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Abe T, Maruyama S, Kaneyoshi K, Neshige S. Varicella-zoster Virus Meningitis Besides Bacterial Otitis. Intern Med 2024; 63:1329-1330. [PMID: 37779062 DOI: 10.2169/internalmedicine.2518-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/03/2023] Open
Affiliation(s)
- Takafumi Abe
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Japan
| | - Satoko Maruyama
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Japan
| | - Kenta Kaneyoshi
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Japan
| | - Shuichiro Neshige
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Japan
- Epilepsy Center, Hiroshima University Hospital, Japan
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2
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Abu Rached N, Gambichler T, Ocker L, Schultheis B, Susok L, Schmidt W, Bechara FG. Upadacitinib treatment associated with varicella zoster infection complicated by haemophagocytic lymphohistiocytosis in a patient with severe hidradenitis suppurativa. J Eur Acad Dermatol Venereol 2024; 38:e139-e141. [PMID: 37641970 DOI: 10.1111/jdv.19483] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 08/22/2023] [Indexed: 08/31/2023]
Affiliation(s)
- Nessr Abu Rached
- International Centre for Hidradenitis Suppurativa/Acne Inversa (ICH), Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Bochum, Germany
- Skin Cancer Center, Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Bochum, Germany
| | - Thilo Gambichler
- Skin Cancer Center, Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Bochum, Germany
- Department of Dermatology and Phlebology, Christian Hospital Unna, Unna, Germany
| | - Lennart Ocker
- International Centre for Hidradenitis Suppurativa/Acne Inversa (ICH), Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Bochum, Germany
- Skin Cancer Center, Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Bochum, Germany
| | - Beate Schultheis
- Department of Hematology and Oncology with Palliative Care, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Laura Susok
- Skin Cancer Center, Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Bochum, Germany
| | - Wolfgang Schmidt
- Department of Internal Medicine, Ruhr-University Bochum, Bochum, Germany
| | - Falk G Bechara
- International Centre for Hidradenitis Suppurativa/Acne Inversa (ICH), Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Bochum, Germany
- Skin Cancer Center, Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Bochum, Germany
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3
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Ishino Y, Fukasawa H, Kitamoto S, Nakagami D, Kaneko M, Yasuda H, Furuya R. A survival case of visceral disseminated varicella zoster virus infection in a patient with systemic lupus erythematosus. BMC Nephrol 2023; 24:164. [PMID: 37291486 PMCID: PMC10251651 DOI: 10.1186/s12882-023-03223-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 03/10/2023] [Accepted: 05/31/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Visceral disseminated varicella zoster virus (VZV) infection is a rare but life-threatening complication in immunosuppressed patients. Herein, we report a survival case of visceral disseminated VZV infection in a patient with systemic lupus erythematosus (SLE). CASE PRESENTATION A 37-year-old woman was diagnosed as SLE and initial induction therapy was started. Two months after starting the immunosuppressive therapy consisting of 40 mg of prednisolone (PSL) and 1500 mg of mycophenolate mofetil (MMF) daily, she suddenly developed strong abdominal pain, which was required opioid analgesics, followed by systemic skin blisters, which were diagnosed as varicella. Laboratory findings showed rapid exacerbation of severe liver failure, coagulation abnormalities and increased numbers of blood VZV deoxyribonucleic acid (DNA). Therefore, she was diagnosed as visceral disseminated VZV infection. Multidisciplinary treatment with acyclovir, immunoglobulin and antibiotics was started, the dose of PSL was reduced, and MMF was withdrawn. By their treatment, her symptoms were resolved and she finally discharged. CONCLUSIONS Our case highlights the importance of a clinical suspicion of visceral disseminated VZV infections, and the necessity of immediate administration of acyclovir and reduced doses of immunosuppressant to save patients with SLE.
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Affiliation(s)
- Yuri Ishino
- Renal Division, Department of Internal Medicine, Iwata City Hospital, 512-3 Ohkubo, Iwata, Shizuoka, 438-8550, Japan
| | - Hirotaka Fukasawa
- Renal Division, Department of Internal Medicine, Iwata City Hospital, 512-3 Ohkubo, Iwata, Shizuoka, 438-8550, Japan.
| | - Shuhei Kitamoto
- Renal Division, Department of Internal Medicine, Iwata City Hospital, 512-3 Ohkubo, Iwata, Shizuoka, 438-8550, Japan
| | - Daisuke Nakagami
- Renal Division, Department of Internal Medicine, Iwata City Hospital, 512-3 Ohkubo, Iwata, Shizuoka, 438-8550, Japan
| | - Mai Kaneko
- Renal Division, Department of Internal Medicine, Iwata City Hospital, 512-3 Ohkubo, Iwata, Shizuoka, 438-8550, Japan
| | - Hideo Yasuda
- First Department of Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Ryuichi Furuya
- Renal Division, Department of Internal Medicine, Iwata City Hospital, 512-3 Ohkubo, Iwata, Shizuoka, 438-8550, Japan
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4
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Lan D, Liu L. Concomitant transverse myelitis and Guillain-Barré syndrome following varicella-zoster virus infection. Chin Med J (Engl) 2023; 136:1256-1257. [PMID: 37253254 PMCID: PMC10278752 DOI: 10.1097/cm9.0000000000002662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Indexed: 06/01/2023] Open
Affiliation(s)
- Danmei Lan
- Department of Neurorehabilitation, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai 201619, China
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Kobayashi H, Yoshida Y, Komoshita T, Suma H, Hosokawa Y, Hirose Y, Sugimoto T, Mokuda S, Hirata S, Sugiyama E. The Efficacy of Amenamevir for the Treatment of Disseminated Herpes Zoster Complicated with Probable Varicella-zoster Pneumonia in an Immunocompromised Patient. Intern Med 2022; 61:1785-1788. [PMID: 34776482 PMCID: PMC9259304 DOI: 10.2169/internalmedicine.8104-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
We herein report the case of a 78-year-old woman who was diagnosed as having disseminated herpes zoster (DHZ) complicated with probable varicella-zoster pneumonia during maintenance therapy for microscopic polyangiitis. Because the patient had severe renal dysfunction, amenamevir administration was started to avoid any neurotoxicity of acyclovir, which is suggested to be optimal for treatment. It ameliorated her symptoms without any adverse events. This is the first report suggesting the efficacy of amenamevir in the treatment of severe herpes zoster infection with coexisting DHZ and probable varicella-zoster pneumonia. Amenamevir could thus be a treatment option for severe varicella zoster virus infections.
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Affiliation(s)
- Hiroki Kobayashi
- Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Japan
- Department of Rheumatology, Medical Corporation JR Hiroshima Hospital, Japan
| | - Yusuke Yoshida
- Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Japan
| | - Tomoki Komoshita
- Postgraduate Clinical Training Center, Hiroshima University Hospital, Japan
| | - Harumichi Suma
- Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Japan
- Department of Rheumatology, National Hospital Organization, Kure Medical Center and Chugoku Cancer Center, Japan
| | - Yohei Hosokawa
- Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Japan
- Department of Rheumatology, Hiroshima Prefectural Hospital, Japan
| | - Yoshikazu Hirose
- Department of Dermatology, Hiroshima University Hospital, Japan
- Department of Dermatology, Hiroshima Prefectural Hospital, Japan
| | - Tomohiro Sugimoto
- Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Japan
| | - Sho Mokuda
- Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Japan
- Department of Rheumatology, Medical Corporation JR Hiroshima Hospital, Japan
| | - Shintaro Hirata
- Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Japan
| | - Eiji Sugiyama
- Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Japan
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6
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Motohashi S, Takahashi J, Umehara T, Komatsu T, Murakami H, Iguchi Y. [A 73-year-old man with polyradiculopathy and multiple cranial neuropathies emerging separate from the originating dermatome of a varicella zoster skin lesion]. Rinsho Shinkeigaku 2022; 62:380-385. [PMID: 35474287 DOI: 10.5692/clinicalneurol.cn-001699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Indexed: 06/14/2023]
Abstract
A 73-year-old man developed delayed-onset multiple cranial neuropathies of cranial nerves V, VII and VIII, and segmental paresis in the ipsilateral upper extremity related to the C4 to Th1 segment, after all skin lesions with varicella zoster (VZV) on the left neck of the C3-4 dermatome had dried and crusted over. On admission, cerebrospinal fluid (CSF) revealed pleocytosis (all mononuclear cells, 12/μl). Treatment was started with intravenous acyclovir (10 mg/kg, every 8 h for 14 days) and methylprednisolone (1,000 mg/day for 3 days). Four days after starting treatment, left segmental paresis was improved, but the multiple cranial neuropathies persisted. Oral prednisolone (0.5 mg/kg/day) was administered for 5 days, then tapered off. All neurological symptoms had disappeared by hospital day 23. Of particular interest was the discrepancy between skin regions affected by VZV (C3-4) and the regions of cranial neuropathy (cranial nerves V, VII, and VIII) and muscle weakness innervated by C4-Th1. Although CSF was negative for VZV DNA according to PCR testing, the antibody index for VZV was elevated. This suggests intrathecal synthesis of VZV antibodies and supports the diagnosis of VZV meningitis. Also, all cranial nerves involved in this case were reported to have the cranial nerve ganglia where VZV could have established latency and been reactivated. This suggests concurrent reactivation on each cranial nerve ganglia without cutaneous lesions, as zoster sine herpete. In addition, anastomoses among the upper cervical nerves, which are found in some patients, may have contributed to this condition. These mechanisms underlie various neurological symptoms associated with VZV infection.
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Affiliation(s)
| | | | - Tadashi Umehara
- Department of Neurology, The Jikei University School of Medicine
| | - Teppei Komatsu
- Department of Neurology, The Jikei University School of Medicine
| | | | - Yasuyuki Iguchi
- Department of Neurology, The Jikei University School of Medicine
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7
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Silva DH, Banganho D, Moreira B, Silva AG. Varicella-zoster virus infection: more than just a rash. BMJ Case Rep 2022; 15:e247006. [PMID: 35228233 PMCID: PMC8886380 DOI: 10.1136/bcr-2021-247006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2022] [Indexed: 11/03/2022] Open
Affiliation(s)
- Diana H Silva
- Department of Pediatrics, Hospital de São Bernardo, Centro Hospitalar de Setúbal EPE, Setubal, Portugal
| | - Denise Banganho
- Department of Pediatrics, Hospital de São Bernardo, Centro Hospitalar de Setúbal EPE, Setubal, Portugal
| | - Biana Moreira
- Department of Pediatrics, Hospital de São Bernardo, Centro Hospitalar de Setúbal EPE, Setubal, Portugal
| | - Ana Gomes Silva
- Department of Pediatrics, Hospital de São Bernardo, Centro Hospitalar de Setúbal EPE, Setubal, Portugal
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8
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Kuwano K, Ota Y, Tsuji K, Torigoe K, Yamashita A, Muta K, Kitamura M, Yamashita H, Uramatsu T, Tashiro M, Hayashi H, Izumikawa K, Mukae H, Nishino T. An Autopsy Case of Disseminated Varicella Zoster Virus Infection during the Treatment of Nephrotic Syndrome. Intern Med 2022; 61:571-576. [PMID: 34393162 PMCID: PMC8907779 DOI: 10.2169/internalmedicine.7332-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A 68-year-old woman developed systemic blisters while receiving treatment for nephrotic syndrome. As she also developed marked liver dysfunction and disseminated intravascular coagulation, she was admitted to our hospital. She was diagnosed with varicella zoster virus (VZV) infection. Treatment was administered in the intensive-care unit, but the patient died on day 24 post-admission after severe VZV infection. A post-mortem examination showed micro-abscesses and necrosis caused by varicella zoster infection in multiple organs, including the liver, kidneys, and gastrointestinal tract. Because VZV infection can become severe in immunocompromised patients, careful consideration is needed for the prevention and treatment of the viral infection.
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Affiliation(s)
| | - Yuki Ota
- Department of Nephrology, Nagasaki University Hospital, Japan
| | - Kiyokazu Tsuji
- Department of Nephrology, Nagasaki University Hospital, Japan
| | - Kenta Torigoe
- Department of Nephrology, Nagasaki University Hospital, Japan
| | - Ayuko Yamashita
- Department of Nephrology, Nagasaki University Hospital, Japan
| | - Kumiko Muta
- Department of Nephrology, Nagasaki University Hospital, Japan
| | | | | | | | - Masato Tashiro
- Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Hiroko Hayashi
- Department of Pathology, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Koichi Izumikawa
- Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Hiroshi Mukae
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Tomoya Nishino
- Department of Nephrology, Nagasaki University Hospital, Japan
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Abstract
BACKGROUND HLA molecules are inherited key molecules in the immune inflammation and specific responses to environmental pathogens. We investigated the association of HLA-A alleles with Varicella zoster virus (VZV) seropositivity in patients with atherosclerosis (AS). MATERIALS AND METHODS Plasma Anti-VZV IgG and molecular HLA type were detected in 203 (100 AS+ and 103 AS-) individuals. RESULTS Of 100 AS+ individuals, 66 were anti-VZV+ and 34 were anti-VZV-. Of 103 age/sex-matched AS- individuals, 59 were anti-VZV+ and 44 were anti-VZV-. Anti-VZV-IgG in AS+ cases was higher than AS- controls (p = .034). The mean anti-VZV IgG in HLA-A*02+AS+ individuals was higher than HLA-A*02+AS- controls (p < .001). HLA-A*02 was associated with VZV-seropositivity (p = .01) in AS+ patients. A higher frequency of HLA-A*02-allele in AS+ patients compared to AS- controls (p = .015) and an accumulation of HLA-A*02-allele in AS+ anti-VZV+ group (33.3%, p = .004) was observed. CONCLUSIONS HLA-A alleles and immune responses to VZV are associated with clinical atherosclerosis.
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Affiliation(s)
- Hamed Fouladseresht
- Department of Immunology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amin Safa
- Department of Immunology, Ophthalmology and ENT, School of Medicine, Complutense University, Madrid, Spain
| | - Shahdad Khosropanah
- Department of Cardiology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehrnoosh Doroudchi
- Department of Immunology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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10
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Abstract
A variety of acute oral lesions may be encountered in the scope of dermatology. Oral lesions may be single or multiple; may arise secondary to infectious, immune, congenital, medication use, or idiopathic causes; and may take a variety of forms. A thorough evaluation of the oral cavity is required to assess patients with oral lesions. Affected patients may be monitored, treated, or referred to an appropriate specialist for further management as needed. Many acute oral lesions are self-limiting in nature and patients may require only assessment and reassurance. Several common acute oral lesions are discussed in this article.
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Affiliation(s)
- Katherine France
- Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, 240 South 40th Street, Philadelphia, PA 19104, USA.
| | - Alessandro Villa
- Department of Orofacial Sciences, University of California San Francisco, 513 Parnassus Avenue, Suite 512A, San Francisco, CA 94143, USA
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11
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Yoon MK, Kelly HR, Freitag SK, Marneros AG, Barshak MB, Brackett DG. Case 12-2021: A 78-Year-Old Man with a Rash on the Scalp and Face. N Engl J Med 2021; 384:1553-1562. [PMID: 33882209 DOI: 10.1056/nejmcpc2100276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Michael K Yoon
- From the Departments of Ophthalmology (M.K.Y., S.K.F.) and Radiology (H.R.K.), Massachusetts Eye and Ear, the Departments of Radiology (H.R.K.), Dermatology (A.G.M.), Medicine (M.B.B.), and Pathology (D.G.B.), Massachusetts General Hospital, and the Departments of Radiology (H.R.K.), Dermatology (A.G.M.), Medicine (M.B.B.), and Pathology (D.G.B.), Harvard Medical School - all in Boston
| | - Hillary R Kelly
- From the Departments of Ophthalmology (M.K.Y., S.K.F.) and Radiology (H.R.K.), Massachusetts Eye and Ear, the Departments of Radiology (H.R.K.), Dermatology (A.G.M.), Medicine (M.B.B.), and Pathology (D.G.B.), Massachusetts General Hospital, and the Departments of Radiology (H.R.K.), Dermatology (A.G.M.), Medicine (M.B.B.), and Pathology (D.G.B.), Harvard Medical School - all in Boston
| | - Suzanne K Freitag
- From the Departments of Ophthalmology (M.K.Y., S.K.F.) and Radiology (H.R.K.), Massachusetts Eye and Ear, the Departments of Radiology (H.R.K.), Dermatology (A.G.M.), Medicine (M.B.B.), and Pathology (D.G.B.), Massachusetts General Hospital, and the Departments of Radiology (H.R.K.), Dermatology (A.G.M.), Medicine (M.B.B.), and Pathology (D.G.B.), Harvard Medical School - all in Boston
| | - Alexander G Marneros
- From the Departments of Ophthalmology (M.K.Y., S.K.F.) and Radiology (H.R.K.), Massachusetts Eye and Ear, the Departments of Radiology (H.R.K.), Dermatology (A.G.M.), Medicine (M.B.B.), and Pathology (D.G.B.), Massachusetts General Hospital, and the Departments of Radiology (H.R.K.), Dermatology (A.G.M.), Medicine (M.B.B.), and Pathology (D.G.B.), Harvard Medical School - all in Boston
| | - Miriam B Barshak
- From the Departments of Ophthalmology (M.K.Y., S.K.F.) and Radiology (H.R.K.), Massachusetts Eye and Ear, the Departments of Radiology (H.R.K.), Dermatology (A.G.M.), Medicine (M.B.B.), and Pathology (D.G.B.), Massachusetts General Hospital, and the Departments of Radiology (H.R.K.), Dermatology (A.G.M.), Medicine (M.B.B.), and Pathology (D.G.B.), Harvard Medical School - all in Boston
| | - Diane G Brackett
- From the Departments of Ophthalmology (M.K.Y., S.K.F.) and Radiology (H.R.K.), Massachusetts Eye and Ear, the Departments of Radiology (H.R.K.), Dermatology (A.G.M.), Medicine (M.B.B.), and Pathology (D.G.B.), Massachusetts General Hospital, and the Departments of Radiology (H.R.K.), Dermatology (A.G.M.), Medicine (M.B.B.), and Pathology (D.G.B.), Harvard Medical School - all in Boston
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Meziane FZ, Dali-Sahi M, Dennouni-Medjati N, Boulenouar H, Kachekouche Y, Benslama Y, Harek Y. Molecular mimicry between varicella, measles virus and Hsp60 in type 1 diabetes associated HLA-DR3/DR4 molecules. Diabetes Metab Syndr 2020; 14:1783-1789. [PMID: 32947109 DOI: 10.1016/j.dsx.2020.08.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 08/05/2020] [Accepted: 08/11/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND AIMS Type 1 diabetes (T1D) is a multifactorial autoimmune disease that combines genetics and environmental factors. The aim of this study is to determine the environmental risk factors and to investigate how virals infections are risks factors for type 1 diabetics whom have HLA DR3/DR4 predisposition in our population. METHODS This study includes 233 subjects, 145 diabetics and 88 controls from regions of the extreme western of Algeria. All the informations related to the disease were collected using predesigned questionnaire. Using in silico approach, we attempt to improve the understanding of this analytical result by molecular mimicry, which is associated with the breakdown of several autoimmune pathologies. RESULTS The statistical study showed that history of varicella and measles infection and T1D related inheritance and type 2 diabetes are risk factors for T1D in the population of Tlemcen. We have determined the homologous antigenic regions between the glycoprotein "gE" of the varicella virus, the "hemagglutinin" of measles and the human protein "HSP60" at the level of their sequence and 3D structure. These cross-reactive epitopes bind to MHC class II molecules (HLA DR3/DR4) that predispose to T1D but not to MHC class II molecules (HLA DR2) that protect against T1D. This epitopes induce Th2 cells but only "hemagglutinin" and "Hsp60" can activate Th1 differentiation. This indicates their potential to destroy pancreatic cells β. CONCLUSION Our study can allow us to adapt biological markers to genetically predisposed T1D and to establish a preventive strategy for healthy genetic predisposed individuals in Tlemcen population.
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Affiliation(s)
- Fatima Zohra Meziane
- Department of Biology, Laboratory of Analytical Chemistry and Electrochemistry, Unviversity of Tlemcen, Algeria.
| | - Majda Dali-Sahi
- Department of Biology, Laboratory of Analytical Chemistry and Electrochemistry, Unviversity of Tlemcen, Algeria
| | - Nouria Dennouni-Medjati
- Department of Biology, Laboratory of Analytical Chemistry and Electrochemistry, Unviversity of Tlemcen, Algeria
| | | | - Youssouf Kachekouche
- Department of Biology, Laboratory of Analytical Chemistry and Electrochemistry, Unviversity of Tlemcen, Algeria
| | - Yasmine Benslama
- Department of Biology, Laboratory of Analytical Chemistry and Electrochemistry, Unviversity of Tlemcen, Algeria
| | - Yahia Harek
- Department of Biology, Laboratory of Analytical Chemistry and Electrochemistry, Unviversity of Tlemcen, Algeria
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13
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Paudel V. Erectile Dysfunction Secondary to Herpes Zoster. J Nepal Health Res Counc 2020; 17:556-557. [PMID: 32001867 DOI: 10.33314/jnhrc.v17i4.2174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 01/21/2020] [Indexed: 06/10/2023]
Abstract
Varicella Zoster is dermatomal neuropathic disease caused by reactivation of varicella zoster virus, characterized by vesico-bullous eruptions. The sacral dermatomal involvement in shingles is a rare phenomenon but well recognized cause of urinary retention, bladder dysfunction but rarely erectile dysfunction. We present a case of sacral herpes zoster with erectile dysfunction in a sexually active adult male. Keywords: Erectile Dysfunction; herpes zoster; Nepal.
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Affiliation(s)
- Vikash Paudel
- Department of Dermatology and Venereology, National Medical College, Birgunj, Parsa, Nepal
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14
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Kontou E, Bontzos G, Triantafyllou D, Garnavou-Xirou C, Ragkousis A, Xirou T. Conservative management of streptococcal necrotizing periorbital fasciitis following primary VZV infection. G Chir 2020; 41:114-117. [PMID: 32038022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
A 45-year old male patient, with a past history of illicit drug abuse and hepatitis C, presented with a 2 day history of worsening eyelid edema. Examination of the globe was impossible due to eyelid fusion caused by extensive soft tissue damage. Based on the examination, a diagnosis of necrotic fasciitis secondary to VZV infection was Romamade. The patient received empirical treatment with intravenous acyclovir, meropenem and vancomycin. CT imaging demonstrated no ocular involvement. Lesions were cultivated, revealing presence of Streptococcus pyogenes. Intravenous clindamycin was added to his course. Improvement was gradually observed. The patient received treatment for a total of 21 days, resulting in excellent final outcome. His final visual acuity was 0.9 on a Snellen chart, without signs of ocular inflammation. No surgical intervention was required and lesions fully healed with conservative management. Clinical outcomes depend on prompt treatment initiation, whilst delay in the diagnosis can prove fatal.
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15
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Deoshatwar AR, Behera SP, Kumar N, Misra BR, Deval H, Bondre VP, Mittal M. Primary varicella zoster virus infection-related hemiparesis and fatal neurological complications in an immunocompetent girl. Natl Med J India 2019; 32:381-382. [PMID: 33380643 DOI: 10.4103/0970-258x.303630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Avinash R Deoshatwar
- Division of Encephalitis, ICMR-National Institute of Virology, Pune, Maharashtra, India
| | - Sthita Pragnya Behera
- Division of Encephalitis, ICMR-National Institute of Virology, Pune, Maharashtra, India
| | - Niraj Kumar
- Division of Encephalitis, ICMR-National Institute of Virology, Pune, Maharashtra, India
| | - Brij Ranjan Misra
- Division of Encephalitis, ICMR-National Institute of Virology, Pune, Maharashtra, India
| | - Hirawati Deval
- Division of Encephalitis, ICMR-National Institute of Virology, Pune, Maharashtra, India
| | - Vijay P Bondre
- Division of Encephalitis, ICMR-National Institute of Virology, Pune, Maharashtra, India
| | - Mahima Mittal
- Department of Paediatrics, Baba Raghav Das Medical College, Gorakhpur, Uttar Pradesh, India
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Asada H. VZV-specific cell-mediated immunity, but not humoral immunity, correlates inversely with the incidence of herpes zoster and the severity of skin symptoms and zoster-associated pain: The SHEZ study. Vaccine 2019; 37:6776-6781. [PMID: 31543415 DOI: 10.1016/j.vaccine.2019.09.031] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [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: 04/17/2019] [Revised: 08/18/2019] [Accepted: 08/18/2019] [Indexed: 12/19/2022]
Abstract
Onset of herpes zoster (HZ) is thought to be related to a decline in cell-mediated immunity (CMI). However, until recently, there have been no large-scale prospective studies on the relationship between varicella-zoster virus (VZV)-specific CMI and the onset and severity of HZ. The Japanese researchers conducted a cohort study on VZV immunity in a population living on an island cluster, Shozu County in Japan, and examined the people who developed HZ during a follow-up period of three years to clarify the relationship between the onset and severity of HZ and immunity. In this study, they focused on the relationship between cell-mediated and humoral immunity and the onset and severity of HZ. CMI was measured by VZV skin test, and humoral immunity was assessed with serological tests for VZV-specific antibodies. A total of 12,522 people over the age of 50 were enrolled in this study, and 401 registrants were diagnosed as HZ. VZV-specific CMI assessed by VZV skin test showed a significant inverse relationship with the incidence of HZ and the severity of skin lesions and acute and subacute pain, and with the occurrence of postherpetic neuralgia. In contrast, VZV-specific antibody titer was not associated with the incidence and severity of HZ. These results suggest that VZV-specific CMI, but not humoral immunity, plays a key role in controlling the onset of HZ, the severity of skin lesions, and zoster-associated pain.
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Affiliation(s)
- Hideo Asada
- Department of Dermatology, Nara Medical University School of Medicine, Nara, Japan
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Isobe T, Umemoto J, Kobayashi M, Okuno T, Shiratsuki Y, Kodama A, Nakao M, Amano Y, Hotta T, Hamaguchi M, Okimoto T, Hamaguchi S, Tsubata Y. Varicella-zoster Virus Related Pulmonary Granulomas in Which Varicella-zoster Virus DNA Was Demonstrated in a Thoracoscopic Lung Biopsy Specimen. Intern Med 2019; 58:2101-2105. [PMID: 30918176 PMCID: PMC6702000 DOI: 10.2169/internalmedicine.2021-18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 43-year-old man with malignant lymphoma who had been treated with the cyclosphamide, vincrstine, procarbazine, and prednisolone (C-MOPP) regimen was admitted to our hospital with skin eruption. He was diagnosed to have varicella, and treatment with acyclovir and immune globulin was started. Chest computed tomography revealed multiple nodules in the both lung fields. Diagnostic thoracoscopic lung biopsy specimens revealed granuloma formation, and polymerase chain reaction testing revealed the presence of varicella-zoster virus DNA in the granulomatous tissue. It was unusual for the lung nodule in varicella pneumonia to increase in size over time in a patient who had undergone antiviral therapy, while also demonstrating multiple granulomas.
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Affiliation(s)
- Takeshi Isobe
- Department of Internal Medicine, Division of Medical Oncology & Respiratory Medicine, Shimane University Faculty of Medicine, Japan
| | - Jyunro Umemoto
- Department of Internal Medicine, Division of Medical Oncology & Respiratory Medicine, Shimane University Faculty of Medicine, Japan
| | - Misato Kobayashi
- Department of Internal Medicine, Division of Medical Oncology & Respiratory Medicine, Shimane University Faculty of Medicine, Japan
| | - Takae Okuno
- Department of Internal Medicine, Division of Medical Oncology & Respiratory Medicine, Shimane University Faculty of Medicine, Japan
| | - Youhei Shiratsuki
- Department of Internal Medicine, Division of Medical Oncology & Respiratory Medicine, Shimane University Faculty of Medicine, Japan
| | - Akari Kodama
- Department of Internal Medicine, Division of Medical Oncology & Respiratory Medicine, Shimane University Faculty of Medicine, Japan
| | - Mika Nakao
- Department of Internal Medicine, Division of Medical Oncology & Respiratory Medicine, Shimane University Faculty of Medicine, Japan
| | - Yoshihiro Amano
- Department of Internal Medicine, Division of Medical Oncology & Respiratory Medicine, Shimane University Faculty of Medicine, Japan
| | - Takamasa Hotta
- Department of Internal Medicine, Division of Medical Oncology & Respiratory Medicine, Shimane University Faculty of Medicine, Japan
| | - Megumi Hamaguchi
- Department of Internal Medicine, Division of Medical Oncology & Respiratory Medicine, Shimane University Faculty of Medicine, Japan
| | - Tamio Okimoto
- Department of Internal Medicine, Division of Medical Oncology & Respiratory Medicine, Shimane University Faculty of Medicine, Japan
| | - Shunichi Hamaguchi
- Department of Internal Medicine, Division of Medical Oncology & Respiratory Medicine, Shimane University Faculty of Medicine, Japan
| | - Yukari Tsubata
- Department of Internal Medicine, Division of Medical Oncology & Respiratory Medicine, Shimane University Faculty of Medicine, Japan
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18
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Wang X, Feng Y, Xu JC. [Ramsey-Hunt syndrome with initial syndrome of hoarseness: a case report]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2019; 33:283-288. [PMID: 30813705 DOI: 10.13201/j.issn.1001-1781.2019.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Indexed: 06/09/2023]
Abstract
Summary Ramsey-Hunt syndrome is caused by the varicella zoster virus, which mainly affects the facial nerve. The typical clinical features of Ramsey-Hunt syndrome are peripheral facial paralysis and ear herpes. In this case, initial symptoms were hoarseness and coughing, afterwards typical symptom occurred 5 days later which were earache, late-onset herpes, and facial paralysis. Ramsey-Hunt syndrome are difficult to diagnose because of its seemingly unrelated initial symptoms.
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Shubhakaran K. Varicella Zoster Virus and Neurological Complications. J Assoc Physicians India 2019; 67:99. [PMID: 30935191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Abstract
RATIONALE Chronic uveitis with immunosuppressive agents could develop chronic herpetic retinitis with varicella-zoster virus (VZV) or herpes simplex virus (HSV). Ocular Epstein-Barr virus (EBV) infection develops uveitis and vitritis, but the clinical feature of EBV retinitis is not typical as a viral retinitis. EBV retinitis is rare, and only a few cases of EBV retinitis have been reported. Herein, we describe a case of retinitis with EBV and VZV which were the primary viruses verified by multiplex polymerase chain reaction (PCR). PATIENT CONCERNS A 75-year-old woman suffered from sudden visual loss in the left eye. She had been diagnosed with rheumatoid arthritis. At presentation, visual acuity (VA) was 20/400 in the left eye. Slit lamp examination disclosed fine white keratic precipitates with infiltrating cells and dense vitreous opacities in the anterior segment and vitreous. Fundus photographs showed multifocal chorioretinal scars in macula and peripheral retina, and granular lesions surrounding arcade vessels. DIAGNOSES Ocular toxoplasmosis was primarily suspected. INTERVENTIONS However, serological test showed negative of toxoplasmosis. Therefore, a diagnostic and therapeutic vitrectomy was performed. Vitreous fluid sample was used for multiplex PCR for detection of human herpesvirus (HHV) -1 to -8, toxoplasmosis and toxocariasis. OUTCOMES Multiplex PCR detected 5.8 × 10 copies/mL of EBV-deoxyribonucleic acid (DNA), and 3.6 × 10 copies/mL of VZV-DNA in the sample. Therefore, we could diagnose the unidentified panuveitis a retinitis associated with double infection of EBV and VZV. At 85 days after the vitrectomy, VA of the left eye recovered to be 20/16. LESSONS Elderly patients under immunosuppression may be susceptible to develop retinitis associated with infection of multiple HHVs, and multiplex PCR is an excellent tool to diagnose an unidentified panuveitis resembling this case.
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Affiliation(s)
- Tomohito Sato
- Department of Ophthalmology, National Defense Medical College, Saitama
| | - Riki Kitamura
- Department of Ophthalmology, National Defense Medical College, Saitama
| | | | - Masaru Takeuchi
- Department of Ophthalmology, National Defense Medical College, Saitama
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Abstract
This is a rare case of Varicella zoster virus (VZV) lumbosacral plexopathy in an 84-year-old women presenting with lower limb weakness and rash. Contrast-enhanced MRI showed enhancement of the left L3-L5 descending nerves and left lumbosacral plexus consistent with inflammatory/infectious aetiology. Cerebrospinal fluid PCR confirmed VZV DNA and cerebrospinal fluid serological testing was positive for VZV immunoglobulin (Ig)M and IgG antibodies. The patient was treated with intravenous acyclovir but this was complicated by the development of acute renal failure attributed to acyclovir-induced nephropathy, requiring dose adjustment. After a prolonged course of oral acyclovir and inpatient rehabilitation, the patient made a partial neurological and functional recovery.
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Cha MJ, Seo HM, Choi EK, Lee JH, Han K, Lee SR, Lim WH, Park YM, Oh S. Increased Risk of Atrial Fibrillation in the Early Period after Herpes Zoster Infection: a Nationwide Population-based Case-control Study. J Korean Med Sci 2018; 33:e160. [PMID: 29805341 PMCID: PMC5966375 DOI: 10.3346/jkms.2018.33.e160] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 04/11/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Herpes zoster (HZ) is a chronic inflammatory disease that could result in autonomic dysfunction, often leading to atrial fibrillation (AF). METHODS From the Korean National Health Insurance Service database of 738,559 subjects, patients newly diagnosed with HZ (n = 30,685) between 2004 and 2011, with no history of HZ or AF were identified. For the non-HZ control group, 122,740 age- and sex-matched subjects were selected. AF development in the first two-years following HZ diagnosis, and during the overall follow-up period were compared among severe (requiring hospitalization, n = 2,213), mild (n = 28,472), and non-HZ (n = 122,740) groups. RESULTS There were 2,204 (1.4%) patients diagnosed with AF during follow-up, and 825 (0.5%) were diagnosed within the first two years after HZ. The severe HZ group showed higher rates of AF development (6.4 per 1,000 patient-years [PTPY]) compared to mild-HZ group (2.9 PTPY) and non-HZ group (2.7 PTPY). The risk of developing AF was higher in the first two-years after HZ diagnosis in the severe HZ group (10.6 PTPY vs. 2.7 PTPY in mild-HZ group and 2.6 PTPY in non-HZ group). CONCLUSION Severe HZ that requires hospitalization shows an increased risk of incident AF, and the risk is higher in the first two-years following HZ diagnosis.
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Affiliation(s)
- Myung-Jin Cha
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hyun-Min Seo
- Department of Dermatology, Hanyang University Guri Hospital, Guri, Korea
| | - Eue-Keun Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Ji Hyun Lee
- Department of Dermatology, The Catholic University of Korea, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Kyungdo Han
- Department of Biostatistics, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - So-Ryoung Lee
- Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Woo-Hyun Lim
- Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Young Min Park
- Department of Dermatology, The Catholic University of Korea, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Seil Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
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Heitz AFN, Hofstee HMA, Gelinck LBS, Puylaert JB. A rare case of Waterhouse- Friderichsen syndrome during primary Varicella zoster infection. Neth J Med 2017; 75:351-353. [PMID: 29219830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Primary Varicella zoster virus infection in adults is associated with a higher risk of complications when compared with the benign disease course of primary infection during childhood. We present a rare complication of adult primary Varicella zoster in the form of acute, irreversible adrenal insufficiency due to bilateral adrenal haemorrhage, which is also known as the WaterhouseFriderichsensyndrome.
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Affiliation(s)
- A F N Heitz
- Department of Internal Medicine, Haaglanden Medical Centre, The Hague, the Netherlands
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Ma H, Chen H, Dong A, Wang Y, Bian Y, Xie K. [Hydrogen-rich saline attenuates hyperalgesia and reduces cytokines in rats with post-herpetic neuralgia via activating autophagy]. Xi Bao Yu Fen Zi Mian Yi Xue Za Zhi 2017; 33:155-158. [PMID: 29762002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To investigate the role of autophagy in hydrogen-rich saline attenuating post-herpetic neuralgia( PHN) in rats. METHODS A total of 100 male SD rats were randomly divided into the five groups( n = 20) : control group,PHN group,PHN group treated with hydrogen-rich saline( PHN-H2group),PHN group treated with hydrogen-rich saline and3-MA( PHN-H2-3-MA group),PHN group treated with hydrogen-rich saline and rapamycin( PHN-H2-Rap group). PHN models were established by varicella-zoster virus( VZV) inoculation. After modeling,15 mg / kg 3-MA or 10 mg / kg rapamycin were intraperitoneally injected in corresponding rats with PHN once two days for 3 times. Hydrogen-rich saline( 10 m L / kg)was injected intraperitoneally twice a day for 7 consecutive days in PHN-H2 group,PHN-H2-3-MA group and PHN-H2-Rap group after VZV injection. The paw withdrawal thresholds( PWT) of 50 rats were detected at 3,7,14 and 21 days after modeling. Spinal cord enlargements of the other 50 rats were collected to examine tumor necrosis factor α( TNF-α),interleukine 1β( IL-1β) and IL-6 by ELISA and autophagy protein microtubule-associated protein 1 light chain 3( LC3),beclin 1and P62 by Western blotting. RESULTS Compared with the control group,the rats in the PHN group presented with decreased PWT,increased levels of TNF-α,IL-1β,IL-6,LC3Ⅱ and beclin 1,and down-regulated P62 expression. Compared with PHN group,the rats in the PHN-H2 group and PHN-H2-Rap group showed increased PWT,decreased levels of TNF-α,IL-1β and IL-6,further up-regulated expressions of LC3 and beclin 1 as wel as P62 expression. Compared with PHN-H2 group,the rats in the PHN-H2-3-MA group had reduced PWT,elevated expressions of TNF-α,IL-1β and IL-6,suppressed expressions of LC3 and beclin 1,and enhanced p62 expression. CONCLUSION Hydrogen-rich saline attenuated PWT and inhibited the release of cytokines TNF-α,IL-1β,IL-6 in rats with PHN via activating autophagy.
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Gayathri K, Ramalingam PK, Santhakumar R, Manjunath BV, Karuppuswamy N, Vetriveran B, Selvamani S, Vishnuram P, Natarajan K. Cerebral Sinus Venous Thrombosis as a Rare Complication of Primary Varicella Zoster Virus Infection. J Assoc Physicians India 2016; 64:74-76. [PMID: 27759349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
We present the case of a 23 year old with acute onset left hemiparesis and meningeal irritation, associated with recent history of chickenpox 15 days prior. Varicella-IgG and IgM was positive in the CSF and blood along with reduced serum/CSF ratios of VZV immunoglobulins. MRV showed thrombosis (CVT) of superior sagittal, transverse, right sigmoid sinuses with haemorrhagic infarct in right frontoparietal region. Patient responded well to intravenous heparin, Acyclovir and oral anticoagulant therapy.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Kumar Natarajan
- Professor and Head of Medicine, Department of General Medicine, Coimbatore Medical College Hospital, Coimbatore, Tamil Nadu
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Maia C, Fonseca J, Carvalho I, Santos H, Moreira D. [Clinical and Epidemiological Study of Complicated Infection by Varicella-Zoster Virus in the Pediatric Age]. ACTA MEDICA PORT 2015; 28:741-748. [PMID: 26849759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Accepted: 06/30/2015] [Indexed: 06/05/2023]
Abstract
INTRODUCTION In Portugal, the incidence of complicated infection by varicella-zoster virus is unknown. The purpose of this study was to describe the epidemiological and clinical features of complicated infection by varicella-zoster virus in children. MATERIAL AND METHODS Retrospective review of the clinical files of patients admitted between January 1999 and July 2013, with a diagnosis of complicated varicella-zoster virus infection. RESULTS Ninety-four patients were hospitalized with complicated varicella-zoster virus infection, two of them by reactivation of latent infection. The median age was 38 (IQR 18 - 65) months. The most frequent types of complications were bacterial overinfection of the skin and subcutaneous cellular tissue (37.2%) and respiratory complications (24.5%). Other complications were neurologic complications (19.1%), gastrointestinal (9.6%), hematologic (5.3%) and osteoarticular (4.3%). In 38 patients invasive bacterial infections were diagnosed, with bacteremia in 6 patients. The median age was highest in the immunological complications compared with infectious complications. Neurological complications occurred mainly in healthy children, while infectious complications, including the invasive bacterial infections were more frequent in patients treated with ibuprofen and/or corticosteroids. The evolution was favorable in most cases. DISCUSSION The complications of varicella-zoster virus infection occurred mainly in pre-school age and in healthy children. Infectious complications, particularly respiratory complications and bacterial overinfection of the skin and subcutaneous cellular tissue, were the most frequent. There was association between infectious complications and previous therapy with ibuprofen and / or corticosteroids. CONCLUSION Multicenter studies should be planned in order to optimize and adjust the vaccine strategies to our reality.
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Affiliation(s)
- Catarina Maia
- Serviço de Pediatria Médica. Centro Hospitalar Vila Nova de Gaia/Espinho. Gaia. Portugal
| | - Jacinta Fonseca
- Serviço de Pediatria Médica. Centro Hospitalar Vila Nova de Gaia/Espinho. Gaia. Portugal
| | - Isabel Carvalho
- Serviço de Pediatria Médica. Centro Hospitalar Vila Nova de Gaia/Espinho. Gaia. Portugal
| | - Helena Santos
- Serviço de Pediatria Médica. Centro Hospitalar Vila Nova de Gaia/Espinho. Gaia. Portugal
| | - Diana Moreira
- Serviço de Pediatria Médica. Centro Hospitalar Vila Nova de Gaia/Espinho. Gaia. Portugal
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Gershon AA, Breuer J, Cohen JI, Cohrs RJ, Gershon MD, Gilden D, Grose C, Hambleton S, Kennedy PGE, Oxman MN, Seward JF, Yamanishi K. Varicella zoster virus infection. Nat Rev Dis Primers 2015; 1:15016. [PMID: 27188665 PMCID: PMC5381807 DOI: 10.1038/nrdp.2015.16] [Citation(s) in RCA: 333] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Infection with varicella zoster virus (VZV) causes varicella (chickenpox), which can be severe in immunocompromised individuals, infants and adults. Primary infection is followed by latency in ganglionic neurons. During this period, no virus particles are produced and no obvious neuronal damage occurs. Reactivation of the virus leads to virus replication, which causes zoster (shingles) in tissues innervated by the involved neurons, inflammation and cell death - a process that can lead to persistent radicular pain (postherpetic neuralgia). The pathogenesis of postherpetic neuralgia is unknown and it is difficult to treat. Furthermore, other zoster complications can develop, including myelitis, cranial nerve palsies, meningitis, stroke (vasculopathy), retinitis, and gastroenterological infections such as ulcers, pancreatitis and hepatitis. VZV is the only human herpesvirus for which highly effective vaccines are available. After varicella or vaccination, both wild-type and vaccine-type VZV establish latency, and long-term immunity to varicella develops. However, immunity does not protect against reactivation. Thus, two vaccines are used: one to prevent varicella and one to prevent zoster. In this Primer we discuss the pathogenesis, diagnosis, treatment, and prevention of VZV infections, with an emphasis on the molecular events that regulate these diseases. For an illustrated summary of this Primer, visit: http://go.nature.com/14xVI1.
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Affiliation(s)
- Anne A Gershon
- Columbia University College of Physicians and Surgeons, 630 West 168th Street, New York, New York 10032, USA
| | - Judith Breuer
- Department of Infection and Immunity, University College London, UK
| | - Jeffrey I Cohen
- Medical Virology Section, Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Massachusetts, USA
| | - Randall J Cohrs
- Departments of Neurology and Microbiology and Immunology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Michael D Gershon
- Department of Pathology and Cell Biology, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Don Gilden
- Departments of Neurology and Microbiology and Immunology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Charles Grose
- Division of Infectious Diseases/Virology, Children's Hospital, University of Iowa, Iowa City, Iowa, USA
| | - Sophie Hambleton
- Primary Immunodeficiency Group, Institute of Cellular Medicine, Newcastle University Medical School, Newcastle upon Tyne, UK
| | - Peter G E Kennedy
- Department of Neurology, Institute of Neurological Sciences, Southern General Hospital, Glasgow University, Glasgow, Scotland, UK
| | - Michael N Oxman
- Infectious Diseases Section, Medicine Service, Veterans Affairs San Diego Healthcare System, Division of Infectious Diseases, Department of Medicine, University of California San Diego School of Medicine, San Diego, California, USA
| | - Jane F Seward
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Koichi Yamanishi
- Research Foundation for Microbial Diseases, Osaka University, Suita, Osaka, Japan
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