, 10th Revision, code B01. All age groups were assessed. Varicella-specific mortality rates were calculated and seasonality of varicella-zoster virus-associated hospitalizations was described. There were 2334 varicella deaths between 1996 and 2011, 19.3% in infants aged less than 1 year and 36% in children from 1 to 4 years. In infants under 1 year, varicella mortality rates reached 3.2/100,000/year. In children aged 1-4 years, varicella mortality rates reach 1.64/100,000/year. Average annual mortality rates for varicella in Brazil are 0.88/100,000 in infants under 1 year and 0.40/100,000 in children aged 1-4 years. The total number of hospitalizations associated with varicella zoster virus was 62,246 from 2008 to 2013. Varicella-associated hospitalizations have a seasonal distribution in children, peaking in November. In the elderly, monthly averages of herpes zoster-associated hospitalizations present no significant seasonal variation. Varicella is associated, in the pre-vaccine period, to significant morbidity and mortality in Brazil. The universal vaccination program is expected to decrease the disease burden from varicella. Copyright © 2016 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.
... Print Share Cold Sores in Children: About the Herpes Simplex Virus Page Content A child's toddler and ... Cold sores (also called fever blisters or oral herpes) start as small blisters that form around the ...
Herpes simplex virus (HSV) types -1 and -2 in pregnant women in. Port Harcourt, Nigeria. ... Cite as: Okonko IO, Cookey TI. Seropositivity and determinants of immunoglobulin-G (IgG) antibodies against Herpes simplex virus (HSV) ..... zadeh, Z. and Akbari, S. Seroepidemiology of Herpes. Simplex Virus Type 1 and 2 in ...
Herpes - genital - self-care; Herpes simplex - genital - self-care; Herpesvirus 2 - self-care; HSV-2 - self-care ... One type of herpes virus stays in the body by hiding within nerve cells. It can remain "asleep" (dormant) for a long time. ...
Langan, Sinéad M; Thomas, Sara L; Smeeth, Liam; Margolis, David J; Nitsch, Dorothea
Growing epidemiological evidence demonstrates increased zoster risks in people with chronic kidney disease (CKD). Study objectives were to determine zoster vaccine effectiveness in individuals with CKD in pragmatic use. A population-based cohort study was undertaken in a 5% random sample of US Medicare from 2007 to 2009 involving 766 330 eligible individuals aged ≥65 years who were (29 785) and were not (736 545) exposed to the zoster vaccine. Incidence rates for zoster in vaccinated and unvaccinated individuals and hazard ratios for zoster comparing vaccinated with unvaccinated were determined for individuals with CKD. Time-updated Cox proportional hazards models were used, adjusting for relevant confounders. CKD was present in 183 762 (24%) of individuals (15% of vaccinees). Adjusted vaccine effectiveness [95% confidence intervals (CIs)] in individuals with CKD was 0.49 (0.36-0.65). The adjusted vaccine effectiveness in participants with both CKD and diabetes mellitus was 0.46 (95% CI 0.09-0.68). Vaccine effectiveness estimates were similar to those previously reported for the general population [vaccine effectiveness 0.48 (95% CI 0.39-0.56)]. Zoster vaccine is effective against incident zoster in older individuals with CKD. Extra efforts are warranted to increase vaccine uptake in individuals with CKD given the known low uptake in these higher risk individuals. © The Author 2016. Published by Oxford University Press on behalf of ERA-EDTA.
... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Varicella-zoster virus serological reagents. 866... Varicella-zoster virus serological reagents. (a) Identification. Varicella-zoster virus serological reagents..., occurring in adults who were previously infected with varicella-zoster viruses. Zoster is the response...
Full Text Available In 1999, two independent groups identified plasmacytoid dendritic cells (PDC as major type I interferon- (IFN- producing cells in the blood. Since then, evidence is accumulating that PDC are a multifunctional cell population effectively coordinating innate and adaptive immune responses. This paper focuses on the role of different immune cells and their interactions in the surveillance of alpha herpes virus infections, summarizes current knowledge on PDC surface receptors and their role in direct cell-cell contacts, and develops a risk factor model for the clinical implications of herpes simplex and varicella zoster virus reactivation. Data from studies involving knockout mice and cell-depletion experiments as well as human studies converge into a “spider web”, in which the direct and indirect crosstalk between many cell populations tightly controls acute, latent, and recurrent alpha herpes virus infections. Notably, cells involved in innate immune regulations appear to shape adaptive immune responses more extensively than previously thought.
Nohr, Erik W; Itani, Doha M; Andrews, Christopher N; Kelly, Margaret M
We report varicella-zoster virus (VZV) gastritis in a 70-year-old woman postchemotherapy for lymphoma, presenting with abdominal pain, vomiting, and delirium without rash. A gastric biopsy demonstrated viral inclusions but posed a diagnostic challenge as immunohistochemistry for cytomegalovirus and herpes simplex virus were negative, and VZV immunohistochemistry was not available. The patient developed a vesicular rash 7 days after her symptoms began. Molecular testing of the gastric biopsy and a skin swab both confirmed VZV infection. She also had probable involvement of her liver and pancreas based on imaging and serum chemistry, and possible central nervous system involvement. She recovered with appropriate antiviral therapy but later developed a postherpetic neuralgia, and chronic intrahepatic biliary strictures; liver biopsy demonstrated a cholangiopathy of uncertain etiology. A literature review of the pathogenesis, epidemiology and sequelae of VZV infection is included.
Greenidge, Paulette A.; Merz, Alfred; Folkers, Gerd
A representative range of pyrimidine nucleoside analogues that are known to inhibit herpes simplex virus (HSV) replication have been used to construct receptor binding site models for the varicella-zoster virus (VZV), thymidine kinase (TK) and human TK1. Given a set of interacting ligands, superimposed in such a manner as to define a pharmacophore, the pseudoreceptor modelling technique Yak provides a means of building binding site models of macromolecules for which no three-dimensional experimental structures are available. Once the models have been evaluated by their ability to reproduce experimental binding data [Vedani et al., J. Am. Chem. Soc., 117 (1995) 4987], they can be used for predictive purposes. Calculated and experimental values of relative binding affinity are compared. Our models suggest that the substitution of one residue may be sufficient to determine ligand subtype affinity.
Fonnest, G; de la Fuente Fonnest, I; Weber, Tom
-1984 through 1984-1991. Three mothers (10%) had recurrent herpes at delivery, three (10%) had primary herpes, and five (17%) had oral herpes. Seven infants (23%) were delivered by Cesarean section. Nine (30%) only had cutaneous herpes, four (13%) had CNS herpes, nine (30%) had disseminated disease. Six (20...
Groves, Mary Jo
Genital herpes is a common sexually transmitted disease, affecting more than 400 million persons worldwide. It is caused by herpes simplex virus (HSV) and characterized by lifelong infection and periodic reactivation. A visible outbreak consists of single or clustered vesicles on the genitalia, perineum, buttocks, upper thighs, or perianal areas that ulcerate before resolving. Symptoms of primary infection may include malaise, fever, or localized adenopathy. Subsequent outbreaks, caused by reactivation of latent virus, are usually milder. Asymptomatic shedding of transmissible virus is common. Although HSV-1 and HSV-2 are indistinguishable visually, they exhibit differences in behavior that may affect management. Patients with HSV-2 have a higher risk of acquiring human immunodeficiency virus (HIV) infection. Polymerase chain reaction assay is the preferred method of confirming HSV infection in patients with active lesions. Treatment of primary and subsequent outbreaks with nucleoside analogues is well tolerated and reduces duration, severity, and frequency of recurrences. In patients with HSV who are HIV-negative, treatment reduces transmission of HSV to uninfected partners. During pregnancy, antiviral prophylaxis with acyclovir is recommended from 36 weeks of gestation until delivery in women with a history of genital herpes. Elective cesarean delivery should be performed in laboring patients with active lesions to reduce the risk of neonatal herpes.
Jørgensen, Laura Krogh; Mogensen, Trine Hyrup
Herpes simplex encephalitis (HSE) is a rare disease, although it is the most common form of sporadic encephalitis worldwide. Recently, studies have provided important new insight into the genetic and immunological basis of HSE. However, even in the presence of antiviral treatment, mortality...
Pollak, L; Mehta, S K; Pierson, D L; Sacagiu, T; Avneri Kalmanovich, S; Cohrs, R J
Since the routine use of polymerase chain reaction testing (PCR) in diagnosing herpes infections, varicella-zoster virus is increasingly recognized as a cause of varicella-zoster meningoencephalitis (VZV ME) among immunocompetent patients. We were interested to determine whether patients with VZV ME had VZV DNA in their saliva during the acute phase of the illness. Forty-five consecutive patients who underwent a lumbar puncture for diagnostic purposes were included in the study. The cerebrospinal fluid was examined for the presence of VZV DNA by PCR, and patients with positive findings were treated with acyclovir. The saliva was later analyzed in a blinded fashion for the presence of VZV DNA. VZV DNA was found in saliva in four of five (80%) patients with PCR confirmed VZV ME (sensitivity 0.8, specificity 0.84, and likelihood ratio 5). This was significantly more than in patients with non-zoster viral ME (0%, P = 0.009), parainfectious headache (12%, P = 0.03) and controls (9.5%, P = 0.007). In immunocompromised patients with systemic lymphoma and AIDS, VZV DNA was present at a similar rate (67%, P = 0.6). We have found VZV DNA in saliva of patients with PCR confirmed VZV ME at a higher proportion than in controls and patients with non-VZV viral ME. This finding might be of clinical importance, especially in immunocompetent individuals with suspected VZV ME where the results of genetic and immunological testing are not conclusive. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Selariu, Anca; Cheng, Tong; Tang, Qiyi; Silver, Benjamin; Yang, Lianwei; Liu, Che; Ye, Xiangzhong; Markus, Amos; Goldstein, Ronald S.; Cruz-Cosme, Ruth S.; Lin, Yanzhen; Wen, Lanling; Qian, Hongliu; Han, Jinle; Dulal, Kalpana; Huang, Ying; Li, Yimin; Xia, Ningshao
Varicella-zoster virus (VZV) is the causative agent of chickenpox and herpes zoster (shingles). After the primary infection, the virus remains latent in sensory ganglia and reactivates upon weakening of the cellular immune system due to various conditions, erupting from sensory neurons and infecting the corresponding skin tissue. The current varicella vaccine is highly attenuated in the skin and yet retains its neurovirulence and may reactivate and damage sensory neurons. The factors involved in neuronal invasion and establishment of latency are still elusive. Previously, we constructed a library of whole-gene deletion mutants carrying a bacterial artificial chromosome sequence and a luciferase marker in order to perform a comprehensive VZV genome functional analysis. Here, screening of dispensable gene deletion mutants in differentiated neuronal cells led to the identification of ORF7 as the first known, likely a main, VZV neurotropic factor. ORF7 is a virion component localized to the Golgi compartment in infected cells, whose deletion causes loss of polykaryon formation in epithelial cell culture. Interestingly, ORF7 deletion completely abolishes viral spread in human nervous tissue ex vivo and in an in vivo mouse model. This finding adds to our previous report that ORF7 is also a skin-tropic factor. The results of our investigation will not only lead to a better understanding of VZV neurotropism but could also contribute to the development of a neuroattenuated vaccine candidate against shingles or a vector for delivery of other antigens. PMID:22674980
Rothbart, Haim; Rishpon, Shmuel
Varicella is a highly infectious disease caused by the varicella-zoster virus (VZV). Usually chickenpox is a self-limiting and relatively mild disease of childhood, although it is frequently more severe with significant complications, and less often, is responsible for case fatalities. Varicella disease is more severe and its complications are more frequent and severe amongst high risk groups (neonates, pregnant women and immunocompromised patients). After the initial infection, the VZV remains dormant in dorsal root ganglia and may reactivate with declining cellular immunity to cause herpes zoster, particularly in the elderly and immunocompromised. Varicella vaccine is an effective preventive tool for decreasing the burden attributable to the disease and its complications. The incorporation of VZV vaccination in childhood immunization schedules was restricted until recently. Nowadays, many countries implement it. A few years ago, the Israeli Ministry of Health recommended adding the vaccine to the childhood immunization schedule. This was not enacted because of budgetary constraints. This is due in September this year, together with an additional dose of pertussis vaccine for pupils in 8th grade. During the next few years there are plans for other new vaccines, that are being incorporated in the routine vaccination programs in developed countries, also to be added to the Israeli childhood immunization schedule: the conjugated pneumococcal vaccine, the vaccine against the rotavirus and the HPV vaccine.
Full Text Available Most varicella-zoster virus (VZV infections after cord blood transplantation (CBT present as localized herpes zoster. Here, we report a case of VZV reinfection in an adult patient after CBT that appeared clinically to be varicella. A 50-year-old Japanese man underwent CBT for the management of acute lymphoblastic leukemia. Seventeen months later, he developed a small number of vesicles with umbilicated centers. A skin biopsy showed an intraepidermal blister containing degenerated balloon cells. Subsequently, the skin eruption developed over his entire body. The patient was treated with intravenous acyclovir for 5 days, followed by oral valacyclovir for 9 days. It took more than 3 weeks for most of the skin lesions to scab. Serum levels of anti-VZV IgG on days 3 and 33 after the onset of the skin eruption were negative and 260 mIU/ml, respectively. Serum anti-VZV IgM on days 3 and 33 was not detected. Our patient was diagnosed with VZV reinfection.
Benjamin, L A; Kelly, M; Cohen, D; Neuhann, F; Galbraith, S; Mallewa, M; Hopkins, M; Hart, I J; Guiver, M; Lalloo, D G; Heyderman, R S; Solomon, T
We looked for herpes simplex virus types 1 and 2 (HSV-1 and HSV-2, respectively), varicella zoster virus (VZV), Epstein-Barr virus (EBV) and cytomegalovirus (CMV) DNA in Malawian adults with clinically suspected meningitis. We collected cerebrospinal fluid (CSF) from consecutive adults admitted with clinically suspected meningitis to Queen Elizabeth Central Hospital (QECH), Blantyre, Malawi, for a period of 3 months. Those with proven bacterial or fungal meningitis were excluded. Real-time polymerase chain reaction (PCR) was performed on the CSF for HSV-1 and HSV-2, VZV, EBV and CMV DNA. A total of 183 patients presented with clinically suspected meningitis. Of these, 59 (32 %) had proven meningitis (bacterial, tuberculous or cryptococcal), 39 (21 %) had normal CSF and 14 (8 %) had aseptic meningitis. For the latter group, a herpes virus was detected in 9 (64 %): 7 (50 %) had EBV and 2 (14 %) had CMV, all were human immunodeficiency virus (HIV)-positive. HSV-2 and VZV were not detected. Amongst those with a normal CSF, 8 (21 %) had a detectable herpes virus, of which 7 (88 %) were HIV-positive. The spectrum of causes of herpes viral meningitis in this African population is different to that in Western industrialised settings, with EBV being frequently detected in the CSF. The significance of this needs further investigation.
Full Text Available Varicella-zoster virus is an important human pathogen that causes varicella after primary infection and zoster after recurrence. Following primary infection, the virus remains latently for life in dorsal root and cranial nerve ganglia. Varicella and zoster are worldwide widespread diseases and may be associated with significant complications. This manuscript presents a short overview about the fundamental knowledge including the most important clinical signs, the capabilities for antiviral treatment and the spectrum of methods for laboratory diagnosis.
Rice, Philip S
Of the eight human herpes viruses, varicella-zoster virus, which causes chickenpox and zoster, has a unique epidemiology. Primary infection is much less common in children in the tropics compared with temperate areas. This results in increased adult susceptibility causing outbreaks, for example in health-care workers migrating from tropical to temperate countries. The recent demonstration that there are different genotypes of varicella-zoster virus and their geographic segregation into tropical and temperate areas suggests a distinct, yet previously unconsidered climatic factor may be responsible for both the clinical and molecular epidemiological features of this virus infection. Unlike other human herpes viruses, varicella-zoster virus does not require intimate contact for infection to occur indicating that transmission may be interrupted by a geographically restricted climatic factor. The factor with the largest difference between tropical and temperate zones is ultra-violet radiation. This could reduce the infectiousness of chickenpox cases by inactivating virus in vesicles, before or after rupture. This would explain decreased transmissibility in the tropics and why the peak chickenpox incidence in temperate zones occurs during winter and spring, when ultra-violet radiation is at its lowest. The evolution of geographically restricted genotypes is also explained by ultra-violet radiation driving natural selection of different virus genotypes with varying degrees of resistance to inactivation, tropical genotypes being the most resistant. Consequently, temperate viruses should be more sensitive to its effects. This is supported by the observation that temperate genotypes are found in the tropics only in specific circumstances, namely where ultra-violet radiation has either been excluded or significantly reduced in intensity. The hypothesis is testable by exposing different virus genotypes to ultra-violet radiation and quantifying virus survival by plaque forming
Rice Philip S
Full Text Available Abstract Background Of the eight human herpes viruses, varicella-zoster virus, which causes chickenpox and zoster, has a unique epidemiology. Primary infection is much less common in children in the tropics compared with temperate areas. This results in increased adult susceptibility causing outbreaks, for example in health-care workers migrating from tropical to temperate countries. The recent demonstration that there are different genotypes of varicella-zoster virus and their geographic segregation into tropical and temperate areas suggests a distinct, yet previously unconsidered climatic factor may be responsible for both the clinical and molecular epidemiological features of this virus infection. Presentation of the hypothesis Unlike other human herpes viruses, varicella-zoster virus does not require intimate contact for infection to occur indicating that transmission may be interrupted by a geographically restricted climatic factor. The factor with the largest difference between tropical and temperate zones is ultra-violet radiation. This could reduce the infectiousness of chickenpox cases by inactivating virus in vesicles, before or after rupture. This would explain decreased transmissibility in the tropics and why the peak chickenpox incidence in temperate zones occurs during winter and spring, when ultra-violet radiation is at its lowest. The evolution of geographically restricted genotypes is also explained by ultra-violet radiation driving natural selection of different virus genotypes with varying degrees of resistance to inactivation, tropical genotypes being the most resistant. Consequently, temperate viruses should be more sensitive to its effects. This is supported by the observation that temperate genotypes are found in the tropics only in specific circumstances, namely where ultra-violet radiation has either been excluded or significantly reduced in intensity. Testing the Hypothesis The hypothesis is testable by exposing
Lamont, Ronald F; Sobel, Jack D; Carrington, D
Please cite this paper as: Lamont R, Sobel J, Carrington D, Mazaki-Tovi S, Kusanovic J, Vaisbuch E, Romero R. Varicella-zoster virus (chickenpox) infection in pregnancy. BJOG 2011; DOI: 10.1111/j.1471-0528.2011.02983.x. Congenital varicella syndrome, maternal varicella-zoster virus pneumonia...... and neonatal varicella infection are associated with serious fetomaternal morbidity and, not infrequently, mortality. Vaccination against varicella-zoster virus can prevent the disease, and outbreak control limits the exposure of pregnant women to the infectious agent. Maternal varicella-zoster immunoglobulin...
Full Text Available OBJECTIVE: We investigated the relationship of the Herpesviridiae with inflammation and subclinical atherosclerosis in HIV-infected patients. METHODS: Prospective study including virologically suppressed HIV-infected patients. IgG antibodies against herpesviruses, carotid intima-media thickness (cIMT, endothelial function through flow-mediated dilatation (FMD of the brachial artery, and blood atherosclerosis biomarkers (hsCRP, TNF-α, IL-6, MCP-1, MDA, sCD14, sCD163, VCAM-1, ICAM-1, D-dimer, and PAI-1 were measured. RESULTS: 136 patients with HIV viral load <200 copies/ml were included. 93.4% patients were infected with herpes simplex virus type-1, 55.9% with herpes simplex virus type-2, 97.1% with varicella-zoster virus, 65.4% with human herpesvirus-6, 91.2% with cytomegalovirus, and 99.3% with Epstein-Barr virus. Previous AIDS diagnosis was associated with higher cytomegalovirus IgG titers (23,000 vs 17,000 AU, P = 0.011 and higher varicella-zoster virus IgG titers (3.19 vs 2.88 AU, P = 0.047, and there was a positive correlation of the Framingham risk score with IgG levels against cytomegalovirus (Spearman's Rho 0.216, P = 0.016 and Herpes simplex virus-2 (Spearman's Rho 0.293, P = 0.001. IgG antibodies against cytomegalovirus correlated in adjusted analysis with the cIMT (P = 0.030. High seropositivity for varicella-zoster virus (OR 2.91, 95% CI 1.05-8.01, P = 0.039, and for cytomegalovirus (OR 3.79, 95% CI 1.20-11.97, P = 0.023 were predictors for the highest quartile of the cIMT in adjusted analyses. PAI-1 levels were independently associated with cytomegalovirus IgG titers (P = 0.041, IL-6 and ICAM-1 levels with varicella-zoster virus IgG (P = 0.046 and P = 0.035 respectively, and hsCRP levels with Herpes simplex virus-2 IgG (P = 0.035. CONCLUSION: In virologically suppressed HIV-infected patients, antibody responses against herpesviruses are associated with subclinical atherosclerosis, and with increased inflammation and coagulation
Leen, W.G.; Weemaes, C.M.R.; Verbeek, M.M.; Willemsen, M.A.A.P.; Rotteveel, J.J.
Although herpes simplex virus is a major cause of acute encephalitis in childhood, chronic herpes simplex virus encephalitis has only rarely been reported. This report presents a case of chronic herpes simplex virus encephalitis in a 6-year-old female. Diagnosis was based on the detection of herpes
Fonnest, G; de la Fuente Fonnest, I; Weber, Tom
BACKGROUND: To prevent neonatal herpes, women in labor with genital herpes infection are still delivered by Cesarean section. This policy is currently being debated. The aim of this study was to determine the incidence of neonatal herpes in Denmark and to evaluate the prevention practice. METHODS......: All newborns with perinatal herpes in Denmark 1977-1991 were identified from hospital-records. RESULTS: Of 862,298 deliveries 136 possible cases were found but only 30 (22%) fulfilled the criteria for neonatal herpes. The incidence increased from 2.36 to 4.56 per 100,000 live births during 1977......-1984 through 1984-1991. Three mothers (10%) had recurrent herpes at delivery, three (10%) had primary herpes, and five (17%) had oral herpes. Seven infants (23%) were delivered by Cesarean section. Nine (30%) only had cutaneous herpes, four (13%) had CNS herpes, nine (30%) had disseminated disease. Six (20...
Mantero, Vittorio; Rigamonti, Andrea; Valentini, Sergio; Fiumani, Anna; Piamarta, Francesca; Bonfanti, Paolo; Salmaggi, Andrea
We present a case of zoster sine herpete causing isolated acute dysphagia in an immunocompetent patient. The interest of this paper is the atypical presentation of varicella-zoster virus reactivation. A 77-year-old woman presented with a 3-day history of fever and worsening dysphagia for both liquid and solid foods. Cerebrospinal fluid examination revealed lymphocytic pleocytosis and PCR amplified varicella-zoster virus DNA with high antibody titers in both serum and cerebrospinal fluid. The panel was suggestive of a cranial neuritis due to varicella-zoster virus, involved cranial nerves, even in the absence of a cutaneous and mucosal rash. Varicella-zoster virus reactivation should be included in the differential diagnosis of isolated or multiple cranial nerve palsies, with or without zosteriform skin lesions. A prompt etiologic diagnosis can lead to early administration of antiviral therapy. Copyright © 2014 Elsevier B.V. All rights reserved.
Kuhn, Maike; Sühs, Kurt-Wolfram; Akmatov, Manas K; Klawonn, Frank; Wang, Junxi; Skripuletz, Thomas; Kaever, Volkhard; Stangel, Martin; Pessler, Frank
Varicella zoster virus (VZV) reactivation spans the spectrum from uncomplicated segmental herpes zoster to life-threatening disseminated CNS infection. Moreover, in the absence of a small animal model for this human pathogen, studies of pathogenesis at the organismal level depend on analysis of human biosamples. Changes in cerebrospinal fluid (CSF) metabolites may reflect critical aspects of host responses and end-organ damage in neuroinfection and neuroinflammation. We therefore applied a targeted metabolomics screen of CSF to three clinically distinct forms of VZV reactivation and infectious and non-infectious disease controls in order to identify biomarkers for CNS involvement in VZV reactivation. Metabolite profiles were determined by targeted liquid chromatography-mass spectrometry in CSF from patients with segmental zoster (shingles, n = 14), facial nerve zoster (n = 16), VZV meningitis/encephalitis (n = 15), enteroviral meningitis (n = 10), idiopathic Bell's palsy (n = 11), and normal pressure hydrocephalus (n = 15). Concentrations of 88 metabolites passing quality assessment clearly separated the three VZV reactivation forms from each other and from the non-infected samples. Internal cross-validation identified four metabolites (SM C16:1, glycine, lysoPC a C26:1, PC ae C34:0) that were particularly associated with VZV meningoencephalitis. SM(OH) C14:1 accurately distinguished facial nerve zoster from Bell's palsy. Random forest construction revealed even more accurate classifiers (signatures comprising 2-4 metabolites) for most comparisons. Some of the most accurate biomarkers correlated only weakly with CSF leukocyte count, indicating that they do not merely reflect recruitment of inflammatory cells but, rather, specific pathophysiological mechanisms. Across all samples, only the sum of hexoses and the amino acids arginine, serine, and tryptophan correlated negatively with leukocyte count. Increased expression of the metabolites
Gruce, M.; Lajara Lambrecht, M.; Bonavita, A.
Introducción: La gingivoestomatitis herpética primaria (GEHP) es la primo infección causada por el virus herpes simple tipo 1 (VHS-1); si bien la infección inicial suele ser subclínica, alrededor del 1% de los pacientes experimenta manifestaciones agudas en forma de GEHP. Las manifestaciones clínicas son malestar general, odinofagia, fiebre, linfoadenopatías y lesiones bucales. Descripción del caso: Se diagnostica un caso clínico de primo infección herpética primaria en un pre adolescente de ...
Ioannidis, Dimitrios; Lachanas, Vasileios A; Florou, Zoe; Bizakis, John G; Petinaki, Efthymia; Skoulakis, Charalampos E
Chronic rhinosinusitis with nasal polyps is a multifactorial disease entity with an unclear pathogenesis. Contradictory data exist in the literature on the potential implication of viral elements in adult patients with chronic rhinosinusitis. To compare the prevalence of human herpes viruses (1-6) and Human Papilloma Virus in adult patients with chronic rhinosinusitis with nasal polyps and healthy controls. Viral DNA presence was evaluated by real-time polymerase chain reaction application to nasal polyps specimens from 91 chronic rhinosinusitis with nasal polyps patients and nasal turbinate mucosa from 38 healthy controls. Epstein-Barr virus positivity was higher in nasal polyps (24/91; 26.4%) versus controls (4/38; 10.5%), but the difference did not reach significance (p=0.06). Human herpes virus-6 positivity was lower in nasal polyps (13/91; 14.29%) versus controls (10/38; 26.32%, p=0.13). In chronic rhinosinusitis with nasal polyps group, 1 sample was herpes simplex virus-1-positive (1/91; 1.1%), and another was cytomegalovirus-positive (1/91; 1.1%), versus none in controls. No sample was positive for herpes simplex virus-2, varicella-zoster virus, high-risk-human papilloma viruses (16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59) and low-risk-human papilloma viruses (6, 11). Differences in Epstein-Barr virus and human herpes virus-6 positivity among patients with chronic rhinosinusitis with nasal polyps and healthy controls are not statistically significant, weakening the likelihood of their implication in chronic rhinosinusitis with nasal polyps pathogenesis. Copyright © 2015 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.
Full Text Available ABSTRACT INTRODUCTION: Chronic rhinosinusitis with nasal polyps is a multifactorial disease entity with an unclear pathogenesis. Contradictory data exist in the literature on the potential implication of viral elements in adult patients with chronic rhinosinusitis. OBJECTIVE: To compare the prevalence of human herpes viruses (1-6 and Human Papilloma Virus in adult patients with chronic rhinosinusitis with nasal polyps and healthy controls. METHODS: Viral DNA presence was evaluated by real-time polymerase chain reaction application to nasal polyps specimens from 91 chronic rhinosinusitis with nasal polyps patients and nasal turbinate mucosa from 38 healthy controls. RESULTS: Epstein-Barr virus positivity was higher in nasal polyps (24/91; 26.4% versus controls (4/38; 10.5%, but the difference did not reach significance (p = 0.06. Human herpes virus-6 positivity was lower in nasal polyps (13/91; 14.29% versus controls (10/38; 26.32%,p = 0.13. In chronic rhinosinusitis with nasal polyps group, 1 sample was herpes simplex virus-1-positive (1/91; 1.1%, and another was cytomegalovirus-positive (1/91; 1.1%, versus none in controls. No sample was positive for herpes simplex virus-2, varicella-zoster virus, high-risk-human papilloma viruses (16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 and low-risk-human papilloma viruses (6, 11. CONCLUSION: Differences in Epstein-Barr virus and human herpes virus-6 positivity among patients with chronic rhinosinusitis with nasal polyps and healthy controls are not statistically significant, weakening the likelihood of their implication in chronic rhinosinusitis with nasal polyps pathogenesis.
Masiá, Mar; Robledano, Catalina; Ortiz de la Tabla, Victoria; Antequera, Pedro; López, Natividad; Gutiérrez, Félix
We investigated the relationship of the Herpesviridiae with inflammation and subclinical atherosclerosis in HIV-infected patients. Prospective study including virologically suppressed HIV-infected patients. IgG antibodies against herpesviruses, carotid intima-media thickness (cIMT), endothelial function through flow-mediated dilatation (FMD) of the brachial artery, and blood atherosclerosis biomarkers (hsCRP, TNF-α, IL-6, MCP-1, MDA, sCD14, sCD163, VCAM-1, ICAM-1, D-dimer, and PAI-1) were measured. 136 patients with HIV viral load virus type-1, 55.9% with herpes simplex virus type-2, 97.1% with varicella-zoster virus, 65.4% with human herpesvirus-6, 91.2% with cytomegalovirus, and 99.3% with Epstein-Barr virus. Previous AIDS diagnosis was associated with higher cytomegalovirus IgG titers (23,000 vs 17,000 AU, P = 0.011) and higher varicella-zoster virus IgG titers (3.19 vs 2.88 AU, P = 0.047), and there was a positive correlation of the Framingham risk score with IgG levels against cytomegalovirus (Spearman's Rho 0.216, P = 0.016) and Herpes simplex virus-2 (Spearman's Rho 0.293, P = 0.001). IgG antibodies against cytomegalovirus correlated in adjusted analysis with the cIMT (P = 0.030). High seropositivity for varicella-zoster virus (OR 2.91, 95% CI 1.05-8.01, P = 0.039), and for cytomegalovirus (OR 3.79, 95% CI 1.20-11.97, P = 0.023) were predictors for the highest quartile of the cIMT in adjusted analyses. PAI-1 levels were independently associated with cytomegalovirus IgG titers (P = 0.041), IL-6 and ICAM-1 levels with varicella-zoster virus IgG (P = 0.046 and P = 0.035 respectively), and hsCRP levels with Herpes simplex virus-2 IgG (P = 0.035). In virologically suppressed HIV-infected patients, antibody responses against herpesviruses are associated with subclinical atherosclerosis, and with increased inflammation and coagulation biomarkers.
Oscar L. Rueda O.
Full Text Available Introducción: Herpes Zoster es la reactivación del Virus Varicela Zóster en los ganglios sensoriales y/o autonómicos, típicamente caracterizado por dolor profundo de distribución dermatómica y erupciones vesiculares en piel. De manera infrecuente, puede presentarse el Zoster Sine Herpete, condición en la cual se presenta la distribución dermatómica del dolor en ausencia de lesiones dérmicas, convirtiendo el diagnóstico en un reto clínico. Caso clínico: Hombre de 69 años con dolor periorbitario, epifora, ptosis y pérdida de la aducción del ojo derecho. Los estudios imagenológicos y de laboratorio fueron normales, descartando así las principales causas de parálisis del nervio oculomotor. Se hizo diagnóstico presuntivo de Zoster Sine Herpete y se inició prueba terapéutica con valaciclovir, observándose resolución total de la sintomatología seis semanas después. Discusión: Este caso puede ser el primero en describir una parálisis parcial dolorosa del nervio oculomotor como única manifestación clínica de la reactivación del Virus Varicela Zóster y busca alertar al personal médico sobre una enfermedad latente que hace de sus reapariciones una gama de presentaciones no siempre fáciles de identificar.
Full Text Available Abstract Background Varicella-Zoster virus causes chickenpox upon primary infection and shingles after reactivation. Currently available serological tests to detect VZV-specific antibodies are exclusively based on antigens derived from VZV-infected cells. Results We present a systematic approach for the identification of novel, serologically reactive VZV antigens. Therefore, all VZV open reading frames were cloned into a bacterial expression vector and checked for small scale recombinant protein expression. Serum profiling experiments using purified VZV proteins and clinically defined sera in a microarray revealed 5 putative antigens (ORFs 1, 4, 14, 49, and 68. These were rearranged in line format and validated with pre-characterized sera. Conclusions The line assay confirmed the seroreactivity of the identified antigens and revealed its suitability for VZV serodiagnostics comparable to commercially available VZV-ELISA. Recombinant ORF68 (gE proved to be an antigen for high-confidence determination of VZV serostatus. Furthermore, our data suggest that a serological differentiation between chickenpox and herpes zoster may be possible by analysis of the IgM-portfolio against individual viral antigens.
Zhu, Rui; Liu, Jian; Chen, Chunye; Ye, Xiangzhong; Xu, Longfa; Wang, Wei; Zhao, Qinjian; Zhu, Hua; Cheng, Tong; Xia, Ningshao
Varicella-zoster virus (VZV) is a highly infectious agent of varicella and herpes zoster (HZ). Vaccination is by far the most effective way to prevent these diseases. More safe, stable and efficient vaccines, such as epitope-based vaccines, now have been increasingly investigated by many researchers. However, only a few VZV neutralizing epitopes have been identified to date. We have previously identified a linear epitope between amino acid residues 121 and 135 of gE. In this study, we validated that this epitope is highly conserved amongst different VZV strains that covered five existing phylogenetic clades with an identity of 100%. We evaluated the immunogenicity of the recombinant hepatitis B virus core (HBc) virus-like particles (VLPs) which included amino acids (121-135). VZV-gE-specific antibodies were detected in immunized mouse serum using ELISA. The anti-peptide antiserum positively detected VZV via Western blot and immunofluorescent staining assays. More importantly, these peptides could neutralize VZV, indicating that these peptides represented neutralizing epitopes. These findings have important implications for the development of epitope-based protective VZV vaccines. Copyright © 2016 Elsevier Ltd. All rights reserved.
Stanfield, Brent; Kousoulas, Konstantin Gus
Herpes simplex virus type-1 (HSV-1) and its closely related type-2 (HSV-2) viruses cause important clinical manifestations in humans including acute ocular disease and genital infections. These viruses establish latency in the trigeminal ganglionic and dorsal root neurons, respectively. Both viruses are widespread among humans and can frequently reactivate from latency causing disease. Currently, there are no vaccines available against herpes simplex viral infections. However, a number of promising vaccine approaches are being explored in pre-clinical investigations with few progressing to early phase clinical trials. Consensus research findings suggest that robust humoral and cellular immune responses may partially control the frequency of reactivation episodes and reduce clinical symptoms. Live-attenuated viral vaccines have long been considered as a viable option for generating robust and protective immune responses against viral pathogens. Varicella zoster virus (VZV) belongs to the same alphaherpesvirus subfamily with herpes simplex viruses. A live-attenuated VZV vaccine has been extensively used in a prophylactic and therapeutic approach to combat primary and recurrent VZV infection indicating that a similar vaccine approach may be feasible for HSVs. In this review, we summarize pre-clinical approaches to HSV vaccine development and current efforts to test certain vaccine approaches in human clinical trials. Also, we discuss the potential advantages of using a safe, live-attenuated HSV-1 vaccine strain to protect against both HSV-1 and HSV-2 infections. PMID:27114893
Burgos, Rubén; Ordoñez, Graciela; Vázquez-Mellado, Janitzia; Pineda, Benjamín; Sotelo, Julio
Viral agents have been suspected as participants of immune-mediated disorders. In the case of rheumatic diseases, the synovial joint cavity represents a secluded area of inflammation which could harbor etiological agents. We analyzed by polymerase chain reaction the possible presence of DNA from various herpes viruses in blood and synovial fluid from patients with either rheumatoid arthritis (n = 18), axial spondyloarthritis (n = 11), or osteoarthritis (n = 8). Relevant findings were as follows: DNA from varicella zoster virus was found in synovial fluid but not in blood mononuclear cells from 33 % of patients with rheumatoid arthritis and in 45 % of patients with axial spondyloarthritis but not in patients with osteoarthritis. Also, DNA from herpes simplex viruses 1 and 2 was found both in the blood and in the synovial fluid from 33 % of patients with rheumatoid arthritis. Our results indicate the occasional presence of DNA from herpes viruses in patients with rheumatoid arthritis or with axial spondyloarthritis. However, these findings might represent a parallel epiphenomenon of viral activation associated either with immunosuppressive therapy or with primary immune disturbances, rather than the etiological participation of herpes viruses in these disorders.
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Förster, Matti; Umnus, Astrid; Siebrecht, Dieter; Baron, Ralf; Wasner, Gunnar
Complex regional pain syndrome (CRPS) and postherpetic neuralgia (PHN) represent neuropathic pain syndromes that may appear with similar clinical signs and symptoms. Medical history and clinical distribution of symptoms and signs (PHN typically at the thorax; CRPS typically at the limbs) is obvious in most cases, helping to discriminate between both disorders. Here, we present a patient suffering from CRPS II following PHN of one upper extremity. This case demonstrates that both etiology and part of the body affected by a neuropathy influence the pain phenotype. Copyright © 2012 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.
Shao-Chung V. Hsia
Conclusions: Together these findings support the hypothesis that a constant level of TH will provide a degree of protection from contracting HZ. More studies are underway to evaluate the laboratory data for an analysis of hormonal effects on individuals.
Conclusion: HZ and its sequelae impose a substantial economic burden in Latin America which is expected to rise as the population ages and the number of HZ cases increases. The results support the need for early intervention, preventative strategies and improved disease management to reduce the HZ-associated disease burden in Latin America.
Insinga, Ralph P; Itzler, Robbin F; Pellissier, James M; Saddier, Patricia; Nikas, Alexander A
.... health plan enrollees. DESIGN: Data for the years 2000 to 2001 were obtained from the Medstat MarketScan database, containing health insurance enrollment and claims data from over 4 million U.S. individuals...
Li, Qing-fu; Li, Duo; Zhou, Hong-mei; Lin, Mei
Herpes associated erythema multiforme (HAEM) is an acute exudative dermatic and mucosal disease caused by infecting herpes simplex virus. It has recurrence and idiorestriction, characterized by increasing of CD4+T leukomonocyte. This article reports a case of herpes associated erythema multiforme, and by way of reviewing relevant literature, discusses the possible mechanism, diagnosis, treatment and prognosis of HAEM.
Li, Yanwen; Pan, Zhigang; Ji, Yuan; Sheppard, Mary; Jeffries, Donald J.; Archard, Leonard C.; Zhang, Hongyi
Some findings suggest an infectious factor in cardiac myxoma and certain histopathological features indicate herpes simplex virus type 1 (HSV-1) infection. We hypothesized that HSV-1 may be involved in the pathogenesis of cardiac myxoma. Paraffin-embedded tissue samples from 17 patients with atrial myxoma were investigated for HSV-1 antigen by immunohistochemistry and viral genomic DNA by nested polymerase chain reaction. The histogenesis and oncogenesis of atrial myxoma were assessed by the expression of calretinin, Ki67, and p53 protein, respectively. Autopsy myocardial samples, including endocardium from 12 patients who died by accident or other conditions, were used for comparison. HSV-1 antigen was detected in atrial myxoma from 12 of 17 patients: 8 of these 12 samples were positive also for HSV-1 DNA. No HSV-1 antigen or DNA was found in tissue from the comparison group. Antigens of HSV-2, varicella-zoster virus, Epstein-Barr virus, and cytomegalovirus were not found in atrial myxoma. Calretinin was found in myxoma cells of all 17 cases but Ki67 was present only in smooth muscle cells or infiltrating cells in some cases. p53 was not detectable in any myxoma. Most infiltrating cells were cytotoxic T lymphocytes. These data suggest that HSV-1 infection is associated with some cases of sporadic atrial myxoma and that these may result from a chronic inflammatory lesion of endocardium. PMID:14633612
Papaioannou, Lamprini; Tsolkas, Georgios; Theodossiadis, Panagiotis; Papathanassiou, Miltiadis
To present an atypical case of herpes simplex virus (HSV) endotheliitis. The authors report the case of a 62-year-old female patient who presented with unilateral diffuse corneal edema with Descemet's membrane folds and bullae, without keratic precipitates, iritis, significant anterior chamber reaction, or intraocular pressure (IOP) elevation. The patient had no documented positive history of ocular surgery and no abnormal findings were present in the fellow eye. Endotheliitis of viral origin was suspected and Goldmann-Witmer coefficient for HSV, cytomegalovirus, and varicela zoster virus was calculated. Goldmann-Witmer coefficient was positive for HSV. Treatment with oral valacyclovir and topical dexamethasone resulted in complete resolution of corneal edema within 1 week. HSV endotheliitis can present with bullous keratopathy as the only clinical manifestation, without typical findings such as keratic precipitates, iritis, and IOP elevation.
Full Text Available Chickenpox is due to infection with the varicella zoster virus (VZV, a human alphaherpervirus found worldwide. Classically, the cinical disease is a febrile illness with a pruritic vesicular rash. Maternal chickenpox between 5 days before delivery to 2 days after delivery (perinatal varicella can cause severe and even fatal illness in the newborn. A 7-day old girl baby presented on day 4 of postnatal with the complaints of widespread vesicular rash and non-suckling. Mother of the baby also had a similar eruption four day prior to delivery, which was clinically characteristic of varicella. Considering history and clinical presentation, a diagnosis of perinatal chickenpox was considered and the baby was treated with acyclovir which she responded and recovered. Herein, the clinical feasures and treatment of chickenpox infection in the perinatal period have been emphasized with this case report. [Cukurova Med J 2013; 38(2.000: 311-314
Full Text Available Purpose: To report a case of varicella-zoster virus (VZV keratitis with detection of VZV DNA in the tear fluid of not only the symptomatic eye but also the contralateral asymptomatic eye by polymerase chain reaction (PCR. Methods: This is a case report. A 63-year-old otherwise healthy woman presented with circular corneal ulcer and stromal opacity with infiltration accompanied by mild conjunctival and ciliary injections in the left eye. Bacterial cultures of the corneal scrapings and virus PCR analyses of tear fluid from both eyes were performed. Results: No pathogen was found by bacterial cultures. PCR was negative for Acanthamoeba, herpes simplex virus and cytomegalovirus, but positive for VZV. VZV DNA was also detected in the unaffected eye. Based on the diagnosis of VZV keratitis, oral valacyclovir and acyclovir eye ointment were administered to the corneal infected eye. The infected eye was healed and VZV DNA turned negative in the tear fluid of the treated eye after 6 months of treatment; however, VZV DNA was still positive in the tear fluid of the contralateral eye. Conclusions: To our knowledge, this is the first case report of the detection of VZV DNA in the tear fluid of both affected and unaffected eyes in a patient with VZV keratitis. Asymptomatic conjunctival shedding of VZV may continue in the healthy unaffected eye in VZV keratitis patients.
Mercier-Darty, Mélanie; Boutolleau, David; Lepeule, Raphaël; Rodriguez, Christophe; Burrel, Sonia
We report the first application of ultra-deep sequencing (UDS) to varicella-zoster virus (VZV) genotypic antiviral testing in a case of acyclovir-resistant VZV infection initially detected by Sanger sequencing within a deeply immunocompromised heart transplant recipient. As added-value compared to Sanger analysis, UDS revealed complex dynamics of viral population under antiviral pressure. Varicella-zoster virus (VZV) is a ubiquitous human herpesvirus affecting populations worldwide. VZV is commonly acquired in youth whose primary infection usually manifests as benign varicella (chickenpox). After the initial infection, the virus establishes lifelong latency in sensory ganglia leading to a risk of subsequent reactivation. Reactivation usually results in the development of localized herpes zoster (HZ) lesions, a painful skin rash commonly known as shingles (Cohen, 2013). The incidence and severity of HZ increase with impaired specific cell-mediated immunity mainly as a result of increasing age, malignancy, immunodeficiency, organ transplantation, or immunosuppressive drug therapy (Cohen, 2013; Koo et al., 2014; Pavlopoulou et al., 2015). In particular, HZ remains a significant cause of morbidity among solid organ transplant (SOT) recipients, especially in patients undergoing heart transplantation (HT) compared with liver, kidney, or lung transplant recipients (Carby et al., 2007; Koo et al., 2014; Pavlopoulou et al., 2015). These particular individuals are at increased risk of primary infection, reactivation followed by dissemination with visceral involvement and associated with bacterial superinfection, and chronic recurrences (Cohen, 2013). VZV infections may also engender debilitating neuralgia among highly immunocompromised patients (Sampathkumar et al., 2009). HT is also associated with the risk of reactivation of other latent viruses belonging to the Herpesviridae family as herpes simplex virus (HSV). Currently licensed drugs to prevent or to cure HSV- or VZV
Hofstetter, Annika M; Rosenthal, Susan L; Stanberry, Lawrence R
Genital herpes has a high global prevalence and burden of disease. This manuscript highlights recent advances in our understanding of genital herpes simplex virus (HSV) infections. Studies demonstrate a changing epidemiological landscape with an increasing proportion of genital herpes cases associated with HSV type 1. There is also growing evidence that the majority of infected individuals exhibit frequent, brief shedding episodes that are most often asymptomatic, which likely contribute to high HSV transmission rates. Given this finding as well as readily available serological assays, some have proposed that routine HSV screening be performed; however, this remains controversial and is not currently recommended. Host immune responses, particularly local CD4 and CD8 T cell activity, are crucial for HSV control and clearance following initial infection, during latency and after reactivation. Prior HSV immunity may also afford partial protection against HSV reinfection and disease. Although HSV vaccine trials have been disappointing to date and existing antiviral medications are limited, novel prophylactic and therapeutic modalities are currently in development. Although much remains unknown about genital herpes, improved knowledge of HSV epidemiology, pathogenesis and host immunity may help guide new strategies for disease prevention and control.
Erni Marlina; Bagus Soebadi
.... The aim of this paper was to report and discuss management of recurrent oral herpes simplex infection which complicated in the diagnosis due to manifestation of both herpes labialis and intraoral...
Erni Marlina; Bagus Soebadi
Recurrent oral herpes simplex infection was the secondary or recurrent form of primary herpes simpex infection. In human, herpes simplex virus was latent or dormant and could reactivate. Recurrency due to virus reactivation induced by emotional stress, high fever, ultraviolet exposed, oral tissue or neuron tissue trauma, immunosuppresion condition, and hormonal disturbance. The aim of this paper was to report and discuss management of recurrent oral herpes simplex infection which ...
As one of the most common sexually transmitted diseases, genital herpes is a global medical problem with significant physical and psychological morbidity. Genital herpes is caused by herpes simplex virus type 1 or type 2 and can manifest as primary and/or recurrent infection. This manuscript provides an overview about the fundamental knowledge on the virus, its epidemiology, and infection. Furthermore, the current possibilities of antiviral therapeutic interventions and laboratory diagnosis of genital herpes as well as the present situation and perspectives for the treatment by novel antivirals and prevention of disease by vaccination are presented. Since the medical management of patients with genital herpes simplex virus infection is often unsatisfactory, this review aims at all physicians and health professionals who are involved in the care of patients with genital herpes. The information provided would help to improve the counseling of affected patients and to optimize the diagnosis, treatment, and prevention of this particular disease.
Herpes genitalis is caused by the herpes simplex virus type 1 or type 2 and can manifest as primary or recurrent infection. It is one of the most common sexually transmitted infections and due to associated physical and psychological morbidity it constitutes a considerable, often underestimated medical problem. In addition to providing the reader with basic knowledge of the pathogen and clinical presentation of herpes genitalis, this review article discusses important aspects of the laborator...
Tétrault, I.; Boivin, G.
OBJECTIVE: To provide an update on new diagnostic tests and antiviral strategies for managing genital herpes. QUALITY OF EVIDENCE: Treatment guidelines are based on randomized clinical trials and recommendations from the Expert Working Group on Canadian Guidelines for Sexually Transmitted Diseases. Recommendations concerning other aspects of managing genital herpes (e.g., indications for using type-specific serologic tests) are mainly based on expert opinion. MAIN MESSAGE: Genital herpes is o...
Money, Deborah; Steben, Marc
The purpose of this guideline is to provide recommendations to gynaecology health care providers on optimal management of genital herpes. More effective prevention of complications and transmission of genital herpes. Medline was searched for articles published in French and English related to genital herpes and gynaecology. Additional articles were identified through the references of these articles. All study types and recommendation reports were reviewed. Copyright © 2017. Published by Elsevier Inc.
Mehta, Satish K.; Pierson, Duane L.
The hypothesis tested by this project is that space flight increases the incidence and duration of herpes virus reactivation and shedding in saliva. Saliva, urine, and blood samples were collected from 3 crew members who participated in a 14-day Odessa Soyuz taxi mission. Saliva samples were collected before, during, and after the mission, and blood and urine were collected before and after the mission. The saliva and urine samples were analyzed using the polymerase chain reaction to detect the presence of 3 important herpes viruses. Epstein-Barr virus (EBV) and varicella-zoster virus (VZV) were tested in saliva, and cytomegalovirus (CMV) was measured in urine samples. Plasma antibodies levels to these viruses were determined by enzyme-linked immunosorbent assay before and after flight. EBV reactivated before, during, and after flight; CMV reactivated before and after flight; and VZV reactivated during and after flight. In other studies, greater frequencies of positive samples and greater numbers of copies of viral DNA have been found. No increases in titer of antibodies to these viruses were found, suggesting that an immune response may not be necessary for reactivation.
Hicks, Caitlin W; Lum, Ying Wei; Heller, Jennifer A
Herpes simplex virus infection following surgery is an unusual postoperative phenomenon. Many mechanisms have been suggested, with the most likely explanation related to latent virus reactivation due to a proinflammatory response in the setting of local trauma. Here, we present a case of herpes simplex virus reactivation in an immunocompetent female following a conventional right lower extremity stab phlebectomy. Salient clinical and physical examination findings are described, and management strategies for herpes simplex virus reactivation are outlined. This is the first known case report of herpes simplex virus reactivation following lower extremity phlebectomy.
Kurapati, Sravya; Sadaoka, Tomohiko; Rajbhandari, Labchan; Jagdish, Balaji; Shukla, Priya; Ali, Mir A; Kim, Yong Jun; Lee, Gabsang; Cohen, Jeffrey I; Venkatesan, Arun
Mechanisms of neuronal infection by varicella-zoster virus (VZV) have been challenging to study due to the relatively strict human tropism of the virus and the paucity of tractable experimental models. Cellular mitogen-activated protein kinases (MAPKs) have been shown to play a role in VZV infection of nonneuronal cells, with distinct consequences for infectivity in different cell types. Here, we utilize several human neuronal culture systems to investigate the role of one such MAPK, the c-Jun N-terminal kinase (JNK), in VZV lytic infection and reactivation. We find that the JNK pathway is specifically activated following infection of human embryonic stem cell-derived neurons and that this activation of JNK is essential for efficient viral protein expression and replication. Inhibition of the JNK pathway blocked viral replication in a manner distinct from that of acyclovir, and an acyclovir-resistant VZV isolate was as sensitive to the effects of JNK inhibition as an acyclovir-sensitive VZV isolate in neurons. Moreover, in a microfluidic-based human neuronal model of viral latency and reactivation, we found that inhibition of the JNK pathway resulted in a marked reduction in reactivation of VZV. Finally, we utilized a novel technique to efficiently generate cells expressing markers of human sensory neurons from neural crest cells and established a critical role for the JNK pathway in infection of these cells. In summary, the JNK pathway plays an important role in lytic infection and reactivation of VZV in physiologically relevant cell types and may provide an alternative target for antiviral therapy. IMPORTANCE Varicella-zoster virus (VZV) has infected over 90% of people worldwide. While primary infection leads to the typically self-limiting condition of chickenpox, the virus can remain dormant in the nervous system and may reactivate later in life, leading to shingles or inflammatory diseases of the nervous system and eye with potentially severe consequences. Here
Chan, D Y L; Lam, K K W; Lau, E Y L; Yeung, W S B; Ng, E H Y
Human varicella zoster virus (VZV) is a member of the herpes virus family and affects humans only. Information about the presence of the virus in the semen samples of men affected by chickenpox is rather limited in the literature. Here, we reported a husband was affected by VZV during in vitro fertilisation treatment of his wife treated in our centre. The semen sample was checked for the presence of VZV by the PCR technique. The PCR result found no detectable viral DNA in the semen sample. The semen sample was then used for conventional IVF insemination and subsequently a healthy baby boy was born. This single case report suggests that the semen sample of men affected by chickenpox may be safe to use for assisted reproduction methods during the VZV infective period. © 2017 Blackwell Verlag GmbH.
Takada, Akitsugu; Katashima, Masataka; Kaibara, Atsunori; Sawamoto, Taiji; Zhang, Wenhui; Keirns, James
Amenamevir is the international non-proprietary name for ASP2151 synthesized by Astellas Pharma, Inc. It is a structurally novel class of helicase-primase inhibitor and demonstrated more potency in vitro anti-viral activity with low cytotoxicity against varicella-zoster virus (VZV), herpes simplex virus type 1 (HSV-1), and herpes simplex virus type 2 (HSV-2) than acyclovir (ACV). Phase II randomized trial assessed the safety and efficacy of ASP2151 for episodic therapy of recurrent genital herpes was conducted. Participants self-initiated with ASP2151 (100, 200, or 400 mg daily for 3 days), ASP2151 (1,200 mg as a single dose), placebo for 3 days, or Valacyclovir (500 mg twice daily for 3 days). We present a first population pharmacokinetic (PPK) modeling analysis of Amenamevir for genital herpes patients. The final model retained the effect of Weight and Albumin on CL. Statistical analysis between pharmacokinetics and clinical efficacies was done by using the time above 200 ng/mL (T200 ). T200 derived from the final PPK model to consider the correlation with Time to lesion healing and viral shedding. This finding suggested that it could be necessary to maintain the Amenamevir concentration above the threshold level to prevent the virus replication. © 2014, The American College of Clinical Pharmacology.
Herman, T E; Cleveland, R H; Kushner, D C; Taveras, J M
Seven neonates with proven herpes (HSV type 2) encephalitis exhibited a characteristic sequence of findings on cranial computed tomography (CT). The initial CT abnormalities in all infants were fingerlike areas of cortical increased attenuation noted on unenhanced scans obtained 2-30 days after presentation. These usually were accentuated by increased white-matter lucency. Subsequently (more than 30 days after presentation), extensive cerebral destruction, multicystic encephalomalacia, and calcification were seen on follow-up CT scans obtained in five infants.
Depledge, Daniel P; Yamanishi, Koichi; Gomi, Yasuyuki; Gershon, Anne A; Breuer, Judith
The continued success of the live attenuated varicella-zoster virus vaccine in preventing varicella-zoster and herpes zoster is well documented, as are many of the mutations that contribute to the attenuation of the vOka virus for replication in skin. At least three different preparations of vOka are marketed. Here, we show using deep sequencing of seven batches of vOka vaccine (including ZostaVax, VariVax, VarilRix, and the Oka/Biken working seed) from three different manufacturers (VariVax, GSK, and Biken) that 137 single-nucleotide polymorphism (SNP) mutations are present in all vaccine batches. This includes six sites at which the vaccine allele is fixed or near fixation, which we speculate are likely to be important for attenuation. We also show that despite differences in the vaccine populations between preparations, batch-to-batch variation is minimal, as is the number and frequency of mutations unique to individual batches. This suggests that the vaccine manufacturing processes are not introducing new mutations and that, notwithstanding the mixture of variants present, VZV live vaccines are extremely stable. The continued success of vaccinations to prevent chickenpox and shingles, combined with the extremely low incidence of adverse reactions, indicates the quality of these vaccines. The vaccine itself is comprised of a heterogeneous live attenuated virus population and thus requires deep-sequencing technologies to explore the differences and similarities in the virus populations between different preparations and batches of the vaccines. Our data demonstrate minimal variation between batches, an important safety feature, and provide new insights into the extent of the mutations present in this attenuated virus. Copyright © 2016 Depledge et al.
Full Text Available Varicella zoster virus (VZV, a human alphaherpesvirus, causes varicella during primary infection. VZV reactivation from neuronal latency may cause herpes zoster, post herpetic neuralgia (PHN and other neurologic syndromes. To investigate VZV neuropathogenesis, we developed a model using human dorsal root ganglia (DRG xenografts in immunodeficient (SCID mice. The SCID DRG model provides an opportunity to examine characteristics of VZV infection that occur in the context of the specialized architecture of DRG, in which nerve cell bodies are ensheathed by satellite glial cells (SGC which support neuronal homeostasis. We hypothesized that VZV exhibits neuron-subtype specific tropism and that VZV tropism for SGC contributes to VZV-related ganglionopathy. Based on quantitative analyses of viral and cell protein expression in DRG tissue sections, we demonstrated that, whereas DRG neurons had an immature neuronal phenotype prior to implantation, subtype heterogeneity was observed within 20 weeks and SGC retained the capacity to maintain neuronal homeostasis longterm. Profiling VZV protein expression in DRG neurons showed that VZV enters peripherin+ nociceptive and RT97+ mechanoreceptive neurons by both axonal transport and contiguous spread from SGC, but replication in RT97+ neurons is blocked. Restriction occurs even when the SGC surrounding the neuronal cell body were infected and after entry and ORF61 expression, but before IE62 or IE63 protein expression. Notably, although contiguous VZV spread with loss of SGC support would be predicted to affect survival of both nociceptive and mechanoreceptive neurons, RT97+ neurons showed selective loss relative to peripherin+ neurons at later times in DRG infection. Profiling cell factors that were upregulated in VZV-infected DRG indicated that VZV infection induced marked pro-inflammatory responses, as well as proteins of the interferon pathway and neuroprotective responses. These neuropathologic changes
Asiki, Gershim; Stockdale, Lisa; Kasamba, Ivan; Vudriko, Tobias; Tumwekwase, Grace; Johnston, Tom; Kaleebu, Pontiano; Kamali, Anatoli; Seeley, Janet; Newton, Robert
The risk of stroke rises after episodes of herpes zoster and chickenpox, which are caused by varicella zoster virus (VZV). We conducted a pilot case-control study of stroke, nested within a long-standing cohort in Uganda (the General Population Cohort), to examine antibodies against VZV prior to diagnosis. We used stored sera to examine the evolution of IgG and IgM antibodies against VZV among 31 clinically confirmed cases of stroke and 132 matched controls. For each participant, three samples of sera were identified: one each, taken at or near the time of (pseudo)diagnosis, between 5 and 10 years prior to diagnosis and at 15 years prior to diagnosis. All participants had detectable antibodies against VZV, but there were no significant differences between cases and controls in the 15 years prior to diagnosis. As a secondary finding, 16% (5/31) of cases and 6% (8/132) of controls had HIV (OR 3.0; 95% CI 0.8-10.1; P = 0.06). This is the first prospective study to examine a biological measure of exposure to VZV prior to diagnosis of stroke and although we identified no significant association, in this small pilot, with limited characterisation of cases, we cannot exclude the possibility that the virus is causal for a subset. The impact of HIV on risk of stroke has not been well characterised and warrants further study. © 2015 John Wiley & Sons Ltd.
Full Text Available Varicella Zoster Virus (VZV, the alphaherpesvirus that causes varicella upon primary infection and Herpes zoster (shingles following reactivation in latently infected neurons, is known to be fusogenic. It forms polynuclear syncytia in culture, in varicella skin lesions and in infected fetal human ganglia xenografted to mice. After axonal infection using VZV expressing green fluorescent protein (GFP in compartmentalized microfluidic cultures there is diffuse filling of axons with GFP as well as punctate fluorescence corresponding to capsids. Use of viruses with fluorescent fusions to VZV proteins reveals that both proteins encoded by VZV genes and those of the infecting cell are transferred in bulk from infecting non-neuronal cells to axons. Similar transfer of protein to axons was observed following cell associated HSV1 infection. Fluorescence recovery after photobleaching (FRAP experiments provide evidence that this transfer is by diffusion of proteins from the infecting cells into axons. Time-lapse movies and immunocytochemical experiments in co-cultures demonstrate that non-neuronal cells fuse with neuronal somata and proteins from both cell types are present in the syncytia formed. The fusogenic nature of VZV therefore may enable not only conventional entry of virions and capsids into axonal endings in the skin by classical entry mechanisms, but also by cytoplasmic fusion that permits viral protein transfer to neurons in bulk.
Xing, Yi; Oliver, Stefan L; Nguyen, TuongVi; Ciferri, Claudio; Nandi, Avishek; Hickman, Julie; Giovani, Cinzia; Yang, Edward; Palladino, Giuseppe; Grose, Charles; Uematsu, Yasushi; Lilja, Anders E; Arvin, Ann M; Carfí, Andrea
Varicella-zoster virus (VZV), of the family Alphaherpesvirinae, causes varicella in children and young adults, potentially leading to herpes zoster later in life on reactivation from latency. The conserved herpesvirus glycoprotein gB and the heterodimer gHgL mediate virion envelope fusion with cell membranes during virus entry. Naturally occurring neutralizing antibodies against herpesviruses target these entry proteins. To determine the molecular basis for VZV neutralization, crystal structures of gHgL were determined in complex with fragments of antigen binding (Fabs) from two human monoclonal antibodies, IgG-94 and IgG-RC, isolated from seropositive subjects. These structures reveal that the antibodies target the same site, composed of residues from both gH and gL, distinct from two other neutralizing epitopes identified by negative-stain electron microscopy and mutational analysis. Inhibition of gB/gHgL-mediated membrane fusion and structural comparisons with herpesvirus homologs suggest that the IgG-RC/94 epitope is in proximity to the site on VZV gHgL that activates gB. Immunization studies proved that the anti-gHgL IgG-RC/94 epitope is a critical target for antibodies that neutralize VZV. Thus, the gHgL/Fab structures delineate a site of herpesvirus vulnerability targeted by natural immunity.
Yang, Edward; Arvin, Ann M; Oliver, Stefan L
Varicella-zoster virus (VZV) is an alphaherpesvirus that causes varicella and herpes zoster. Membrane fusion is essential for VZV entry and the distinctive syncytium formation in VZV-infected skin and neuronal tissue. Herpesvirus fusion is mediated by a complex of glycoproteins gB and gH-gL, which are necessary and sufficient for VZV to induce membrane fusion. However, the cellular requirements of fusion are poorly understood. Integrins have been implicated to facilitate entry of several human herpesviruses, but their role in VZV entry has not yet been explored. To determine the involvement of integrins in VZV fusion, a quantitative cell-cell fusion assay was developed using a VZV-permissive melanoma cell line. The cells constitutively expressed a reporter protein and short hairpin RNAs (shRNAs) to knock down the expression of integrin subunits shown to be expressed in these cells by RNA sequencing. The αV integrin subunit was identified as mediating VZV gB/gH-gL fusion, as its knockdown by shRNAs reduced fusion levels to 60% of that of control cells. A comparable reduction in fusion levels was observed when an anti-αV antibody specific to its extracellular domain was tested in the fusion assay, confirming that the domain was important for VZV fusion. In addition, reduced spread was observed in αV knockdown cells infected with the VZV pOka strain relative to that of the control cells. This was demonstrated by reductions in plaque size, replication kinetics, and virion entry in the αV subunit knockdown cells. Thus, the αV integrin subunit is important for VZV gB/gH-gL fusion and infection. Varicella-zoster virus (VZV) is a highly infectious pathogen that causes chickenpox and shingles. A common complication of shingles is the excruciating condition called postherpetic neuralgia, which has proven difficult to treat. While a vaccine is now available, it is not recommended for immunocompromised individuals and its efficacy decreases with the recipient's age. These
Jiang, Hai-Fei; Wang, Wei; Jiang, Xuan; Zeng, Wen-Bo; Shen, Zhang-Zhou; Song, Yi-Ge; Yang, Hong; Liu, Xi-Juan; Dong, Xiao; Zhou, Jing; Sun, Jin-Yan; Yu, Fei-Long; Guo, Lin; Cheng, Tong; Rayner, Simon; Zhao, Fei; Zhu, Hua; Luo, Min-Hua
, highlighting a potential strategy to develop a neurovirulence-attenuated vaccine against chickenpox and herpes zoster and providing a new target for intervention of neuropathy induced by VZV. Copyright © 2017 American Society for Microbiology.
Gilden, Don; Nagel, Maria A
Giant cell arteritis (GCA) is a serious disease and the most common cause of vasculitis in the elderly. Here, studies describing the recent discovery of varicella zoster virus (VZV) in the temporal arteries of patients with GCA are reviewed. GCA is characterized by severe headache/head pain and scalp tenderness. Many patients also have a history of vision loss, jaw claudication, polymyalgia rheumatica, fever, night sweats, weight loss, and fatigue. The erythrocyte sedimentation rate and C-reactive protein are usually elevated. Diagnosis is confirmed by temporal artery biopsy, which reveals vessel wall damage and inflammation, with multinucleated giant cells and/or epithelioid macrophages. Skip lesions are common. Importantly, temporal artery biopsies are pathologically negative in many clinically suspect cases. The present review highlights recent virological findings in temporal arteries from patients with pathologically verified GCA and in temporal arteries from patients who manifest clinical and laboratory features of GCA but whose temporal artery biopsies are pathologically negative for GCA. Virological analysis revealed that VZV is present in most GCA-positive and GCA-negative temporal artery biopsies, particularly in skip areas that correlate with adjacent GCA disease. The presence of VZV in GCA-positive and GCA-negative temporal arteries reflects the possible role of VZV in triggering the immunopathology of GCA and indicates that both groups of patients should be treated with antivirals in addition to corticosteroids. Whether oral antiviral agents and steroids are as effective as intravenous acyclovir and steroids, and the dosage and duration of treatment, remain to be determined.
Full Text Available We describe recurrent acute right-sided facial urticaria associated with herpes labialis infection in a middle-aged female patient. Antiviral medications and antihistamines not only successfully cleared the herpes infection and urticaria but also prevented further recurrences.
Longo, David J.; And Others
Assigned 21 individuals with recurrent genital herpes to psychosocial intervention, social support, or waiting-list control conditions. Those receiving psychosocial intervention (herpes simplex virus information, relaxation training, stress management instructions, and an imagery technique) reported significantly greater reductions in herpes…
Cummings, Anne L.
Explores potential benefits of incorporating concepts and interventions from experimental therapy to help clients with psychosocial difficulties in learning to live with genital herpes. Recommends experimental counseling of two-chair dialog, empty chair, and metaphor for helping clients with emotional sequelae of genital herpes. Presents case…
SHORT COMMUNICATION. Serological profiles of Herpes simplex ... Herpes Simplex Virus Type-2 (HSV-2) infections is one of the most common sexually transmitted infections (STIs) and causes ... A total of 174 non HIV infected health professional students were enrolled between April and May 2016 from Mwanza City, ...
... presented with urinary retention due to varicella zoster virus infection involving the sacral nerves, confirmed on serological testing. The perineum over dermatomes S2 - S4 on the left was involved with a vesicular and superficially erosive rash. A transurethral catheter was inserted and the patient was treated with acyclovir ...
tested for varicella zoster virus (VZV) antibodies using enzyme immunosorbent assay (ELISA) technique at Kenya Medical Research Institute (KEMRI) laboratories, The data were anaIysed using the SPSS software and presented in form of tables and graphs. The prevalence of VZV antibodies was determined and 95% ...
An 11-year-old boy receiving antiretroviral therapy for HIV infection and antibacterial therapy for pulmonary tuberculosis presented with urinary retention due to varicella zoster virus infection involving the sacral nerves, confirmed on serological testing. The perineum over dermatomes S2 - S4 on the left was involved with a ...
Wolthers, Benjamin Ole; Thiested, Ebbe; Gyhrs, Anette F
This case report describes how a three-year-old girl referred to our paediatric ward, infected with varicella-zoster virus and a bacterial pneumonia causing atelectasis. The girl did not respond to initial treatment with intravenous antibiotics. Only after a lung drain was inserted she gradually ...
Le Goaster J
Full Text Available Jacqueline Le Goaster,1 Sylvie Gonzalo,2 Patrice Bourée,1 Frederic Tangy,3 Anne-Lise Haenni41Department of Tropical Diseases, Centre Hospitalo-Universitaire (CHU, University of Paris XI, Le Kremlin Bicêtre, 2Biomnis Laboratory, Ivry-sur-Seine, 3Retro-Virology, Centre National de Recherche Scientifique (CNRS, Pasteur Institute, Paris; 4Jacques Monod Institute, Centre National de Recherche Scientifique (CNRS, University of Paris VII, Paris, FranceBackground: The aim of this study was to evaluate the possibility of using the anti-varicella zoster virus (anti-VZV, also known as anti-HSV3 vaccine against orobuccal herpes simplex virus type 1 (HSV1 and genital herpes simplex virus type 2 (HSV2. This was suggested by study of the phylogenetic tree of members of the herpes virus family, which showed a close relationship between VZV (HSV3 and the HSV1 and HSV2 herpes viruses.Methods: The present prospective study was conducted from January 2005 through January 2011. Twenty-four patients afflicted with HSV1 and HSV2 herpes recurrences over a period of years, numbering 6–8 and more recurrences per year, agreed to receive the anti-VZV vaccine. They were compared with 26 nonvaccinated patients presenting with herpes simplex diseases 2–5 times a year. All 50 patients were documented with anti-HSV1, anti-HSV2, and anti-VZV antibody serological testing.Results: From 2005 through 2011, for the 24 anti-VZV vaccinated patients, the average number of herpes relapses decreased to 0, correlated with an increased anti-VZV antibody level and clinical recovery of all patients, whereas no improvement was observed for the 26 nonvaccinated herpes patients.Conclusion: Data for the anti-VZV serological antibody levels tested before and after anti-VZV vaccination showed a significant (P < 0.001 increase among vaccinated patients. This suggests defective anti-VZV immune power in these patients. After 6 years of positive results for anti-VZV vaccine, this is a logical and
... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Herpes simplex virus serological assays. 866.3305... simplex virus serological assays. (a) Identification. Herpes simplex virus serological assays are devices... herpes simplex virus in serum. Additionally, some of the assays consist of herpes simplex virus antisera...
Awasthi, Sita; Hook, Lauren M; Shaw, Carolyn E; Friedman, Harvey M
An estimated 417 million people worldwide ages 15 to 49 are infected with herpes simplex virus type 2 (HSV-2), the most common cause of genital ulcer disease. Some individuals experience frequent recurrences of genital lesions, while others only have subclinical infection, yet all risk transmitting infection to their intimate partners. A vaccine was developed that prevents shingles, which is a recurrent infection caused by varicella-zoster virus (VZV), a closely related member of the Herpesviridae family. The success of the VZV vaccine has stimulated renewed interest in a therapeutic vaccine for genital herpes. We have been evaluating a trivalent subunit antigen vaccine for prevention of genital herpes. Here, we assess the trivalent vaccine as immunotherapy in guinea pigs that were previously infected intravaginally with HSV-2. The trivalent vaccine contains HSV-2 glycoproteins C, D, and E (gC2, gD2, gE2) subunit antigens administered with CpG and alum as adjuvants. We previously demonstrated that antibodies to gD2 neutralize the virus while antibodies to gC2 and gE2 block their immune evasion activities, including evading complement attack and inhibiting activities mediated by the IgG Fc domain, respectively. Here, we demonstrate that the trivalent vaccine significantly boosts ELISA titers and neutralizing antibody titers. The trivalent vaccine reduces the frequency of recurrent genital lesions and vaginal shedding of HSV-2 DNA by approximately 50% and almost totally eliminates vaginal shedding of replication-competent virus, suggesting that the trivalent vaccine is a worthy candidate for immunotherapy of genital herpes.
Grose, Charles; Buckingham, Erin M; Carpenter, John E; Kunkel, Jeremy P
Varicella-zoster virus (VZV) induces abundant autophagy. Of the nine human herpesviruses, the VZV genome is the smallest (~124 kbp), lacking any known inhibitors of autophagy, such as the herpes simplex virus ICP34.5 neurovirulence gene. Therefore, this review assesses the evidence for VZV-induced cellular stress, endoplasmic-reticulum-associated degradation (ERAD), and autophagic flux during the VZV infectious cycle. Even though VZV is difficult to propagate in cell culture, the biosynthesis of the both N - and O -linked viral glycoproteins was found to be abundant. In turn, this biosynthesis provided evidence of endoplasmic reticulum (ER) stress, including a greatly enlarged ER and a greatly diminished production of cellular glycoproteins. Other signs of ER stress following VZV infection included detection of the alternatively spliced higher-molecular-weight form of XBP1 as well as CHOP. VZV infection in cultured cells leads to abundant autophagosome production, as was visualized by the detection of the microtubule-associated protein 1 light chain 3-II (LC3-II). The degree of autophagy induced by VZV infection is comparable to that induced in uninfected cells by serum starvation. The inhibition of autophagic flux by chemicals such as 3-methyladenine or ATG5 siRNA, followed by diminished virus spread and titers, has been observed. Since the latter observation pointed to the virus assembly/trafficking compartments, we purified VZ virions by ultracentrifugation and examined the virion fraction for components of the autophagy pathway. We detected LC3-II protein (an autophagy marker) as well as Rab11 protein, a component of the endosomal pathway. We also observed that the virion-containing vesicles were single-walled; thus, they are not autophagosomes. These results suggested that some VZ virions after secondary envelopment were transported to the outer cell membrane in a vesicle derived from both the autophagy and endosomal pathways, such as an amphisome. Thus, these
Mônica Alcantara de Oliveira Santos
Full Text Available Embora a paralisia de Bell seja o tipo mais frequente de paralisia facial periférica,sua causa ainda é objeto de inúmeros questionamentos. A reativação do vírus varicela zoster tem sido considerada uma das principais causas da paralisia de Bell, porém, os poucos trabalhos que estudam a prevalência do VVZ como agente etiológico da PB são japoneses, o que determina características geográficas e populacionais bastante díspares de nossa população. OBJETIVOS: Verificar a frequência do vírus varicela zoster em saliva de indivíduos com PB, pela técnica de PCR. MATERIAL E MÉTODO: Estudo prospectivo com 171 pacientes com PFP, sendo 120 pacientes portadores de paralisia de Bell, com até uma semana de evolução, sem uso prévio de drogas antivirais. O grupo controle foi composto de 20 adultos sadios. Nestes indivíduos foram coletadas três amostras de saliva em semanas consecutivas, para pesquisa de DNA viral pela técnica de PCR. RESULTADOS: O vírus varicela zoster foi encontrado em amostras de saliva de dois pacientes com paralisia de Bell (1,7%. Nenhum vírus foi identificado no grupo controle. CONCLUSÃO: Foi verificada frequência de 1,7% para vírus varicela zoster em amostras de saliva de pacientes com paralisia de Bell, pela técnica de PCR.Although Bell's palsy is the major cause of acute peripheral facial palsy, its pathogenesis remains unknown. Reactivation of the varicella zoster virus has been implicated as one of the main causes of Bell's palsy, however, studies which investigate the varicella zoster virus reactivation in Bell's palsy patients are mostly Japanese and, therefore, personal and geographic characteristics are quite different from our population. AIMS: To determine varicella zoster virus frequency in saliva samples from patients with Bell's palsy, using PCR. MATERIAL AND METHOD: One hundred seventy one patients with acute peripheral facial palsy were prospectively enrolled in this study. One hundred twenty
James, Scott H; Kimberlin, David W
Herpes simplex virus (HSV) 1 and HSV-2 infections are highly prevalent worldwide and are characterized by establishing lifelong infection with periods of latency interspersed with periodic episodes of reactivation. Acquisition of HSV by an infant during the peripartum or postpartum period results in neonatal HSV disease, a rare but significant infection that can be associated with severe morbidity and mortality, especially if there is dissemination or central nervous system involvement. Diagnostic and therapeutic advances have led to improvements in mortality and, to a lesser extent, neurodevelopmental outcomes, but room exists for further improvement. Copyright © 2015 Elsevier Inc. All rights reserved.
Sevinç Gümüş Pekacar
Full Text Available Symptomatic primary genital herpes infection is very rare in early childhood. Herpes simplex virus 1 type is the infectious agent in 20-50% percent of primery infections. Sexual abuse should be considered when genital herpes is seen in a person before sexual active age. It is mild and self limiting unless the patient is immune compramised. In this paper we discussed a 17 months old patient with genital herpes and approach to genital herpes in children.
Lewis, Michelle P.; Harding, Robert
1.Technology Description-Researchers discovered that when the Varicella Zoster Virus (VZV) reactivates from latency in the body, the virus is consistently present in saliva before the appearance of skin lesions. A small saliva sample is mixed with a specialized reagent in a test kit. If the virus is present in the saliva sample, the mixture turns a red color. The sensitivity and specificity emanates from an antibody-antigen reaction. This technology is a rapid, non-invasive, point of-of-care testing kit for detecting the virus from a saliva sample. The device is easy to use and can be used in clinics and in remote locations to quickly detect VZV and begin treatment with antiviral drugs. 2.Market Opportunity- RST Bioscience will be the first and only company to market a rapid, same day test kit for the detection of VZV in saliva. The RST detection test kit will have several advantages over existing, competitive technology. The test kit is self contained and laboratory equipment is not required for analysis of the sample. Only a single saliva sample is required to be taken instead of blood or cerebral spinal fluid. The test kit is portable, sterile and disposable after use. RST detection test kits require no electrical power or expensive storage equipment and can be used in remote locations. 3.Market Analysis- According to the CDC, it is estimated that 1 million cases of shingles occur each year in the U.S. with more than half over the age of sixty. There is a high demand for rapid diagnostics by the public. The point-of-care testing (POCT) market is growing faster than other segments of in vitro diagnostics. According to a July 2007 InteLab Corporation industry report the overall market for POCT was forecast to increase from $10.3 billion in 2005 to $18.7 billion by 2011. The market value of this test kit has not been determined. 4.Competition- The VZV vaccine prevents 50% of cases and reduces neuralgia by 66%. The most popular test detects VZV-specific IgM antibody
Guerra, B; Puccetti, C; Cervi, F
Genital herpes is a common sexually transmitted infection. In reproductive age it involves the additional risk of vertical transmission to the neonate. Rates of transmission are affected by the viral type and whether the infection around delivery is primary or recurrent. Neonatal herpes is a rare but very severe complication of genital herpes infection and is caused by contact with infected genital secretions at the time of labor. Maternal acquisition of herpes simplex virus (HSV) in the third trimester of pregnancy carries the highest risk of neonatal transmission. Prevention of neonatal herpes depends on preventing acquisition of genital HSV infection during late pregnancy and avoiding exposure of the infant to herpetic lesions during delivery. Uninfected woman should be counselled about the need of avoiding sexual contact during the third trimester. Elective caesarean section before the onset of labor is the choice mode of delivery for women with genital lesions or with prodromal symptoms near the term, even if it offers only a partial protection against neonatal infection. Antiviral suppressive therapy is used from 36 weeks of gestation until delivery in pregnant women with recurrences to prevent genital lesions at the time of labor so reducing the need of caesarean sections. Currently, routine maternal serologic screening is not yet recommended. Because most mothers of infants who acquire neonatal herpes lack histories of clinically evident genital herpes, researchers should focus on the recognition of asymptomatic primary genital HSV infections.
Full Text Available Varicella-zoster virus and herpes simplex virus types 1 and 2 are neurotropic viruses that can be reactivated after a surgical or stressful intervention. Although such cases are uncommon, consequences can be debilitating, and variable treatment responses merit consideration. We describe a 41-year-old male with a history of varicella-mediated skin eruptions, who presented with continuing right arm pain, burning, and numbness in a C6 dermatomal distribution following a C5-6 anterior cervical discectomy and fusion and epidural steroid injections. The operative course was uncomplicated and he was discharged home on postoperative day 1. Approximately ten days after surgery, the patient presented to the emergency department complaining of severe pain in his right upper extremity and a vesicular rash from his elbow to his second digit. He was started on Acyclovir and discharged home. On outpatient follow-up, his rash had resolved though his pain continued. The patient was started on a neuromodulating agent for chronic pain. This case adds to the limited literature regarding this rare complication, brings attention to the symptoms for proper diagnosis and treatment, and emphasizes the importance of prompt antiviral therapy. We suggest adding a neuromodulating agent to prevent long-term sequelae and resolve acute symptoms.
than 67%. 3. Most often children of all age groups infected with herpes simplex virus (HSV and cytomegalovirus (CMV. 4. With age the rate of infection with varicella-zoster virus (VZV, Epstein-Barr virus ( EBV, human herpesvirus 6 (HHV6 higher than those for the HSV and CMV, and to 11 years in the frequency of detection of antibodies to any of the 5 studied types of herpes viruses among frequently ill children exceeds 50%.
Chamizo, Francisco J; Gilarranz, Raúl; Hernández, Melisa; Ramos, Diana; Pena, María José
We carried out a clinical and epidemiological study of adult patients with varicella-zoster virus central nervous system infection diagnosed by PCR in cerebrospinal fluid. Twenty-six patients were included. Twelve (46.2 %) patients were diagnosed with meningitis and fourteen (53.8 %) with meningoencephalitis. Twelve (46.2 %) had cranial nerves involvement (mainly the facial (VII) and vestibulocochlear (VIII) nerves), six (23.1 %) had cerebellar involvement, fourteen (53.8 %) had rash, and four (15.4 %) developed Ramsay Hunt syndrome. Three (11.5 %) patients had sequelae. Length of stay was significantly lower in patients diagnosed with meningitis and treatment with acyclovir was more frequent in patients diagnosed with meningoencephalitis. We believe routine detection of varicella-zoster virus, regardless of the presence of rash, is important because the patient may benefit from a different clinical management.
Evolução branda de recidiva de infecção por varicela zoster após tratamento com fingolimode em paciente com esclerose múltipla: relato de casoBenign evolution of shingles with fingolimod in a patient with multiple sclerosis: case report
Antonio Arlindo Morais
Full Text Available Objetivo: Relatar o caso de um paciente com recidiva de herpes-zoster (HZ e evolução benigna mesmo diante de imunomodulação para esclerose múltipla (EM. Descrição de caso: Mulher de 48 anos com história de EM durante seis anos, previamente tratada com interferon1b, iniciou tratamento com fingolimode, desenvolvendo HZ após 10 meses de tratamento. Mesmo sem tratamento com acyclovir, a paciente desenvolveu um curso brando, sem posterior desenvolvimento de neuralgia pós-herpética. Conclusões: As novas terapias para EM podem estar associadas a novos tipos de eventos adversos. Apesar da potencial gravidade, nem todos os pacientes com HZ em uso das novas terapias para EM têm curso desfavorável, sendo necessários estudos para identificar fatores de risco para as formas graves.
J Gordon Millichap
Full Text Available The association between herpes simplex virus-1 (HSV-1 infection and Bell palsy was determined in 47 children studied at Children's Hospital at Montefiore, Bronx, NY. Swabs of saliva and conjunctiva were taken for PCR testing.
Shin, Haina; Iwasaki, Akiko
Genital herpes is an incurable, chronic disease that affects millions of people worldwide. Not only does genital herpes cause painful, recurrent symptoms, it is also a significant risk factor for the acquisition of other sexually transmitted infections such as HIV-1. Antiviral drugs are used to treat herpes simplex virus (HSV) infection, but they cannot stop viral shedding and transmission. Thus, developing a vaccine that can prevent or clear infection will be crucial in limiting the spread of disease. In this review we outline recent studies that improve our understanding of host responses against HSV infection, discuss past clinical vaccine trials, and highlight new strategies for vaccine design against genital herpes. Copyright © 2013 Elsevier Ltd. All rights reserved.
Herpes genitalis is caused by the herpes simplex virus type 1 or type 2 and can manifest as primary or recurrent infection. It is one of the most common sexually transmitted infections and due to associated physical and psychological morbidity it constitutes a considerable, often underestimated medical problem. In addition to providing the reader with basic knowledge of the pathogen and clinical presentation of herpes genitalis, this review article discusses important aspects of the laboratory diagnostics, antiviral therapy and prophylaxis. The article is aimed at all health-care workers managing patients with herpes genitalis and attempts to improve the often suboptimal counselling, targeted use of laboratory diagnostics, treatment and preventive measures provided to patients. PMID:28017972
Choo, Hye Jeung; Kim, Kun Il [Busan National Univ. Hospital, Busan (Korea, Republic of); Lee, Ki Nam [College of Medicine, Donga Univ., Busan (Korea, Republic of)
To describe the high-resolution CT findings of varicella-zoster pneumonia. Seven adult patients with clinically and serologically diagnosed varicella-zoster pneumonia underwent HRCT scanning. One had undergone a kidney transplant, and the others were immunocompetent. The HRCT findings were retrospectively analyzed by two radiologists in terms of the presence of a nodule, pneumonia consolidation, ground-glass attenuation and pleural effusion, and with regard to the number, size and distribution of nodules. HRCT findings of varicella pneumonia included nodule (n=7), consolidation (n=3), diffuse ground-glass attenuation (n=1) and pleural effusion (n=1). Nodules were mostly 2-10 mm in size, and multiple (n=6), and zonal predominancy was not apparent. One case in which HRCT demonstrated diffuse ground-glass opacity and slight bilateral pleural effusion involved a patient in whom complications of acute respiratory distress syndrome occured. When HRCT demonstrates the presence of nodules 2-10 mm in size multiple nodules, or nodule surrounded by ground-glass attenuation, or the coalescence of nodules and consolidation is observed in adults with chickenpox, the varicella-zoster pneumonia should be included in the differential diagnosis.
Full Text Available During 1983-86, 225 patients were clinically diagnosed to have genital herpes (GH at our clinic. Of these, 90 men and 55 women were currently married. All the spouses were screened clinically and through standardized techniques for isolation and typing of herpes simplex virus, serological testing and Papanicolaou smear. There were 90 couples in whom at least one spouse had GH and in 38 (42% couples both partners had GH. Clinically, 49% of wives and 75% of husbands of GH patients were diagnosed to have the disease. The spouses of recurrent GH patients had a higher frequency of the disease than spouses of primary GH patients. Among spouses who were clinically asymptomatic, 40% had high serological titres suggestive of GH. Wives generally experienced more severe symptoms, especially pain in the lesions. Majority of lesions in both the partners were vesicles and ulcers. Prodromata were more among recurrent GH patients in both the partners. The frequency of recurrences wasalso similar in spouses. Seventy percent of wives and 40% of husbands could not identify any precipitating factor. Intercourse, physical stress and rich food were cited as possible factors in the remaining. All the wives had acquired the diseases through their husbands who were promiscuous. Fifty percent of husbands had been infected before marriage. Given the fact that asymptomatic carriers exist, it is better to consider all marital partners of GH as infected. Repeated and long-term follow, - up examination, particularly of wives of GH patients is therefore essential as an important socio-preventive aspect of this disease.
Tétrault, I.; Boivin, G.
OBJECTIVE: To provide an update on new diagnostic tests and antiviral strategies for managing genital herpes. QUALITY OF EVIDENCE: Treatment guidelines are based on randomized clinical trials and recommendations from the Expert Working Group on Canadian Guidelines for Sexually Transmitted Diseases. Recommendations concerning other aspects of managing genital herpes (e.g., indications for using type-specific serologic tests) are mainly based on expert opinion. MAIN MESSAGE: Genital herpes is one of the most common sexually transmitted diseases, affecting about 20% of sexually active people; up to 80% of cases are undiagnosed. Because of frequent atypical presentation and the emotional burden associated with genital herpes, clinical diagnosis should be confirmed by viral culture. Type-specific serologic assays are now available, but their use is often restricted to special situations and requires adequate counseling. New antivirals (valacyclovir and famciclovir) with improved pharmacokinetic profiles have now been approved for episodic treatment of recurrences and suppressive therapy. CONCLUSION: Wise use of new diagnostic assays for herpes simplex coupled with more convenient treatment regimens should provide better management of patients with genital herpes. Images Figure 1 PMID:10955181
... Factor Antibody Iron Iron Tests JAK2 Mutation Kidney Stone Analysis Kidney Stone Risk Panel KRAS Mutation Lactate Lactate Dehydrogenase (LD) ... open lesions. HSV-1 primarily causes blisters or "cold sores" around the mouth, while HSV-2 usually ...
González-Motos, Víctor; Jürgens, Carina; Ritter, Birgit
Varicella zoster virus (VZV) is a highly prevalent human pathogen that establishes latency in neurons of the peripheral nervous system. Primary infection causes varicella whereas reactivation results in zoster, which is often followed by chronic pain in adults. Following infection of epithelial c...
van den Horn, G. J.; Meenken, C.; Troost, D.
A patient with AIDS who developed the clinical picture of bilateral progressive outer retinal necrosis (PORN) in combination with varicella zoster encephalitis is described. The picture developed more than 2 years after an episode of ophthalmic zoster infection, and following intermittent exposure
Bleker, O. P.; van der Meijden, W. I.; Wittenberg, J.; van Bergen, J. E. A. M.; Boeke, A. J. P.; van Doornum, G. J. J.; Henquet, C. J. M.; Galama, J. M. D.; Postma, M. J.; Prins, J. M.; van Voorst Vader, P. C.
The Dutch Institute for Health Care Improvement revised guideline, 'Sexually transmitted diseases and neonatal herpes' summarises the current scientific position on the diagnosis and treatment of a great number of sexually transmitted diseases (STD) and neonatal herpes. Symptomatic treatment of
Yanachkova, Milka; Xu, Wei-Chu; Dvoskin, Sofya; Dix, Edward J; Yanachkov, Ivan B; Focher, Federico; Savi, Lida; Sanchez, M Dulfary; Foster, Timothy P; Wright, George E
Because guanine-based herpes simplex virus thymidine kinase inhibitors are not orally available, we synthesized various 6-deoxy prodrugs of these compounds and evaluated them with regard to solubility in water, oral bioavailability, and efficacy to prevent herpes simplex virus-1 reactivation from latency in a mouse model. Organic synthesis was used to prepare compounds, High Performance Liquid Chromatography (HPLC) to analyze hydrolytic conversion, Mass Spectrometry (MS) to measure oral bioavailability, and mouse latent infection and induced reactivation to evaluate the efficacy of a specific prodrug. Aqueous solubilities of prodrugs were improved, oxidation of prodrugs by animal cytosols occurred in vitro, and oral absorption of the optimal prodrug sacrovir™ (6-deoxy-mCF3PG) in the presence of the aqueous adjuvant Soluplus® and conversion to active compound N(2)-[3-(trifluoromethyl)pheny])guanine (mCF3PG) were accomplished in mice. Treatment of herpes simplex virus-1 latent mice with sacrovir™ in 1% Soluplus in drinking water significantly suppressed herpes simplex virus-1 reactivation and viral genomic replication. Ad libitum oral delivery of sacrovir™ was effective in suppressing herpes simplex virus-1 reactivation in ocularly infected latent mice as measured by the numbers of mice shedding infectious virus at the ocular surface, numbers of trigeminal ganglia positive for infectious virus, number of corneas that had detectable infectious virus, and herpes simplex virus-1 genome copy numbers in trigeminal ganglia following reactivation. These results demonstrate the statistically significant effect of the prodrug on suppressing herpes simplex virus-1 reactivation in vivo. © The Author(s) 2015.
Kim, Seong K; Shakya, Akhalesh K; Kim, Seongman; O'Callaghan, Dennis J
The immediate early 62 protein (IE62) of varicella-zoster virus (VZV), a major viral trans-activator, initiates the virus life cycle and is a key component of pathogenesis. The IE62 possesses several domains essential for trans-activation, including an acidic trans-activation domain (TAD), a serine-rich tract (SRT), and binding domains for USF, TFIIB, and TATA box binding protein (TBP). Transient-transfection assays showed that the VZV IE62 lacking the SRT trans-activated the early VZV ORF61 promoter at only 16% of the level of the full-length IE62. When the SRT of IE62 was replaced with the SRT of equine herpesvirus 1 (EHV-1) IEP, its trans-activation activity was completely restored. Herpes simplex virus 1 (HSV-1) ICP4 that lacks a TAD very weakly (1.5-fold) trans-activated the ORF61 promoter. An IE62 TAD-ICP4 chimeric protein exhibited trans-activation ability (10.2-fold), indicating that the IE62 TAD functions with the SRT of HSV-1 ICP4 to trans-activate viral promoters. When the serine and acidic residues of the SRT were replaced with Ala, Leu, and Gly, trans-activation activities of the modified IE62 proteins IE62-SRTΔSe and IE62-SRTΔAc were reduced to 46% and 29% of wild-type activity, respectively. Bimolecular complementation assays showed that the TAD of IE62, EHV-1 IEP, and HSV-1 VP16 interacted with Mediator 25 in human melanoma MeWo cells. The SRT of IE62 interacted with the nucleolar-ribosomal protein EAP, which resulted in the formation of globular structures within the nucleus. These results suggest that the SRT plays an important role in VZV viral gene expression and replication. The immediate early 62 protein (IE62) of varicella-zoster virus (VZV) is a major viral trans-activator and is essential for viral growth. Our data show that the serine-rich tract (SRT) of VZV IE62, which is well conserved within the alphaherpesviruses, is needed for trans-activation mediated by the acidic trans-activation domain (TAD). The TADs of IE62, EHV-1 IEP, and HSV
Herpes simplex virus type 2 (HSV-2) was the major cause of genital herpes in humans. The HSV-2 glycoprotein D (gD2) had been proved to be a potentially effective vaccine for treatment of genital herpes. The present study was to develop a two step culture to express the recombinant gD2 protein using the immobilized ...
J. Maertzdorf (Jeroen)
textabstractThe identification of human herpes virus (HHV) infections can be traced back to ancient Greece where Herpes simplex vims (HSV) infections in humans were first documented. Hippocrates used the word "herpes", meaning to creep or crawl, to describe spreading skin lesions. Although the
Full Text Available Purpose: To document the clinical pattern in recurrent herpes simplex disease. Methods: Eyes with clinically documented pattern of corneal manifestation on more than one occasion were analysed. For each eye recruited, the clinical pattern of the disease at each recurrence of herpes simplex corneal disease, age, disease-free intervals, triggering factors, laterality and steroid abuse were noted and evaluated. Results: For an average follow up of 6.9 years, a recurrence rate of 0.6 episodes per year was observed. Disease-free intervals of 75.7 months for epithelial herpes simplex disease was considerably longer than the 21.3 months observed for stromal disease. Clinical pattern of recurrence was of the same type following first episode of disciform keratitis, epithelial keratitis and endothelitis in 84%, 72.7%, and 75% of the eyes respectively. Conclusion: Herpes simplex disease often recurs in the same manifest clinical pattern as the first episode. This clinical evidence provides additional support for the potential role of herpes simplex biotypes in determining manifestation of clinical disease pattern.
Full Text Available Background and Aims: The effect of therapeutic circumcision in men for preventing recurrences of herpes genitalis remains largely unelucidated despite its well documented albeit conflicting role in reducing the risk of acquiring sexually transmitted infections, including genital herpes. Methods: Twenty volunteer adult males with a history of recurrent herpes genitalis were included in the study after informed consent and circumcision was carried out. Twenty more adult males having recurrent herpes genitalis and registered in the clinic during the same period were selected as controls. All patients and controls were followed-up for recurrences of herpes genitalis. Results and Conclusions: Six patients and six controls did not follow-up. Seven patients reported no recurrences during 3-18 years, seven patients had two to six recurrences during 11-27 years of postcircumcision follow-up, 0.0080 (average recurrences per person per year as compared with 0.20 (average recurrences per person per year recorded before the circumcision. Two patients had first recurrence 11 years after the circumcision. In comparison, 14 controls had 0.17 (average recurrences per person per year, comparable with the number of recurrences in uncircumcised patients, and frequently at shorter intervals. Despite being a small study, the circumcision appears to reduce the number of recurrences on an average and evidently prolongs the disease-free period in between two recurrences.
Carpenter, John E; Clayton, Amy C; Halling, Kevin C; Bonthius, Daniel J; Buckingham, Erin M; Jackson, Wallen; Dotzler, Steven M; Card, J Patrick; Enquist, Lynn W; Grose, Charles
Varicella-zoster virus (VZV) is a highly neurotropic virus that can cause infections in both the peripheral nervous system and the central nervous system. Several studies of VZV reactivation in the peripheral nervous system (herpes zoster) have been published, while exceedingly few investigations have been carried out in a human brain. Notably, there is no animal model for VZV infection of the central nervous system. In this report, we characterized the cellular environment in the temporal lobe of a human subject who recovered from focal VZV encephalitis. The approach included not only VZV DNA/RNA analyses but also a delineation of infected cell types (neurons, microglia, oligodendrocytes, and astrocytes). The average VZV genome copy number per cell was 5. Several VZV regulatory and structural gene transcripts and products were detected. When colocalization studies were performed to determine which cell types harbored the viral proteins, the majority of infected cells were astrocytes, including aggregates of astrocytes. Evidence of syncytium formation within the aggregates included the continuity of cytoplasm positive for the VZV glycoprotein H (gH) fusion-complex protein within a cellular profile with as many as 80 distinct nuclei. As with other causes of brain injury, these results suggested that astrocytes likely formed a defensive perimeter around foci of VZV infection (astrogliosis). Because of the rarity of brain samples from living humans with VZV encephalitis, we compared our VZV results with those found in a rat encephalitis model following infection with the closely related pseudorabies virus and observed similar perimeters of gliosis. Investigations of VZV-infected human brain from living immunocompetent human subjects are exceedingly rare. Therefore, much of our knowledge of VZV neuropathogenesis is gained from studies of VZV-infected brains obtained at autopsy from immunocompromised patients. These are not optimal samples with which to investigate a
Sadaoka, Tomohiko; Schwartz, Cindi L; Rajbhandari, Labchan; Venkatesan, Arun; Cohen, Jeffrey I
Varicella-zoster virus (VZV) is highly cell associated when grown in culture and has a much higher (4,000- to 20,000-fold increased) particle-to-PFU ratio in vitro than herpes simplex virus (HSV). In contrast, VZV is highly infectious in vivo by airborne transmission. Neurons are major targets for VZV in vivo ; in neurons, the virus can establish latency and reactivate to produce infectious virus. Using neurons derived from human embryonic stem cells (hESC) and cell-free wild-type (WT) VZV, we demonstrated that neurons are nearly 100 times more permissive for WT VZV infection than very-early-passage human embryonic lung cells or MRC-5 diploid human fibroblasts, the cells used for vaccine production or virus isolation. The peak titers achieved after infection were ∼10-fold higher in human neurons than in MRC-5 cells, and the viral genome copy number-to-PFU ratio for VZV in human neurons was 500, compared with 50,000 for MRC-5 cells. Thus, VZV may not necessarily have a higher particle-to-PFU ratio than other herpesviruses; instead, the cells previously used to propagate virus in vitro may have been suboptimal. Furthermore, based on electron microscopy, neurons infected with VZV produced fewer defective or incomplete viral particles than MRC-5 cells. Our data suggest that neurons derived from hESC may have advantages compared to other cells for studies of VZV pathogenesis, for obtaining stocks of virus with high titers, and for isolating VZV from clinical specimens. IMPORTANCE Varicella-zoster virus (VZV) causes chickenpox and shingles. Cell-free VZV has been difficult to obtain, both for in vitro studies and for vaccine production. While numerous cells lines have been tested for their ability to produce high titers of VZV, the number of total virus particles relative to the number of viral particles that can form plaques in culture has been reported to be extremely high relative to that in other viruses. We show that VZV grows to much higher titers in human
Strezova, Ana; Godeaux, Olivier; Aggarwal, Naresh; Leroux-Roels, Geert; Lopez-Fauqued, Marta; Van Damme, Pierre; Vanden Abeele, Carline; Vastiau, Ilse; Heineman, Thomas C; Lal, Himal
The risk of developing herpes zoster (HZ) increases with age and is thought to be associated with a decrease in cell-mediated immunity in older adults. The adjuvanted varicella-zoster virus (VZV) glycoprotein E (gE) recombinant subunit vaccine (HZ/su) showed >90% efficacy in the prevention of HZ when administered in adults ≥50 years of age. Here we aim to evaluate immunogenicity consistency of 3 different HZ/su vaccine lots and to assess safety of these lots. This multicenter, phase III, double-blind, randomized study (NCT02075515), assessed lot-to-lot consistency in terms of immunogenicity of HZ/su and also assessed safety of these lots. Participants aged 50 years or older were randomized (1:1:1) to receive 2 doses of HZ/su, 2 months apart, from 1 out of 3 randomized HZ/su lots (Lots A, B and C). Humoral immunogenicity was assessed pre-vaccination and 1 month post-second vaccination by anti-gE antibody enzyme-linked immunosorbent assay. Lot-to-lot consistency was demonstrated if the 2-sided 95% confidence intervals of the anti-gE geometric mean concentration ratio between all lot pairs were within 0.67 and 1.5. Solicited symptoms were recorded within 7 days and unsolicited adverse events (AEs) within 30 days after each vaccination. Serious AEs (SAEs) and potential immune-mediated diseases (pIMDs) were reported until study end (12 months post-second vaccination). Of 651 participants enrolled in the study, 638 received both doses of the HZ/su vaccine and 634 completed the study. Humoral immune responses were robust and consistency between 3 manufacturing lots was demonstrated. The incidence of solicited symptoms, unsolicited AEs and SAEs was comparable between all lots. Three fatal SAEs, 1 in each lot, were reported, none of which were considered vaccine-related by investigator assessment. Two out of the 8 reported pIMDs were considered vaccine-related by the investigator. The three HZ/su manufacturing lots demonstrated consistent immunogenicity. No safety
Peters, Cole; Rabkin, Samuel D
Oncolytic herpes simplex virus (oHSV) was one of the first genetically-engineered oncolytic viruses. Because HSV is a natural human pathogen that can cause serious disease, it is incumbent that it can be genetically-engineered or significantly attenuated for safety. Here, we present a detailed explanation of the functions of HSV-1 genes frequently mutated to endow oncolytic activity. These genes are nonessential for growth in tissue culture cells but are important for growth in postmitotic cells, interfering with intrinsic antiviral and innate immune responses or causing pathology, functions dispensable for replication in cancer cells. Understanding the function of these genes leads to informed creation of new oHSVs with better therapeutic efficacy. Virus infection and replication can also be directed to cancer cells through tumor-selective receptor binding and transcriptional- or post-transcriptional miRNA-targeting, respectively. In addition to the direct effects of oHSV on infected cancer cells and tumors, oHSV can be “armed” with transgenes that are: reporters, to track virus replication and spread; cytotoxic, to kill uninfected tumor cells; immune modulatory, to stimulate antitumor immunity; or tumor microenvironment altering, to enhance virus spread or to inhibit tumor growth. In addition to HSV-1, other alphaherpesviruses are also discussed for their oncolytic activity. PMID:26462293
Malvy, Denis; Ezzedine, Khaled; Pistone, Thierry; Receveur, Marie-Catherine; Longy-Boursier, Maïté
Hookworm-related cutaneous larva migrans (CLM) is a frequent cutaneous disease among travelers returning from the tropics. It can be misdiagnosed or treated incorrectly. We present a 42-year-old French patient who contracted the disease during a holiday in Thailand and who experienced an extensive CLM syndrome with a less frequent abdominal localization and a pseudo-multimetameric homolateral topography. The condition was late diagnosed and secondarily efficiently cured by a unique administration of ivermectin. Simple anamnestic information--often revealing beach activities--and clinical aspect of the creeping eruption allow to prevent diagnosis delay and to avoid aggressive or inadequate intervention.
Carol L. Berkower
Full Text Available Following initial infection, herpesviruses retreat into a permanent latent state with periodic reactivation resulting in an enhanced likelihood of transmission and clinical disease. The nucleoside analogue acyclovir reduces clinical symptoms of the three human alpha herpesviruses, HSV-1, HSV-2, and VZV. Long-term administration of acyclovir (ACV can reduce the frequency and severity of reactivation, but its low bioavailability and short half-life require a daily drug regimen. Our lab is working to develop a subcutaneous delivery system to provide long-lasting, sustained release of ACV. Previously, we demonstrated that an implantable silicone (MED-4050 device, impregnated with ACV protected against HSV-1 both in vitro and in vivo. Here, we extend our in vitro observations to include protection against both HSV-2 and VZV. We also demonstrate protection against HSV-2 in vitro using MED-4750, a silicone polymer designed for long-term use in humans. When release of ACV from MED-4750 is quantitated on a daily basis, an initial burst of 5 days is observed, followed by a long period of slow release with near-zero-order kinetics, with an average daily release of 1.3923 ± 0.5908 μg ACV over days 20–60. Development of a slow-release implant has the potential to significantly impact the treatment of human alpha herpesvirus infections.
Alies van Lier
Conclusions: Cost-effectiveness of varicella vaccination depends strongly on the impact on HZ and the economic time horizon. Our findings reveal ethical dilemmas as varicella vaccination may result in unequal distribution of health effects between generations.
Kennedy, Peter G. E.; Montague, Paul; Scott, Fiona; Grinfeld, Esther; Ashrafi, G. H.; Breuer, Judith; Rowan, Edward G.
Post-herpetic neuralgia (PHN) is the most significant complication of herpes zoster caused by reactivation of latent Varicella-Zoster virus (VZV). We undertook a heterologous infection in vitro study to determine whether PHN-associated VZV isolates induce changes in sodium ion channel currents known to be associated with neuropathic pain. Twenty VZV isolates were studied blind from 11 PHN and 9 non-PHN subjects. Viruses were propagated in the MeWo cell line from which cell-free virus was harvested and applied to the ND7/23-Nav1.8 rat DRG x mouse neuroblastoma hybrid cell line which showed constitutive expression of the exogenous Nav 1.8, and endogenous expression of Nav 1.6 and Nav 1.7 genes all encoding sodium ion channels the dysregulation of which is associated with a range of neuropathic pain syndromes. After 72 hrs all three classes of VZV gene transcripts were detected in the absence of infectious virus. Single cell sodium ion channel recording was performed after 72 hr by voltage-clamping. PHN-associated VZV significantly increased sodium current amplitude in the cell line when compared with non-PHN VZV, wild-type (Dumas) or vaccine VZV strains ((POka, Merck and GSK). These sodium current increases were unaffected by acyclovir pre-treatment but were abolished by exposure to Tetrodotoxin (TTX) which blocks the TTX-sensitive fast Nav 1.6 and Nav 1.7 channels but not the TTX-resistant slow Nav 1.8 channel. PHN-associated VZV sodium current increases were therefore mediated in part by the Nav 1.6 and Nav 1.7 sodium ion channels. An additional observation was a modest increase in message levels of both Nav1.6 and Nav1.7 mRNA but not Nav 1.8 in PHN virally infected cells. PMID:23382806