1
|
Tao BKL, Soor D, Micieli JA. Herpes zoster in neuro-ophthalmology: a practical approach. Eye (Lond) 2024; 38:2327-2336. [PMID: 38538778 PMCID: PMC11306775 DOI: 10.1038/s41433-024-03030-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 02/12/2024] [Accepted: 03/08/2024] [Indexed: 08/09/2024] Open
Abstract
Herpes Zoster (HZ) or shingles is the reactivation of the Varicella Zoster Virus (VZV), usually along a single sensory nerve, but can affect both sensory and motor cranial nerves. Major risk factors for HZ include immunosuppressed status and age older than 60 years. In the United States, the lifetime risk of HZ is approximately 30%. Worldwide, the median incidence of HZ is 4-4.5 per 1000 person-years across the Americas, Eurasia, and Australia. HZ ophthalmicus, occurring in 10-20% of patients, is an ophthalmic emergency characterized by VZV reactivation along the V1 branch of the trigeminal nerve. Approximately half of this patient subgroup will go on to develop ocular manifestations, requiring prompt diagnosis and management. While anterior segment complications are more common, neuro-ophthalmic manifestations are rarer and can also occur outside the context of overt HZ ophthalmicus. Neuro-ophthalmic manifestations include optic neuropathy, acute retinal necrosis or progressive outer retinal necrosis, cranial neuropathy (isolated or multiple), orbitopathy, and CNS manifestations. Although typically a clinical diagnosis, diagnosis may be aided by neuroimaging and laboratory (e.g., PCR and serology) studies. Early antiviral therapy is indicated as soon as a presumptive diagnosis of VZV is made and the role of corticosteroids remains debated. Generally, there is wide variation of prognosis with neuro-ophthalmic involvement. Vaccine-mediated prevention is recommended. In this review, we summarize neuro-ophthalmic manifestations of VZV.
Collapse
Affiliation(s)
- Brendan Ka-Lok Tao
- Faculty of Medicine, The University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Deep Soor
- Faculty of Arts & Science, University of Toronto, 100 St. George Street, Toronto, ON, M5S 3G3, Canada
| | - Jonathan A Micieli
- Faculty of Arts & Science, University of Toronto, 100 St. George Street, Toronto, ON, M5S 3G3, Canada.
- Department of Ophthalmology and Vision Sciences, University of Toronto, 340 College Street, Toronto, ON, M5T 3A9, Canada.
- Division of Neurology, Department of Medicine, University of Toronto, 6 Queen's Park Crescent West, Toronto, ON, M5S 3H2, Canada.
- Kensington Vision and Research Center, 340 College Street, Toronto, ON, M5T 3A9, Canada.
- St. Michael's Hospital, 30 Bond Street, 7 Donnelly Eye Clinic, Toronto, ON, M5B 1W8, Canada.
| |
Collapse
|
2
|
Xie JS, Yang SP, Munoz DG, Micieli JA. Bilateral Vision Loss From Varicella Zoster Virus-Associated Giant Cell Arteritis. J Neuroophthalmol 2023; 43:e109-e110. [PMID: 34924537 DOI: 10.1097/wno.0000000000001416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Jim S Xie
- Michael G. DeGroote School of Medicine (JSX), McMaster University, Hamilton, Canada; Division of Rheumatology (SPY), Department of Medicine, University of Toronto, Toronto, Canada; Department of Laboratory Medicine (DGM), Unity Health, Toronto, Canada; Department of Laboratory Medicine and Pathobiology (DGM), University of Toronto, Toronto, Canada; Department of Ophthalmology and Vision Sciences (JAM), University of Toronto, Toronto, Canada; Division of Neurology, Department of Medicine (JAM), University of Toronto, Toronto, Canada; and Kensington Vision and Research Centre (JAM), Toronto, Canada
| | | | | | | |
Collapse
|
3
|
Nichani P, Micieli JA. Granuloma Annulare, Scalp Necrosis, and Ischemic Optic Neuropathy From Giant Cell Arteritis After Varicella-Zoster Virus Vaccination. J Neuroophthalmol 2021; 41:e145-e148. [PMID: 32235218 DOI: 10.1097/wno.0000000000000947] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Prem Nichani
- Faculty of Medicine (PN), University of Toronto, Toronto, Canada ; Department of Ophthalmology and Vision Sciences (JAM), University of Toronto, Toronto, Canada ; and Division of Neurology (JAM), Department of Medicine, University of Toronto, Toronto, Canada
| | | |
Collapse
|
4
|
Agger WA, Deviley JA, Borgert AJ, Rasmussen CM. Increased Incidence of Giant Cell Arteritis After Introduction of a Live Varicella Zoster Virus Vaccine. Open Forum Infect Dis 2021; 8:ofaa647. [PMID: 33598502 PMCID: PMC7875324 DOI: 10.1093/ofid/ofaa647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 12/28/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Varicella zoster virus (VZV) has been associated with giant cell arteritis (GCA). The introduction of a live attenuated vaccine against this virus (ZVL) might have changed the incidence of GCA. METHODS The incidence of GCA was retrospectively measured using 2 matched cohorts seen in a regional health system located in the Midwestern United States: ZVL recipients from the years 2007 through 2015 following the introduction of the vaccine and nonrecipients from the years 2000 through 2015. RESULTS In the ZVL cohort, a significant increase of GCA was associated with clinical criteria alone for the diagnosis of GCA (hazard ratio [HR], 2.70; 95% CI, 1.48-4.45; P = .004). In addition, using only pathologically confirmed GCA, the same matched cohort comparison analysis also found that ZVL recipients were at significantly higher risk than those who did not receive ZVL (HR, 2.70; 95% CI, 1.48-4.95; P = .001). CONCLUSION Using a matched cohort, retrospective comparison, ZVL was associated with an increased incidence of GCA.
Collapse
Affiliation(s)
- William A Agger
- Department of Infectious Disease, Gundersen Health System, La Crosse, Wisconsin, USA
- Department of Medical Research, Gundersen Health System, La Crosse, Wisconsin, USA
| | - Jake A Deviley
- Department of Medical Research, Gundersen Health System, La Crosse, Wisconsin, USA
| | - Andrew J Borgert
- Department of Medical Research, Gundersen Health System, La Crosse, Wisconsin, USA
| | - Cary M Rasmussen
- Department of Medical Research, Gundersen Health System, La Crosse, Wisconsin, USA
| |
Collapse
|
5
|
Abstract
The 3 neurotropic human herpes viruses, herpes simplex virus (HSV) type 1 and 2, and varicella-zoster virus (VZV) are capable of establishment of latent viral infection in trigeminal and dorsal root ganglia. HSV-1, and more rarely HSV-2, carries the potential to cause meningoencephalitis, with devastating clinical consequences. Immediate diagnosis, based on clinical presentation, MRI imaging, and molecular diagnosis by polymerase chain reaction, and initiation of therapy are mandatory to reduce mortality and neurologic permanent sequelae. VZV is associated with postprimary infection and reactivation disorders that may affect anywhere in the neuraxis. Early diagnosis and therapy are required.
Collapse
Affiliation(s)
- Israel Steiner
- Department of Neurology, Felsenstein Medical Research Institut, Rabin Medical Center, Beilinson Hospital, Beilinson Campus, Petach Tikva 49100, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel.
| | - Felix Benninger
- Department of Neurology, Felsenstein Medical Research Institut, Rabin Medical Center, Beilinson Hospital, Beilinson Campus, Petach Tikva 49100, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| |
Collapse
|
6
|
Ostrowski RA, Metgud S, Tehrani R, Jay WM. Varicella Zoster Virus in Giant Cell Arteritis: A Review of Current Medical Literature. Neuroophthalmology 2019; 43:159-170. [PMID: 31312240 DOI: 10.1080/01658107.2019.1604763] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 03/30/2019] [Accepted: 04/04/2019] [Indexed: 10/26/2022] Open
Abstract
In recent years, the search for the cause of giant cell arteritis (GCA) has led investigators to look to varicella zoster virus (VZV) as the answer. In some ways, the nature of VZV infection makes it an attractive explanation for the pathology observed in GCA. However, studies to date yield a level of inconsistency that still leaves uncertainty as to whether VZV directly causes GCA, and positive findings have not been successfully reproduced.
Collapse
Affiliation(s)
- Rochella A Ostrowski
- Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Loyola, University Chicago, Stritch School of Medicine, Maywood, Illinois, USA
| | - Sheela Metgud
- Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Loyola, University Chicago, Stritch School of Medicine, Maywood, Illinois, USA
| | - Rodney Tehrani
- Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Loyola, University Chicago, Stritch School of Medicine, Maywood, Illinois, USA
| | - Walter M Jay
- Department of Ophthalmology, Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois, USA
| |
Collapse
|
7
|
Clinical Features of Varicella-Zoster Virus Infection. Viruses 2018; 10:v10110609. [PMID: 30400213 PMCID: PMC6266119 DOI: 10.3390/v10110609] [Citation(s) in RCA: 158] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 10/30/2018] [Accepted: 10/31/2018] [Indexed: 12/30/2022] Open
Abstract
Varicella-zoster virus (VZV) is a pathogenic human herpes virus that causes varicella (chickenpox) as a primary infection, following which it becomes latent in peripheral ganglia. Decades later, the virus may reactivate either spontaneously or after a number of triggering factors to cause herpes zoster (shingles). Varicella and its complications are more severe in the immunosuppressed. The most frequent and important complication of VZV reactivation is postherpetic neuralgia, the cause of which is unknown and for which treatment is usually ineffective. Reactivation of VZV may also cause a wide variety of neurological syndromes, the most significant of which is a vasculitis, which is treated with corticosteroids and the antiviral drug acyclovir. Other VZV reactivation complications include an encephalitis, segmental motor weakness and myelopathy, cranial neuropathies, Guillain–Barré syndrome, enteric features, and zoster sine herpete, in which the viral reactivation occurs in the absence of the characteristic dermatomally distributed vesicular rash of herpes zoster. There has also been a recent association of VZV with giant cell arteritis and this interesting finding needs further corroboration. Vaccination is now available for the prevention of both varicella in children and herpes zoster in older individuals.
Collapse
|
8
|
Should Antiviral/Anti-Varicella Zoster Virus Treatment Be Used in Patients With Giant Cell Arteritis? J Neuroophthalmol 2018; 39:134-141. [PMID: 29877905 DOI: 10.1097/wno.0000000000000664] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
|
9
|
Abstract
PURPOSE OF REVIEW To summarize the recent advances in the prevention of herpes zoster. The recent Food and Drug Administration (FDA) approval of an adjuvanted subunit vaccine may have a significant impact on the prevention of herpes zoster ophthalmicus. RECENT FINDINGS There are currently two commercially available vaccines for the prevention of herpes zoster: a live-attenuated vaccine and a new recombinant subunit vaccine. The latter has been shown to be more effective, have fewer contraindications, but requires two separate inoculations, has higher reactogenicity, and has only short-term postmarketing surveillance. SUMMARY The adjuvanted zoster subunit vaccine offers several advantages over the previously available vaccine. Following the current treatment recommendations, physicians should recommend vaccination to all patients older than 50 years of age with no contraindications, this should also prevent ophthalmic complications of the disease.
Collapse
|
10
|
Polymyalgia Rheumatica After Herpes-Zoster. Arch Rheumatol 2018; 33:494-495. [PMID: 30874245 DOI: 10.5606/archrheumatol.2018.6859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Accepted: 02/03/2018] [Indexed: 11/21/2022] Open
|