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Simons-Linares CR, Imam Z, Chahal P. Viral-Attributed Acute Pancreatitis: A Systematic Review. Dig Dis Sci 2021; 66:2162-2172. [PMID: 32789532 DOI: 10.1007/s10620-020-06531-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 07/31/2020] [Indexed: 01/18/2023]
Abstract
Infectious etiologies are rare cause of acute pancreatitis (AP). We sought to investigate the frequency of viral-attributed AP (VIAP) and describe its natural course and clinical features. Comprehensive review of PubMed and EMBASE in English until December 31, 2019, was performed. AP diagnosis and severity were defined per the Revised Atlanta Classification. Viral infections were diagnosed by serology and/or histology. A diagnosis of viral infection, with a concurrent AP diagnosis, a temporal resolution of both entities, and the attempt to exclude the most common etiologies of AP defined VIAP. Two independent reviewers reviewed eligible publications. Bias risk was assessed with the Murad tool. A total of 209 cases identified in 128 publications met inclusion criteria. Mean age was 38.9 ± 1.28 years. Male-to-female ratio was 2.2:1, and 28% of patients were immunocompromised. Viral hepatitis (A, B, C, D and E) was the most common virus and accounted for 34.4% of cases, followed by coxsackie and echoviruses (14.8%), hemorrhagic fever viruses (12.4%), CMV (12.0%), VZV (10.5%), mumps and measles (3.8%), primary HIV infection (3.8%), HSV (1.9%), EBV (1.9%), and the remainder of cases (2.9%) attributed to adenovirus, influenza H1N1, and multiple viruses. Severity of AP was: 43.1% mild, 11.7% moderately severe, 32.4% severe. Death occurred in 42 (20.1%) patients. A significant portion of VIAP patients were immunocompromised (28.0%) and accounted for 71.4% of mortality cases. Mortality was higher than that reported for AP from other etiologies in the literature.
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Affiliation(s)
- C Roberto Simons-Linares
- Gastroenterology and Hepatology Department, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
| | - Zaid Imam
- Department of Internal Medicine, William Beaumont Hospital, Royal Oak, MI, USA
| | - Prabhleen Chahal
- Gastroenterology and Hepatology Department, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
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Ra SH, Kwon JS, Kim JY, Cha HH, Lee HJ, Jung J, Kim MJ, Chong YP, Lee SO, Choi SH, Kim YS, Kim WY, Kim SH. Frequency of putative enteric zoster diagnosed using saliva samples in patients with abdominal pain: a prospective study. Infect Dis (Lond) 2021; 53:713-718. [PMID: 33830871 DOI: 10.1080/23744235.2021.1908593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Varicella-zoster virus (VZV) infects and establishes latency in neurons in the ganglia of the cranial nerve, dorsal root and enteric ganglia. VZV reactivation in enteric neurons (enteric zoster) can cause non-specific abdominal pain and/or serious gastrointestinal dysfunction without cutaneous manifestations. Detection of VZV DNA in saliva may be useful for identifying enteric zoster. We evaluated the frequency of putative enteric zoster based on the presence of salivary VZV DNA in patients with acute abdominal pain. METHODS Adult patients who visited the emergency room due to moderate to severe acute abdominal pain were prospectively enrolled at a tertiary hospital between May 2019 and November 2019. Abdominopelvic computed tomography (APCT) was performed in all patients. We also evaluated the presence of salivary VZV DNA in patients with confirmed coronavirus disease-19 (COVID-19) who were under stressful conditions. Saliva samples were collected from all studied patients. Enteric zoster was suspected based on the presence of salivary VZV DNA, detected using real-time polymerase chain reaction (PCR). RESULTS Fifty patients with moderate to severe abdominal pain were enrolled. Five of 50 patients exhibited positive VZV-DNA PCR results. APCT revealed that among these five patients, two had pancreatic head cancer, two had small bowel obstruction after intra-abdominal surgery, and one had no remarkable findings. However, all 14 patients with COVID-19 showed negative salivary VZV-DNA PCR results. CONCLUSIONS Approximately 10% of patients with moderate to severe acute abdominal pain showed positivity for salivary VZV DNA. Further studies are warranted on whether antiviral therapy based on salivary VZV-DNA PCR results may relieve abdominal pain in the studied patient population. TRIAL REGISTRATION clinicaltrial.gov, number NCT03862092.
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Affiliation(s)
- Sang Hyun Ra
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ji-Soo Kwon
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ji Yeun Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hye-Hee Cha
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hyun-Jung Lee
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jiwon Jung
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Min Jae Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yong Pil Chong
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang-Oh Lee
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang-Ho Choi
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yang Soo Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Won Young Kim
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sung-Han Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Imam Z, Simons-Linares CR, Chahal P. Infectious causes of acute pancreatitis: A systematic review. Pancreatology 2020; 20:1312-1322. [PMID: 32938554 DOI: 10.1016/j.pan.2020.08.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 08/21/2020] [Accepted: 08/24/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND Infectious etiologies of acute pancreatitis (AP) are rare and include viruses, bacteria, mycobacteria, parasites, and fungi. We aimed to conduct a comprehensive review on infectious etiologies of AP analyzing the frequency, clinical features, and outcomes of individuals presenting with this condition. METHODS Eligible articles reporting on AP attributed to infectious etiologies were included. A comprehensive literature search of PubMed from time of inception and until September 6,2019 was performed using all relevant MeSH (medical subject heading) keywords. Articles were assessed for eligibility and independently reviewed by two reviewers for clinical features of AP, local complications, and mortality. Methodological quality of included studies was evaluated using the Murad tool. RESULTS A total of 212 articles were included, of which 168 (79.2%) were at high risk of bias. 320 cases of AP were identified. Viruses were the leading etiology of infection attributed AP (65.3%) followed by helminths (19.1%), and bacteria (12.5%). Protozoa, mycobacteria, and fungi accounted for the remaining 3.1% of cases. Mean age was 40.5 ± 18.4 years and M:F ratio was 1.94:1. Mortality occurred in 50 patients. Mortality rate was higher in the virus attributed AP patients than AP from other infectious etiologies (21.8% vs. 7.0%, p < 0.0005). INTERPRETATION Literature quality on infection attributed AP is limited. Virus attributed AP appears to carry a higher mortality than other etiologies of infection attributed AP.
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Affiliation(s)
- Zaid Imam
- Department of Internal Medicine, William Beaumont Hospital, Royal Oak, MI, USA
| | - C Roberto Simons-Linares
- Department of Gastroenterology, Hepatology, and Nutrition; Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Prabhleen Chahal
- Department of Gastroenterology, Hepatology, and Nutrition; Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
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Song J, Lleo A, Yang GX, Zhang W, Bowlus CL, Gershwin ME, Leung PSC. Common Variable Immunodeficiency and Liver Involvement. Clin Rev Allergy Immunol 2018; 55:340-351. [PMID: 28785926 PMCID: PMC5803456 DOI: 10.1007/s12016-017-8638-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Common variable immunodeficiency (CVID) is a primary B-cell immunodeficiency disorder, characterized by remarkable hypogammaglobulinemia. The disease can develop at any age without gender predominance. The prevalence of CVID varies widely worldwide. The underlying causes of CVID remain largely unknown; primary B-cell dysfunctions, defects in T cells and antigen-presenting cells are involved. Although some monogenetic defects have been identified in some CVID patients, it is likely that CVID is polygenic. Patients with CVID develop recurrent and chronic infections (e.g., bacterial infections of the respiratory or gastrointestinal tract), autoimmune diseases, lymphoproliferation, malignancies, and granulomatous lesions. Interestingly, autoimmunity can be the only clinical manifestation of CVID at the time of diagnosis and may even develop prior to hypogammaglobulinemia. The diagnosis of CVID is largely based on the criteria established by European Society for Immunodeficiencies and Pan-American Group for Immunodeficiency (ESID/PAGID) and with some recent modifications. The disease can affect multiple organs, including the liver. Clinical features of CVID patients with liver involvement include abnormal liver biochemistries, primarily elevation of alkaline phosphatase (ALP), nodular regenerative hyperplasia (NRH), or liver cirrhosis and its complications. Replacement therapy with immunoglobulin (Ig) and anti-infection therapy are the primary treatment regimen for CVID patients. No specific therapy for liver involvement of CVID is currently available, and liver transplantation is an option only in select cases. The prognosis of CVID varies widely. Further understanding in the etiology and pathophysiology will facilitate early diagnosis and treatments to improve prognosis.
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Affiliation(s)
- Junmin Song
- Division of Rheumatology/Allergy and Clinical Immunology, University of California at Davis School of Medicine, 451 Health Sciences Drive, Davis, CA, 95616, USA
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, 110004, People's Republic of China
| | - Ana Lleo
- Liver Unit and Center for Autoimmune Liver Diseases, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Guo Xiang Yang
- Division of Rheumatology/Allergy and Clinical Immunology, University of California at Davis School of Medicine, 451 Health Sciences Drive, Davis, CA, 95616, USA
| | - Weici Zhang
- Division of Rheumatology/Allergy and Clinical Immunology, University of California at Davis School of Medicine, 451 Health Sciences Drive, Davis, CA, 95616, USA
| | - Christopher L Bowlus
- Division of Gastroenterology and Hepatology, University of California, Davis, CA, 95616, USA
| | - M Eric Gershwin
- Division of Rheumatology/Allergy and Clinical Immunology, University of California at Davis School of Medicine, 451 Health Sciences Drive, Davis, CA, 95616, USA
| | - Patrick S C Leung
- Division of Rheumatology/Allergy and Clinical Immunology, University of California at Davis School of Medicine, 451 Health Sciences Drive, Davis, CA, 95616, USA.
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Abstract
Varicella zoster virus (VZV) infects and becomes latent in sensory, enteric, and other autonomic neurons during the viremia of varicella. Reactivation of VZV in neurons that project to the skin causes the rash of zoster; however, reactivation of VZV in enteric neurons can cause a painful gastrointestinal disorder ("enteric zoster") without cutaneous manifestations. Detection of VZV DNA in saliva of patients with gastrointestinal symptoms may suggest enteric zoster. This diagnosis is reinforced by observing a response to antiviral therapy and can be confirmed by detecting VZV gene products in intestinal mucosal biopsies. We developed an in vivo guinea pig model that may be useful in studies of VZV latency and reactivation. VZV-infected lymphocytes are used to induce latent infection in sensory and enteric neurons; evidence suggests that exosomes and stimulator of interferon genes (STING) may, by preventing proliferation play roles in the establishment of neuronal latency.
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Affiliation(s)
- Michael Gershon
- Department of Pathology, Columbia University College of Physicians and Surgeons, New York, New York
| | - Anne Gershon
- Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, New York
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Pennington MR, Cossic BGA, Perkins GA, Duffy C, Duhamel GE, Van de Walle GR. First demonstration of equid gammaherpesviruses within the gastric mucosal epithelium of horses. Virus Res 2017; 242:30-36. [PMID: 28870469 DOI: 10.1016/j.virusres.2017.09.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 08/31/2017] [Accepted: 09/01/2017] [Indexed: 12/25/2022]
Abstract
Horses commonly develop gastric mucosal ulcers, similar to humans, a condition known as equine gastric ulcer syndrome (EGUS) that can lead to poor performance and lost training time and care expenses. Unlike humans, however, an infectious bacterial cause of ulcers has not been conclusively identified. Herpesviruses, while well-established causative agents of diseases such as cold sores, genital lesions, and certain types of cancer, have also been implicated in the development of a subset of gastric ulcers in humans. The presence of equid herpesviruses in the gastrointestinal tract and their potential contribution to EGUS has not been evaluated. Here, we provide the first evidence of equid gammaherpesviruses 2 and 5 (EHV-2 and -5) within the epithelium of the gastric mucosa of horses. These viruses were initially detected by a nested PCR screen of gastric tissue samples obtained from client- and university-owned horses with and without ulcers; however, no association with EGUS was found in this limited sample set. We then validated a highly sensitive in situ hybridization (ISH) assay and used this assay to characterize the distribution of these viruses in necropsy gastric tissue samples from five racehorses. Analyses revealed frequent EHV-2 and EHV-5 co-infections within the gastric mucosal epithelium, regardless of the ulcer status. These results are the first to demonstrate the presence of equid gammaherpesviruses in the gastric mucosa of horses and warrants further investigation to determine the contribution of these viruses to the development of EGUS and/or other gastrointestinal diseases.
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Affiliation(s)
- Matthew R Pennington
- Baker Institute for Animal Health, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA
| | - Brieuc G A Cossic
- Department of Biomedical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA
| | - Gillian A Perkins
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA
| | - Carol Duffy
- Department of Biological Sciences, College of Arts and Sciences, University of Alabama, Tuscaloosa, AL, USA
| | - Gerald E Duhamel
- Department of Biomedical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA
| | - Gerlinde R Van de Walle
- Baker Institute for Animal Health, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA.
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Saman S, Henes JC, Niepel D, Bosmüller H, Werner CR, Lauer UM, Malek NP, Xenitidis T. [Varicella gastritis under immunosuppression : Case report of a woman after lung transplantation due to granulomatosis with polyangiitis]. Internist (Berl) 2017; 58:855-858. [PMID: 28405696 DOI: 10.1007/s00108-017-0231-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A 35-year-old woman who had previously undergone a lung transplantation presented with severe abdominal pain and vomiting. The gastroscopy showed diffuse ulcerative gastric lesions. Tests for varicella zoster virus and Epstein-Barr virus via polymerase chain reactions (PCR) on endoscopically obtained gastric biopsies were found to be positive and confirmed varicella gastritis. Intravenous antiviral therapy with acyclovir was administered resulting in a normalization of all clinical symptoms, especially of abdominal pain and inflammation parameters.
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Affiliation(s)
- S Saman
- Abteilung Innere Medizin I (Hepatologie, Gastroenterologie, Infektiologie), Universitätsklinikum Tübingen, Otfried-Müller-Str. 10, 72076, Tübingen, Deutschland.
| | - J-C Henes
- Abteilung Innere Medizin II (Onkologie, Hämatologie, Rheumatologie, Immunologie, Pulmonologie), Universitätsklinikum Tübingen, Otfried-Müller-Str. 10, 72076, Tübingen, Deutschland
| | - D Niepel
- Abteilung Innere Medizin I (Hepatologie, Gastroenterologie, Infektiologie), Universitätsklinikum Tübingen, Otfried-Müller-Str. 10, 72076, Tübingen, Deutschland
| | - H Bosmüller
- Abteilung Allgemeine Pathologie, Institut für Pathologie und Neuropathologie, Liebermeisterstr. 8, 72076, Tübingen, Deutschland
| | - C R Werner
- Abteilung Innere Medizin I (Hepatologie, Gastroenterologie, Infektiologie), Universitätsklinikum Tübingen, Otfried-Müller-Str. 10, 72076, Tübingen, Deutschland
| | - U M Lauer
- Abteilung Innere Medizin I (Hepatologie, Gastroenterologie, Infektiologie), Universitätsklinikum Tübingen, Otfried-Müller-Str. 10, 72076, Tübingen, Deutschland
| | - N P Malek
- Abteilung Innere Medizin I (Hepatologie, Gastroenterologie, Infektiologie), Universitätsklinikum Tübingen, Otfried-Müller-Str. 10, 72076, Tübingen, Deutschland
| | - T Xenitidis
- Abteilung Innere Medizin II (Onkologie, Hämatologie, Rheumatologie, Immunologie, Pulmonologie), Universitätsklinikum Tübingen, Otfried-Müller-Str. 10, 72076, Tübingen, Deutschland
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Chhabra P, Ranjan P, Bhasin DK. Simultaneous Occurrence of Varicella Zoster Virus-Induced Pancreatitis and Hepatitis in a Renal Transplant Recipient: A Case Report and Review of Literature. Perm J 2017; 21:16-083. [PMID: 28333601 DOI: 10.7812/tpp/16-083] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Gastrointestinal complications are common after renal transplantation, including oral lesions, esophagitis, gastritis, diarrhea, and colon carcinoma. The differential diagnosis is difficult in this scenario because multiple factors such as drugs, infections, and preexisting gastrointestinal disease come into play. CASE PRESENTATION We report a case of varicella zoster virus-induced pancreatitis and hepatitis in a renal transplant recipient. The patient underwent renal transplantation 3 years earlier and now presented with severe pain in the epigastrium radiating to his back and had raised serum lipase levels and skin lesions characteristic of varicella. Liver enzyme levels were also elevated. He was started on a regimen of acyclovir. His pain improved in 24 hours, and liver enzyme levels returned to normal in 48 hours. DISCUSSION There is a paucity of literature on the simultaneous occurrence of varicella zoster virus-induced hepatitis and pancreatitis in both immunocompetent and immunocompromised patients. Our case highlights the gastrointestinal complications of varicella infection in immunocompromised patients that may precede the characteristic dermatologic manifestations, and the fact that rarely both hepatitis and pancreatitis may be seen.
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Affiliation(s)
- Puneet Chhabra
- Attending Consultant in the Department of Gastroenterology and Hepatology at the Fortis Hospital Mohali in Chandigarh, Mohali, Punjab, India.
| | - Priyadarshi Ranjan
- Director of the Urology and Kidney Transplantation Department at the Fortis Hospital Mohali in Chandigarh, Mohali, Punjab, India.
| | - Deepak K Bhasin
- Director of Gastroenterology, Hepatology and Interventional Endoscopy at the Fortis Hospital Mohali in Chandigarh, Mohali, Punjab, India.
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Boettler T, Lutz L, Schmidt N, Thimme R, Neumann-Haefelin C. An uncommon presentation of a common pathogen. Gut 2015; 64:1411, 1453. [PMID: 25564406 DOI: 10.1136/gutjnl-2014-308851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 12/22/2014] [Indexed: 12/19/2022]
Affiliation(s)
- Tobias Boettler
- Department of Medicine II, University Hospital Freiburg, Freiburg, Germany
| | - Lisa Lutz
- Department of Pathology, University Hospital Freiburg, Freiburg, Germany
| | - Nathalie Schmidt
- Department of Medicine II, University Hospital Freiburg, Freiburg, Germany
| | - Robert Thimme
- Department of Medicine II, University Hospital Freiburg, Freiburg, Germany
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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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11
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Pellicano R, Fagoonee S. Herpes zoster in patients with peptic ulcer disease: a plausible association? Int J Epidemiol 2014; 44:361. [DOI: 10.1093/ije/dyu216] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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12
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Habas F, Jacquot A, Carbasse A, Cambonie G. [Life-threatening erosive gastritis in a child with varicella-induced thrombocytopenia]. Arch Pediatr 2014; 21:903-4. [PMID: 24951270 DOI: 10.1016/j.arcped.2014.05.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 04/19/2014] [Accepted: 05/15/2014] [Indexed: 11/19/2022]
Affiliation(s)
- F Habas
- Pédiatrie néonatale et réanimations, hôpital Arnaud de Villeneuve, 371, avenue du Doyen-G.-Giraud, 34295 Montpellier cedex 5, France
| | - A Jacquot
- Pédiatrie néonatale et réanimations, hôpital Arnaud de Villeneuve, 371, avenue du Doyen-G.-Giraud, 34295 Montpellier cedex 5, France
| | - A Carbasse
- Urgence et post-urgence, CHU de Montpellier, 34000 Montpellier, France
| | - G Cambonie
- Pédiatrie néonatale et réanimations, hôpital Arnaud de Villeneuve, 371, avenue du Doyen-G.-Giraud, 34295 Montpellier cedex 5, France.
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13
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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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Gershon AA, Gershon MD. Pathogenesis and current approaches to control of varicella-zoster virus infections. Clin Microbiol Rev 2013; 26:728-43. [PMID: 24092852 PMCID: PMC3811230 DOI: 10.1128/cmr.00052-13] [Citation(s) in RCA: 127] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Varicella-zoster virus (VZV) was once thought to be a fairly innocuous pathogen. That view is no longer tenable. The morbidity and mortality due to the primary and secondary diseases that VZV causes, varicella and herpes zoster (HZ), are significant. Fortunately, modern advances, including an available vaccine to prevent varicella, a therapeutic vaccine to diminish the incidence and ameliorate sequelae of HZ, effective antiviral drugs, a better understanding of VZV pathogenesis, and advances in diagnostic virology have made it possible to control VZV in the United States. Occult forms of VZV-induced disease have been recognized, including zoster sine herpete and enteric zoster, which have expanded the field. Future progress should include development of more effective vaccines to prevent HZ and a more complete understanding of the consequences of VZV latency in the enteric nervous system.
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Serris A, Michot JM, Fourn E, Le Bras P, Dollat M, Hirsch G, Pallier C, Carbonnel F, Tertian G, Lambotte O. [Disseminated varicella-zoster virus infection with hemorrhagic gastritis during the course of chronic lymphocytic leukemia: case report and literature review]. Rev Med Interne 2013; 35:337-40. [PMID: 23773904 DOI: 10.1016/j.revmed.2013.05.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Revised: 03/24/2013] [Accepted: 05/03/2013] [Indexed: 01/30/2023]
Abstract
INTRODUCTION The reactivation of varicella-zoster virus occurs in immunocompromised patients, especially in cases of hematological malignancy. Disseminated reactivation could involve digestive tract with life-threatening condition. CASE REPORT A 76-year-old woman, with a history of chronic lymphocytic leukemia, presented with left hypochondrium pain, and a vesicular rash with hemorrhagic shock that revealed an hemorrhagic gastritis due to varicella-zoster virus. The literature review identified 28 additional cases of gastrointestinal mucosal damage during reactivation of varicella-zoster virus. Mortality is 40%. We report here the first case in the course of low-grade lymphoid malignancy. CONCLUSION Acute gastrointestinal symptoms in immunocompromised patients should evoke a varicella-zoster virus reactivation with gastrointestinal involvement. This clinical manifestation, although rare, should not be ignored because of its severity.
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MESH Headings
- Aged
- Female
- Gastritis/complications
- Gastritis/diagnosis
- Gastritis/virology
- Gastrointestinal Hemorrhage/complications
- Gastrointestinal Hemorrhage/diagnosis
- Gastrointestinal Hemorrhage/virology
- Herpes Zoster/complications
- Herpes Zoster/diagnosis
- Herpesvirus 3, Human/physiology
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/complications
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemia, Lymphocytic, Chronic, B-Cell/virology
- Virus Activation
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Affiliation(s)
- A Serris
- Service de médecine interne, hôpital Bicêtre, Assistance publique-Hôpitaux de Paris, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre cedex, France; Université Paris Sud XI, 94275 Le Kremlin-Bicêtre cedex, France
| | - J-M Michot
- Service de médecine interne, hôpital Bicêtre, Assistance publique-Hôpitaux de Paris, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre cedex, France; Université Paris Sud XI, 94275 Le Kremlin-Bicêtre cedex, France.
| | - E Fourn
- Service de médecine interne, hôpital Bicêtre, Assistance publique-Hôpitaux de Paris, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre cedex, France; Université Paris Sud XI, 94275 Le Kremlin-Bicêtre cedex, France
| | - P Le Bras
- Service de médecine interne, hôpital Bicêtre, Assistance publique-Hôpitaux de Paris, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre cedex, France; Université Paris Sud XI, 94275 Le Kremlin-Bicêtre cedex, France
| | - M Dollat
- Service de médecine interne, hôpital Bicêtre, Assistance publique-Hôpitaux de Paris, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre cedex, France; Université Paris Sud XI, 94275 Le Kremlin-Bicêtre cedex, France
| | - G Hirsch
- Service de médecine interne, hôpital Bicêtre, Assistance publique-Hôpitaux de Paris, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre cedex, France; Université Paris Sud XI, 94275 Le Kremlin-Bicêtre cedex, France
| | - C Pallier
- Service de microbiologie et virologie, hôpital Bicêtre, Assistance publique-Hôpitaux de Paris, 94275 Le Kremlin-Bicêtre cedex, France; Université Paris Sud XI, 94275 Le Kremlin-Bicêtre cedex, France
| | - F Carbonnel
- Service de gastro-entérologie, hôpital Bicêtre, Assistance publique-Hôpitaux de Paris, 94275 Le Kremlin-Bicêtre cedex, France; Université Paris Sud XI, 94275 Le Kremlin-Bicêtre cedex, France
| | - G Tertian
- Service d'hématologie biologique, hôpital Bicêtre, Assistance publique-Hôpitaux de Paris, 94275 Le Kremlin-Bicêtre cedex, France; Université Paris Sud XI, 94275 Le Kremlin-Bicêtre cedex, France
| | - O Lambotte
- Service de médecine interne, hôpital Bicêtre, Assistance publique-Hôpitaux de Paris, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre cedex, France; Université Paris Sud XI, 94275 Le Kremlin-Bicêtre cedex, France
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Haberthur K, Messaoudi I. Animal models of varicella zoster virus infection. Pathogens 2013; 2:364-82. [PMID: 25437040 PMCID: PMC4235715 DOI: 10.3390/pathogens2020364] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 04/16/2013] [Accepted: 05/01/2013] [Indexed: 11/16/2022] Open
Abstract
Primary infection with varicella zoster virus (VZV) results in varicella (chickenpox) followed by the establishment of latency in sensory ganglia. Declining T cell immunity due to aging or immune suppressive treatments can lead to VZV reactivation and the development of herpes zoster (HZ, shingles). HZ is often associated with significant morbidity and occasionally mortality in elderly and immune compromised patients. There are currently two FDA-approved vaccines for the prevention of VZV: Varivax® (for varicella) and Zostavax® (for HZ). Both vaccines contain the live-attenuated Oka strain of VZV. Although highly immunogenic, a two-dose regimen is required to achieve a 99% seroconversion rate. Zostavax vaccination reduces the incidence of HZ by 51% within a 3-year period, but a significant reduction in vaccine-induced immunity is observed within the first year after vaccination. Developing more efficacious vaccines and therapeutics requires a better understanding of the host response to VZV. These studies have been hampered by the scarcity of animal models that recapitulate all aspects of VZV infections in humans. In this review, we describe different animal models of VZV infection as well as an alternative animal model that leverages the infection of Old World macaques with the highly related simian varicella virus (SVV) and discuss their contributions to our understanding of pathogenesis and immunity during VZV infection.
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Affiliation(s)
- Kristen Haberthur
- Department of Microbiology and Molecular Immunology, Oregon Health and Science University, Portland, OR 97239, USA.
| | - Ilhem Messaoudi
- Department of Microbiology and Molecular Immunology, Oregon Health and Science University, Portland, OR 97239, USA.
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