Concomitant blindness and deafness, after varicella zoster virus encephalitis in HIV positive patient

Disseminated herpes zoster with acute encephalitis in an immunocompetent elderly man

Varicella-zoster virus (VZV) encephalitis typically occurs in immunosuppressed populations such as in patients with HIV/AIDS, transplantation and autoimmune disease. However, it can also occur in healthy hosts. We present the case of an immunocompetent patient who presented with a clinical picture of VZV encephalitis with the sole precipitating factor of advanced age. We want to stress the importance of including VZV in the differential diagnosis for encephalitis in healthy elderly hosts. In patients with a clinical diagnosis of encephalitis, the presence of herpes zoster rash increases the likelihood of VZV encephalitis. However, the absence of a skin rash may not exclude the diagnosis. In general, there is an elevated risk of transient ischaemic attack and stroke associated with the diagnosis of herpes zoster infection. Early treatment is essential to prevent complications, including death.

Correlation between herpes zoster and stroke-A case-control study

Cerebrovascular accident is the second most common cause of death in the world. Herpes zoster (HZ) is reported to be a major trigger of the stroke syndrome. Considering the high prevalence of stroke in Iran, we carried out a study to assess the correlation between stroke and HZ. This is one of the very few studies carried out on this correlation in Asian nations. One hundred and five cases and 105 controls were included in this study. The cases had been diagnosed with stroke by a neurologist and confirmed by brain imaging. The controls had never had any type of stroke. Both groups were between 30 and 90 years of age. We looked for the HZ infection in both groups. Logistic regression analysis was used to evaluate the association between stroke and HZ. The mean age of the cases was 63.95 ± 12.24 years and the man age of the controls was 66.99 ± 14.58 years. There was a significant difference in the HZ infection between the cases and the controls (P < .0001). Head zoster (including ophthalmic zoster) was significantly higher in the case group than the control group (P < .0001). The risk of stroke was the highest 2-4 weeks after the onset of HZ and the incidences of ischemic stroke were higher than those of hemorrhagic stroke (P < .0001). In an analysis adjusted for the age, sex, and hypertension, HZ was found to be associated with an increased risk of stroke (odds ratio, 5.84; 95% confidence interval, 1.98-8.23). Close monitoring is suggested for cerebrovascular diseases in patients who have had the head zoster, especially in the first month after the infection.

Varicella infection in the Middle East: Prevalence, complications, and vaccination

Varicella (chickenpox) is the primary infection of varicella-zoster virus (VZV), it is a mild self-limiting infection, but it is also highly contagious and can cause severe complications among high-risk group of individuals. It is usually a childhood infection providing lifelong immunity, but adults without varicella history are also susceptible to infection. High-risk group of individuals is more likely to develop serious complications. Varicella vaccine was introduced to protect this group of individuals and to prevent epidemic spread of VZV infection in a community. Thus, it was added to the recommended vaccination schedules for children in most developed countries. This review aimed to outline varicella status, seroprevalence, complications, and vaccination in the Middle East region. Based on our findings, children were the most affected age group, but there are also adult cases due to high number of expatriates, especially in Gulf Cooperation Council countries. Central nervous system involvements and skin diseases followed by varicella pneumonia were the most varicella-associated complications. Varicella vaccine was introduced in most Middle East countries, either mandatory by the Ministries of Health or optional in the private clinics. Few numbers of studies have reported an obvious reduction in varicella prevalence, hospitalizations, and deaths in the Middle East following varicella vaccination. A basic database about varicella infection before the initiation and implementation of a vaccination policy is essential to determine the target group of individuals. As far as our knowledge, this is the first review about varicella infection in the Middle East.