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Niemeyer CS, Traina-Dorge V, Doyle-Meyers L, Das A, Looper J, Mescher T, Feia B, Medina E, Nagel MA, Mahalingam R, Bubak AN. Simian varicella virus infection and reactivation in rhesus macaques trigger cytokine and Aβ40/42 alterations in serum and cerebrospinal fluid. J Neurovirol 2024; 30:86-99. [PMID: 38453879 DOI: 10.1007/s13365-024-01196-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 02/07/2024] [Accepted: 02/20/2024] [Indexed: 03/09/2024]
Abstract
Simian varicella virus (SVV) produces peripheral inflammatory responses during varicella (primary infection) and zoster (reactivation) in rhesus macaques (RM). However, it is unclear if peripheral measures are accurate proxies for central nervous system (CNS) responses. Thus, we analyzed cytokine and Aβ42/Aβ40 changes in paired serum and cerebrospinal fluid (CSF) during the course of infection. During varicella and zoster, every RM had variable changes in serum and CSF cytokine and Aβ42/Aβ40 levels compared to pre-inoculation levels. Overall, peripheral infection appears to affect CNS cytokine and Aβ42/Aβ40 levels independent of serum responses, suggesting that peripheral disease may contribute to CNS disease.
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Affiliation(s)
- Christy S Niemeyer
- Department of Neurology, University of Colorado School of Medicine, 12700 E. 19th Avenue, Mail Stop B182, Aurora, Co, 80045, USA
| | - Vicki Traina-Dorge
- Division of Microbiology, Tulane National Primate Research Center, Tulane University, 18703 Three Rivers Road, Covington, LA, 70433, USA
| | - Lara Doyle-Meyers
- Division of Veterinary Medicine, Tulane National Primate Research Center, Tulane University, 18703 Three Rivers Road, Covington, LA, 70433, USA
| | - Arpita Das
- Division of Microbiology, Tulane National Primate Research Center, Tulane University, 18703 Three Rivers Road, Covington, LA, 70433, USA
| | - Jayme Looper
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA, 70803, USA
| | - Teresa Mescher
- Department of Psychiatry Behavioral Health and Wellness Program, University of Colorado School of Medicine, Aurora, Co, 80045, USA
| | - Brittany Feia
- Department of Neurology, University of Colorado School of Medicine, 12700 E. 19th Avenue, Mail Stop B182, Aurora, Co, 80045, USA
| | - Eva Medina
- Department of Neurology, University of Colorado School of Medicine, 12700 E. 19th Avenue, Mail Stop B182, Aurora, Co, 80045, USA
| | - Maria A Nagel
- Department of Neurology, University of Colorado School of Medicine, 12700 E. 19th Avenue, Mail Stop B182, Aurora, Co, 80045, USA
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Co, 80045, USA
| | - Ravi Mahalingam
- Department of Neurology, University of Colorado School of Medicine, 12700 E. 19th Avenue, Mail Stop B182, Aurora, Co, 80045, USA
| | - Andrew N Bubak
- Department of Neurology, University of Colorado School of Medicine, 12700 E. 19th Avenue, Mail Stop B182, Aurora, Co, 80045, USA.
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Upreti G, Rathod K. Zoster Polyneuritis Cranialis and Intracranial Vasculopathy. Indian J Otolaryngol Head Neck Surg 2023; 75:971-974. [PMID: 37275114 PMCID: PMC10235217 DOI: 10.1007/s12070-022-03235-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 10/11/2022] [Indexed: 11/08/2022] Open
Abstract
A case report of varicella zoster virus (VZV) producing cranial polyneuropathy with intracranial vasculopathy afflicting the internal carotid artery, in a 45-year lady is presented. The clinical features included appearance of zosteriform rash in the left external auditory canal and concha, affliction of ophthalmic and maxillary divisions of V, VI, VII, VIII, IX and X cranial nerves. Contrast MRI brain demonstrated attenuated flow void in the left internal carotid artery. The diagnosis was confirmed with raised level of IgG VZV antibody in serum and detection of VZV IgG antibody in CSF, although PCR for VZV DNA in CSF was negative. The significance lies in atypical presentation, the diagnostic dilemma it poses, poor prognosis of cranial nerve function and the need for multidisciplinary approach to patient management and rehabilitation.
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Affiliation(s)
- Garima Upreti
- Department of Otorhinolaryngology and Head-Neck Surgery, Pandit Deendayal Upadhyay Medical College, Rajkot, Gujarat India
- Present Address: Department of Otorhinolaryngology and Head-Neck Surgery, All India Institute of Medical Sciences, Rajkot, Gujarat India
| | - Khevna Rathod
- Department of Otorhinolaryngology and Head-Neck Surgery, Pandit Deendayal Upadhyay Medical College, Rajkot, Gujarat India
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Yang Y, Mahmood T, Siddiqui AH, Aziz MA. Zoster Sine Herpete: two unusual cases of varicella-zoster reactivation with atypical complaints of acute chest pain and severe headache. BMC Infect Dis 2023; 23:239. [PMID: 37072696 PMCID: PMC10111296 DOI: 10.1186/s12879-023-08093-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 02/16/2023] [Indexed: 04/20/2023] Open
Abstract
In this case report, we describe two unusual presentations of varicella-zoster virus (VZV) reactivation without rash, a condition known as Zoster Sine Herpete (ZSH). In Case 1, a 58-year-old woman presented with severe right-sided chest pain under her breast that radiated to the ipsilateral back. After the initial workup ruled out cardiac and musculoskeletal etiologies, the characteristic dermatomal distribution of pain made us suspect VZV reactivation. A diagnosis of ZSH was made with positive VZV IgG and IgM serologies and symptomatic relief after famciclovir treatment. In Case 2, a 43-year-old woman presented with a severe headache and resolved sharp right flank pain. She was diagnosed with varicella meningitis after cerebrospinal fluid showed positive VZV DNA. Intravenous acyclovir treatment resulted in symptom resolution. The most common presentation of VZV reactivation is Herpes Zoster, or shingles, making ZSH a frequently missed diagnosis. High clinical suspicion is warranted to prevent life-threatening complications of ZSH.
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Affiliation(s)
- Yilin Yang
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Talha Mahmood
- Biological Sciences, Florida International University, Miami, FL, USA
| | - Afsheen H Siddiqui
- Johns Hopkins Community Physicians, CIMS Hospitalist, Howard County General Hospital, Johns Hopkins Medicine, 5755 Cedar Lane, Columbia, MD, 21044, USA
| | - Muhammad A Aziz
- Johns Hopkins Community Physicians, CIMS Hospitalist, Howard County General Hospital, Johns Hopkins Medicine, 5755 Cedar Lane, Columbia, MD, 21044, USA.
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Melnikov D, Tomova A, Kovaleva K, Venediktov M. Varicella Manifestation after Mastopexy with Simultaneous Breast Augmentation. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e4807. [PMID: 36751506 PMCID: PMC9894340 DOI: 10.1097/gox.0000000000004807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 11/29/2022] [Indexed: 06/18/2023]
Abstract
We report on a rare case of primary varicella infection manifestation in the early postoperative period after mastopexy with simultaneous breast augmentation that caused dehiscence of surgical wound edges and spread of infection to a subcutaneous fat layer, leading to unaesthetic scarring. Whether such dehiscence in the background of varicella occurred coincidentally or was specifically triggered by the infection is unknown. The treatment is comprised of oral antiviral therapy, surgical wound debridement, and topical application of antiseptic solutions and ointments. We would like to raise awareness of the existence of such a rare case of chickenpox in an early postoperative period of a plastic surgery patient. Thereby, physicians can recognize it, test for it, and treat it promptly and appropriately. Also, we recommend taking a detailed history of infectious diseases.
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Affiliation(s)
- Dmitry Melnikov
- From the Department of Plastic Surgery, University Clinical Hospital №1, Moscow, Russian Federation
- Department of Reconstructive and Plastic Surgery, Lancet Clinic, Moscow, Russian Federation
| | - Alina Tomova
- From the Department of Plastic Surgery, University Clinical Hospital №1, Moscow, Russian Federation
| | - Ksenia Kovaleva
- Department of Reconstructive and Plastic Surgery, Lancet Clinic, Moscow, Russian Federation
| | - Maxim Venediktov
- Department of Reconstructive and Plastic Surgery, Lancet Clinic, Moscow, Russian Federation
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Davis S, Thomas E, Lowery A, Kahue C, Gelbard A. Varicella Zoster Virus Reactivation Involving the Vagus Nerve. Ann Otol Rhinol Laryngol 2022:34894221111259. [PMID: 35833239 DOI: 10.1177/00034894221111259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To characterize the presentation, clinical course and functional outcomes of patients with varicella zoster virus (VZV) reactivation involving the vagus nerve. To highlight the role of otolaryngology in acute and long-term management of laryngopharyngeal VZV and its sequelae. METHODS Retrospective review of 3 patients with laryngopharyngeal VZV, managed at a tertiary referral center. RESULTS All cases presented with vesicular lesions involving mucosa of the laryngopharynx. Each experienced vocal fold hypomobility, among other otolaryngologic sequelae. All were treated with systemic antivirals and corticosteroids. Mucosal lesions resolved within 7 days of treatment initiation; functional deficits persisted for months to years. Dysphonia improved to a plateau at 3 months, while dysphagia took longer to resolve. One patient with disseminated disease experienced bilateral vocal fold paralysis requiring temporary tracheostomy. CONCLUSIONS Vagal neuropathy secondary to VZV reactivation is a rare clinical entity with a variety of laryngeal manifestations. Early initiation of systemic therapy and serial endoscopic evaluations are critical components of acute management when laryngopharyngeal involvement is suspected. Otolaryngologists should plan for long-term phonatory and deglutitive therapy in these cases, as neurologic sequelae can persist for months to years following initial insult. LEVEL OF EVIDENCE Level 4 (Case-series).
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Affiliation(s)
- Seth Davis
- Department of Otolaryngology-Head & Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Evan Thomas
- Department of General Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Anne Lowery
- Vanderbilt University School of Medicine, Vanderbilt University, Nashville, TN, USA
| | - Charissa Kahue
- Department of Otolaryngology-Head & Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Alexander Gelbard
- Department of Otolaryngology-Head & Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.,Division of Laryngology, Vanderbilt University Medical Center, Nashville, TN, USA
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Zhang J, Han X, Su D, Gu X, Yu W. Research Trends and Hotspots on Herpes Zoster: A 10-Year Bibliometric Analysis (2012-2021). Front Med (Lausanne) 2022; 9:850762. [PMID: 35559334 PMCID: PMC9089455 DOI: 10.3389/fmed.2022.850762] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 03/18/2022] [Indexed: 12/30/2022] Open
Abstract
Purpose Herpes zoster infection, with its considerable burden to individuals and society, remains a challenge around the world. However, to the knowledge of the authors, little bibliometric quantitative or qualitative analysis has been carried out to evaluate herpes zoster research. This study aimed to use a bibliometric analysis to evaluate current publication trends and hotspots on herpes zoster research worldwide, in order to advance research in this field. Methods Relevant publications from January 2012 to December 2021 were collected from the Web of Science Core Collection database. Citespace (V5.8.R3) was used to analyze the research points, including publication countries, institutions and authors, cited author, cited reference and their clustering, and keyword co-occurrence, and burst keyword to acquire research trends and hotspots. Results A total of 9,259 publications were obtained, with a steady increase in the number of annual publications during the decade. Articles were the main type of publication. The United States is the leading country in this research, and the University of Colorado has the highest influence in this field. Oxman is the most representative author, with a main research interest in herpes zoster vaccines. The top five cited authors' publications focused on herpes zoster vaccines, molecular mechanisms, and postherpetic neuralgia. A co-citation map resulted 19 main clusters, and revealed that vaccines, postherpetic neuralgia, treatments, varicella zoster virus and its mechanisms, and epidemiology of herpes zoster were the current research focus after clustering co-cited publications. Human herpesviruses, antiviral prophylaxis, rheumatoid arthritis, recombinant zoster vaccine, varicella vaccination and postherpetic neuralgia were the top clusters after co-occurrence keywords analysis. Moreover, burst keywords detection showed that the subunit vaccine was the new hotspot in the field of herpes zoster. Conclusion This bibliometric study defined the overall prospects in the field of herpes zoster and provided valuable instruction for the ongoing research. The keyword "subunit vaccine" indicated that a vaccine for herpes zoster prevention was the hotspot. Efforts to prevent varicella zoster virus infection will be essential to improve herpes zoster outcomes.
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Affiliation(s)
- Jian Zhang
- NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Jiangsu Province Key Laboratory of Anesthesiology, Jiangsu Province Key laboratory of Anesthesia and Analgesia, Xuzhou Medical University, Xuzhou, China
- Department of Anesthesiology, Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xu Han
- Department of Anesthesiology, Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Diansan Su
- Department of Anesthesiology, Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiyao Gu
- Department of Anesthesiology, Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weifeng Yu
- NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Jiangsu Province Key Laboratory of Anesthesiology, Jiangsu Province Key laboratory of Anesthesia and Analgesia, Xuzhou Medical University, Xuzhou, China
- Department of Anesthesiology, Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Gupta S, Biswas A, Chandra A, Ray BK, Dutta A, Pandit A. Post-Varicella Neurological Complications: A Preliminary Observation from a Tertiary Care Centre of Eastern India. Ann Indian Acad Neurol 2022; 25:207-213. [PMID: 35693688 PMCID: PMC9175418 DOI: 10.4103/aian.aian_270_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 07/20/2021] [Accepted: 08/25/2021] [Indexed: 11/16/2022] Open
Abstract
Objectives: The objective of this study is to analyse detailed clinical presentations, imaging findings, and outcome in a series of 17 cases (n = 17) with neurological complications following acute varicella infection. Methods: It is an observational study on the patients who presented to the neurology outpatient department of our institute with neurological abnormalities following acute varicella infection within the last 3 months. Results: Neuroimaging, either computed tomography or magnetic resonance imaging, cerebrospinal fluid analysis, electroencephalography and nerve conduction studies were performed in all the patients along with other specialized investigations as per clinical context. The age of presentation varied from childhood to middle age (median age was 23 years) and range of clinical spectrum was also wide. Peripheral nervous system involvement was more common in the form of Guillain–Barré syndrome (29.4%) and isolated lower motor neuron facial nerve palsy (23.5%) compared to central nervous system (CNS) involvement. CNS involvement was documented in the form of ataxia (11.76%), myelopathy (17.6%), stroke (5.88%) and encephalitis (5.88%). Conclusion: Chickenpox is a common viral disease and most patients recover without any complication. Although rare, neurological complications following acute varicella infection may have myriad presentations ranging from lower motor neuron facial palsy to life-threatening encephalitis. Compared to other studies, varicella encephalitis and ataxia were not so common in our study group. Response to therapy was uniformly good except in the patients presenting with ataxia. Response was particularly good to central and peripheral demyelinating disorders.
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Affiliation(s)
- Subhadeep Gupta
- Department of Neuromedicine, Bangur Institute of Neurosciences, IPGMER and SSKM Hospital, Kolkata, West Bengal, India
| | - Atanu Biswas
- Department of Neuromedicine, Bangur Institute of Neurosciences, IPGMER and SSKM Hospital, Kolkata, West Bengal, India
| | - Atanu Chandra
- Department of Internal Medicine, RG Kar Medical College and Hospital, Kolkata, West Bengal, India
| | - Biman Kanti Ray
- Department of Neuromedicine, Bangur Institute of Neurosciences, IPGMER and SSKM Hospital, Kolkata, West Bengal, India
| | - Arpan Dutta
- Department of Neuromedicine, Bangur Institute of Neurosciences, IPGMER and SSKM Hospital, Kolkata, West Bengal, India
| | - Alak Pandit
- Department of Neuromedicine, Bangur Institute of Neurosciences, IPGMER and SSKM Hospital, Kolkata, West Bengal, India
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Lenfant T, L'Honneur A, Ranque B, Pilmis B, Charlier C, Zuber M, Pouchot J, Rozenberg F, Michon A. Neurological complications of varicella zoster virus reactivation: Prognosis, diagnosis, and treatment of 72 patients with positive PCR in the cerebrospinal fluid. Brain Behav 2022; 12:e2455. [PMID: 35040287 PMCID: PMC8865153 DOI: 10.1002/brb3.2455] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 11/05/2021] [Accepted: 11/11/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND VZV infection can involve every level of the neurologic system: from the central nervous system (CNS) to the peripheral nervous system (PNS), including aseptic meningitis. Prognosis seems to differ between these neurological involvements. Prognostic factors remain unknown. METHODS This is a retrospective multicenter study including all patients with a positive VZV polymerase chain reaction (PCR) in the cerebrospinal fluid (CSF) from eight centers in Paris (France) between 2011 and 2018. Unfavorable outcome was defined as mortality linked to VZV or incomplete recovery. Modified Rankin Scale (mRS) evaluated disability before and after the infection, with the difference designated as Rankin Delta. RESULTS Seventy-two patients were included (53% male, median age 51 years, median mRS 0). Immunosuppression was reported in 42%. The clinical spectrum included 26 cases of meningitis, 27 instances of CNS involvement, 16 of PNS involvement, and 3 isolated replications (positive PCR but no criteria for neurological complications from VZV). Antiviral treatment was administered to 69 patients (96%). Sixty-two patients completed follow-up. Death linked to VZV occurred in eight cases. Unfavorable outcome (UO) occurred in 60% and was significantly associated with a higher prior mRS (Odd-ratio (OR) 3.1 [1.4-8.8] p = .012) and the presence of PNS or CNS manifestations (OR 22 [4-181] p = .001, OR 6.2 [1.3-33] p = .03, respectively, compared to meningitis). In the CSF, higher protein level (p < .0001) was also significantly associated with a higher Rankin Delta. CONCLUSIONS Neurological complications of VZV with evidence of CSF viral replication are heterogeneous: aseptic meningitis has a good prognosis, whereas presence of CNS and PNS involvement is associated with a higher risk of mortality and of sequelae, respectively.
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Affiliation(s)
- Tiphaine Lenfant
- Université de Paris, Service de Médecine InterneHôpital Européen Georges Pompidou, AP‐HPParisFrance
| | | | - Brigitte Ranque
- Université de Paris, Service de Médecine InterneHôpital Européen Georges Pompidou, AP‐HPParisFrance
| | - Benoit Pilmis
- Équipe Mobile de Microbiologie CliniqueGroupe Hospitalier Paris Saint JosephParisFrance
| | - Caroline Charlier
- Université de Paris, Equipe Mobile InfectiologieHôpital Cochin Port‐Royal, AP‐HPUnité Biologie des Infections, Institut Pasteur, Inserm U1117ParisFrance
| | - Mathieu Zuber
- Service de Neurologie et NeurovasculaireGroupe Hospitalier Paris Saint JosephParisFrance
| | - Jacques Pouchot
- Université de Paris, Service de Médecine InterneHôpital Européen Georges Pompidou, AP‐HPParisFrance
| | - Flore Rozenberg
- Université de Paris, Service de VirologieHôpital Cochin, AP‐HPParisFrance
| | - Adrien Michon
- Université de Paris, Service de Médecine InterneHôpital Européen Georges Pompidou, AP‐HPParisFrance
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Yun G, Kim E, Baik J, Do W, Jung YH, You CM. Diagnosis and management of ophthalmic zoster sine herpete accompanied by cervical spine disc protrusion: A case report. World J Clin Cases 2021; 9:7588-7592. [PMID: 34616830 PMCID: PMC8464478 DOI: 10.12998/wjcc.v9.i25.7588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/14/2021] [Accepted: 07/22/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Zoster sine herpete (ZSH) can be misdiagnosed because there are no typical vesicular eruptions characterized by a dermatomal distribution. However, incorrect treatment due to a misdiagnosis can lead to severe pain and fatal complications.
CASE SUMMARY A 75-year-old woman complained of sudden onset right shoulder pain and atypical headache. After 18 d, sudden hearing loss occurred in the left ear. In serology tests conducted after the onset of hearing loss, varicella-zoster virus IgM was positive. She had no history of a rash or trauma. Under the suspicion of ZSH, antiviral treatment and stellate ganglion block were administered four times, and the pain was effectively controlled.
CONCLUSION Early diagnosis and treatment of ZSH can help not only by reducing pain but also by preventing fatal complications.
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Affiliation(s)
- Giyoung Yun
- Department of Anesthesia and Pain Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, South Korea
- Department of Anesthesia and Pain Medicine, Pusan National University, School of Medicine, Yangsan 50612, South Korea
| | - Eunsoo Kim
- Department of Anesthesia and Pain Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, South Korea
- Department of Anesthesia and Pain Medicine, Pusan National University, School of Medicine, Yangsan 50612, South Korea
| | - Jiseok Baik
- Department of Anesthesia and Pain Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, South Korea
| | - Wangseok Do
- Department of Anesthesia and Pain Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, South Korea
| | - Young-Hoon Jung
- Department of Anesthesia and Pain Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, South Korea
| | - Chang-Min You
- Department of Anesthesia and Pain Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, South Korea
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Sahra S, Jahangir A, Gavica MC, Mobarakai N, Jahangir A. First case report of pulmonary embolism with Zoster Sine Herpete. Respir Med Case Rep 2021; 33:101462. [PMID: 34401298 PMCID: PMC8349081 DOI: 10.1016/j.rmcr.2021.101462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 06/11/2021] [Accepted: 06/15/2021] [Indexed: 11/02/2022] Open
Abstract
Background Varicella-Zoster Virus (VZV) infection is known to cause coagulation abnormalities leading to pulmonary embolism and ischemic strokes. The incidence of vascular and thrombotic complications with Zoster Sine Herpete has been reported very infrequently in the medical literature. Case presentation A 32-year-old man with no significant past medical history presented to Emergency Room with right-sided facial weakness and headache. We saw no rash on physical examination. A sub-segmental pulmonary embolus was found on C.T. angiography of the chest. VZV was detected on Lumbar Puncture studies. The patient responded well to anti-viral treatment and was discharged home without any complications. Conclusion The suspicion of thrombo-embolic complications should be high with Zoster Sine Herpete. Screening for coagulopathies and timely initiation of anticoagulation should be carried out in appropriate clinical settings.
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Affiliation(s)
- Syeda Sahra
- Staten Island University Hospital, Staten Island, NY, 10305, USA
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Varicella-Zoster Meningitis in an Immunocompetent Male without Fever or Rash. Case Rep Infect Dis 2021; 2021:9940393. [PMID: 34035968 PMCID: PMC8118730 DOI: 10.1155/2021/9940393] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 04/17/2021] [Accepted: 04/20/2021] [Indexed: 11/27/2022] Open
Abstract
Varicella-Zoster virus (VZV) is a human herpesvirus that primarily causes chickenpox and can reactivate later in life. Chickenpox occurs mostly in children and is characterized by a typical generalized vesicular rash. Following the primary infection, VZV can remain latent and can reactivate decades later to produce Zoster, being more common in the elderly as well as immunosuppressed individuals. The diagnosis of both the primary and reactivation is mostly clinical from the typical rash. However, when presentations are atypical, it leads to diagnostic challenges. We report an unusual case of VZ reactivation in an immunocompetent young adult presenting without fever, zoster rash, or neuralgia. The diagnosis was established by a positive polymerase chain reaction (PCR) performed on cerebrospinal fluid samples. The patient was treated with acyclovir and responded very well. The diagnosis of VZ meningitis is challenging in the absence of typical features of Zoster rash and requires a high index of suspicion.
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12
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Wang Z, Lotina T, Malaty J. Uncommon presentation and complications of herpes zoster infection involving the cervical, vagus and accessory nerves which caused a delay in diagnosis and treatment. BMJ Case Rep 2021; 14:14/5/e241881. [PMID: 33962929 PMCID: PMC8108672 DOI: 10.1136/bcr-2021-241881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 70-year-old man with a history of invasive anal squamous cell carcinoma treated with excision and chemoradiation presented to the emergency department with right-sided neck pain and submandibular lymphadenopathy. CT imaging of the head and neck was unrevealing. The patient eventually developed cranial nerves X and XI dysfunction, manifesting as severe vocal cord paralysis (dysphonia), dysphagia, asymmetric palate elevation/deviation and trapezius muscle atrophy, in addition to scalene muscle atrophy. After an extensive workup, the patient's symptoms were determined to be due to sequelae of varicella zoster infection, which was confirmed with antibody titers. The patient's dysphagia and dysphonia eventually improved with vocal cord medialisation injection and Botox injection. However, despite delayed treatment with acyclovir and valacyclovir, the patient continued to have neuropathic pain and exhibit signs of CN X and CN XI paresis, in addition to scalene muscle atrophy.
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Affiliation(s)
- Ziqi Wang
- University of Florida Health, Gainesville, Florida, USA
| | - Thomas Lotina
- Department of Community Health and Family Medicine, University of Florida Physicians Family Practice Medical Group, Gainesville, Florida, USA
| | - John Malaty
- Department of Community Health and Family Medicine, University of Florida Physicians Family Practice Medical Group, Gainesville, Florida, USA
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13
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Choi JW, Lee J, Lee DH, Shin JE, Kim CH. Mastoid effusion on temporal bone MRI in patients with Bell's palsy and Ramsay Hunt syndrome. Sci Rep 2021; 11:3127. [PMID: 33542465 PMCID: PMC7862290 DOI: 10.1038/s41598-021-82984-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 01/27/2021] [Indexed: 12/02/2022] Open
Abstract
This study aimed to investigate the incidence of mastoid effusion on temporal bone magnetic resonance imaging (MRI) in patients with Bell’s palsy (BP) and Ramsay Hunt syndrome (RHS), and evaluate the usefulness of mastoid effusion in early differential diagnosis between BP and RHS. The incidence of mastoid effusion on 3.0 T—temporal bone MRI, which was conducted within 10 days after the onset of acute facial nerve palsy, was compared between 131 patients with BP and 33 patients with RHS. Findings of mastoid cavity on temporal bone MRI were classified into three groups as normal mastoid, mastoid effusion, and sclerotic change, and the incidence of ipsilesional mastoid effusion was significantly higher in RHS than BP (P < 0.001). Tympanic membrane was normal in 7 of 14 RHS patients with mastoid effusion, and injected without middle ear effusion in 7 patients. This study highlights significantly higher incidence of ipsilesional mastoid effusion in RHS than BP, and suggests that the presence of mastoid effusion may provide additional information for differential diagnosis between RHS and BP.
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Affiliation(s)
- Jin Woo Choi
- Department of Radiology, Konkuk University Medical Center, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Jiyeon Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk University Medical Center, Research Institute of Medical Science, Konkuk University School of Medicine, 120-1 Neungdong-ro, Gwangjin-gu, Seoul, 05030, Republic of Korea
| | - Dong-Han Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk University Medical Center, Research Institute of Medical Science, Konkuk University School of Medicine, 120-1 Neungdong-ro, Gwangjin-gu, Seoul, 05030, Republic of Korea
| | - Jung Eun Shin
- Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk University Medical Center, Research Institute of Medical Science, Konkuk University School of Medicine, 120-1 Neungdong-ro, Gwangjin-gu, Seoul, 05030, Republic of Korea
| | - Chang-Hee Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk University Medical Center, Research Institute of Medical Science, Konkuk University School of Medicine, 120-1 Neungdong-ro, Gwangjin-gu, Seoul, 05030, Republic of Korea.
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Evaluation of Varicella-Zoster Virus Immunoglobulin G in Children With Malignancies on Chemotherapy. ARCHIVES OF PEDIATRIC INFECTIOUS DISEASES 2020. [DOI: 10.5812/pedinfect.107218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Varicella-Zoster Virus (VZV) infection in children with different malignancies on chemotherapy has become an alarming problem. There are insufficient data about VZV seroprevalence among patients in Iran. Objectives: The current study was conducted to assess the seroprevalence of VZV serum IgG antibodies in children with malignancies on chemotherapy. Methods: The current single-center cross-sectional study was conducted from January 2018 to December 2019 at Mofid children’s hospital, Tehran, Iran. Five milliliters of blood samples were collected from the patients. Serum samples were then tested in duplicate for the IgG antibody against VZV using Varicella-Zoster ELISA IgG/IgM kit. Results: A total of 54 children with different malignancies were included. Overall, 24 and 30 serum samples were collected from females and males, respectively. The children were five months to 15-years-old with a mean age of 5.5 years. The overall seroprevalence of VZV IgG in the children was 21.1% (n = 13/54). Of patients with positive VZV IgG antibody, 9 (69.2%) were male, and four (30.8%) were female. Besides, Acute Lymphocytic Leukemia (ALL) with 61.1% (n = 33/54) was the most common underlying malignancy among these patients. The prevalence of anti-VZV IgG antibodies was 21.2% (n = 7/33) in the group of children with ALL. The highest seroprevalence of the VZV IgG antibody was seen in 11 to 15-year-old children (n = 3/7; 42.9%). The prevalence rates of IgG antibodies against VZV among children aged 0-2 years, 3-5 years, and 6-10 years were 28.6%, 25.9%, and 7.7%, respectively. Conclusions: The results showed that children with different malignancies on chemotherapy are quite susceptible to chickenpox infection. It is suggested that a safe and effective live attenuated varicella vaccine in line with the WHO recommendations be incorporated into Iran’s national immunization program for children with various malignancies.
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15
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Fan JN, Fan J, Ali H. Cranial nerve involvement in varicella zoster virus after renal transplantation. Proc (Bayl Univ Med Cent) 2020; 33:612-613. [DOI: 10.1080/08998280.2020.1775031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- Jennifer Nielsen Fan
- Department of Family Medicine, Baylor Scott & White Medical Center – Round Rock, Round Rock, Texas
| | - Jerry Fan
- Department of Internal Medicine, Baylor Scott & White Medical Center – Temple, Temple, Texas
| | - Hameed Ali
- Department of Internal Medicine, Baylor Scott & White Medical Center – Temple, Temple, Texas
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16
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Zhou J, Li J, Ma L, Cao S. Zoster sine herpete: a review. Korean J Pain 2020; 33:208-215. [PMID: 32606265 PMCID: PMC7336347 DOI: 10.3344/kjp.2020.33.3.208] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/30/2020] [Accepted: 06/02/2020] [Indexed: 02/07/2023] Open
Abstract
Zoster sine herpete (ZSH) is one of the atypical clinical manifestations of herpes zoster (HZ), which stems from infection and reactivation of the varicella-zoster virus (VZV) in the cranial nerve, spinal nerve, viscera, or autonomic nerve. Patients with ZSH display variable symptoms, such as neuralgia, however, different from HZ, ZSH show no zoster, which makes clinical diagnosis difficult. ZSH not only causes initial symptoms, such as neuropathic pain in the affected nerve, Bell palsy, and Ramsay Hunt syndrome, but also postherpetic neuralgia and fatal complications such as VZV encephalitis and stroke. The misdiagnosis of ZSH and tardy antiviral treatment may lead to severe ZSH sequelae. We review the publications related to ZSH, especially its diagnosis with VZV DNA and/or anti-VZV immunoglobulin (IgG and IgM). More work about ZSH, especially ZSH epidemiological survey and guidelines for its diagnosis and treatment, are needed because most of the present studies are case reports.
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Affiliation(s)
- Junli Zhou
- Department of Pain Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Juan Li
- Department of Pain Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Lulin Ma
- Department of Pain Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Song Cao
- Department of Pain Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, China.,Guizhou Key Laboratory of Anesthesia and Organ Protection, Zunyi Medical University, Zunyi, China
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17
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Ashour A, Obeidat K, Azrieh B, Alsaud A, Yassin M. An Association of Varicella Zoster Virus, Facial Palsy, and Meningitis in a Young Immunocompetent Male. Case Rep Neurol 2020; 12:136-139. [PMID: 32399017 PMCID: PMC7204867 DOI: 10.1159/000506192] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 01/21/2020] [Indexed: 11/19/2022] Open
Abstract
Varicella zoster is a secondary infection caused by the virus of chickenpox, after becoming latent in neurons of dorsal root ganglia or trigeminal ganglia. Varicella zoster virus (VZV) can be reactivated years later to produce shingles (zoster), generally in immunocompromised adults to produce neurological deficits and rash. Meningeal involvement of VZV is also reported and can be diagnosed. Herein, we report a 39-year-old immunocompetent male adult with a rare manifestation caused by VZV. The report is an association between facial nerve palsy and a polymerase chain reaction-confirmed VZV meningitis, even without the dermal typical rash. The patient eventually recovered after receiving acyclovir intravenously.
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Affiliation(s)
- Amr Ashour
- *Amr Ashour, MD, Resident, Internal Medicine, Hamad Medical Corporation, Al-Aziziya, Asian Village 10, PO Box 3050, Doha (Qatar),
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18
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Imani S, Palavra NC, Oboudiyat C, Ip J. Varicella-zoster meningitis in an immunocompetent young man presenting with a painless erythematous rash. BMJ Case Rep 2020; 13:13/1/e233511. [PMID: 31969416 DOI: 10.1136/bcr-2019-233511] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 32-year-old man presented with a 7-day history of generalised headache, intermittent fever, emesis and diarrhoea. Four days after symptom onset, he developed a vesicular rash on his medial left thigh, without associated pain, paraesthesia or pruritus. He had no significant past medical history, and no HIV risk factors. He was presumed to have enteroviral meningitis and was commenced on supportive therapy. Lumbar puncture was performed and cerebrospinal fluid (CSF) analysis revealed a lymphocytic pleocytosis. While awaiting CSF serology, the formation of a new vesicle was noted at the site of the rash and was swabbed. Results for both the CSF and vesicle swab returned positive for varicella-zoster virus (VZV) confirming concurrent VZV meningitis with atypical painless herpes zoster in a young immunocompetent patient. He was initiated on intravenous acyclovir and made a full recovery after 2 weeks of treatment.
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Affiliation(s)
- Sahand Imani
- Department of Neurology, Sydney Adventist Hospital, Sydney, New South Wales, Australia.,Northern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Natalie C Palavra
- Department of Neurology, Sydney Adventist Hospital, Sydney, New South Wales, Australia .,Northern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Carly Oboudiyat
- Department of Neurology, Sydney Adventist Hospital, Sydney, New South Wales, Australia.,Northern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Jerome Ip
- Department of Neurology, Sydney Adventist Hospital, Sydney, New South Wales, Australia.,Northern Sydney Local Health District, Sydney, New South Wales, Australia
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19
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Mann V, Sundaresan A, Mehta SK, Crucian B, Doursout MF, Devakottai S. Effects of microgravity and other space stressors in immunosuppression and viral reactivation with potential nervous system involvement. Neurol India 2019; 67:S198-S203. [PMID: 31134910 DOI: 10.4103/0028-3886.259125] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Space exploration exposes astronauts to a variety of gravitational stresses. Exposure to a reduced gravity environment affects human anatomy and physiology. Countermeasures to restore homeostatic states within the human body have begun. The pathophysiological effects of exposure to microgravity, on the neurological system, are, however, still not clear. NASA has scheduled deep space exploration of extraterrestrial locations such as the Moon and Mars in the 2030s. Adverse health effects related to the human exposure to microgravity from previous, relatively shorter missions have been documented. A lengthy deep space travel to Mars could be overburdened by significant adverse health effects. Astronauts demonstrate a significant increase in the number of many types of circulating white blood cells (neutrophils, monocytes, T-helper cells, and B-cells) but a decrease in natural killer cells. It is unclear whether these changes are due to increased production or decreased clearance of these cells. In this review, viral reactivation in astronauts will be discussed, including the occurrence of clinical cases before, during, or after spaceflight and their management during and after flight. Studies on models used in spaceflight studies such as the AKATA cells (an immortalized B-cell line derived from a Japanese patient with Burkitt's lymphoma, a tumor induced by Epstein-Barr virus) and other cell lines which shed these latent viruses, will be reviewed with specific reference to gravitational changes, radiation, and spaceflight-induced immune suppression.
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Affiliation(s)
- Vivek Mann
- Department of Biology, Texas Southern University, Houston, Texas, USA
| | | | - Satish K Mehta
- Immunology/Virology Laboratory, NASA, Johnson Space Center, Houston, Texas, USA
| | - Brian Crucian
- Immunology/Virology Laboratory, NASA, Johnson Space Center, Houston, Texas, USA
| | - Marie F Doursout
- Department of Anesthesiology, McGovernSchool of Medicine, UT Health, Houston, Texas, USA
| | - Sundar Devakottai
- University of Incarnate Word School of Osteopathic Medicine, San Antonio, Texas, USA
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20
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Zamora LD, Collante MTM, Navarra SV. Risk factors for herpes zoster infection among Filipinos with systemic lupus erythematosus. Int J Rheum Dis 2019; 23:197-202. [DOI: 10.1111/1756-185x.13725] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 09/23/2019] [Accepted: 09/30/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Leonid D. Zamora
- Section of Rheumatology University of Santo Tomas Manila Philippines
| | | | - Sandra V. Navarra
- Section of Rheumatology University of Santo Tomas Manila Philippines
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21
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Brogan K, Lockington D, Ramaesh K. Temporomandibular Disorder: An Important Cause of Temporal Headache in Patients Unlikely to Have Giant Cell Arteritis. Semin Ophthalmol 2019; 34:80-84. [PMID: 30763136 DOI: 10.1080/08820538.2019.1578383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Temporal headache often results in an Ophthalmology referral to rule out giant cell arteritis (GCA). When clinical suspicion of GCA is low, alternative diagnoses should be considered. Temporomandibular disorder (TMD) commonly causes a temporal headache. MATERIALS AND METHODS Patients referred with a temporal headache attending the Friday emergency ophthalmology clinic from February to July 2017 were assessed for GCA using the American College of Rheumatology (ACR) diagnostic criteria and TMD using a validated screening questionnaire. RESULTS Ten symptomatic patients presented and were screened for TMD during this period. Four had mild TMD, two moderate, and three severe. The mean TMD score in patients with less than 3 ACR GCA criteria was 14.75 (SD 4.03) versus 6.8 (SD 3.06) in patients with 3 or more criteria (p = 0.0075). CONCLUSION TMD is an important cause of a temporal headache in patients unlikely to have GCA. Onward referral to dentistry for further management may be merited.
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Affiliation(s)
- Kerr Brogan
- a Tennent Institute of Ophthalmology , Gartnavel General Hospital , Glasgow , UK
| | - David Lockington
- a Tennent Institute of Ophthalmology , Gartnavel General Hospital , Glasgow , UK
| | - Kanna Ramaesh
- a Tennent Institute of Ophthalmology , Gartnavel General Hospital , Glasgow , UK
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22
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Rooney BV, Crucian BE, Pierson DL, Laudenslager ML, Mehta SK. Herpes Virus Reactivation in Astronauts During Spaceflight and Its Application on Earth. Front Microbiol 2019; 10:16. [PMID: 30792698 PMCID: PMC6374706 DOI: 10.3389/fmicb.2019.00016] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 01/09/2019] [Indexed: 12/30/2022] Open
Abstract
Latent herpes virus reactivation has been demonstrated in astronauts during shuttle (10–16 days) and International Space Station (≥180 days) flights. Following reactivation, viruses are shed in the body fluids of astronauts. Typically, shedding of viral DNA is asymptomatic in astronauts regardless of mission duration; however, in some cases, live/infectious virus was recovered by tissue culture that was associated with atopic-dermatitis or skin lesions during and after spaceflight. Hypothalamic-pituitary-adrenal (HPA) and sympathetic-adrenal-medullary (SAM) axes activation during spaceflight occurs as indicated by increased levels of stress hormones including cortisol, dehydroepiandrosterone, epinephrine, and norepinephrine. These changes, along with a decreased cell mediated immunity, contribute to the reactivation of latent herpes viruses in astronauts. Currently, 47/89 (53%) astronauts from shuttle-flights and 14/23 (61%) astronauts from ISS missions shed one or more herpes viruses in saliva/urine samples. Astronauts shed Epstein–Barr virus (EBV), varicella-zoster virus (VZV), and herpes-simplex-1 (HSV-1) in saliva and cytomegalovirus (CMV) in urine. Larger quantities and increased frequencies for these viruses were found during spaceflight as compared to before or after flight samples and their matched healthy controls. The shedding did not abate during the longer ISS missions, but rather increased in frequency and amplitude. These findings coincided with the immune system dysregulation observed in astronauts from shuttle and ISS missions. VZV shedding increased from 41% in space shuttle to 65% in ISS missions, EBV increased 82 to 96%, and CMV increased 47 to 61%. In addition, VZV/CMV shed ≤30 days after ISS in contrast to shuttle where VZV/CMV shed up to 5 and 3 days after flight respectively. Continued shedding of infectious-virus post-flight may pose a potential risk for crew who may encounter newborn infants, sero-negative adults or any immunocompromised individuals on Earth. Therefore, developing spaceflight countermeasures to prevent viral reactivation is essential. Our spaceflight-developed technologies for saliva collection/rapid viral detection have been extended to include clinical applications including zoster patients, chicken pox, post-herpetic neuralgia, multiple sclerosis, and various neurological disorders. These protocols are employed in various clinics and hospitals including the CDC and Columbia University in New York, as well as overseas in Switzerland and Israel.
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Affiliation(s)
| | | | | | - Mark L Laudenslager
- Anschutz Medical Campus, University of Colorado Denver, Aurora, CO, United States
| | - Satish K Mehta
- Jes Tech, KBR Wyle Laboratories Houston, Houston, TX, United States
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23
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Ptaszyńska-Sarosiek I, Dunaj J, Zajkowska A, Niemcunowicz-Janica A, Król M, Pancewicz S, Zajkowska J. Post-mortem detection of six human herpesviruses (HSV-1, HSV-2, VZV, EBV, CMV, HHV-6) in trigeminal and facial nerve ganglia by PCR. PeerJ 2019; 6:e6095. [PMID: 30643675 PMCID: PMC6330031 DOI: 10.7717/peerj.6095] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 11/10/2018] [Indexed: 12/14/2022] Open
Abstract
Background Among over 100 types of Herpesviridae viruses, eight can infect humans: herpes simplex viruses (HSV-1, HSV-2), varicella zoster virus (VZV), cytomegalovirus (CMV), Epstein-Barr virus (EBV), and human herpesviruses 6, 7, and 8 (HHV-6, HHV-7, HHV-8). After initial infection, the viruses remain latent for the lifetime of the host. The aim of this study was to determine the distribution of six different herpesviruses: HSV-1, HSV-2, VZV, EBV, CMV, and HHV-6 in trigeminal and facial nerve ganglia among a random group of Polish population. Methods The studied group consisted of 47 individuals (40 male, seven female); mean age of 47.4 ± 16.5 years) who died of independent causes (suicide, traffic accident, and poisoning, among others). Bilateral trigeminal and facial nerve ganglia of each cadaver were collected during the autopsy. Herpesviruses were detected using multiplex polymerase chain reaction technique. Results Herpesviruses were found in trigeminal and/or facial ganglia in 30/47 (63.8%) of cadavers. HHV-6 was the most prevalent of the herpesviruses and was found in nearly half of cadavers (n = 22; 46.8%), followed by HSV-1 (n = 7; 14.9%), VZV (n = 4; 8.5%), EBV (n = 4; 8.5%), HSV-2 (n = 2; 4.3%), and CMV (n = 1; 2.1%). Facial nerve ganglia (n = 23; 48.9%) were more often infected than trigeminal ganglia (n = 13; 27.7%). Discussion The results of this study have revealed a common presence of the herpesviruses in trigeminal and facial nerve ganglia among a random group of Polish population. Furthermore, the data also demonstrate simultaneous infection of the ganglia with different herpesviruses. This study has contributed to the knowledge of prevalence and localization of herpesviruses in different structures of the nervous system.
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Affiliation(s)
| | - Justyna Dunaj
- Department of Infectious Diseases and Neuroinfections, Medical University of Bialystok, Białystok, Poland
| | - Agata Zajkowska
- Department of Neurology, Medical University of Bialystok, Bialystok, Poland
| | | | - Monika Król
- Department of Infectious Diseases and Neuroinfections, Medical University of Bialystok, Białystok, Poland
| | - Sławomir Pancewicz
- Department of Infectious Diseases and Neuroinfections, Medical University of Bialystok, Białystok, Poland
| | - Joanna Zajkowska
- Department of Infectious Diseases and Neuroinfections, Medical University of Bialystok, Białystok, Poland
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Monette A, Mouland AJ. T Lymphocytes as Measurable Targets of Protection and Vaccination Against Viral Disorders. INTERNATIONAL REVIEW OF CELL AND MOLECULAR BIOLOGY 2019; 342:175-263. [PMID: 30635091 PMCID: PMC7104940 DOI: 10.1016/bs.ircmb.2018.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Continuous epidemiological surveillance of existing and emerging viruses and their associated disorders is gaining importance in light of their abilities to cause unpredictable outbreaks as a result of increased travel and vaccination choices by steadily growing and aging populations. Close surveillance of outbreaks and herd immunity are also at the forefront, even in industrialized countries, where previously eradicated viruses are now at risk of re-emergence due to instances of strain recombination, contractions in viral vector geographies, and from their potential use as agents of bioterrorism. There is a great need for the rational design of current and future vaccines targeting viruses, with a strong focus on vaccine targeting of adaptive immune effector memory T cells as the gold standard of immunity conferring long-lived protection against a wide variety of pathogens and malignancies. Here, we review viruses that have historically caused large outbreaks and severe lethal disorders, including respiratory, gastric, skin, hepatic, neurologic, and hemorrhagic fevers. To observe trends in vaccinology against these viral disorders, we describe viral genetic, replication, transmission, and tropism, host-immune evasion strategies, and the epidemiology and health risks of their associated syndromes. We focus on immunity generated against both natural infection and vaccination, where a steady shift in conferred vaccination immunogenicity is observed from quantifying activated and proliferating, long-lived effector memory T cell subsets, as the prominent biomarkers of long-term immunity against viruses and their associated disorders causing high morbidity and mortality rates.
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25
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Bradshaw MJ, Gilden D, Lavin P, Sriram S. Clinical Reasoning: A 57-year-old woman with ataxia and oscillopsia: Varicella-zoster encephalitis. Neurology 2018; 87:e61-4. [PMID: 27527543 DOI: 10.1212/wnl.0000000000002981] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Michael J Bradshaw
- From the Department of Neurology (M.J.B., P.L., S.S.), Vanderbilt University Medical Center, Nashville, TN; and Department of Neurology and Immunology & Microbiology (D.G.), University of Colorado School of Medicine, Aurora.
| | - Don Gilden
- From the Department of Neurology (M.J.B., P.L., S.S.), Vanderbilt University Medical Center, Nashville, TN; and Department of Neurology and Immunology & Microbiology (D.G.), University of Colorado School of Medicine, Aurora
| | - Patrick Lavin
- From the Department of Neurology (M.J.B., P.L., S.S.), Vanderbilt University Medical Center, Nashville, TN; and Department of Neurology and Immunology & Microbiology (D.G.), University of Colorado School of Medicine, Aurora
| | - Subramaniam Sriram
- From the Department of Neurology (M.J.B., P.L., S.S.), Vanderbilt University Medical Center, Nashville, TN; and Department of Neurology and Immunology & Microbiology (D.G.), University of Colorado School of Medicine, Aurora
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Suri V, Mendiratta L, Chatterjee S, Sardana R, Butta H. Unusual Presentation of Varicella zoster Virus Meningitis - Role of Molecular Rapid Diagnostics in Diagnosis and Antimicrobial Stewardship. Ann Indian Acad Neurol 2018; 21:168-169. [PMID: 30122848 PMCID: PMC6073969 DOI: 10.4103/aian.aian_438_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Vinit Suri
- Department of Neurosciences, Indraprastha Apollo Hospitals, New Delhi, India
| | - Leena Mendiratta
- Department of Microbiology, Indraprastha Apollo Hospitals, New Delhi, India
| | - Suranjit Chatterjee
- Department of Internal Medicine, Indraprastha Apollo Hospitals, New Delhi, India
| | - Raman Sardana
- Department of Microbiology, Indraprastha Apollo Hospitals, New Delhi, India
| | - Hena Butta
- Department of Microbiology, Indraprastha Apollo Hospitals, New Delhi, India
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Spernovasilis N, Milioni A, Gialamas I, Kokorakis E, Fanti G. Varicella-zoster virus meningitis with hypoglycorrhachia in a young immunocompetent adult without rash: A case report and literature review. IDCases 2018; 12:104-106. [PMID: 29682449 PMCID: PMC5909022 DOI: 10.1016/j.idcr.2018.04.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 04/10/2018] [Accepted: 04/11/2018] [Indexed: 01/22/2023] Open
Abstract
Overt aseptic meningitis rarely complicates varicella-zoster virus (VZV) reactivation in young and immunocompetent adults. Many of the cases of VZV meningitis are associated with an exanthem. We describe an otherwise healthy 36-year-old adult who had aseptic meningitis without skin rash, caused by reactivation of varicella-zoster virus. Cerebrospinal fluid (CSF) analysis revealed lymphocytosis, increased total protein, and low glucose. Diagnosis was made by polymerase chain reaction in CSF. The present case highlights the fact that VZV should be considered as a cause of aseptic meningitis with hypoglycorrhachia in healthy and young individuals, even in the absence of an exanthem.
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Affiliation(s)
- Nikolaos Spernovasilis
- Department of Internal Medicine, Infectious Diseases Unit, University Hospital of Heraklion, Heraklion, Greece
| | - Athanasia Milioni
- Department of Otorhinolaryngology, University Hospital of Heraklion, Heraklion, Greece
| | - Ioannis Gialamas
- Department of Internal Medicine, Infectious Diseases Unit, University Hospital of Heraklion, Heraklion, Greece
| | - Evangelos Kokorakis
- Department of Internal Medicine, Infectious Diseases Unit, University Hospital of Heraklion, Heraklion, Greece
| | - Garufallia Fanti
- Department of Internal Medicine, Infectious Diseases Unit, University Hospital of Heraklion, Heraklion, Greece
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Increased risk of dementia following herpes zoster ophthalmicus. PLoS One 2017; 12:e0188490. [PMID: 29166672 PMCID: PMC5699837 DOI: 10.1371/journal.pone.0188490] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Accepted: 11/05/2017] [Indexed: 12/17/2022] Open
Abstract
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.
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Tecellioglu M, Kamisli S, Erbay MF, Kamisli O, Ozcan C. A Rare Presentation of Cranial Polyneuropathy Without Rash Caused by Varicella Zoster Virus. Med Arch 2017; 71:293-295. [PMID: 28974853 PMCID: PMC5585840 DOI: 10.5455/medarh.2017.71.293-295] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Accepted: 07/27/2017] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Varicella Zoster Virus (VZV) is associated with many disorders of the central and peripheral nervous systems including neuralgia, meningitis, meningoencephalitis, cerebellitis, vasculopathy, myelopathy, Ramsay-Hunt syndrome, and polyneuritis cranialis. Cranial nerves V, VI, VII, VIII, IX, X, XI, and/or XII may be affected. The neurological disorders caused by VZV usually present with rash, but may rarely present without rash. CASE REPORT We herein present a case of polyneuritis cranialis without rash caused by VZV affecting cranial nerves VII, VIII, IX, and X. After excluding other causes of the condition, we diagnosed VZV infection based on VZV DNA in the CSF and an elevated anti-VZV IgG level in serum. The patient responded well to antiviral therapy. CONCLUSION VZV infection should be kept in mind during the differential diagnosis of polyneuritis cranialis; it is important to note that VZV re-activation may occur without rash.
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Affiliation(s)
- Mehmet Tecellioglu
- Inonu university, Turgut Ozal medicine center, Neurology department, Malatya, Turkey
| | - Suat Kamisli
- Inonu university, Turgut Ozal medicine center, Neurology department, Malatya, Turkey
| | - Mehmet Fatih Erbay
- Inonu university, Turgut Ozal medicine center, Radiology department, Malatya, Turkey
| | - Ozden Kamisli
- Inonu university, Turgut Ozal medicine center, Neurology department, Malatya, Turkey
| | - Cemal Ozcan
- Inonu university, Turgut Ozal medicine center, Neurology department, Malatya, Turkey
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Bari O, Cohen PR. Eosinophilic dermatosis of hematologic malignancy mimicking varicella zoster infection: report in a woman with chronic lymphocytic leukemia and review of the literature. Dermatol Pract Concept 2017; 7:6-15. [PMID: 29085714 PMCID: PMC5661154 DOI: 10.5826/dpc.0703a02] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 04/29/2017] [Indexed: 10/31/2022] Open
Abstract
Eosinophilic dermatosis of hematologic malignancy is a rare papulovesicular eruption that presents in patients with hematoproliferative disorders, particularly chronic lymphocytic leukemia. A 59-year-old woman with chronic lymphocytic leukemia who developed eosinophilic dermatosis of hematologic malignancy mimicking varicella zoster infection is described. PubMed database was searched with the key words: chronic, dermatosis, eosinophilic, hematologic, infection, leukemia, lymphocytic, malignancy, varicella, zoster. The papers generated by the search and their references were reviewed. The patient presented, on more than 20 occasions, with a dermatomal vesicular eruption. Her oncologist, based on the clinical presentation, treated each episode as recurrent varicella zoster virus infection. A complete workup of the patient not only demonstrated negative viral studies but also revealed pathologic changes consistent with eosinophilic dermatosis of hematologic malignancy on lesional skin biopsy. The recurrence of the patient's dermatosis was less frequent when her malignancy was under better control. Eosinophilic dermatosis of hematologic malignancy may mimic other reactive dermatoses. The morphology of our patient's recurrent dermatosis resembled varicella zoster virus infection. Disseminated zoster virus infection with dermatomal and non-dermatomal distribution should be added to the clinical differential diagnosis of eosinophilic dermatosis of hematologic malignancy.
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Affiliation(s)
- Omar Bari
- University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Philip R Cohen
- Department of Dermatology, University of California San Diego, La Jolla, CA, USA
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Carod-Artal FJ. Infectious diseases causing autonomic dysfunction. Clin Auton Res 2017; 28:67-81. [PMID: 28730326 DOI: 10.1007/s10286-017-0452-4] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 07/10/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To review infectious diseases that may cause autonomic dysfunction. METHODS Review of published papers indexed in medline/embase. RESULTS Autonomic dysfunction has been reported in retrovirus (human immunodeficiency virus (HIV), human T-lymphotropic virus), herpes viruses, flavivirus, enterovirus 71 and lyssavirus infections. Autonomic dysfunction is relatively common in HIV-infected patients and heart rate variability is reduced even in early stages of infection. Orthostatic hypotension, urinary dysfunction and hypohidrosis have been described in tropical spastic paraparesis patients. Varicella zoster reactivation from autonomic ganglia may be involved in visceral disease and chronic intestinal pseudo-obstruction. Autonomic and peripheral nervous system dysfunction may happen in acute tick-borne encephalitis virus infections. Hydrophobia, hypersalivation, dyspnea, photophobia, and piloerection are frequently observed in human rabies. Autonomic dysfunction and vagal denervation is common in Chagas disease. Neuronal depopulation occurs mainly in chagasic heart disease and myenteric plexus, and megacolon, megaesophagus and cardiomyopathy are common complications in the chronic stage of Chagas disease. Parasympathetic autonomic dysfunction precedes left ventricle systolic dysfunction in Chagas disease. A high prevalence of subclinical autonomic neuropathy in leprosy patients has been reported, and autonomic nerve dysfunction may be an early manifestation of the disease. Autonomic dysfunction features in leprosy include anhidrosis, impaired sweating function, localised alopecia ,and reduced heart rate variability. Urinary retention and intestinal pseudo-obstruction have been described in Lyme disease. Diphtheritic polyneuropathy, tetanus and botulism are examples of bacterial infections releasing toxins that affect the autonomic nervous system. CONCLUSIONS Autonomic dysfunction may be responsible for additional morbidity in some infectious diseases.
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Affiliation(s)
- Francisco Javier Carod-Artal
- Neurology Department, Raigmore Hospital, Inverness, UK. .,Health Sciences Faculty, Universitat Internacional de Catalunya (UIC), Barcelona, Spain.
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Abstract
The most common specimens from immunocompromised patients that are analyzed for detection of herpes simplex virus (HSV) or varicella-zoster virus (VZV) are from skin lesions. Many types of assays are applicable to these samples, but some, such as virus isolation and direct fluorescent antibody testing, are useful only in the early phases of the lesions. In contrast, nucleic acid (NA) detection methods, which generally have superior sensitivity and specificity, can be applied to skin lesions at any stage of progression. NA methods are also the best choice, and sometimes the only choice, for detecting HSV or VZV in blood, cerebrospinal fluid, aqueous or vitreous humor, and from mucosal surfaces. NA methods provide the best performance when reliability and speed (within 24 hours) are considered together. They readily distinguish the type of HSV detected or the source of VZV detected (wild type or vaccine strain). Nucleic acid detection methods are constantly being improved with respect to speed and ease of performance. Broader applications are under study, such as the use of quantitative results of viral load for prognosis and to assess the efficacy of antiviral therapy.
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Westman G, Blomberg J, Yun Z, Lannfelt L, Ingelsson M, Eriksson BM. Decreased HHV-6 IgG in Alzheimer's Disease. Front Neurol 2017; 8:40. [PMID: 28265256 PMCID: PMC5316842 DOI: 10.3389/fneur.2017.00040] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 01/27/2017] [Indexed: 01/20/2023] Open
Abstract
Human herpesviruses have previously been implicated in the pathogenesis of Alzheimer's disease (AD) but whether they are causal, facilitating, or confounding factors is yet to be established. A total of 50 AD subjects and 52 non-demented (ND) controls were analyzed in a multiplex assay for IgG reactivity toward herpes simplex virus (HSV), varicella zoster virus (VZV), cytomegalovirus (CMV), and human herpesvirus 6 (HHV-6). The HHV-6 IgG reactivity was significantly lower in AD subjects compared to ND controls, whereas there were no differences in HSV, VZV, or CMV antibody levels between the groups. Analysis of peripheral blood mononuclear cells with a subtype-specific HHV-6 PCR revealed no signs of reactivation, as AD and ND subjects presented with comparable HHV-6 DNA levels in PBMCs, and all positive samples were of subtype B. Whether HHV-6 is a factor in AD remains to be elucidated in future studies.
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Affiliation(s)
- Gabriel Westman
- Department of Medical Sciences, Uppsala University , Uppsala , Sweden
| | - Jonas Blomberg
- Department of Medical Sciences, Uppsala University , Uppsala , Sweden
| | - Zhibing Yun
- Department of Laboratory Medicine, Karolinska Institutet , Stockholm , Sweden
| | - Lars Lannfelt
- Department of Public Health and Caring Sciences, Uppsala University , Uppsala , Sweden
| | - Martin Ingelsson
- Department of Public Health and Caring Sciences, Uppsala University , Uppsala , Sweden
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Mallick-Searle T, Snodgrass B, Brant JM. Postherpetic neuralgia: epidemiology, pathophysiology, and pain management pharmacology. J Multidiscip Healthc 2016; 9:447-454. [PMID: 27703368 PMCID: PMC5036669 DOI: 10.2147/jmdh.s106340] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Herpes zoster, also known as shingles, is a distinctive clinical condition caused by the reactivation of latent varicella zoster (chickenpox) virus following an initial infection. Approximately 1 million cases of herpes zoster occur annually in the US, and one in every three people develops herpes zoster during their lifetime. Postherpetic neuralgia is a neuropathic pain syndrome characterized by pain that persists for months to years after resolution of the herpes zoster rash. It stems from damage to peripheral and central neurons that may be a byproduct of the immune/inflammatory response accompanying varicella zoster virus reactivation. Patients with postherpetic neuralgia report decreased quality of life and interference with activities of daily living. Approaches to management of postherpetic neuralgia include preventing herpes zoster through vaccination and/or antiviral treatment, and administering specific medications to treat pain. Current guidelines recommend treatment of postherpetic neuralgia in a hierarchical manner, with calcium channel α2-δ ligands (gabapentin and pregabalin), tricyclic antidepressants (amitriptyline, nortriptyline, or desipramine), or topical lidocaine patches as first-line drugs. The safety and tolerability of pharmacologic therapies for pain are important issues to consider as postherpetic neuralgia affects primarily an older population. Patients should be educated on appropriate dosing, titration if applicable, the importance of adherence to treatment for optimal effectiveness, and possible side effects. Health-care professionals play a key role in helping to ameliorate the pain caused by postherpetic neuralgia through early recognition and diligent assessment of the problem; recommending evidence-based treatments; and monitoring treatment adherence, adverse events, responses, and expectations. Nurse practitioners are especially crucial in establishing communication with patients and encouraging the initiation of appropriate pain-relieving treatments.
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Oliver SL, Yang E, Arvin AM. Varicella-Zoster Virus Glycoproteins: Entry, Replication, and Pathogenesis. CURRENT CLINICAL MICROBIOLOGY REPORTS 2016; 3:204-215. [PMID: 28367398 DOI: 10.1007/s40588-016-0044-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Varicella-zoster virus (VZV), an alphaherpesvirus that causes chicken pox (varicella) and shingles (herpes zoster), is a medically important pathogen that causes considerable morbidity and, on occasion, mortality in immunocompromised patients. Herpes zoster can afflict the elderly with a debilitating condition, postherpetic neuralgia, triggering severe, untreatable pain for months or years. The lipid envelope of VZV, similar to all herpesviruses, contains numerous glycoproteins required for replication and pathogenesis. PURPOSE OF REVIEW To summarize the current knowledge about VZV glycoproteins and their roles in cell entry, replication and pathogenesis. RECENT FINDINGS The functions for some VZV glycoproteins are known, such as gB, gH and gL in membrane fusion, cell-cell fusion regulation, and receptor binding properties. However, the molecular mechanisms that trigger or mediate VZV glycoproteins remains poorly understood. SUMMARY VZV glycoproteins are central to successful replication but their modus operandi during replication and pathogenesis remain elusive requiring further mechanistic based studies.
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Affiliation(s)
- Stefan L Oliver
- Departments of Pediatrics and Microbiology & Immunology, Stanford University School of Medicine, Stanford, California, 94305-5208
| | - Edward Yang
- Departments of Pediatrics and Microbiology & Immunology, Stanford University School of Medicine, Stanford, California, 94305-5208
| | - Ann M Arvin
- Departments of Pediatrics and Microbiology & Immunology, Stanford University School of Medicine, Stanford, California, 94305-5208
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Zosteriform Morphea Without History of Herpes Zoster Infection. Arch Rheumatol 2016; 31:390-392. [PMID: 30375569 DOI: 10.5606/archrheumatol.2017.5902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 05/23/2016] [Indexed: 11/21/2022] Open
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Cohrs RJ, Badani H, Bos N, Scianna C, Hoskins I, Baird NL, Gilden D. Alphaherpesvirus DNA replication in dissociated human trigeminal ganglia. J Neurovirol 2016; 22:688-694. [PMID: 27173396 DOI: 10.1007/s13365-016-0450-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 04/25/2016] [Accepted: 05/02/2016] [Indexed: 01/08/2023]
Abstract
Analysis of the frequency and PCR-quantifiable abundance of herpes simplex virus type 1 (HSV-1) and varicella zoster virus (VZV) DNA in multiple biological replicates of cells from dissociated randomly distributed human trigeminal ganglia (TG) of four subjects revealed an increase in both parameters and in both viruses during 5 days of culture, with no further change by 10 days. Dissociated TG provides a platform to analyze initiation of latent virus DNA replication within 5 days of culture.
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Affiliation(s)
- Randall J Cohrs
- Department of Neurology, University of Colorado School of Medicine, 12700 E. 19th Avenue, Mail Stop B182, Aurora, CO, 80045, USA.
- Department of Immunology and Microbiology, University of Colorado School of Medicine, Aurora, CO, 80045, USA.
| | - Hussain Badani
- Department of Neurology, University of Colorado School of Medicine, 12700 E. 19th Avenue, Mail Stop B182, Aurora, CO, 80045, USA
| | - Nathan Bos
- Department of Neurology, University of Colorado School of Medicine, 12700 E. 19th Avenue, Mail Stop B182, Aurora, CO, 80045, USA
| | - Charles Scianna
- Department of Neurology, University of Colorado School of Medicine, 12700 E. 19th Avenue, Mail Stop B182, Aurora, CO, 80045, USA
| | - Ian Hoskins
- Department of Neurology, University of Colorado School of Medicine, 12700 E. 19th Avenue, Mail Stop B182, Aurora, CO, 80045, USA
| | - Nicholas L Baird
- Department of Neurology, University of Colorado School of Medicine, 12700 E. 19th Avenue, Mail Stop B182, Aurora, CO, 80045, USA
| | - Don Gilden
- Department of Neurology, University of Colorado School of Medicine, 12700 E. 19th Avenue, Mail Stop B182, Aurora, CO, 80045, USA
- Department of Immunology and Microbiology, University of Colorado School of Medicine, Aurora, CO, 80045, USA
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Gershon AA, Gershon M. Varicella Zoster Virus and Giant Cell Arteritis. J Infect Dis 2016; 213:1859-61. [PMID: 27037085 DOI: 10.1093/infdis/jiw110] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 03/15/2016] [Indexed: 12/30/2022] Open
Affiliation(s)
| | - Michael Gershon
- Department of Pathology and Cell Biology, Columbia University College of Physicians and Surgeons, New York, New York
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Frequency of varicella zoster virus DNA in human adrenal glands. J Neurovirol 2016; 22:400-2. [PMID: 26843382 PMCID: PMC5654543 DOI: 10.1007/s13365-016-0425-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 01/12/2016] [Indexed: 10/22/2022]
Abstract
Varicella zoster virus (VZV) becomes latent in ganglionic neurons derived from neural crest cells. Because the adrenal gland also contains medullary chromaffin cells of neural crest origin, we examined human adrenal glands and medullary chromaffin cell tumors (pheochromocytomas) for VZV and herpes simplex virus type 1 (HSV-1). We found VZV, but not HSV-1, DNA in 4/63 (6 %) normal adrenal glands. No VZV transcripts or antigens were detected in the 4 VZV DNA-positive samples. No VZV or HSV-1 DNA was found in 21 pheochromocytomas.
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40
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Central nervous system infections caused by varicella-zoster virus. J Neurovirol 2016; 22:529-32. [DOI: 10.1007/s13365-016-0422-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 12/30/2015] [Accepted: 01/04/2016] [Indexed: 10/22/2022]
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Gershon AA, Gershon MD. THE JEREMIAH METZGER LECTURE VARICELLA ZOSTER VIRUS: FROM OUTSIDE TO INSIDE. TRANSACTIONS OF THE AMERICAN CLINICAL AND CLIMATOLOGICAL ASSOCIATION 2016; 127:282-299. [PMID: 28066065 PMCID: PMC5216500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Varicella zoster virus (VZV) gives rise to two diseases, a primary infection, varicella, and a secondary infection, zoster. Morbidity and mortality from VZV in the United States has decreased by 80% to 90% due to the effective use of attenuated live viral vaccines. Because latent VZV continues to reactivate, however, serious VZV-induced disease persists. Newly developed molecular analyses have revealed that zoster is more common than previously realized; moreover, the establishment of VZV latency in neurons, such as those of the enteric nervous system, which do not project to the skin, leads to unexpected, serious, and clandestine manifestations of disease, including perforating gastrointestinal ulcers and intestinal pseudo-obstruction. The development of the first animal model of zoster, in guinea pigs, now enables the pathophysiology of latency and reactivation to be analyzed.
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Galetta KM, Gilden D. Zeroing in on zoster: A tale of many disorders produced by one virus. J Neurol Sci 2015; 358:38-45. [PMID: 26454371 PMCID: PMC4628852 DOI: 10.1016/j.jns.2015.10.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 09/30/2015] [Accepted: 10/01/2015] [Indexed: 12/21/2022]
Abstract
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.
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Affiliation(s)
- Kristin M Galetta
- Department of Neurology, Brigham and Women's Hospital, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Don Gilden
- Departments of Neurology and Immunology & Microbiology, University of Colorado School of Medicine, Aurora, CO, USA.
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Gershon AA, Breuer J, Cohen JI, Cohrs RJ, Gershon MD, Gilden D, Grose C, Hambleton S, Kennedy PGE, Oxman MN, Seward JF, Yamanishi K. Varicella zoster virus infection. Nat Rev Dis Primers 2015; 1:15016. [PMID: 27188665 PMCID: PMC5381807 DOI: 10.1038/nrdp.2015.16] [Citation(s) in RCA: 369] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Infection with varicella zoster virus (VZV) causes varicella (chickenpox), which can be severe in immunocompromised individuals, infants and adults. Primary infection is followed by latency in ganglionic neurons. During this period, no virus particles are produced and no obvious neuronal damage occurs. Reactivation of the virus leads to virus replication, which causes zoster (shingles) in tissues innervated by the involved neurons, inflammation and cell death - a process that can lead to persistent radicular pain (postherpetic neuralgia). The pathogenesis of postherpetic neuralgia is unknown and it is difficult to treat. Furthermore, other zoster complications can develop, including myelitis, cranial nerve palsies, meningitis, stroke (vasculopathy), retinitis, and gastroenterological infections such as ulcers, pancreatitis and hepatitis. VZV is the only human herpesvirus for which highly effective vaccines are available. After varicella or vaccination, both wild-type and vaccine-type VZV establish latency, and long-term immunity to varicella develops. However, immunity does not protect against reactivation. Thus, two vaccines are used: one to prevent varicella and one to prevent zoster. In this Primer we discuss the pathogenesis, diagnosis, treatment, and prevention of VZV infections, with an emphasis on the molecular events that regulate these diseases. For an illustrated summary of this Primer, visit: http://go.nature.com/14xVI1.
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Affiliation(s)
- Anne A Gershon
- Columbia University College of Physicians and Surgeons, 630 West 168th Street, New York, New York 10032, USA
| | - Judith Breuer
- Department of Infection and Immunity, University College London, UK
| | - Jeffrey I Cohen
- Medical Virology Section, Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Massachusetts, USA
| | - Randall J Cohrs
- Departments of Neurology and Microbiology and Immunology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Michael D Gershon
- Department of Pathology and Cell Biology, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Don Gilden
- Departments of Neurology and Microbiology and Immunology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Charles Grose
- Division of Infectious Diseases/Virology, Children's Hospital, University of Iowa, Iowa City, Iowa, USA
| | - Sophie Hambleton
- Primary Immunodeficiency Group, Institute of Cellular Medicine, Newcastle University Medical School, Newcastle upon Tyne, UK
| | - Peter G E Kennedy
- Department of Neurology, Institute of Neurological Sciences, Southern General Hospital, Glasgow University, Glasgow, Scotland, UK
| | - Michael N Oxman
- Infectious Diseases Section, Medicine Service, Veterans Affairs San Diego Healthcare System, Division of Infectious Diseases, Department of Medicine, University of California San Diego School of Medicine, San Diego, California, USA
| | - Jane F Seward
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Koichi Yamanishi
- Research Foundation for Microbial Diseases, Osaka University, Suita, Osaka, Japan
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Zerboni L, Arvin A. Neuronal Subtype and Satellite Cell Tropism Are Determinants of Varicella-Zoster Virus Virulence in Human Dorsal Root Ganglia Xenografts In Vivo. PLoS Pathog 2015; 11:e1004989. [PMID: 26090802 PMCID: PMC4474629 DOI: 10.1371/journal.ppat.1004989] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 05/28/2015] [Indexed: 11/18/2022] Open
Abstract
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 observed in sensory ganglia infected with VZV may help to explain the neurologic sequelae often associated with zoster and PHN. Varicella zoster virus (VZV) causes varicella; herpes zoster results from VZV reactivation and is associated with post herpetic neuralgia (PHN). We hypothesized that VZV exhibits neuron-subtype specific tropism and that VZV tropism for satellite glial cells (SGC) results in loss of SGC functions that support neurons and contributes to VZV-related ganglionopathy. Using human DRG xenografts in SCID mice, we demonstrated that initial VZV access to neuronal cell bodies occurs by the axonal route, followed by axonal and contiguous spread between neuron-satellite cell complexes. VZV replication is restricted in mechanoreceptive neurons compared to nociceptive neurons. Despite restricted infection, mechanoreceptive neurons were selectively depleted in association with SGC loss following acute DRG infection. VZV infection of DRG triggers release of pro-inflammatory cytokines that cause neuronal damage. These observations may help to explain the neurologic sequelae often associated with herpes zoster and PHN.
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Affiliation(s)
- Leigh Zerboni
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, United States of America
- * E-mail:
| | - Ann Arvin
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, United States of America
- Departments of Pediatrics and Microbiology & Immunology, Stanford University School of Medicine, Stanford, California, United States of America
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Severe headache with eye involvement from herpes zoster ophthalmicus, trigeminal tract, and brainstem nuclei. Case Rep Radiol 2015; 2015:402015. [PMID: 25922780 PMCID: PMC4398962 DOI: 10.1155/2015/402015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 02/04/2015] [Accepted: 03/19/2015] [Indexed: 11/18/2022] Open
Abstract
A 43-year-old female presented with severe sharp stabbing right-sided periorbital and retroorbital area headache, dull-aching unilateral jaw pain, eyelid swelling, ptosis, and tearing of the right eye but no rash. The pain episodes lasted five minutes to one hour and occurred 10–15 times per day with unremitting milder pain between the attacks. She later developed an erythematous maculopapular rash over the right forehead and therefore was treated with antivirals. MRI performed one month after the onset revealed small hypersignal-T2 in the right dorsolateral mid-pons and from the right dorsolateral aspect of the pontomedullary region to the right dorsolateral aspect of the upper cervical cord, along the course of the principal sensory nucleus and spinal nucleus of the right trigeminal nerve. No definite contrast enhancement of the right brain stem/upper cervical cord was seen. Orbital imaging showed no abnormality of bilateral optic nerves/chiasm, extraocular muscles, and globes. Slight enhancement of the right V1, V2, and the cisterna right trigeminal nerve was detected. Our findings support the hypothesis of direct involvement by virus theory, reflecting rostral viral transmission along the gasserian ganglion to the trigeminal nuclei at brainstem and caudal spreading along the descending tract of CN V.
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Gershon AA, Chen J, Gershon MD. Use of Saliva to Identify Varicella Zoster Virus Infection of the Gut. Clin Infect Dis 2015; 61:536-44. [PMID: 25882301 DOI: 10.1093/cid/civ320] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Accepted: 04/08/2015] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Varicella zoster virus (VZV) establishes latency in dorsal root, cranial nerve, and enteric ganglia and can reactivate to cause zoster. Serious gastrointestinal dysfunction can result from VZV reactivation in enteric neurons (enteric zoster), but an absence of rash makes diagnosis difficult. We thus determined whether detecting VZV DNA in saliva facilitates identification of enteric zoster. METHODS Nested and real-time polymerase chain reaction were used to validate salivary VZV DNA as a surrogate marker of VZV reactivation and then to determine the utility of that marker for the identification of those individuals within a population defined by abdominal pain that might have enteric zoster. RESULTS Salivary VZV DNA was detected in 0 of 20 healthy negative controls, 11 of 16 positive controls with zoster or varicella (P < .0001), 2 of 2 patients with zoster sine herpete (P < .01), 6 of 11 patients with unexplained abdominal pain (P < .001), and 0 of 8 patients with unrelated gastrointestinal disorders. Salivary VZV DNA disappeared after recovery in 9 of 9 tested subjects with zoster, 2 of 2 with zoster sine herpete, and 5 of 5 with abdominal pain. One patient with abdominal pain and salivary VZV DNA had perforated gastric ulcers, necessitating a wedge gastrectomy. VZV DNA (vaccine type) was found in the resected stomach; immediate early (ORF63p) and late (gE) VZV proteins were immunocytochemically detected in gastric epithelium. After recovery, VZV DNA and proteins were not detected in gastric biopsies or saliva. CONCLUSIONS Detection of salivary VZV DNA in patients with abdominal pain helps to identify putative enteric zoster for investigation and treatment.
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Affiliation(s)
| | - Jason Chen
- Department of Pathology and Cell Biology, Columbia University College of Physicians and Surgeons, New York, New York
| | - Michael D Gershon
- Department of Pathology and Cell Biology, Columbia University College of Physicians and Surgeons, New York, New York
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Nandhagopal R, Khmeleva N, Jayakrishnan B, White T, Al Azri F, George J, Heintzman A, Al Zeedy K, Rorke-Adams L, Gujjar AR, Schmid DS, Al-Asmi A, Nagel MA, Jacob PC, Gilden D. Varicella zoster virus pneumonitis and brainstem encephalitis without skin rash in an immunocompetent adult. Open Forum Infect Dis 2014; 1:ofu064. [PMID: 25734134 PMCID: PMC4281813 DOI: 10.1093/ofid/ofu064] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 07/07/2014] [Indexed: 11/12/2022] Open
Abstract
Varicella zoster virus (VZV) pneumonitis and brainstem encephalitis developed in an immunocompetent adult without rash. Chest computed tomography exhibited nodularity; lung biopsy revealed multinucleated giant cells, Cowdry A inclusions, VZV antigen, and DNA. Varicella zoster virus central nervous system disease was verified by cerebrospinal fluid (CSF) anti-VZV IgG antibody with reduced serum/CSF ratios.
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Affiliation(s)
| | | | | | | | - Faisal Al Azri
- Radiology and Molecular Imaging , College of Medicine and Health Sciences , Muscat , Oman
| | | | | | | | - Lucy Rorke-Adams
- Department of Pathology , Children's Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania
| | | | - D Scott Schmid
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | - Don Gilden
- Departments of Neurology ; Microbiology , University of Colorado School of Medicine , Aurora
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Extensive VZV Encephalomyelitis without Rash in an Elderly Man. Case Rep Neurol Med 2014; 2014:694750. [PMID: 24864218 PMCID: PMC4017713 DOI: 10.1155/2014/694750] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 03/13/2014] [Accepted: 03/27/2014] [Indexed: 11/23/2022] Open
Abstract
Introduction. Varicella zoster virus (VZV) encephalomyelitis with cranial nerve involvement is rare. Characteristically it is preceded by a rash and primarily presents in the immunocompromised. The spectrum of VZV neurologic disease is extensive and it is not uncommon to present without rash. We report the case of an elderly otherwise immunocompetent patient who presented with diverse manifestations of VZV CNS infection all occurring without rash. Case Report. A 78-year-old man presented with 1 week of progressive paraparesis and sensory loss, malaise, and fevers. MRI of the neuraxis demonstrated numerous enhancing lesions: intramedullary, leptomeningeal, pachymeningeal, and cranial nerves. Cerebrospinal fluid (CSF) showed a white blood cell count of 420/μL with elevated protein (385 mg/dL). CSF VZV qualitative PCR was positive and CSF VZV immunofluorescence assay detected IgM antibody, confirming the diagnosis of VZV encephalomyelitis. Clinical and radiological improvement was observed after intravenous acyclovir treatment. Conclusion. This is a rare report of an immunocompetent patient with extensive VZV encephalomyelitis. We highlight the importance of considering this diagnosis even in the absence of the characteristic rash, and the potential risk of premature discontinuation of antiviral therapy once HSV has been excluded. Prompt recognition and treatment can dramatically reduce morbidity and mortality in patients.
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Guedon JMG, Zhang M, Glorioso JC, Goins WF, Kinchington PR. Relief of pain induced by varicella-zoster virus in a rat model of post-herpetic neuralgia using a herpes simplex virus vector expressing enkephalin. Gene Ther 2014; 21:694-702. [PMID: 24830437 DOI: 10.1038/gt.2014.43] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 03/24/2014] [Accepted: 03/27/2014] [Indexed: 11/09/2022]
Abstract
Acute and chronic pain (post-herpetic neuralgia or PHN) are encountered in patients with herpes zoster that is caused by reactivation of varicella-zoster virus (VZV) from a state of neuronal latency. PHN is often refractory to current treatments, and additional strategies for pain relief are needed. Here we exploited a rat footpad model of PHN to show that herpes simplex virus (HSV) vector-mediated gene delivery of human preproenkephalin (vHPPE) effectively reduced chronic VZV-induced nocifensive indicators of pain. VZV inoculated at the footpad induced prolonged mechanical allodynia and thermal hyperalgesia that did not develop in controls or with ultraviolet light-inactivated VZV. Subsequent footpad administration of vHPPE relieved VZV-induced pain behaviors in a dose-dependent manner for extended periods, and prophylactic vector administration prevented VZV-induced pain from developing. Short-term pain relief following low-dose vHPPE administration could be effectively prolonged by vector re-administration. HPPE transcripts were increased three- to fivefold in ipsilateral ganglia, but not in the contralateral dorsal root ganglia. VZV hypersensitivity and its relief by vHPPE were not affected by peripheral delivery of opioid receptor agonist or antagonist, suggesting that the efficacy was mediated at the ganglion and/or spinal cord level. These results support further development of ganglionic expression of enkephalin as a novel treatment for the pain associated with Zoster.
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Affiliation(s)
- J-M G Guedon
- 1] Graduate Program in Molecular Virology and Microbiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA [2] Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - M Zhang
- Department of Microbiology and Molecular Genetics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - J C Glorioso
- Department of Microbiology and Molecular Genetics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - W F Goins
- Department of Microbiology and Molecular Genetics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - P R Kinchington
- 1] Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA [2] Department of Microbiology and Molecular Genetics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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50
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Frequency and abundance of alphaherpesvirus DNA in human thoracic sympathetic ganglia. J Virol 2014; 88:8189-92. [PMID: 24789785 DOI: 10.1128/jvi.01070-14] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Alphaherpesvirus reactivation from thoracic sympathetic ganglia (TSG) and transaxonal spread to target organs cause human visceral disease. Yet alphaherpesvirus latency in TSG has not been well characterized. In this study, quantitative PCR detected varicella-zoster virus (VZV), herpes simplex virus 1 (HSV-1), and HSV-2 DNA in 117 fresh TSG obtained postmortem from 15 subjects. VZV DNA was found in 76 (65%) ganglia from all subjects, HSV-1 DNA was found in 5 (4%) ganglia from 3 subjects, and no HSV-2 was found.
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