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Wright J, Crowcroft N, McLachlan E, Perez-Iratxeta C, Joh E, Osman S, Hatchette T, Deeks SL, Wilson SE, Hughes SL, Halperin SA, Buchan SA, Ward BJ, Gubbay J, Brisson M, Serhir B, Severini A, Bolotin S. Population immunity to varicella in Canada: A Canadian Immunization Research Network (CIRN) study. PLoS One 2024; 19:e0309154. [PMID: 39159217 PMCID: PMC11332944 DOI: 10.1371/journal.pone.0309154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 08/06/2024] [Indexed: 08/21/2024] Open
Abstract
INTRODUCTION The incidence of varicella in Canada has decreased by almost 99% since vaccination was introduced. However, variation in the timing and eligibility of vaccination programs across the country has resulted in some cohorts being under-vaccinated and therefore potentially susceptible to infection. METHODS We used nationally representative specimens from the Biobank of Statistics Canada's Canadian Health Measures Survey (CHMS) as well as residual specimens from Ontario collected between 2009-2014 to estimate population immunity across age-groups and geography, and identify any groups at increased risk of varicella infection. RESULTS The weighted proportion of specimens with antibody levels above the threshold of protection was 93.6% (95% CI: 92.4, 95.0). Protection was lowest among those aged 3-5 years (54.3%; 95% CI: 47.3, 61.4), but increased with age. Individuals born outside Canada had more than twice the odds of varicella susceptibility than those born in Canada (aOR: 2.7; 95% CI: 1.4, 5.0; p = 0.004). There were no differences by sex or geography within Canada, and there were no statistically significant differences when Ontario CHMS sera were compared to Ontario residual sera, apart from in participants aged 12-19 year age-group, for whom the CHMS estimate (91.2%; 95% CI: 86.7, 95.7) was significantly higher (p = 0.03) than that from residual specimens (85.9%, 95% CI: 81.1, 90.8). DISCUSSION Varicella immunity in Canada is changing. Children appear to have low population immunity, placing them at greater risk of infection and at increased risk of severe disease as they age. Our results underscore the importance of performing periodic serosurveys to monitor further population immunity changes as the proportion of vaccine-eligible birth-cohorts increases, and to continually assess the risk of outbreaks.
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Affiliation(s)
| | - Natasha Crowcroft
- Centre for Vaccine Preventable Diseases, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - Elizabeth McLachlan
- National Microbiology Laboratory Branch, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | | | - Eugene Joh
- Public Health Ontario, Toronto, Ontario, Canada
| | - Selma Osman
- Centre for Vaccine Preventable Diseases, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Todd Hatchette
- Canadian Center for Vaccinology (CCfV), IWK Health Centre, Nova Scotia Health Authority (NSHA), and Dalhousie University, Halifax, Nova Scotia (NS), Canada
| | - Shelley L. Deeks
- Community Health and Epidemiology, Dalhousie University, Nova Scotia, Canada
- Nova Scotia Department of Health and Wellness, Halifax, Canada
| | - Sarah E. Wilson
- Public Health Ontario, Toronto, Ontario, Canada
- Centre for Vaccine Preventable Diseases, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | - Scott A. Halperin
- Canadian Center for Vaccinology (CCfV), IWK Health Centre, Nova Scotia Health Authority (NSHA), and Dalhousie University, Halifax, Nova Scotia (NS), Canada
- Departments of Pediatrics and Microbiology & Immunology, Dalhousie University, Halifax, NS, Canada
| | - Sarah A. Buchan
- Public Health Ontario, Toronto, Ontario, Canada
- Centre for Vaccine Preventable Diseases, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Brian J. Ward
- Department of Microbiology and Immunology, McGill University, Montreal, QC, Canada
| | - Jonathan Gubbay
- Public Health Ontario, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - Marc Brisson
- Département de Médecine Sociale et Préventive, Université Laval, Québec City, QC, Canada
| | - Bouchra Serhir
- Laboratoire de Santé Publique du Québec/Institut National de Santé Publique du Québec, Sainte-Anne-de-Bellevue, QC, Canada
| | - Alberto Severini
- National Microbiology Laboratory Branch, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, MB, Canada
| | - Shelly Bolotin
- Public Health Ontario, Toronto, Ontario, Canada
- Centre for Vaccine Preventable Diseases, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
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Structured Imaging Approach for Viral Encephalitis. Neuroimaging Clin N Am 2023; 33:43-56. [DOI: 10.1016/j.nic.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Heldman MR, Aagaard KM, Hill JA. Assessing and restoring adaptive immunity to HSV, VZV, and HHV-6 in solid organ and hematopoietic cell transplant recipients. Clin Microbiol Infect 2022; 28:1345-1350. [PMID: 35150885 PMCID: PMC9363517 DOI: 10.1016/j.cmi.2022.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 12/22/2021] [Accepted: 02/01/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Herpes simplex virus (HSV) 1 and 2, varicella zoster virus (VZV), and human herpesvirus 6 (HHV-6) cause severe infections in immunocompromised hosts. Interventions to optimize virus-specific adaptive immunity may have advantages over antivirals in the prophylaxis and treatment of these infections. OBJECTIVES We sought to review adaptive immune responses and methods for assessing and replenishing cellular and humoral immunity to HSV, VZV, and HHV-6 in solid organ transplant and hematopoietic cell transplant recipients. SOURCES We searched PubMed for relevant studies on immune responses to HSV, VZV, and HHV-6 as well as studies describing methods for evaluating and restoring cell-mediated immunity to other double-stranded DNA viruses in transplant recipients. Recent studies, randomized controlled trials, and investigations highlighting key concepts in clinical virology were prioritized for inclusion. CONTENT We describe the mechanisms of adaptive immunity to HSV, VZV, and HHV-6 and limitations of antivirals as prophylaxis and treatment for these infections in solid organ transplant and hematopoietic cell transplant recipients. We review methods for measuring and restoring cellular immunity to double-stranded DNA viruses; their potential applications to management of HSV, VZV, and HHV-6 in immunocompromised hosts; and barriers to clinical use. Vaccination and virus-specific T cell therapies are discussed in detail. IMPLICATIONS The growing repertoire of diagnostic and therapeutic techniques focused on virus-specific adaptive immunity provides a novel approach to management of viral infections in transplant recipients. Investigations to optimize such interventions specifically in HSV, VZV, and HHV-6 are needed.
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Affiliation(s)
- Madeleine R. Heldman
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Kaja M. Aagaard
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Joshua A. Hill
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA
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Prikhodchenko NG. Varicella-pox virus infection: features of the course, clinical manifestations, complications, and possibilities for prevention. TERAPEVT ARKH 2021; 93:1401-1406. [DOI: 10.26442/00403660.2021.11.201192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 01/28/2022] [Indexed: 11/22/2022]
Abstract
Varicella zoster virus (VZV) is a pathogenic human herpes virus that causes chickenpox as a primary infection, after which it persists for a long time and latently in the peripheral ganglia. Decades later, the virus can reactivate spontaneously, or after exposure to a number of triggering factors, causing herpes zoster (shingles). The reasons for the long-term persistence of VZV are gradually being revealed, but some issues remain unknown at the moment. Chickenpox and its complications are especially difficult in immunocompromised patients, but they are often found in people without risk factors. The most frequent and important complication of VZV reactivation is postherpetic neuralgia; encephalitis, segmental motor weakness and myelopathy, cranial neuropathies, and gastrointestinal complications often develop. The only scientifically proven effective and affordable way of mass prevention at the moment is vaccination. Chickenpox vaccines are safe and effective in preventing morbidity and mortality associated with the disease.
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Epidemiological impact of universal varicella vaccination on consecutive emergency department visits for varicella and its economic impact among children in Kobe City, Japan. J Infect Chemother 2021; 28:35-40. [PMID: 34620534 DOI: 10.1016/j.jiac.2021.09.017] [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] [Received: 07/24/2021] [Revised: 09/17/2021] [Accepted: 09/24/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Previous studies reported a dramatic decline in the incidence of varicella and varicella-related deaths after implementing universal varicella vaccination (VarV). Although previous studies reported the effectiveness and economic impact of VarV, they were unknown in the emergency department (ED) setting. METHODS To determine the effectiveness and economic impact of VarV in the ED, Kobe, Japan, we retrospectively reviewed the clinical database of consecutive patients younger than 16 years presenting to our primary ED from 2011 to 2019. RESULTS Of the 265,191 children presenting to our ED, 3,092 patients were clinically diagnosed with varicella. The number of patients with varicella was approximately 500 annually, before introducing the universal two-dose VarV for children aged 1 to <3 years in October 2014, in the Japanese national immunization program, and decreased to approximately 200 in 2019. The number of patients with varicella younger than 1 year (ineligible for the vaccination) also decreased. Regarding the economic impact, the medical cost in our ED reduced after the introduction of VarV was JPY 4.1 million (US$ 40,049) annually. From the central data, approximately 95% of children were vaccinated after October 2014; however, a relatively large percentage of infected unvaccinated children (59.0%) presented to ED in this study. After the implementation of the universal VarV, infection was mainly observed in older children (i.e., the unvaccinated generation). CONCLUSIONS Our data showed the effectiveness and economic impact of VarV in the ED setting. Additionally, our data suggested that the public vaccination program should include older unvaccinated children and other unvaccinated individuals.
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Li Z, Yao Y, Lu X, Liu J, Huang Z, Sun X, Lu Y. Impact of a two-dose varicella immunization program on the incidence of varicella: a multi-year observational study in Shanghai, China. Expert Rev Vaccines 2021; 20:1177-1183. [PMID: 34343035 DOI: 10.1080/14760584.2021.1963236] [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: 10/20/2022]
Abstract
BACKGROUND It remains hesitant to include a two-dose varicella vaccine (VarV) in a national routine immunization program in China. We aimed to quantify the impact of the two-dose VarV on varicella incidence in Shanghai. RESEARCH DESIGN AND METHODS We directly extracted the data of varicella cases and VarV doses in 2013-2020 in Shanghai, and then estimated the effects of two-dose VarV using a Serfling model. RESULTS A two-dose VarV immunization program has been extensively implemented since October 2017 and become free since August 2018 in Shanghai. Before and after this program, varicella cases significantly declined in children (P < 0.01), whereas did not in adults aged >18 years (P = 0.22). Compared to the predicted number of varicella cases, actual number was significantly lower by 8% in 2018 and 28% in 2019. Among children aged 4-6 years, the reduction in varicella cases was largest. Moreover, there was a significant reduction in varicella cases throughout 2020 (P < 0.001), in which the decrease due to social distancing for the COVID-19 was 54%. CONCLUSIONS A two-dose VarV immunization program may further reduce approximately one-third of varicella cases in Shanghai. Children <4 years and adults benefit less in this program, which warrants enhancing the immunization.
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Affiliation(s)
- Zhi Li
- Division Of Immunization, Shanghai Municipal Center For Disease Control And Prevention, Shanghai China
| | - Ye Yao
- Department Of Biostatistics, Ministry Of Education Key Laboratory Of Public Health Safety, School Of Public Health, Fudan University, Shanghai, China
| | - Xinyue Lu
- Department Of Epidemiology, Ministry Of Education Key Laboratory Of Public Health Safety, School Of Public Health, Fudan University, Shanghai China
| | - Jiechen Liu
- Division Of Immunization, Shanghai Municipal Center For Disease Control And Prevention, Shanghai China
| | - Zhuoying Huang
- Division Of Immunization, Shanghai Municipal Center For Disease Control And Prevention, Shanghai China
| | - Xiaodong Sun
- Division Of Immunization, Shanghai Municipal Center For Disease Control And Prevention, Shanghai China
| | - Yihan Lu
- Department Of Epidemiology, Ministry Of Education Key Laboratory Of Public Health Safety, School Of Public Health, Fudan University, Shanghai China
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Palacios-Pedrero MÁ, Osterhaus ADME, Becker T, Elbahesh H, Rimmelzwaan GF, Saletti G. Aging and Options to Halt Declining Immunity to Virus Infections. Front Immunol 2021; 12:681449. [PMID: 34054872 PMCID: PMC8149791 DOI: 10.3389/fimmu.2021.681449] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 04/26/2021] [Indexed: 12/15/2022] Open
Abstract
Immunosenescence is a process associated with aging that leads to dysregulation of cells of innate and adaptive immunity, which may become dysfunctional. Consequently, older adults show increased severity of viral and bacterial infections and impaired responses to vaccinations. A better understanding of the process of immunosenescence will aid the development of novel strategies to boost the immune system in older adults. In this review, we focus on major alterations of the immune system triggered by aging, and address the effect of chronic viral infections, effectiveness of vaccination of older adults and strategies to improve immune function in this vulnerable age group.
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Affiliation(s)
| | - Albert D M E Osterhaus
- Research Center for Emerging Infections and Zoonoses, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Tanja Becker
- Research Center for Emerging Infections and Zoonoses, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Husni Elbahesh
- Research Center for Emerging Infections and Zoonoses, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Guus F Rimmelzwaan
- Research Center for Emerging Infections and Zoonoses, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Giulietta Saletti
- Research Center for Emerging Infections and Zoonoses, University of Veterinary Medicine Hannover, Hannover, Germany
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Habib MA, Prymula R, Carryn S, Esposito S, Henry O, Ravault S, Usonis V, Wysocki J, Gillard P, Povey M. Correlation of protection against varicella in a randomized Phase III varicella-containing vaccine efficacy trial in healthy infants. Vaccine 2021; 39:3445-3454. [PMID: 33736915 DOI: 10.1016/j.vaccine.2021.02.074] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 02/15/2021] [Accepted: 02/28/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Varicella vaccination confers high and long-lasting protection against chickenpox and induces robust immune responses, but an absolute correlate of protection (CoP) against varicella has not been established. This study models the relationship between varicella humoral response and protection against varicella. METHODS This was a post-hoc analysis of data from a Phase IIIb, multicenter, randomized trial (NCT00226499) conducted in ten varicella-endemic European countries. Healthy children aged 12-22 months were randomized 3:3:1 to receive one dose of measles-mumps-rubella and one dose of varicella vaccine (one-dose group) or two doses of measles-mumps-rubella-varicella vaccine (two-dose group) or two doses of measles-mumps-rubella vaccine (control group) six weeks apart. The study remained observer-blind until completion, except in countries with obligatory additional immunizations. The objective was to correlate varicella-specific antibody concentrations with protection against varicella and probability of varicella breakthrough, using Cox proportional hazards and Dunning and accelerated failure time statistical models. The analysis was guided by the Prentice framework to explore a CoP against varicella. RESULTS The trial included 5803 participants, 5289 in the efficacy (2266: one-dose group, 2279: two-dose group and 744: control group) and 5235 (2248, 2245 and 742 in the same groups) in the immunogenicity cohort. The trial ended in 2016 with a median follow-up time of 9.8 years. Six weeks after vaccination with one- or two-dose varicella-containing vaccine, more than 93.0% of vaccinees were seropositive for varicella-specific antibodies. Estimated vaccine efficacy correlated positively with antibody concentrations. The fourth Prentice CoP criterion was not met, due to predicted positive vaccine efficacy in seronegative participants. Further modelling showed decreased probability of moderate to severe varicella breakthrough with increasing varicella-specific antibody concentrations (ten-year probability <0.1 for antibody concentrations ≥2-fold above the seropositivity cut-off). CONCLUSIONS Varicella-specific antibody concentrations are a good predictor of protection, given their inverse correlation with varicella occurrence. CLINICAL TRIAL NCT00226499.
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Affiliation(s)
| | - Roman Prymula
- Charles University, Faculty of Medicine, Department of Social Medicine, Simkova street 870, 500 03 Hradec Kralove, Czechia.
| | | | - Susanna Esposito
- Pediatric Clinic Pietro Barilla Children's Hospital, Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43126 Parma, Italy.
| | - Ouzama Henry
- GSK, 14200 Shady Grove Road, Rockville, MD 20850, USA.
| | | | - Vytautas Usonis
- Clinic of Children's Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, M. K. Čiurlionio g. 21/27, 03101 Vilnius, Lithuania.
| | - Jacek Wysocki
- Department of Preventive Medicine, University of Medical Sciences, ul. Święcickiego 6, 60-781 Poznań, Poland.
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Immunogenicity and safety profiles of a new MAV/06 strain varicella vaccine in healthy children: A multinational, multicenter, randomized, double-blinded, active-controlled phase III study. Vaccine 2021; 39:1758-1764. [PMID: 33627245 DOI: 10.1016/j.vaccine.2021.02.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 01/12/2021] [Accepted: 02/06/2021] [Indexed: 11/22/2022]
Abstract
Immunization is the most effective preventive strategy against varicella. While the Oka strain is commonly used for varicella vaccination worldwide, Korea widely uses the MAV/06 strain. A new live attenuated MAV/06 strain varicella vaccine (MG1111), which uses the new cell line Medical Research Council-5 for better viral propagation, was developed. MG1111 was approved by Korean health authorities. Here, we report the results of phase III, randomized, double-blind, multicenter study conducted in Korea and Thailand, which compared the immunogenicity and safety profiles of MG1111 versus the control vaccine, VarivaxTM. In total, 515 healthy children (12 month-12 years) were randomized 1:1 to receive either the MG1111 or control vaccine (MG1111: 258, Control: 257). The seroconversion rate (SCR) and geometric mean titer (GMT) were measured using the fluorescent antibody to membrane antigen (FAMA) test. The MG1111 group achieved a SCR of 97.9% (95% CI: 95.2-99.3) after vaccination. The lower limit of 95% CI for SCR difference (MG1111-VarivaxTM) was -4.0%, which was higher than the specified non-inferiority margin of -10%. Further, the GMT of the MG1111 increased from 2.0 to 74.2 (95% CI: 65.0-84.8) and the lower limits of the 95% CI for post-vaccination GMT ratios (MG1111/VarivaxTM) were 0.55 higher than the specified parameter of 0.5. Therefore, the MG1111 group was not statistically inferior to the control vaccine group in terms of SCR and GMT. Furthermore, the MG1111 and control vaccine groups were not significantly different in the percentage of participants showing adverse events-solicited, local, or systemic during 43-day period of observation and serious adverse events during 6 month of observation. The present results indicate that MG1111was not immunologically inferior to VarivaxTM, and safety profiles of MG1111 are similar to those of VarivaxTM.
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Abstract
Central nervous system (CNS) vasculopathy caused by varicella zoster virus (VZV) is a rare condition. Rarer still is the development of CNS vasculopathy in the absence of a typical zoster rash, a phenomenon known as zoster sine herpete. We report a case of a 34-year-old male with HIV, non-compliant with highly active antiretroviral therapy (HAART), who presented with left-sided temporal headaches and numbness without rash. The patient had a complicated one-month hospital stay when he was initially diagnosed with mycobacterium avium complex (MAC) tuberculosis infection and treated with isoniazid, rifabutin, ethambutol, and azithromycin. Additionally, he was thought to have immune reconstitution inflammatory syndrome (IRIS) and was given steroids. Unfortunately, he presented one day post-discharge with lethargy, aphasia, and dysphagia and was found to have acute/subacute infarcts affecting multiple areas of the brain. CT angiogram (CTA) of the brain showed evidence of multifocal areas of mild to moderate stenosis throughout the intracranial arterial circulation. The patient underwent conventional angiography, which showed segmental arterial constrictions with post-stenotic dilatation consistent with vasculitis. Cerebrospinal fluid (CSF) studies eventually returned positive for VZV by polymerase chain reaction (PCR), confirming a diagnosis of VZV-induced CNS vasculopathy, or more specifically, CNS vasculopathy due to zoster sine herpete. The patient was treated with high-dose steroids as well as IV acyclovir with improvement in his symptoms. He was discharged with advice for a close follow-up with the infectious disease (ID) department. Our case highlights the importance of maintaining a high index of suspicion for varicella infection masquerading as CNS vasculitis, particularly in the absence of classic blistering shingles rash. Early detection may prevent neurological sequelae of the infection, including stroke, dissection, or neuropathy.
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Affiliation(s)
- Arthur Lau
- Rheumatology, Temple University Hospital, Philadelphia, USA
| | - Eno-Obong Essien
- Internal Medicine, Temple University Hospital, Philadelphia, USA
| | - Irene J Tan
- Rheumatology, Einstein Medical Center, Philadelphia, USA
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Clinical Features of Varicella-Zoster Virus Infection. Viruses 2018; 10:v10110609. [PMID: 30400213 PMCID: PMC6266119 DOI: 10.3390/v10110609] [Citation(s) in RCA: 149] [Impact Index Per Article: 24.8] [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.
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