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Sullivan NL, Eberhardt CS, Wieland A, Akondy RS, Yi J, McElroy AK, Ahmed R. Characterization of Virus-specific Immune Response During Varicella Zoster Virus Encephalitis in a Young Adult. Clin Infect Dis 2019; 69:348-351. [PMID: 30668661 PMCID: PMC7322817 DOI: 10.1093/cid/ciy984] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 01/02/2019] [Indexed: 12/12/2022] Open
Abstract
An immunocompetent adult received corticosteroids for chest pain, which later was clinically found to be herpes zoster (HZ). She developed severe disease and rapid viral dissemination that elicited an exceptionally strong varicella zoster virus-specific B-cell and CD8 T-cell response. Clinicians should consider atypical HZ presentation prior to corticosteroid administration.
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Affiliation(s)
- Nicole L Sullivan
- Emory Vaccine Center and Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, Georgia
| | - Christiane S Eberhardt
- Emory Vaccine Center and Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, Georgia
- Department of Pediatrics and Pathology-Immunology, Center for Vaccinology and Neonatal Immunology, University Hospitals of Geneva and Faculty of Medicine, University of Geneva, Switzerland
| | - Andreas Wieland
- Emory Vaccine Center and Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, Georgia
| | - Rama S Akondy
- Emory Vaccine Center and Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, Georgia
| | - Jumi Yi
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, Georgia
| | - Anita K McElroy
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, Georgia
| | - Rafi Ahmed
- Emory Vaccine Center and Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, Georgia
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2
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Carter-Timofte ME, Paludan SR, Mogensen TH. RNA Polymerase III as a Gatekeeper to Prevent Severe VZV Infections. Trends Mol Med 2018; 24:904-915. [PMID: 30115567 DOI: 10.1016/j.molmed.2018.07.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 07/07/2018] [Accepted: 07/20/2018] [Indexed: 12/13/2022]
Abstract
In most individuals, varicella zoster virus (VZV) causes varicella upon primary infection and zoster during reactivation. However, in a subset of individuals, VZV may cause severe disease, including encephalitis. Host genetics is believed to be the main determinant of exacerbated disease manifestations. Recent studies have demonstrated that defects in the DNA sensor RNA polymerase III (POL III) confer selective increased susceptibility to VZV infection, thus providing fundamental new insight into VZV immunity. Here we describe the roles of POL III in housekeeping and immune surveillance during VZV infection. We present the latest knowledge on the role of POL III in VZV infection and discuss outstanding questions related to the role of POL III in VZV immunity, and how this insight can be translated into clinical medicine.
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MESH Headings
- Adult
- Chickenpox/genetics
- Chickenpox/immunology
- Chickenpox/pathology
- Chickenpox/virology
- DEAD Box Protein 58/genetics
- DEAD Box Protein 58/immunology
- DNA, Viral/genetics
- DNA, Viral/immunology
- Encephalitis, Varicella Zoster/genetics
- Encephalitis, Varicella Zoster/immunology
- Encephalitis, Varicella Zoster/pathology
- Encephalitis, Varicella Zoster/virology
- Gene Expression Regulation
- Genetic Predisposition to Disease
- Herpes Zoster/genetics
- Herpes Zoster/immunology
- Herpes Zoster/pathology
- Herpes Zoster/virology
- Herpesvirus 3, Human/genetics
- Herpesvirus 3, Human/immunology
- Host-Pathogen Interactions
- Humans
- Immunity, Innate
- Immunologic Surveillance
- Interferons/genetics
- Interferons/immunology
- Protein Subunits/genetics
- Protein Subunits/immunology
- RNA Polymerase III/genetics
- RNA Polymerase III/immunology
- Receptors, Immunologic
- Virus Activation
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Affiliation(s)
- Madalina E Carter-Timofte
- Department of Infectious Diseases, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark; Department of Biomedicine, Aarhus University, Wilhelm Meyers Alle 4, 8000 Aarhus C, Denmark
| | - Søren R Paludan
- Department of Biomedicine, Aarhus University, Wilhelm Meyers Alle 4, 8000 Aarhus C, Denmark; Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Trine H Mogensen
- Department of Infectious Diseases, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark; Department of Biomedicine, Aarhus University, Wilhelm Meyers Alle 4, 8000 Aarhus C, Denmark; Department of Clinical Medicine, Aarhus University, Palle Juul Jensens Boulevard 82, 8200 Aarhus N, Denmark.
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3
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Więdłocha M, Marcinowicz P, Stańczykiewicz B. Psychiatric aspects of herpes simplex encephalitis, tick-borne encephalitis and herpes zoster encephalitis among immunocompetent patients. ADV CLIN EXP MED 2015; 24:361-71. [PMID: 25931371 DOI: 10.17219/acem/40460] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The psychopathological symptoms occurring in the course of diseases associated with infections are often initially isolated and non-characteristic, and may cause diagnostic difficulties. Moreover, such disorders tend to be less responsive to psychiatric management. Among possible causes such as trauma, neoplasm and vascular changes, inflammatory changes of the brain as a result of a viral infection should also be considered. There were 452 registered cases of viral encephalitis in Poland in 2010, and although not very prevalent they remain a severe and life-threatening condition. What is more, the frequently occurring neurological and psychiatric complications of viral encephalitis often result in permanent disabilities, causing a significant decrease in the quality of life. This article presents the three types of encephalitis that are most prevalent among immunocompetent patients in Poland, i.e. herpes simplex encephalitis (HSE), tick-borne encephalitis (TBE) and herpes zoster encephalitis (HZE). The psychopathology of the acute phase of the infection, the residual symptoms, features apparent in imaging studies and some neuropathological aspects are also presented. The paper also focuses on psychiatric aspects of the diagnostics and treatment of the described conditions. The clinical pictures of these infections are quite specific, although they cover a wide range of symptoms, and these characteristic features are described. The aim of this review is also to show the significance of thorough diagnostics and a multidisciplinary approach to patients with viral CNS infections.
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MESH Headings
- Encephalitis, Herpes Simplex/diagnosis
- Encephalitis, Herpes Simplex/epidemiology
- Encephalitis, Herpes Simplex/immunology
- Encephalitis, Herpes Simplex/psychology
- Encephalitis, Herpes Simplex/therapy
- Encephalitis, Herpes Simplex/virology
- Encephalitis, Tick-Borne/diagnosis
- Encephalitis, Tick-Borne/epidemiology
- Encephalitis, Tick-Borne/immunology
- Encephalitis, Tick-Borne/parasitology
- Encephalitis, Tick-Borne/psychology
- Encephalitis, Tick-Borne/therapy
- Encephalitis, Varicella Zoster/diagnosis
- Encephalitis, Varicella Zoster/epidemiology
- Encephalitis, Varicella Zoster/immunology
- Encephalitis, Varicella Zoster/psychology
- Encephalitis, Varicella Zoster/therapy
- Encephalitis, Varicella Zoster/virology
- Humans
- Immunocompetence
- Poland/epidemiology
- Prevalence
- Prognosis
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Affiliation(s)
- Magdalena Więdłocha
- Division of Consultation Psychiatry and Neuroscience, Department of Psychiatry, Wroclaw Medical University, Poland
| | - Piotr Marcinowicz
- Division of Consultation Psychiatry and Neuroscience, Department of Psychiatry, Wroclaw Medical University, Poland
| | - Bartłomiej Stańczykiewicz
- Division of Consultation Psychiatry and Neuroscience, Department of Psychiatry, Wroclaw Medical University, Poland
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Pirounaki M, Liatsos G, Elefsiniotis I, Skounakis M, Moulakakis A. Unusual onset of varicella zoster reactivation with meningoencephalitis, followed by rhabdomyolysis and renal failure in a young, immunocompetent patient. ACTA ACUST UNITED AC 2009; 39:90-3. [PMID: 17366023 DOI: 10.1080/00365540600798809] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We present an unusual onset of meningoencephalitis due to VZV reactivation, with increased intrathecal production of IgG VZV antibodies and negative PCR, in a young, immunocompetent adult. Herpes zoster erupted 5 d later. Rare complication of VZV-related rhabdomyolysis occurred, with subsequent ARF, in combination with acyclovir and ceftriaxone. The patient recovered fully and remained healthy.
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Affiliation(s)
- Maria Pirounaki
- Department of Internal Medicine, Hippokration General Hospital., Athens, Vasilissis Sofias 114, Greece
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Miravet E, Danchaivijitr N, Basu H, Saunders DE, Ganesan V. Clinical and radiological features of childhood cerebral infarction following varicella zoster virus infection. Dev Med Child Neurol 2007; 49:417-22. [PMID: 17518925 DOI: 10.1111/j.1469-8749.2007.00417.x] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The aim of the study was to describe the clinical and radiological features of childhood post-varicella cerebral infarction (PVCI). A retrospective review was undertaken of children with arterial ischaemic stroke (AIS) who had experienced varicella zoster virus (VZV) infection within the preceding year. Twenty-four children (15 males, nine females; age range at time of VZV infection 2mo-6y) were identified, with a median of 4 months between VZV and AIS (range 1wk-12mo). All had infarction in the middle cerebral artery (MCA) territory and abnormalities of the M1 segment; arteriopathy affected other arteries in 10 children. After a median of 27 months, six patients had recurrent transient ischaemic attacks (TIA), with new infarcts in two of 22 children on re-imaging. Arterial disease improved in 11 children, was stable in four, and progressed in seven (of whom four had recurrent TIA and two had re-infarction). PVCI affects young, previously healthy children within a few months of VZV infection and is characterized by MCA territory infarction and proximal MCA disease. One quarter of patients have recurrence, usually, but not inevitably, associated with progressive arteriopathy. Treatable co-existing AIS risk factors should always be excluded. A more comprehensive diagnostic evaluation should be considered in children with AIS who do not fit the clinical and radiological profile outlined, even where there is a history of recent VZV infection.
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MESH Headings
- Adolescent
- Brain/blood supply
- Brain/diagnostic imaging
- Cerebrovascular Circulation/physiology
- Child
- Child, Preschool
- DNA, Viral/cerebrospinal fluid
- DNA, Viral/immunology
- Encephalitis, Varicella Zoster/complications
- Encephalitis, Varicella Zoster/diagnostic imaging
- Encephalitis, Varicella Zoster/immunology
- Female
- Functional Laterality/physiology
- Humans
- Immunoglobulin G/immunology
- Infant
- Infarction, Middle Cerebral Artery/diagnosis
- Infarction, Middle Cerebral Artery/etiology
- Infarction, Middle Cerebral Artery/physiopathology
- Ischemic Attack, Transient/diagnosis
- Ischemic Attack, Transient/etiology
- Ischemic Attack, Transient/physiopathology
- Magnetic Resonance Angiography
- Male
- Radiography
- Recurrence
- Severity of Illness Index
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Affiliation(s)
- Elena Miravet
- Neurology Department, Great Ormond Street Hospital for Children NHS Trust, London, UK
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6
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Robinson-Agramonte M, Reiber H, Cabrera-Gomez JA, Galvizu R. Intrathecal polyspecific immune response to neurotropic viruses in multiple sclerosis: a comparative report from Cuban patients. Acta Neurol Scand 2007; 115:312-8. [PMID: 17489941 DOI: 10.1111/j.1600-0404.2006.00755.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Intrathecal measles(M)- rubella(R)- and varicella zoster(Z)-antibody synthesis in German and Cuban multiple sclerosis (MS) patients are compared considering the different rubella epidemiology in the tropics. PATIENTS AND METHODS Twenty-three Cuban MS patients with a representative age distribution and gender ratio like the group of 177 German MS patients were analysed for albumin, IgG, IgA IgM, oligoclonal IgG and MRZ- antibodies in cerebrospinal fluid (CSF) and serum. RESULTS Cuban MS patients show similar CSF data patterns like German patients and high frequencies of intrathecal measles- (78/78%) and varicella zoster- (59/55%) antibody synthesis correspondingly. A lower frequency of intrathecal rubella antibody synthesis (rubella-AI >or= 1.5) in Cuban patients (30%, gender ratio of increased rubella - AI m:f = 1:6) compared with German patients (60%, m:f = 1:1.8) is explained by low incidence of rubella infections in Cuba. Only about 10% of the male population (not immunized before 1986, in contrast to females) had rubella antibodies compared to at least 60% in a European male population, representing the relation of increased rubella-AI in male MS patients. CONCLUSION In MS the frequency of intrathecal antibody synthesis is limited by the fraction of seropositives in the population. Natural infection or vaccination are a necessary and equivalent precondition contributing to the arguments against microorganisms as a cause of MS.
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Affiliation(s)
- M Robinson-Agramonte
- Neuroimmunology Department, International Center for Neurological Restoration, Havana City, Cuba
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7
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Losurdo G, Giacchino R, Castagnola E, Gattorno M, Costabel S, Rossi A, Amato S, Di Pietro P, Molinari AC. Cerebrovascular disease and varicella in children. Brain Dev 2006; 28:366-70. [PMID: 16376509 DOI: 10.1016/j.braindev.2005.11.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2005] [Revised: 10/26/2005] [Accepted: 11/11/2005] [Indexed: 11/17/2022]
Abstract
Varicella-associated stroke has been reported with increasing frequency in recent years. In many cases, diagnosis is difficult because of the late onset of manifestations after the acute infectious episode. Four cases of cerebrovascular disease after varicella infection were observed. Three children presented hemiparesis and one facial paresis. The neuroradiological findings comprised stenosis/occlusion of middle cerebral artery or nucleo capsular signal alteration. Because, several pathogenetic mechanisms have been proposed as the cause of stroke, the relationship between prothrombotic conditions, antipospholipid antibodies and stroke in these patients is discussed. The difficulty in defining the pathogenesis of the ischemic episode is related to problems in the choice of antithrombotic treatment, which is still not standardized and must be decided on individual basis. In the event of rapid onset of stroke after exanthem high dose antiviral therapy seems to be justified. On the basis of our experience and of literature data on varicella-associated stroke, we recommend that VZV infection be taken into account in every episode of stroke in children.
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Affiliation(s)
- Giuseppe Losurdo
- Infectious Diseases Unit, G. Gaslini Children's Hospital, Largo G. Gaslini 5, 16147 Genoa, Italy
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8
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Morris P, Davies NWS, Keir G. A screening assay to detect antigen-specific antibodies within cerebrospinal fluid. J Immunol Methods 2006; 311:81-6. [PMID: 16530215 DOI: 10.1016/j.jim.2006.01.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2005] [Revised: 12/16/2005] [Accepted: 01/11/2006] [Indexed: 11/20/2022]
Abstract
Identification of the aetiology of central nervous system infections requires the detection of either the organism or a microbe-specific immune response within the brain or cerebrospinal fluid. We describe a screening assay to detect herpes simplex virus, varicella zoster virus, cytomegalovirus, measles and Toxoplasma gondii specific antibodies in cerebrospinal fluid. Antigen-specific immunoblotting of oligoclonal IgG and IgM was used to confirm the presence of antibody. Of 51 consecutive cerebrospinal fluid samples received by the laboratory from patients with suspected central nervous system infection 18 (35%) were screen positive for one or more antigen. In only 7 of these were antigen-specific oligoclonal IgG or IgM bands confirmed. The assay provides a simple, cheap assay to screen for microbial-specific antibody in the cerebrospinal fluid samples of patients with suspected neurological infections.
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Affiliation(s)
- Patricia Morris
- Department of Neuroimmunology, National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK
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9
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Notarangelo LD, Mazzolari E. Natural killer cell deficiencies and severe varicella infection. J Pediatr 2006; 148:563-4; author reply 564. [PMID: 16647428 DOI: 10.1016/j.jpeds.2005.06.028] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2005] [Accepted: 06/15/2005] [Indexed: 11/24/2022]
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10
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Chan CW, Tam KM, To WK, Law TC, Kwan WK. Hypoglycorrhachia in herpes zoster associated encephalitis of an immunocompetent young male. J Neurol 2005; 252:987-8. [PMID: 15795793 DOI: 10.1007/s00415-005-0786-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2004] [Revised: 12/08/2004] [Accepted: 12/21/2004] [Indexed: 10/25/2022]
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Abstract
A 2-year-old girl with recurrent severe varicella infections had a fatal outcome. Studies of cellular and humoral immunity were normal. No natural killer (NK) cells were detected, and NK activity was markedly decreased. The interleukin (IL)15/IL15R signaling pathway was intact. This case emphasizes the role of NK cells in controlling herpes viral infection.
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Affiliation(s)
- Amos Etzioni
- Meyer Children's Hospital, Department of Immunology, B. Rappaport Medical School, Technion, Haifa, Israel.
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Tenenbaum T, Kramm CM, Laws HJ, Nürnberger W, Lenard HG, Göbel U. Pre-eruptive varicella zoster virus encephalitis in two children after haematopoietic stem cell transplantation. Med Pediatr Oncol 2002; 38:288-9. [PMID: 11920801 DOI: 10.1002/mpo.1329] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Tobias Tenenbaum
- Department of Pediatric Hematology and Oncology, University Children's Hospital, Heinrich-Heine-University Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany
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13
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Abstract
Varicella-zoster virus (VZV) reactivation in the brain caused encephalitis in a 2-year-old immunocompetent child who had chickenpox 20 months before. Radiologic findings were consistent with large to medium-vessel-vasculitis. VZV-DNA was detected in cerebrospinal fluid. Early acquisition of VZV may predispose to major neurologic complications that can occur years after the primary infection.
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Affiliation(s)
- Elena Chiappini
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Florence, Italy
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14
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Abstract
Varicella zoster virus (VZV) is a human herpesvirus that causes varicella (chickenpox) during primary infection, establishes latency in dorsal root ganglia and may reactivate years later, producing herpes zoster. VZV must evade antiviral immunity during three important stages of viral pathogenesis, including the cell-associated viremia characteristic of primary infection, persistence in dorsal root ganglia during latency and the initial period of VZV reactivation. Our observations about the immunomodulatory effects of VZV document its capacity to interfere with adaptive immunity mediated by CD4 as well as CD8 T cells, ensuring the survival of the virus in the human population from generation to generation.
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Affiliation(s)
- A Abendroth
- Centre for Virus Research, Westmead Millenium Institute, NSW, 2145, Australia
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