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Jacques C, Marchand F, Chatelais M, Brulefert A, Floris I. Understanding the Mode of Action of Several Active Ingredients from the Micro-Immunotherapy Medicine 2LZONA ®. J Inflamm Res 2025; 18:4267-4290. [PMID: 40134411 PMCID: PMC11934876 DOI: 10.2147/jir.s498930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2024] [Accepted: 03/04/2025] [Indexed: 03/27/2025] Open
Abstract
Introduction Varicella-zoster virus (VZV) affects over 90% of the global population. The initial encounter with VZV, often in the early years of childhood, results in varicella. From latency, VZV can reactivate in later stages of life, leading to the development of herpes zoster. Considering the importance of host immune responses in preventing reactivation and clinical manifestations associated with VZV infection, a therapy that sustains the immune system could be of great interest. Objective The present work aimed to set the basis of the possible mode of action of 2LZONA®, a micro-immunotherapy medicine composed of five different capsules. Thus, the effects of several active substances employed in this medicine were assessed in human primary immune-related cells. Results and Discussion Our results showed that DNA (8 CH) and RNA (8 CH), two active substances used in 2LZONA, displayed phagocytosis-enhancing capabilities in granulocytes and contained sub-micron particles that could explain, at least partially, the observed effect. These two active substances tested singularly and together with other actives of 2LZONA's capsules, modulated the proliferation of immature, transitory, and mature subsets of natural killer (NK) cells in an IL-15-like pattern, suggesting an enhancement of their activation levels. Moreover, the tested items of 2LZONA increased the secretion of IL-2, IL-6, IL-13, and TNF-α in human peripheral blood mononuclear cells (PBMCs). Furthermore, the proliferation of PBMCs-derived NK cells, intermediate monocytes, and neutrophils was slightly increased by this treatment. In CD3 and CD3/CD28 pre-primed conditions, actives present in one capsule of 2LZONA enhanced the secretion of IL-6 and TNF-α. Finally, one capsule of 2LZONA reduced the expression of human leukocyte antigen (HLA) in IFN-inflamed endothelial cells. Overall, these data provide, for the first time, preliminary experimental evidence of the mechanisms of action of some of the active ingredients employed in 2LZONA capsules.
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Affiliation(s)
- Camille Jacques
- Preclinical Research Department, Labo’life France, Moncoutant-Sur-Sevre, 79320, France
| | | | | | | | - Ilaria Floris
- Preclinical Research Department, Labo’life France, Moncoutant-Sur-Sevre, 79320, France
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Zhang P, Zhang C, Zheng B, Liu Y, Zhang D, Xiao H. The "brain-gut" mechanism of postherpetic neuralgia: a mini-review. Front Neurol 2025; 16:1535136. [PMID: 40129863 PMCID: PMC11932021 DOI: 10.3389/fneur.2025.1535136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2024] [Accepted: 02/17/2025] [Indexed: 03/26/2025] Open
Abstract
Postherpetic neuralgia (PHN), a representative type of neuropathic pain, has attracted much research on its diagnosis and therapy at the molecular level. Interestingly, this study based on the brain-gut axis provided a novel point of view to interpret the mechanism of PHN. Past neuroanatomical and neuroimaging studies of pain suggest that the prefrontal cortex, anterior cingulate cortex, amygdala, and other regions of the brain may play crucial roles in the descending inhibition of PHN. Dominant bacterial species in patients with PHN, such as Lactobacillus, generate short-chain fatty acids, including butyrate. Evidence indicates that disturbance of some metabolites (such as butyrate) is closely related to the development of hyperalgesia. In addition, tryptophan and 5-HT in the intestinal tract act as neurotransmitters that regulate the descending transmission of neuropathic pain signals. Concurrently, the enteric nervous system establishes close connections with the central nervous system through the vagus nerve and other pathways. This review aims to investigate and elucidate the molecular mechanisms associated with PHN, focusing on the interplay among PHN, the gut microbiota, and relevant metabolites while scrutinizing its pathogenesis.
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Affiliation(s)
- Peijun Zhang
- Department of Pain Management, West China Hospital, Sichuan University, Chengdu, China
| | - Cuomaoji Zhang
- Department of Anesthesiology, Affiliated Sport Hospital of Chengdu Sport University, Chengdu Sport University, Chengdu, Sichuan, China
| | - Bixin Zheng
- Department of Pain Management, West China Hospital, Sichuan University, Chengdu, China
| | - Yuntao Liu
- Department of Pain Management, West China Hospital, Sichuan University, Chengdu, China
| | - Dingkun Zhang
- Laboratory of Clinical Proteomics and Metabolomics, Institutes for Systems Genetics, Frontiers Science Center for Disease-related Molecular Network, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Hong Xiao
- Department of Pain Management, West China Hospital, Sichuan University, Chengdu, China
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Al Ghobain M, Farahat F, Zeitouni M, Alsowayan W, Al-Awfi S, AlBarrak A, Al-Basheri S, Alhabeeb F, Alhamad EH. The Saudi thoracic society guidelines for vaccinations in adult patients with chronic respiratory diseases. Ann Thorac Med 2025; 20:36-48. [PMID: 39926401 PMCID: PMC11804953 DOI: 10.4103/atm.atm_202_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2024] [Accepted: 09/24/2024] [Indexed: 02/11/2025] Open
Abstract
Adult patients with chronic respiratory diseases (CRDs) are considered high risk group who are more likely to experience worse clinical outcomes if they acquire viral or bacterial infections. Vaccination is the best preventive tool to reduce the risk of infection and disease occurrence and to reduce the level of severity of complications associated with the various vaccine-preventable infections. These guidelines were developed by the Saudi Thoracic Society task force to emphasize the critical importance of improving the vaccine coverage rates in adult patients with CRD. They are intended to serve as a reference for healthcare practitioners managing CRD patients. The guidelines aimed to review the current knowledge related to vaccination efficacy in adult patients with CRD, based on the recent evidence and recommendations. Integrating the administration of the recommended vaccines in routine healthcare, such as during outpatient visits or before hospital discharge, is crucial for improving the vaccination rates in high-risk patients. The key strategies to address this public health priority include simplifying vaccination guidelines to enhance their accessibility and implementation by healthcare providers, increasing awareness in both the patients and healthcare providers that vaccines are not only intended for children. Additional strategies include maintaining continuous surveillance and advance research to discover novel vaccines. This approach aims to expand the range of preventable diseases and improve overall health and well-being. Vaccine hesitancy remains a significant challenge that necessitates a clear understanding of the community concerns. Providing appropriate education and communication, as well as addressing these concerns, are the crucial steps toward improving vaccine acceptance and uptake. By implementing these guidelines and multifaceted strategies, healthcare systems can optimize vaccine coverage and protection for patients with CRD, reduce the burden of vaccine-preventable complications, and improve the clinical outcomes in this vulnerable population.
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Affiliation(s)
- Mohammed Al Ghobain
- Professor of Pulmonary Medicine, King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Fayssal Farahat
- Director, Community and Public Health, King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Mohammed Zeitouni
- Consultant Pulmonologist, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Waleed Alsowayan
- Consultant Pulmonologist, Security Forces Hospital, Riyadh, Saudi Arabia
| | - Sultan Al-Awfi
- Consultant Infectious Diseases, Security Forces Hospital, Riyadh, Saudi Arabia
| | - Ali AlBarrak
- Consultant Infectious Diseases, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Shareefah Al-Basheri
- Consultant Pulmonologist, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Fatmah Alhabeeb
- Consultant Pulmonologist, King Khalid University Hospital, Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Esam H. Alhamad
- Professor of Pulmonary Medicine, Department of Medicine, Division of Pulmonary Medicine, King Saud University, Riyadh, Saudi Arabia
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Palanimuthu D, Yong E, Ramachandran K, Chen IHK. Neck Abscess as a Rare Sequela of Pediatric Varicella-Zoster Infection: A Case Report. Cureus 2025; 17:e77639. [PMID: 39968434 PMCID: PMC11833142 DOI: 10.7759/cureus.77639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2025] [Indexed: 02/20/2025] Open
Abstract
Chickenpox is caused by the varicella-zoster virus (VZV), a DNA virus of the herpes virus family. While typically mild and self-limiting, it poses a high risk of contagion. A generalized pruritic rash is the common initial symptom among pediatric populations. Complications often include bacterial infections of skin lesions, predominantly staphylococcal or streptococcal, which may progress to cellulitis or bullous impetigo. Additionally, it may lead to more severe complications such as cerebellar ataxia, encephalitis, viral pneumonia, hemorrhagic conditions, and joint involvement. We present a case of a 17-month-old male diagnosed with varicella-zoster infection a week prior. His presentation included diffuse swelling in the left neck, accompanied by fever and reduced oral intake. Clinical and radiological assessments confirmed a left neck abscess with multiple cervical lymphadenitis. Following the incision and drainage of the abscess, the patient achieved complete resolution of symptoms with antimicrobial treatment. To the best of our knowledge, this is the first reported case of pediatric varicella-zoster infection complicated by a secondary bacterial skin infection leading to a neck abscess. It underscores the importance for clinicians to perform comprehensive evaluations in patients manifesting secondary skin lesion infections. Early referral to tertiary care facilities is imperative, as neck abscesses, albeit rare, necessitate prompt treatment to avert potential complications.
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Affiliation(s)
| | - Enci Yong
- Radiology, Hospital Putrajaya, Putrajaya, MYS
| | | | - Irise Hoi Khin Chen
- Otorhinolaryngology - Head and Neck Surgery, Hospital Putrajaya, Putrajaya, MYS
- Otorhinolaryngology - Head and Neck Surgery, Hospital Kuala Lumpur, Kuala Lumpur, MYS
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Faramarzi MR, Hosseinian E, Maghsoodi E. The Role of Moist Dressings in the Management of Herpes Zoster With Scalp Involvement: A Case Report. Clin Case Rep 2024; 12:e9607. [PMID: 39582726 PMCID: PMC11583079 DOI: 10.1002/ccr3.9607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Revised: 09/29/2024] [Accepted: 10/11/2024] [Indexed: 11/26/2024] Open
Abstract
Comprehensive management, including antivirals and pain control, is crucial for mitigating complications and improving patient outcomes in herpes zoster. Moist wound dressings, specifically hydrocoll, effectively reduce pain, and promote healing in herpes zoster with scalp involvement, as demonstrated in the case of a 76-year-old male.
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Affiliation(s)
| | - Erfan Hosseinian
- Department of NursingMaragheh University of Medical SciencesMaraghehIran
| | - Esmaiel Maghsoodi
- Department of NursingMaragheh University of Medical SciencesMaraghehIran
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Nogueira CDO, Lopes da Silva MO, de Lima EV, Christoff RR, Gavino-Leopoldino D, Lemos FS, da Silva NE, Da Poian AT, Assunção-Miranda I, Figueiredo CP, Clarke JR. Immunosuppression-induced Zika virus reactivation causes brain inflammation and behavioral deficits in mice. iScience 2024; 27:110178. [PMID: 38993676 PMCID: PMC11237861 DOI: 10.1016/j.isci.2024.110178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 02/27/2024] [Accepted: 05/31/2024] [Indexed: 07/13/2024] Open
Abstract
Zika virus (ZIKV) is a neurotropic flavivirus that can persist in several tissues. The late consequences of ZIKV persistence and whether new rounds of active replication can occur, remain unaddressed. Here, we investigated whether neonatally ZIKV-infected mice are susceptible to viral reactivation in adulthood. We found that when ZIKV-infected mice are treated with immunosuppressant drugs, they present increased susceptibility to chemically induced seizures. Levels of subgenomic flavivirus RNAs (sfRNAs) were increased, relative to the amounts of genomic RNAs, in the brains of mice following immunosuppression and were associated with changes in cytokine expression. We investigated the impact of immunosuppression on the testicles and found that ZIKV genomic RNA levels are increased in mice following immunosuppression, which also caused significant testicular damage. These findings suggest that ZIKV can establish new rounds of active replication long after acute stages of disease, so exposed patients should be monitored to ensure complete viral eradication.
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Affiliation(s)
- Clara de O Nogueira
- Faculdade de Farmácia, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941902, RJ, Brazil
| | | | - Emanuelle V de Lima
- Faculdade de Farmácia, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941902, RJ, Brazil
- Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941902, RJ, Brazil
| | - Raíssa Rilo Christoff
- Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941902, RJ, Brazil
| | - Daniel Gavino-Leopoldino
- Instituto de Microbiologia Paulo de Goes, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941902, RJ, Brazil
| | - Felipe S Lemos
- Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941902, RJ, Brazil
| | - Nicolas E da Silva
- Faculdade de Farmácia, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941902, RJ, Brazil
| | - Andrea T Da Poian
- Instituto de Bioquímica Médica Leopoldo de Meis, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941902, RJ, Brazil
| | - Iranaia Assunção-Miranda
- Instituto de Microbiologia Paulo de Goes, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941902, RJ, Brazil
| | - Claudia P Figueiredo
- Faculdade de Farmácia, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941902, RJ, Brazil
- Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941902, RJ, Brazil
| | - Julia R Clarke
- Faculdade de Farmácia, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941902, RJ, Brazil
- Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941902, RJ, Brazil
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Giannelos N, Curran D, Nguyen C, Kagia C, Vroom N, Vroling H. The Incidence of Herpes Zoster Complications: A Systematic Literature Review. Infect Dis Ther 2024; 13:1461-1486. [PMID: 38896390 PMCID: PMC11219681 DOI: 10.1007/s40121-024-01002-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 05/30/2024] [Indexed: 06/21/2024] Open
Abstract
INTRODUCTION The objective of this work was to summarize the incidence of herpes zoster (HZ) complications in different populations. METHODS Systematic literature review of PubMed, Embase, and Virtual Health Library records between January 1, 2002 and October 20, 2022 using search strings for HZ, complications, and frequency measurements. RESULTS The review included 124 studies, most conducted in the general population (n = 93) and on individuals with comorbidities (n = 41) ≥ 18 years of age. Most studies were conducted in Europe (n = 44), Asia (n = 40), and North America (n = 36). Postherpetic neuralgia (PHN) was the most studied neurological complication. Variable relative PHN incidence was found in the general population (2.6-46.7%) or based on diagnosis: immunocompromised (3.9-33.8%), depression (0-50%), and human immunodeficiency virus (HIV) (6.1-40.2%). High incidence rates were observed in hematological malignancies (HM) and solid organ malignancies (132.5 and 93.7 per 1000 person-years, respectively). Ocular complications were frequently reported with herpes zoster ophthalmicus (HZO). The relative incidence (incidence rate) of HZO in the general population was reported as 1.4-15.9% (0.31-0.35 per 1000 person-years). High relative incidence was observed in HIV (up to 10.1%) and HM (3.2-11.3%). Disseminated HZ was the most frequently reported cutaneous complication. The relative incidence of disseminated HZ was 0.3-8.2% in the general population, 0-0.5% in the immunocompetent, and 0-20.6% in patients with comorbidities. High relative incidence was reported in HM and solid organ transplant (up to 19.3% and 14.8%, respectively). DISCUSSION Most reported complications were neurological (n = 110), ocular (n = 48), and cutaneous (n = 38). Few studies stratified complications by age or gender (or both). Incidence appeared higher in select immunocompromised populations. Higher incidence was associated with older age in several studies; the general association with gender was unclear. CONCLUSIONS Variable incidence of HZ complications was reported by population subgroup. Further research is required to quantitatively analyze incidence by age, gender, and location.
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Affiliation(s)
| | | | - Chi Nguyen
- Pallas Health Research & Consultancy, a P95 Company, Leuven, Belgium
| | - Carol Kagia
- Pallas Health Research & Consultancy, a P95 Company, Leuven, Belgium
| | - Nikki Vroom
- Pallas Health Research & Consultancy, a P95 Company, Rotterdam, Netherlands
| | - Hilde Vroling
- Pallas Health Research & Consultancy, a P95 Company, Rotterdam, Netherlands
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Arumugam I, Rajasekaran SS, Gopalakrishnan K, Gnanaskandan S, Jeganathan SN, Athi J, Shanmugaraj R, Ramesh R, Shankar V, Krishnasamy K, Ranganathan LN, Balakrishnan U, Mahalingam R, Bubak AN, Nagel MA, Srikanth P. Diagnostic value of anti-VZV IgG in neurological diseases among varicella unvaccinated individuals. J Neurovirol 2024; 30:327-335. [PMID: 39085748 DOI: 10.1007/s13365-024-01224-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Revised: 06/13/2024] [Accepted: 07/10/2024] [Indexed: 08/02/2024]
Abstract
Varicella zoster virus (VZV) is a neurotropic alphaherpesvirus that causes neurological manifestations either as a complication of primary infection or reactivation. VZV induced neurological diseases have a good prognosis when confirmed early and treated with anti-viral therapy. Myelitis, encephalitis, ventriculitis or meningitis can occur without a telltale rash in immunocompetent and immunocompromised individuals making the diagnosis difficult. We analyzed CSF and serum samples from 30 unvaccinated study participants (17 male and 13 female) to determine the presence of VZV DNA by PCR in CSF and to estimate serum and CSF anti-VZV IgG and albumin levels in participants with neurological manifestations with/without rash. Anti-VZV IgG was detected in CSF (n = 22, [73%]) and serum (n = 29, [97%]) of pediatric and adult participants. Anti-VZV IgG were detected in CSF of participants with varied clinical presentation altered sensorium (n = 8, [36%]), meningitis (n = 4, [18%]), acute febrile illness (n = 3, [14%], encephalopathy/meningoencephalitis (n = 2, [9%]), irritability (n = 2, [9%]) and each patient from cerebrovascular stroke, demyelinating disorder and febrile seizure (n = 1, [4.5%]). VZV DNA was detected from one participant and CSF serum albumin levels were elevated in 53% of study participants. VZV DNA is present up to 1-2 weeks post onset of disease, after which anti-VZV antibody may be the only indicator of disease and therefore both VZV DNA and anti-VZV IgG need to be tested for in CSF. As VZV DNA and VZV IgG antibody are both good indicators of VZV reactivation, routine testing would result in reduced morbidity and mortality by early detection of disease and antiviral treatment.
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Affiliation(s)
- Ilakkiya Arumugam
- Department of Microbiology, Sri Ramachandra Faculty of Allied Health Sciences, Sri Ramachandra Institute of Higher Education and Research (SRIHER, DU), Chennai, India
| | - Sivacchandran Subbarayan Rajasekaran
- Department of Microbiology, Sri Ramachandra Medical College and Research Institute, Sri Ramachandra Institute of Higher Education and Research (SRIHER, DU), Chennai, India
| | - Krithika Gopalakrishnan
- Department of Microbiology, Sri Ramachandra Faculty of Allied Health Sciences, Sri Ramachandra Institute of Higher Education and Research (SRIHER, DU), Chennai, India
| | - Sivasubramaniyan Gnanaskandan
- Department of Microbiology, Sri Ramachandra Faculty of Allied Health Sciences, Sri Ramachandra Institute of Higher Education and Research (SRIHER, DU), Chennai, India
| | - Seetha N Jeganathan
- Department of Microbiology, Sri Ramachandra Medical College and Research Institute, Sri Ramachandra Institute of Higher Education and Research (SRIHER, DU), Chennai, India
| | - Jayasri Athi
- Department of Microbiology, Sri Ramachandra Faculty of Allied Health Sciences, Sri Ramachandra Institute of Higher Education and Research (SRIHER, DU), Chennai, India
| | - Ranjana Shanmugaraj
- Department of Microbiology, Sri Ramachandra Faculty of Allied Health Sciences, Sri Ramachandra Institute of Higher Education and Research (SRIHER, DU), Chennai, India
| | - Rithivik Ramesh
- Department of Neurology, Sri Ramachandra Medical College and Research Institute, SRIHER, Porur, Chennai, India
| | - V Shankar
- Department of Neurology, Sri Ramachandra Medical College and Research Institute, SRIHER, Porur, Chennai, India
| | | | | | - Umamaheswari Balakrishnan
- Department of Neonatology, Sri Ramachandra Medical College and Research Institute, SRIHER, Porur, Chennai, India
| | - Ravi Mahalingam
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Andrew N Bubak
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Maria Acena Nagel
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
- Department of Neurology & Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Padma Srikanth
- Department of Microbiology, Sri Ramachandra Medical College and Research Institute, Sri Ramachandra Institute of Higher Education and Research (SRIHER, DU), Chennai, India.
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Park KS. Maxillary Osteonecrosis Related with Herpes Zoster: A Case Report and Review of the Literature. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:883. [PMID: 38929500 PMCID: PMC11205439 DOI: 10.3390/medicina60060883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 05/19/2024] [Accepted: 05/24/2024] [Indexed: 06/28/2024]
Abstract
Osteonecrosis of the jaw (ONJ) can occur through various mechanisms including radiation, medication, and viral infections such as herpes zoster. Although herpes zoster is a varicella-zoster virus infection that can affect the trigeminal nerve, it rarely causes oral complications. The author reports a rare case of herpes zoster-related ONJ, followed by a review of the relevant literature pertaining to herpes zoster-related oral complications, including ONJ. A 73-year-old woman presented with a scarred skin lesion on her left midface with an exposed alveolar bone of the left maxilla. Based on her medical records, she received a diagnosis and treatment for herpes zoster six months prior and experienced a few teeth loss in the left maxilla following a fall preceding the onset of herpes zoster. Sequestrectomy of the left maxilla was performed and ONJ was diagnosed. The operative site recovered favorably. Although unusual, several cases of localized extensive ONJ in herpes zoster-infected patients have been reported. This case illustrates the possibility of a rare occurrence of unilateral widespread osteonecrosis of the jaw (ONJ) even in the maxilla associated with herpes zoster. The exact mechanism has not been elucidated; nevertheless, surgeons should consider the possibility of oral and dental complications, including ONJ, related to a history of herpes zoster.
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Affiliation(s)
- Kwan-Soo Park
- Department of Oral and Maxillofacial Surgery, Inje University Sanggye-Paik Hospital, Seoul 01757, Republic of Korea
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Jakabek D, Chaganti J, Brew BJ. Infectious leukoencephalopathies. HANDBOOK OF CLINICAL NEUROLOGY 2024; 204:431-453. [PMID: 39322393 DOI: 10.1016/b978-0-323-99209-1.00016-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/27/2024]
Abstract
Leukoencephalopathy from infectious agents may have a rapid course, such as human simplex virus encephalitis; however, in many diseases, it may take months or years before diagnosis, such as in subacute sclerosing panencephalitis or Whipple disease. There are wide geographic distributions and susceptible populations, including both immunocompetent and immunodeficient patients. Many infections have high mortality rates, such as John Cunningham virus and subacute sclerosing panencephalitis, although others have effective treatments if suspected and treated early, such as herpes simplex encephalitis. This chapter will describe viral, bacterial, and protozoal infections, which predominantly cause leukoencephalopathy. We focus on the clinical presentation of these infectious agents briefly covering epidemiology and subtypes of infections. Next, we detail current pathophysiologic mechanisms causing white matter injury. Diagnostic and confirmatory tests are discussed. We cover predominantly MRI imaging features of leukoencephalopathies, and in addition, summarize the common imaging features. Additionally, we detail how imaging features may be used to narrow the differential of a leukoencephalopathy clinical presentation. Lastly, we present an outline of common treatment approaches where available.
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Affiliation(s)
- David Jakabek
- Department of Neurology, St. Vincent's Hospital, Sydney, NSW, Australia; University of New South Wales, Sydney, NSW, Australia
| | - Joga Chaganti
- Department of Radiology, St. Vincent's Hospital, Sydney, NSW, Australia
| | - Bruce James Brew
- Department of Neurology, St. Vincent's Hospital, Sydney, NSW, Australia; University of New South Wales, Sydney, NSW, Australia; University of Notre Dame, Sydney, NSW, Australia; Department of HIV Medicine and Peter Duncan Neurosciences Unit St Vincent's Centre for Applied Medical Research, St. Vincent's Hospital, Sydney, NSW, Australia.
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11
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Al Harbi A, Saeedi J, Almowalad E, Alahmari R, Alzuabi HA, Almanea L, AlAbdulhadi A. A Rare Case of Varicella-Zoster Virus Meningitis With High Intracranial Pressure in an Immunocompetent Adult. Cureus 2024; 16:e52437. [PMID: 38370997 PMCID: PMC10870954 DOI: 10.7759/cureus.52437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2024] [Indexed: 02/20/2024] Open
Abstract
Varicella-zoster virus (VZV) is an alphaherpesvirus causing varicella (chickenpox) and herpes zoster. While varicella typically presents with a vesicular rash, latent VZV may reactivate within the sensory ganglia causing shingles, characterized by painful vesicular rash, which may lead to neurologic complications such as aseptic meningitis. This case explores an atypical presentation in an immunocompetent young man with VZV meningitis lacking the characteristic skin rash but featuring elevated intracranial pressure. A literature review revealed rare instances of VZV-related neurologic disease without typical skin manifestations, suggesting the virus's potential to affect the central nervous system directly. Treatment with intravenous acyclovir is recommended, with ganciclovir as an alternative treatment option. This case emphasizes the importance of considering VZV meningitis in the differential diagnosis of patients presenting with viral meningitis symptoms, with or without dermatomal rash or immunocompromised conditions.
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Affiliation(s)
- Awad Al Harbi
- Neurosciences, King Abdullah Bin Abdulaziz University Hospital, Princess Nourah Bint Abdulrahman University, Riyadh, SAU
| | - Jameelah Saeedi
- Neurology, King Abdullah Bin Abdulaziz University Hospital, Riyadh, SAU
| | - Enas Almowalad
- Neurology, King Abdullah Bin Abdulaziz University Hospital, Riyadh, SAU
| | - Razan Alahmari
- College of Medicine, King Abdullah Bin Abdulaziz University Hospital, Princess Nourah Bint Abdulrahman University, Riyadh, SAU
| | - Hana A Alzuabi
- Medicine and Surgery, Princess Nourah Bint Abdulrahman University, Riyadh, SAU
| | - Leenah Almanea
- College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, SAU
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12
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Gobbi L, Martino FK, Sgrò E, Nalesso F, Calo’ LA. Varicella Zoster vaccination in hemodialysis patients: The state of the art. Hum Vaccin Immunother 2023; 19:2286689. [PMID: 38010087 PMCID: PMC10760358 DOI: 10.1080/21645515.2023.2286689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 11/18/2023] [Indexed: 11/29/2023] Open
Abstract
Varicella Zoster Virus (VZV) infection is a common childhood exanthematous disease, which in adults and immunocompromised people may result in severe neurologic complications. Up to one-third of infected subjects may have VZV clinical reactivation particularly if immunocompromised. Patients affected by end-stage renal disease on hemodialysis present immunodepression that contributes to their higher incidence of VZV infections and reactivation. While antiviral treatment in these patients shows low efficacy, the prevention of VZV through vaccination avoids the primary infection and the risk of reactivation. Two VZV vaccines are currently available: the live attenuate Zoster Vaccine (LZV) and a Recombinant Zoster Vaccine (RZV), with the latter appearing to provide greater efficacy. Given the higher incidence of VZV infection and reactivation, the lesser response to antivirals and the lower impact of VZ vaccine in hemodialysis patients in terms of side effects, a higher diffusion of VZV vaccination should be promoted by nephrologists in these patients in particular in those with future transplant opportunities.
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Affiliation(s)
- Laura Gobbi
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Francesca Katiana Martino
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Elena Sgrò
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Federico Nalesso
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Lorenzo A. Calo’
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, University of Padova, Padova, Italy
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13
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Cooley IT, Alamillo A, Eichert J, Mango H. Vestibular Dysfunction Secondary to Reactivation of the Neurotropic Virus VZV After COVID-19: A Case Study. AMERICAN JOURNAL OF CASE REPORTS 2023; 24:e939593. [PMID: 37805707 PMCID: PMC10569076 DOI: 10.12659/ajcr.939593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 08/18/2023] [Accepted: 08/07/2023] [Indexed: 10/09/2023]
Abstract
BACKGROUND The novel coronavirus COVID-19 infection, caused by the SARS-CoV-2 virus, was declared a global pandemic by the World Health Organization (WHO) in March 2020. As of April 14, 2021, the virus has impacted the lives of over 138 million lives globally, with hundreds of thousands more impacted each day. COVID-19 has resulted in a multitude of clinical manifestations such as respiratory pathology, cardiovascular complications, and neurological dysfunction, and recent evidence points to potential changes in vestibular function secondary to COVID-19 infection. CASE REPORT We present the case of a 67-year-old female patient presenting with vertigo, hearing loss, tinnitus, aural dullness, dizziness, and imbalance following a diagnosis of shingles after contracting COVID-19. Results of a comprehensive balance evaluation were suggestive of a right peripheral vestibulopathy, otolith dysfunction, and a right-sided sensorineural hearing loss. The patient's subjective and objective data may support the claim that COVID-19 can lead to an increase in cases of vestibular dysfunction after reactivation of neurotropic viruses. CONCLUSIONS Our study and others suggest the possibility of vestibular deficits following the reactivation of VZV following a period of immunosuppression in conjunction with the lowered cell-mediated immunity caused by COVID-19. Additionally, vestibular interventions such as advanced vestibular treatment could be used to improve vestibular function in a linear manner.
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14
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Jagirdhar GSK, Pulakurthi YS, Chigurupati HD, Surani S. Gastrointestinal tract and viral pathogens. World J Virol 2023; 12:136-150. [PMID: 37396706 PMCID: PMC10311582 DOI: 10.5501/wjv.v12.i3.136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 03/17/2023] [Accepted: 04/27/2023] [Indexed: 06/21/2023] Open
Abstract
Viral gastroenteritis is the most common viral illness that affects the gastrointestinal (GI) tract, causing inflammation and irritation of the lining of the stomach and intestines. Common signs and symptoms associated with this condition include abdominal pain, diarrhea, and dehydration. The infections commonly involved in viral gastroenteritis are rotavirus, norovirus, and adenovirus, which spread through the fecal-oral and contact routes and cause non-bloody diarrhea. These infections can affect both immunocompetent and immunocompromised individuals. Since the pandemic in 2019, coronavirus gastroenteritis has increased in incidence and prevalence. Morbidity and mortality rates from viral gastroenteritis have declined significantly over the years due to early recognition, treatment with oral rehydration salts, and prompt vaccination. Improved sanitation measures have also played a key role in reducing the transmission of infection. In addition to viral hepatitis causing liver disease, herpes virus, and cytomegalovirus are responsible for ulcerative GI disease. They are associated with bloody diarrhea and commonly occur in im-munocompromised individuals. Hepatitis viruses, Epstein-Barr virus, herpesvirus 8, and human papillomavirus have been involved in benign and malignant diseases. This mini review aims to list different viruses affecting the GI tract. It will cover common symptoms aiding in diagnosis and various important aspects of each viral infection that can aid diagnosis and management. This will help primary care physicians and hospitalists diagnose and treat patients more easily.
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Affiliation(s)
| | | | | | - Salim Surani
- Department of Pulmonary, Critical Care and Sleep Medicine, Texas A&M University, College Station, TX 77843, United States
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15
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Kawzowicz M, Bayya M. Varicella Pneumonia in Otherwise Healthy 31-Year-Old Female Nonsmoker With No Prior Varicella Immunity. Cureus 2023; 15:e40507. [PMID: 37461793 PMCID: PMC10350311 DOI: 10.7759/cureus.40507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2023] [Indexed: 07/20/2023] Open
Abstract
Varicella pneumonia is a relatively rare but severe complication of primary varicella infection. It primarily affects adults and is exacerbated by risk factors such as smoking, immunocompromised status, and male gender. Left untreated, the mortality associated with varicella pneumonia is high and ranges from 10-30 percent in the literature. This is a case of an adult female patient with no prior immunity to varicella who presented with increased oxygen requirements approximately 5 days after the onset of cutaneous symptoms. Her symptoms quickly improved after 1-day post administration of valacyclovir, and on discharge, she was prescribed a 7-day course of valacyclovir. Early treatment with acyclovir is the mainstay of treatment and is essential as it has been shown to reduce long-term complications and decrease mortality. Despite the low incidence of varicella pneumonia among patients with primary varicella infection, the index of suspicion for varicella pneumonia among patients with primary varicella infection should be high in the setting of increased oxygen requirements due to the mortality and symptomatic benefits of early treatment.
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Affiliation(s)
| | - Maha Bayya
- Internal Medicine, Upstate University Hospital, Syracuse, USA
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16
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Mahendradas P, Parmar Y, Mishra SB, Patil A, Kawali A, Sanjay S, Shetty B. Pole-to-pole involvement of varicella zoster virus reactivation following COVID-19 vaccination. Indian J Ophthalmol 2023; 71:2001-2007. [PMID: 37203073 PMCID: PMC10391376 DOI: 10.4103/ijo.ijo_2942_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
The aim of this study is to report the clinical features, imaging findings including confocal imaging, corneal nerve fiber analysis, and management outcomes in a series of three cases of varicella zoster virus (VZV) reactivation following one dose of coronavirus disease 2019 (COVID-19) vaccination. This was a retrospective and observational study. All the patients who developed uveitis post-vaccination were pooled together. Patients who had VZV reactivation were included. Two cases had polymerase chain reaction positive for VZV from aqueous humor. At the time of presentation, IgG and IgM spike protein antibodies for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) were tested. Out of this pool, three patients with classical features to describe pole-to-pole manifestations were chosen. A 36-year-old lady with post-vaccination sclerokeratouveitis associated with reactivation of herpes zoster ophthalmicus, a 56-year-old lady with post-vaccination acute anterior uveitis associated with herpes zoster ophthalmicus, and a 43-year-old gentleman with post-vaccination acute retinal necrosis were included. We present a possible link between anti-SARS-CoV-2 virus vaccination and varicella zoster reactivation in these patients and also describe the clinical features, imaging findings including confocal imaging, corneal nerve fiber analysis, and management with detailed discussion.
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Affiliation(s)
- Padmamalini Mahendradas
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Yash Parmar
- Department of Retina, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Sai Bhakti Mishra
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Aditya Patil
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Ankush Kawali
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Srinivasan Sanjay
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Bhujang Shetty
- Department of Cataract and Refractive Surgery, Narayana Nethralaya, Bengaluru, Karnataka, India
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17
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Yu X, Lophatananon A, Mekli K, Muir KR, Guo H. Exploring the causal role of the immune response to varicella-zoster virus on multiple traits: a phenome-wide Mendelian randomization study. BMC Med 2023; 21:143. [PMID: 37046283 PMCID: PMC10099693 DOI: 10.1186/s12916-023-02843-5] [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] [Received: 07/29/2022] [Accepted: 03/20/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND The immune response to infections could be largely driven by the individual's genes, especially in the major histocompatibility complex (MHC) region. Varicella-zoster virus (VZV) is a highly communicable pathogen. In addition to infection, the reactivations of VZV can be a potential causal factor for multiple traits. Identification of VZV immune response-related health conditions can therefore help elucidate the aetiology of certain diseases. METHODS A phenome-wide Mendelian randomization (MR) study of anti-VZV immunoglobulin G (IgG) levels with 1370 traits was conducted to explore the potential causal role of VZV-specific immune response on multiple traits using the UK Biobank cohort. For the robustness of the results, we performed MR analyses using five different methods. To investigate the impact of the MHC region on MR results, the analyses were conducted using instrumental variables (IVs) inside (IVmhc) and outside (IVno.mhc) the MHC region or all together (IVfull). RESULTS Forty-nine single nucleotide polymorphisms (IVfull) were associated with anti-VZV IgG levels, of which five (IVmhc) were located in the MHC region and 44 (IVno.mhc) were not. Statistical evidence (false discovery rate < 0.05 in at least three of the five MR methods) for a causal effect of anti-VZV IgG levels was found on 22 traits using IVmhc, while no evidence was found when using IVno.mhc or IVfull. The reactivations of VZV increased the risk of Dupuytren disease, mononeuropathies of the upper limb, sarcoidosis, coeliac disease, teeth problems and earlier onset of allergic rhinitis, which evidence was concordant with the literature. Suggestive causal evidence (P < 0.05 in at least three of five MR methods) using IVfull, IVmhc and IVno.mhc was detected in 92, 194 and 56 traits, respectively. MR results from IVfull correlated with those from IVmhc or IVno.mhc. However, the results between IVmhc and IVno.mhc were noticeably different, as evidenced by causal associations in opposite directions between anti-VZV IgG and ten traits. CONCLUSIONS In this exploratory study, anti-VZV IgG was causally associated with multiple traits. IVs in the MHC region might have a substantial impact on MR, and therefore, could be potentially considered in future MR studies.
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Affiliation(s)
- Xinzhu Yu
- Centre for Biostatistics, Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - Artitaya Lophatananon
- Centre for Integrated Genomic Medicine, Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - Krisztina Mekli
- Centre for Integrated Genomic Medicine, Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - Kenneth R Muir
- Centre for Integrated Genomic Medicine, Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - Hui Guo
- Centre for Biostatistics, Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Oxford Road, Manchester, M13 9PL, UK.
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18
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Abdominal paresis and pseudo-hernia secondary to herpes zoster infection: A case report and systematic analysis. Heliyon 2023; 9:e13578. [PMID: 36852071 PMCID: PMC9958284 DOI: 10.1016/j.heliyon.2023.e13578] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 01/27/2023] [Accepted: 02/03/2023] [Indexed: 02/11/2023] Open
Abstract
Background Abdominal pseudo-hernia secondary to herpes zoster infection is rare and the clinical features and factors affecting recovery remain poorly understood. Aim We aimed to describe the clinical features of patients with abdominal pseudo-hernia secondary to herpes zoster infection and attempt to identify factors associated with poor recovery. Design Literature review and retrospective Analysis. Methods We report a case and performed a retrospective, systematic review of the demographic background, clinical characteristics and outcomes of patients with abdominal pseudo-hernia secondary to herpes zoster infection in the literature over 20 years (2001-2021). Results We analyzed a total of 34 cases. The median age of the patients was 71.5 years. Most of the patients were male (n = 27, 79.4%). The most frequently affected dermatome was T-11 (n = 20, 66.7%). In four (12.5%) patients, abdominal pseudo-hernia started before the onset of rash. In all patients (n = 12, 100%) who underwent nerve conduction study and electromyography, there was electrophysiological evidence of acute denervation. Seven patients (20.6%) had imaging features suggestive of abdominal wall atrophy and denervation. The majority of patients had good recovery. The median follow-up time was 3 (15 days-12 months) months. Patients with pre-existing medical conditions (p = 0.03) were more likely to have a worse recovery. Conclusion Abdominal pseudo-hernia is a rare complication of herpes zoster infection with a good prognosis for recovery, although patients with pre-existing disease appear to recover worse. In rare cases, it may occur before the onset of typical zoster rashes and should be suspected, especially in older, male patients with involvement of the lower thoracic dermatomes.
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19
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Evaluation of Cellular miR-122 Expression in Association with the Presence of Varicella-Zoster Virus among Central Nervous System Tumors. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2022. [DOI: 10.5812/ijcm-108497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background: Brain tumors are all primary central nervous system (CNS) tumors with unclear etiologies and viral infections, especially human herpesviruses, which have emerged as a hot topic for comprehensive research. Objectives: The present study aimed at assessing the molecular epidemiology of varicella-zoster virus (VZV) and its association with microRNA 122 (miR-122) expression in CNS tumor samples. Methods: Fresh frozen tissue samples were collected from 60 CNS tumor patients and 45 healthy controls. A nested PCR assay was performed to detect the VZV-DNA. Subsequently, the expression level of miR-122 was evaluated in the CNS tumor tissue samples of patients and the brain tissue samples were obtained from healthy controls, using a real-time PCR assay. Results: Of 60 patients with CNS tumors, 29 were men and 31 were women. VZV-DNA was detected in 13.3% of the CNS tumor tissue specimens. There was no statistically significant association between the presence of VZV-DNA and different types of CNS tumors (P > 0.05). Furthermore, the expression level of miR-122 was significantly downregulated in the CNS tumor tissue samples obtained from the patients compared with those of the healthy controls (P < 0.05). Additionally, the expression level of miR-122 was significantly lower in the VZV-positive tumor samples as compared with those of the VZV-negative tumor samples and the healthy controls. Conclusions: Although VZV plays no direct role in the development of CNS tumors, the virus may affect the biology of CNS tumors by decreasing the expression levels of miR-122, which consequently leads to an increased risk of malignancy. However, the experimental data are not conclusive enough; so, further investigations are needed.
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20
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Activation of Interferon-Stimulated Genes following Varicella-Zoster Virus Infection in a Human iPSC-Derived Neuronal In Vitro Model Depends on Exogenous Interferon-α. Viruses 2022; 14:v14112517. [PMID: 36423126 PMCID: PMC9693540 DOI: 10.3390/v14112517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 10/12/2022] [Accepted: 10/26/2022] [Indexed: 11/16/2022] Open
Abstract
Varicella-zoster virus (VZV) infection of neuronal cells and the activation of cell-intrinsic antiviral responses upon infection are still poorly understood mainly due to the scarcity of suitable human in vitro models that are available to study VZV. We developed a compartmentalized human-induced pluripotent stem cell (hiPSC)-derived neuronal culture model that allows axonal VZV infection of the neurons, thereby mimicking the natural route of infection. Using this model, we showed that hiPSC-neurons do not mount an effective interferon-mediated antiviral response following VZV infection. Indeed, in contrast to infection with Sendai virus, VZV infection of the hiPSC-neurons does not result in the upregulation of interferon-stimulated genes (ISGs) that have direct antiviral functions. Furthermore, the hiPSC-neurons do not produce interferon-α (IFNα), a major cytokine that is involved in the innate antiviral response, even upon its stimulation with strong synthetic inducers. In contrast, we showed that exogenous IFNα effectively limits VZV spread in the neuronal cell body compartment and demonstrated that ISGs are efficiently upregulated in these VZV-infected neuronal cultures that are treated with IFNα. Thus, whereas the cultured hiPSC neurons seem to be poor IFNα producers, they are good IFNα responders. This could suggest an important role for other cells such as satellite glial cells or macrophages to produce IFNα for VZV infection control.
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21
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Petrillo F, Petrillo A, Sasso FP, Schettino A, Maione A, Galdiero M. Viral Infection and Antiviral Treatments in Ocular Pathologies. Microorganisms 2022; 10:2224. [PMID: 36363815 PMCID: PMC9694090 DOI: 10.3390/microorganisms10112224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 11/04/2022] [Accepted: 11/07/2022] [Indexed: 08/27/2023] Open
Abstract
Ocular viral infections are common and widespread globally. These infectious diseases are a major cause of acute red eyes and vision loss. The eye and its nearby tissues can be infected by several viral agents, causing infections with a short course and limited ocular implications or a long clinical progression and serious consequences for the function and structure of the ocular region. Several surveillance studies underline the increased emergence of drug resistance among pathogenic viral strains, limiting treatment options for these infections. Currently, in the event of resistant infections, topical or systemic corticosteroids are useful in the management of associated immune reactions in the eye, which contribute to ocular dysfunction. Many cases of viral eye infections are misdiagnosed as being of bacterial origin. In these cases, therapy begins late and is not targeted at the actual cause of the infection, often leading to severe ocular compromises, such as corneal infiltrates, conjunctival scarring, and reduced visual acuity. The present study aims at a better understanding of the viral pathogens that cause eye infections, along with the treatment options available.
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Affiliation(s)
- Francesco Petrillo
- Azienda Ospedaliera Universitaria-Città della Salute e della Scienza di Torino, 10126 Torino, Italy
| | | | | | - Antonietta Schettino
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Angela Maione
- Department of Biology, University of Naples Federico II, 80126 Naples, Italy
| | - Marilena Galdiero
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
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22
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Fergie J, Pawaskar M, Veeranki P, Samant S, Harley C, MacEwan J, Schwartz TT, Surati S, Conway JH. Recognition & management of varicella infections and accuracy of antimicrobial recommendations: Case vignettes study in the US. PLoS One 2022; 17:e0269596. [PMID: 35749342 PMCID: PMC9231738 DOI: 10.1371/journal.pone.0269596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 05/24/2022] [Indexed: 11/18/2022] Open
Abstract
Background
In 1995, the CDC recommended one-dose routine varicella immunization for children <12 years of age, expanding its recommendation to two doses in 2006. Today, with widespread varicella vaccination coverage, an estimated 3.5 million cases of varicella, 9,000 hospitalizations, and 100 deaths are prevented annually in the United States. Since varicella infections are now uncommon, health care providers (HCPs) may not recognize varicella infections and may prescribe inappropriate treatment.
Methods
An online survey of HCPs was conducted to assess recognition and management of varicella infections. Responses to eight varicella vignettes describing patients with varying varicella symptoms were analyzed and descriptive analyses performed. Stratified analysis comparing responses of those licensed before and in/after 1996 was also performed.
Results
153 HCPs (50 nurse practitioners, 103 doctors) completed the survey. Mean age of respondents was 44 years. 62% were female, and 82% were licensed before 1996. Varicella infection was correctly diagnosed 79% of the time. HCPs correctly recognized uncomplicated varicella vignettes 85% of the time versus 61% of the time for complicated varicella vignettes. Antibiotics were recommended 17% of the time and antivirals 18% of the time, of which 25% and 69% (respectively) were not appropriate per guidelines. HCPs licensed before 1996 were better able to recognize varicella compared to those licensed later, but prescribed more antimicrobials medications to treat varicella.
Conclusions
Although most HCPs recognized varicella infection, a sizable proportion could not recognize cases with complications, and some of the varicella cases were inappropriately treated with antibiotics and/or antivirals. Additional HCP training and high vaccination coverage are important strategies to avoid inaccurate diagnoses and minimize unnecessary exposure to antimicrobial/antiviral therapies.
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Affiliation(s)
- Jaime Fergie
- Driscoll Children’s Hospital, Corpus Christi, Texas, United States of America
| | - Manjiri Pawaskar
- Merck & Co. Inc., Rahway, New Jersey, United States of America
- * E-mail:
| | - Phani Veeranki
- PRECISIONheor, Los Angeles, California, United States of America
| | - Salome Samant
- Merck & Co. Inc., Rahway, New Jersey, United States of America
| | - Carolyn Harley
- PRECISIONheor, Los Angeles, California, United States of America
| | - Joanna MacEwan
- PRECISIONheor, Los Angeles, California, United States of America
| | - Taylor T. Schwartz
- Avalere Health, Washington DC, District of Columbia, United States of America
| | - Shikha Surati
- Merck & Co. Inc., Rahway, New Jersey, United States of America
| | - James H. Conway
- School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, United States of America
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23
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Atypical anti-NMDA receptor encephalitis associated with varicella zoster virus infection. J Neurovirol 2022; 28:456-459. [PMID: 35604574 DOI: 10.1007/s13365-022-01080-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 01/29/2022] [Accepted: 04/25/2022] [Indexed: 10/18/2022]
Abstract
The triggering effect of herpes simplex virus infection on the development of anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is now well established. However, there are very few reports that has linked a varicella zoster virus (VZV) reactivation with anti-NMDAR encephalitis. In this report, we describe a case of a 57-year-old man presented with atypical clinical presentation of anti-NMDAR encephalitis with gait ataxia, complete ophtalmoplegia, and abolished reflexes followed by drowsiness and confusion. Initial diagnosis of Bickerstaff's brainstem encephalitis was suspected. Few days later, the patient developed herpes zoster in a localized right T1-T2 dermatome. Cerebrospinal fluid (CSF) polymerase chain reaction (PCR) for VZV was negative. CSF anti-NMDA antibodies were proved positive. A diagnosis of anti-NMDAR encephalitis with concomitant VZV skin reactivation was retained. Favorable outcome with combined antiviral treatment and immunomodulatory therapy was observed. Concomitant VZV reactivation with autoimmune encephalitis is possible. Prognosis and therapeutic options in this rare condition remain to be clarified.
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24
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Gómez-Gutiérrez AK, Flores-Camargo AA, Casillas Fikentscher A, Luna-Ceron E. Primary Varicella or Herpes Zoster? An Educational Case Report From the Primary Care Clinic. Cureus 2022; 14:e23732. [PMID: 35509746 PMCID: PMC9057244 DOI: 10.7759/cureus.23732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2022] [Indexed: 11/30/2022] Open
Abstract
Varicella-zoster virus is a pathogenic virus that can present itself as a primary infection or secondary infection, also known as herpes zoster. Recently, there has been a re-emergence of this vaccine-preventable disease due to gaps in vaccination. Primary varicella in immunocompetent adults is highly uncommon, and it could result in severe complications within this population. Given this delicate scenario, family physicians should be well trained to recognize the characteristic cutaneous lesions of varicella and dictate adequate management for these patients to obtain the best possible outcome and prevent life-threatening complications. We present the case of a 43-year-old immunocompetent woman with the onset of a generalized pruritic dermatosis characterized primarily by the presence of macules, vesicles, and crusts. The patients' lesions were compatible with primary varicella, and serological studies confirmed the diagnosis. Given the absence of acute complications in this individual, supportive treatment and close follow-up were the therapeutic modalities. This article focuses on the educational discussion of the primary differential diagnosis, evaluation for possible complications, and management of this uncommon clinical scenario. We also reinforce the importance of immunization in preventing re-emergent diseases as a critical element within primary care management.
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25
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Gringeri M, Battini V, Cammarata G, Mosini G, Guarnieri G, Leoni C, Pozzi M, Radice S, Clementi E, Carnovale C. Herpes zoster and simplex reactivation following COVID-19 vaccination: new insights from a vaccine adverse event reporting system (VAERS) database analysis. Expert Rev Vaccines 2022; 21:675-684. [PMID: 35191364 DOI: 10.1080/14760584.2022.2044799] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND A few cases of Herpes Zoster and Simplex reactivation following COVID-19 immunization have been recently described, but the real extent of this suspected adverse event has not been elucidated yet. METHODS We performed a nested case/control study by using the U.S. Vaccine Adverse Event Reporting System database. We carried out a case-level clinical review of all Herpes reactivation cases following the administration of COVID-19 vaccines. For cases and controls, significance was set at P = 0.05, differential risk of reporting was assessed for each vaccine as reporting odds ratio and incidence was estimated based on the total number of vaccine doses administered. RESULTS Of 6,195 cases included in the analysis (5,934 and 273 reporting Herpes Zoster and Herpes Simplex, respectively) over 90% were non-serious. We found a slightly higher risk of reporting both for Zoster (ROR = 1.49) and Simplex (ROR = 1.51) infections following the Pfizer-BioNTech vaccine. The estimated incidence was approximately 0.7/100,000 and 0.03/100,000 for Zoster and Simplex, respectively. CONCLUSIONS The paucity of cases (almost all of non-serious nature) makes the potential occurrence of this adverse effect negligible from clinical standpoints, thus supporting the good safety profile of the COVID-19 vaccination, which remains strongly recommended.
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Affiliation(s)
- Michele Gringeri
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, University of Milan, Milano, Italy
| | - Vera Battini
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, University of Milan, Milano, Italy
| | - Gianluca Cammarata
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, University of Milan, Milano, Italy
| | - Giulia Mosini
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, University of Milan, Milano, Italy
| | - Greta Guarnieri
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, University of Milan, Milano, Italy
| | - Chiara Leoni
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, University of Milan, Milano, Italy
| | - Marco Pozzi
- Scientific Institute, IRCCS E. Medea, Bosisio Parini, LC, Italy
| | - Sonia Radice
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, University of Milan, Milano, Italy
| | - Emilio Clementi
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, University of Milan, Milano, Italy.,Scientific Institute, IRCCS E. Medea, Bosisio Parini, LC, Italy
| | - Carla Carnovale
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, University of Milan, Milano, Italy
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26
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Physicochemical properties and stability of nanoemulsions containing Clinacanthus nutans extract for postherpetic neuralgia. J Drug Deliv Sci Technol 2022. [DOI: 10.1016/j.jddst.2022.103116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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27
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Yu X, Li L, Chan MTV, Wu WKK. Bioinformatic analyses suggest augmented interleukin-17 signaling as the mechanism of COVID-19-associated herpes zoster. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:65769-65775. [PMID: 34322810 PMCID: PMC8318549 DOI: 10.1007/s11356-021-15567-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 07/18/2021] [Indexed: 05/05/2023]
Abstract
Herpes zoster results from latent varicella zoster virus reactivation in the dorsal root ganglia, causing blistering rash along the dermatomal distribution and post-herpetic neuralgia. Increasing studies indicated that there may be a correlation between herpes zoster and COVID-19. Nevertheless, the detailed pathophysiological mechanism is still unclear. We used bioinformatic analyses to study the potential genetic crosstalk between herpes zoster and COVID-19. COVID-19 and herpes zoster were associated with a similar subset of genes involved in "cytokine-cytokine receptor interaction," "Jak-STAT signaling pathway," and "IL-17 signaling pathway," including TNF, IL10, ESR1, INFG, HLA-A, CRP, STAT3, IL6, IL7, and IL17A. Protein-protein interaction network assay showed that the combined gene set indicated a raised connectivity as compared to herpes zoster or COVID-19 alone, particularly the potentiated interactions with APOE, ARSA, CCR2, CCR5, CXCL13, EGFR, GAL, GP2, HLA-B, HLA-DRB1, IL5, TECTA, and THBS1, and these genes are related to "cytokine-cytokine receptor interaction". Augmented Th17 cell differentiation and the resulting enhanced IL-17 signaling were identified in both COVID-19 and herpes zoster. Our data suggested aberrant interleukin-17 signaling as one possible mechanism through which COVID-19 could raise the risk of herpes zoster.
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Affiliation(s)
- Xin Yu
- Department of Dermatology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - Linfeng Li
- Department of Dermatology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China.
| | - Matthew T V Chan
- Department of Anaesthesia and Intensive Care and Peter Hung Pain Research Institute, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - William Ka Kei Wu
- Department of Anaesthesia and Intensive Care and Peter Hung Pain Research Institute, The Chinese University of Hong Kong, Hong Kong, Hong Kong.
- State Key Laboratory of Digestive Disease and LKS Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong.
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28
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Jia S, Luong T. Atypical Presentation of Aseptic Meningitis Due to Varicella Zoster: A Case Report. Clin Pract Cases Emerg Med 2021; 5:440-442. [PMID: 34813439 PMCID: PMC8610470 DOI: 10.5811/cpcem.2021.7.53596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 07/11/2021] [Indexed: 11/11/2022] Open
Abstract
Introduction Varicella zoster virus (VZV) meningitis is primarily an infection of the immuno-compromised. However, it can also affect immunocompetent individuals. Reactivation of VZV typically presents with a distinct dermatomal rash suggestive of varicella zoster, but there have also been reports of VZV meningitis presenting without a rash. Case Report We describe a case of VZV meningitis in a healthy, 30-year-old male presenting to the emergency department shortly after receiving his first coronavirus disease 2019 vaccination. He was treated with intravenous acyclovir and then discharged home on oral valacyclovir. Conclusion Emergency physicians should consider aseptic meningitis in immunocompetent patients presenting with atypical headaches in this population.
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Affiliation(s)
- Sharon Jia
- WellSpan York Hospital, Department of Emergency Medicine, York, Pennsylvania
| | - Thuyvi Luong
- WellSpan York Hospital, Department of Emergency Medicine, York, Pennsylvania
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29
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Gern OL, Mulenge F, Pavlou A, Ghita L, Steffen I, Stangel M, Kalinke U. Toll-like Receptors in Viral Encephalitis. Viruses 2021; 13:v13102065. [PMID: 34696494 PMCID: PMC8540543 DOI: 10.3390/v13102065] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/06/2021] [Accepted: 10/08/2021] [Indexed: 12/23/2022] Open
Abstract
Viral encephalitis is a rare but serious syndrome. In addition to DNA-encoded herpes viruses, such as herpes simplex virus and varicella zoster virus, RNA-encoded viruses from the families of Flaviviridae, Rhabdoviridae and Paramyxoviridae are important neurotropic viruses. Whereas in the periphery, the role of Toll-like receptors (TLR) during immune stimulation is well understood, TLR functions within the CNS are less clear. On one hand, TLRs can affect the physiology of neurons during neuronal progenitor cell differentiation and neurite outgrowth, whereas under conditions of infection, the complex interplay between TLR stimulated neurons, astrocytes and microglia is just on the verge of being understood. In this review, we summarize the current knowledge about which TLRs are expressed by cell subsets of the CNS. Furthermore, we specifically highlight functional implications of TLR stimulation in neurons, astrocytes and microglia. After briefly illuminating some examples of viral evasion strategies from TLR signaling, we report on the current knowledge of primary immunodeficiencies in TLR signaling and their consequences for viral encephalitis. Finally, we provide an outlook with examples of TLR agonist mediated intervention strategies and potentiation of vaccine responses against neurotropic virus infections.
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Affiliation(s)
- Olivia Luise Gern
- Institute for Experimental Infection Research, TWINCORE, Centre for Experimental and Clinical Infection Research, a Joint Venture between the Helmholtz Centre for Infection Research and the Hannover Medical School, 30625 Hannover, Germany; (F.M.); (A.P.); (L.G.); (U.K.)
- Department of Pathology, University of Veterinary Medicine Hannover, Foundation, 30559 Hannover, Germany
- Correspondence:
| | - Felix Mulenge
- Institute for Experimental Infection Research, TWINCORE, Centre for Experimental and Clinical Infection Research, a Joint Venture between the Helmholtz Centre for Infection Research and the Hannover Medical School, 30625 Hannover, Germany; (F.M.); (A.P.); (L.G.); (U.K.)
| | - Andreas Pavlou
- Institute for Experimental Infection Research, TWINCORE, Centre for Experimental and Clinical Infection Research, a Joint Venture between the Helmholtz Centre for Infection Research and the Hannover Medical School, 30625 Hannover, Germany; (F.M.); (A.P.); (L.G.); (U.K.)
- Clinical Neuroimmunology and Neurochemistry, Department of Neurology, Hannover Medical School, 30625 Hannover, Germany
- Center for Systems Neuroscience, University of Veterinary Medicine Hannover, 30559 Hannover, Germany
| | - Luca Ghita
- Institute for Experimental Infection Research, TWINCORE, Centre for Experimental and Clinical Infection Research, a Joint Venture between the Helmholtz Centre for Infection Research and the Hannover Medical School, 30625 Hannover, Germany; (F.M.); (A.P.); (L.G.); (U.K.)
- Division of Infectious Diseases and Geographic Medicine, Department of Microbiology and Immunology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Imke Steffen
- Department of Biochemistry and Research Center for Emerging Infections and Zoonoses (RIZ), University of Veterinary Medicine Hannover, Foundation, 30559 Hannover, Germany;
| | - Martin Stangel
- Translational Medicine, Novartis Institute for Biomedical Research (NIBR), 4056 Basel, Switzerland;
| | - Ulrich Kalinke
- Institute for Experimental Infection Research, TWINCORE, Centre for Experimental and Clinical Infection Research, a Joint Venture between the Helmholtz Centre for Infection Research and the Hannover Medical School, 30625 Hannover, Germany; (F.M.); (A.P.); (L.G.); (U.K.)
- Cluster of Excellence—Resolving Infection Susceptibility (RESIST, EXC 2155), Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
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30
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Sahra S, Jahangir A, Gavica MC, Mobarakai N, Jahangir A. First case report of pulmonary embolism with Zoster Sine Herpete. Respir Med Case Rep 2021; 33:101462. [PMID: 34401298 PMCID: PMC8349081 DOI: 10.1016/j.rmcr.2021.101462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 06/11/2021] [Accepted: 06/15/2021] [Indexed: 11/02/2022] Open
Abstract
Background Varicella-Zoster Virus (VZV) infection is known to cause coagulation abnormalities leading to pulmonary embolism and ischemic strokes. The incidence of vascular and thrombotic complications with Zoster Sine Herpete has been reported very infrequently in the medical literature. Case presentation A 32-year-old man with no significant past medical history presented to Emergency Room with right-sided facial weakness and headache. We saw no rash on physical examination. A sub-segmental pulmonary embolus was found on C.T. angiography of the chest. VZV was detected on Lumbar Puncture studies. The patient responded well to anti-viral treatment and was discharged home without any complications. Conclusion The suspicion of thrombo-embolic complications should be high with Zoster Sine Herpete. Screening for coagulopathies and timely initiation of anticoagulation should be carried out in appropriate clinical settings.
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Affiliation(s)
- Syeda Sahra
- Staten Island University Hospital, Staten Island, NY, 10305, USA
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31
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Kennedy PGE. An overview of viral infections of the nervous system in the immunosuppressed. J Neurol 2021; 268:3026-3030. [PMID: 33048220 PMCID: PMC7552955 DOI: 10.1007/s00415-020-10265-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 10/04/2020] [Accepted: 10/07/2020] [Indexed: 12/17/2022]
Abstract
Several viruses have the capacity to cause serious infections of the nervous system in patients who are immunosuppressed. Individuals may be immunosuppressed because of primary inherited immunodeficiency, secondary immunodeficiency due to particular diseases such as malignancy, administration of immunosuppressant drugs or organ or bone marrow transplantation. The viruses capable of such opportunistic infection of the nervous system include herpes simplex virus (HSV), Varicella-Zoster virus (VZV), Cytomegalovirus (CMV), Epstein -Barr virus (EBV), Human Herpes virus type 6 (HHV-6), JC virus (JCV), enterovirus, measles virus and Covid-19. In most cases it seems likely that immunological defence mechanisms in the immunosuppressed are deficient which creates a suitable environment for certain viruses to become opportunistic in the nervous and other systems. Further research is required both to understand these opportunistic mechanisms in more detail and also to determine how many virus infections are modified by specific inborn errors of immunological responses.
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Affiliation(s)
- Peter G E Kennedy
- Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G61 1QH, Scotland, UK.
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32
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Kim HS, Jung JW, Jung YJ, Ro YS, Park SB, Lee KH. Complete recovery of herpes zoster radiculopathy based on electrodiagnostic study: A case report. World J Clin Cases 2021; 9:4303-4309. [PMID: 34141794 PMCID: PMC8173409 DOI: 10.12998/wjcc.v9.i17.4303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 02/03/2021] [Accepted: 03/24/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Herpes zoster is a painful infectious disease caused by the varicella zoster virus. Herpes zoster radiculopathy, which is a type of segmental zoster paresis, can complicate the disease and cause motor weakness. This complication should be considered when a patient with a rash complains of acute-onset motor weakness, and the diagnosis can be verified via electrodiagnostic study.
CASE SUMMARY A 64-year-old female with a history of asthma presented to the emergency department with stabbing pain, an itching sensation, and a rash on the right anterior shoulder that had begun 5 d prior. Physical examination revealed multiple erythematous grouped vesicles in the right C4-5 and T1 dermatome regions. Because herpes zoster was suspected, the patient immediately received intravenous acyclovir. On the third hospital day, she complained of motor weakness in the right upper extremity. Magnetic resonance imaging of the cervical spine revealed mild intervertebral disc herniation at C4-C5 without evidence of nerve root compression. On the 12th hospital day, electrodiagnostic study revealed right cervical radiculopathy, mainly in the C5/6 roots. Six months later, monoparesis resolved, and follow-up electrodiagnostic study was normal.
CONCLUSION This case emphasizes that clinicians should consider the possibility of post-herpetic paresis, such as herpes zoster radiculopathy, and that electrodiagnostic study is useful for diagnosis and follow-up.
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Affiliation(s)
- Hyeon Seong Kim
- Department of Rehabilitation Medicine, Hanyang University Hospital, Seoul 04763, South Korea
| | - Ji Won Jung
- Department of Rehabilitation Medicine, Hanyang University Hospital, Seoul 04763, South Korea
| | - You Jin Jung
- Department of Dermatology, Hanyang University Hospital, Seoul 04763, South Korea
| | - Young Suck Ro
- Department of Dermatology, Hanyang University Hospital, Seoul 04763, South Korea
| | - Si-Bog Park
- Department of Rehabilitation Medicine, Hanyang University Hospital, Seoul 04763, South Korea
| | - Kyu Hoon Lee
- Department of Rehabilitation Medicine, Hanyang University Hospital, Seoul 04763, South Korea
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33
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Patterson BJ, Buck PO, Curran D, Van Oorschot D, Carrico J, Herring WL, Zhang Y, Stoddard JJ. Estimated Public Health Impact of the Recombinant Zoster Vaccine. Mayo Clin Proc Innov Qual Outcomes 2021; 5:596-604. [PMID: 34195552 PMCID: PMC8240325 DOI: 10.1016/j.mayocpiqo.2021.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023] Open
Abstract
OBJECTIVE To investigate the potential public health impact of adult herpes zoster (HZ) vaccination with the adjuvanted recombinant zoster vaccine (RZV) in the United States in the first 15 years after launch. METHODS We used a publicly available model accounting for national population characteristics and HZ epidemiological data, vaccine characteristics from clinical studies, and anticipated vaccine coverage with RZV after launch in 2018. Two scenarios were modeled: a scenario with RZV implemented with 65% coverage after 15 years and a scenario continuing with zoster vaccine live (ZVL) with coverage increasing 10% over the same period. We estimated the numbers vaccinated, and the clinical outcomes and health care use avoided yearly, from January 1, 2018, to December 31, 2032. We varied RZV coverage and investigated the associated impact on HZ cases, complications, and health care resource use. RESULTS With RZV adoption, the numbers of individuals affected by HZ was predicted to progressively decline with an additional 4.6 million cumulative cases avoided if 65% vaccination with RZV was reached within 15 years. In the year 2032, it was predicted that an additional 1.3 million physicians' visits and 14.4 thousand hospitalizations could be avoided, compared with continuing with ZVL alone. These numbers could be reached 2 to 5 years earlier with 15% higher RZV vaccination rates. CONCLUSION Substantial personal and health care burden can be alleviated when vaccination with RZV is adopted. The predicted numbers of HZ cases, complications, physicians' visits, and hospitalizations avoided, compared with continued ZVL vaccination, depends upon the RZV vaccination coverage achieved.
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Affiliation(s)
| | - Philip O. Buck
- GSK, US Health Outcomes & Epidemiology, Philadelphia, PA
| | | | | | - Justin Carrico
- RTI Health Solutions, Health Economics, Research Triangle, NC
| | | | - Yuanhui Zhang
- RTI Health Solutions, Health Economics, Research Triangle, NC
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34
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Wang Z, Lotina T, Malaty J. Uncommon presentation and complications of herpes zoster infection involving the cervical, vagus and accessory nerves which caused a delay in diagnosis and treatment. BMJ Case Rep 2021; 14:14/5/e241881. [PMID: 33962929 PMCID: PMC8108672 DOI: 10.1136/bcr-2021-241881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 70-year-old man with a history of invasive anal squamous cell carcinoma treated with excision and chemoradiation presented to the emergency department with right-sided neck pain and submandibular lymphadenopathy. CT imaging of the head and neck was unrevealing. The patient eventually developed cranial nerves X and XI dysfunction, manifesting as severe vocal cord paralysis (dysphonia), dysphagia, asymmetric palate elevation/deviation and trapezius muscle atrophy, in addition to scalene muscle atrophy. After an extensive workup, the patient's symptoms were determined to be due to sequelae of varicella zoster infection, which was confirmed with antibody titers. The patient's dysphagia and dysphonia eventually improved with vocal cord medialisation injection and Botox injection. However, despite delayed treatment with acyclovir and valacyclovir, the patient continued to have neuropathic pain and exhibit signs of CN X and CN XI paresis, in addition to scalene muscle atrophy.
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Affiliation(s)
- Ziqi Wang
- University of Florida Health, Gainesville, Florida, USA
| | - Thomas Lotina
- Department of Community Health and Family Medicine, University of Florida Physicians Family Practice Medical Group, Gainesville, Florida, USA
| | - John Malaty
- Department of Community Health and Family Medicine, University of Florida Physicians Family Practice Medical Group, Gainesville, Florida, USA
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35
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Muñoz-Ortiz J, Rubio-Romero OL, Cedeño MC, Arteaga-Rivera K, de-la-Torre A. A white circular-spot pattern of iridian atrophy associated with Varicella-zoster virus and Toxoplasma gondii coinfection: a case report. BMC Ophthalmol 2020; 20:479. [PMID: 33287739 PMCID: PMC7720502 DOI: 10.1186/s12886-020-01748-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 11/30/2020] [Indexed: 11/17/2022] Open
Abstract
Background We report a case of white circular spots of iridian atrophy, which we will call “polka dots” pattern, as a rare ophthalmological finding associated with uveitis secondary to varicella-zoster virus and Toxoplasma gondii coinfection in a male patient in Bogotá, Colombia. Case presentation We present de case of a 53-year-old Colombian male patient with a diagnosis of anterior uveitis in his left eye due to varicella-zoster virus and Toxoplasma gondii coinfection documented by polymerase chain reaction analysis. He presented with multiple areas of superficial white circular spots of iridian atrophy in 360º, some with deeper atrophy where the stroma fibers were visualized and only a small punctate defect of transillumination was evident. This rare pattern of iridian atrophy has not been previously described in cases of uveitis in the literature. Conclusions This is the first case reporting the findings of superficial “polka dots” pattern iridian atrophy in 360° secondary to anterior uveitis due to the coinfection of a virus and a parasite. The identification of similar clinical cases may lead to early initiation of systemic treatment in these patients.
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Affiliation(s)
- Juliana Muñoz-Ortiz
- Escuela Barraquer. Research Group, Escuela Superior de Oftalmología - Instituto Barraquer de América, Avenida Calle 100 # 18A - 51, Bogotá, Colombia.,NeURos Research Group, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Carrera 24 # 63 C 69, Bogotá, Colombia
| | - Olga Lorena Rubio-Romero
- NeURos Research Group, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Carrera 24 # 63 C 69, Bogotá, Colombia
| | | | - Karla Arteaga-Rivera
- Escuela Barraquer. Research Group, Escuela Superior de Oftalmología - Instituto Barraquer de América, Avenida Calle 100 # 18A - 51, Bogotá, Colombia
| | - Alejandra de-la-Torre
- NeURos Research Group, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Carrera 24 # 63 C 69, Bogotá, Colombia.
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36
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Maeda Y, Watanabe M, Maeda N, Ogata H, Shinoda K, Iwaki T, Kira JI. [An autopsied case of severe varicella zoster virus-associated encephalomyelitis under immunosuppressant therapy]. Rinsho Shinkeigaku 2020; 60:351-357. [PMID: 32307398 DOI: 10.5692/clinicalneurol.cn-001413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The patient was a 40-year-old woman who was previously diagnosed with systemic lupus erythematosus and myasthenia gravis and had received prednisolone and tacrolimus for more than 7 years. In February 2017, she noticed pain in her lower back and weakness of the lower limbs, and was referred to our hospital on day 5. She had shingles in the right lower thoracic dermatomes and Brown-Séquard syndrome with right-sided dominant weakness in her lower limbs and left-sided superficial sensory disturbance below the L1 level. Varicella zoster virus (VZV)-associated myelopathy was suspected because of her symptoms and clinical findings. Despite the immediate administration of intravenous acyclovir after hospitalization, she lost consciousness and experienced a seizure related to cerebral hemorrhage in the left temporal lobe on the night of day 5. MRI showed enhanced lesions along the spinal cord and leptomeninges of the brainstem and temporal lobe. VZV-IgG and VZV-DNA were positive in the cerebrospinal fluid. Based on these clinical features and laboratory findings, she was diagnosed as VZV-associated vasculopathy and myelopathy. She subsequently had multiple cerebral infractions and hemorrhage, and developed sudden cardiopulmonary arrest on day 6, culminating in death on day 17. Autopsy showed that inflammatory mononuclear cells had infiltrated the vascular walls of the spinal cord. Immunohistochemistry revealed that some neurons and macrophages in the white matter of the spinal cord were positive for VZV. In addition, atrophic neurons, satellite cells surrounding these neurons, and infiltrating macrophages were immune-positive for VZV at the L2 dorsal root ganglia. These findings were consistent with VZV-associated vasculopathy and myelitis. Under immunosuppressive conditions, VZV can cause shingles and neuronal complications such as vasculopathy and myelitis, which are sometimes fatal despite the immediate administration of intravenous acyclovir. New treatment drugs or drugs to prevent VZV activation are desired.
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Affiliation(s)
- Yasuhiro Maeda
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University
| | - Mitsuru Watanabe
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University
| | - Norihisa Maeda
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University.,Department of Neuropathology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University
| | - Hidenori Ogata
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University
| | - Koji Shinoda
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University
| | - Toru Iwaki
- Department of Neuropathology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University
| | - Jun-Ichi Kira
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University
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Kennedy PG, Graner MW, Gunaydin D, Bowlin J, Pointon T, Yu X. Varicella-Zoster Virus infected human neurons are resistant to apoptosis. J Neurovirol 2020; 26:330-337. [PMID: 32125664 DOI: 10.1007/s13365-020-00831-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 12/13/2019] [Accepted: 02/03/2020] [Indexed: 12/25/2022]
Abstract
Varicella-zoster virus (VZV) is a pathogenic human herpesvirus that causes varicella (chickenpox) as a primary infection following which it becomes latent in ganglionic neurons. Following viral reactivation many years later VZV causes herpes zoster (shingles) as well as a variety of other neurological syndromes. The molecular mechanisms of the conversion of the virus from a lytic to a latent state in ganglia are not well understood. In order to gain insights into the neuron-virus interaction, we studied virus-induced apoptosis in cultures of both highly pure terminally differentiated human neurons and human fetal lung fibroblasts (HFL). It was found that (a) VZV DNA did not accumulate in infected human neurons; (b) VZV transcripts were present at lower levels at all days studied post-infection in neurons; (c) Western blot analysis showed less VZV IE 63 and very little detectable VZV gE proteins in infected neurons compared with HFL; (d) lower levels of the apoptotic marker cleaved Caspase-3 protein were detected in VZV-infected neurons compared with HFL, and higher levels of the known anti-apoptotic proteins Bcl2, Bcl-XL and also the mitochondrial MT-CO2 protein were found in VZV-infected neurons compared with uninfected cells; and (e) both the MT-CO2 protein and VZV IE 63-encoded protein were detected in infected neurons by dual immunofluorescence. These findings showed that neurons are resistant to VZV-induced apoptosis, which may have relevance to the switching of VZV from a lytic to latent ganglionic neuronal infection.
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Affiliation(s)
- Peter Ge Kennedy
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Michael W Graner
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Dicle Gunaydin
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jackie Bowlin
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Tiffany Pointon
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Xiaoli Yu
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
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38
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Bilodeau EA, Lalla RV. Recurrent oral ulceration: Etiology, classification, management, and diagnostic algorithm. Periodontol 2000 2019; 80:49-60. [PMID: 31090148 DOI: 10.1111/prd.12262] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Recurrent oral ulcerations are manifestations of a heterogeneous set of both general and more-or-less specific oral diseases due to numerous potential etiologies, including, but not limited to, infections, medications, autoimmune disease, and other systemic disease. This review discusses the pathogenesis, clinical presentation, diagnosis, and management of the common causes of recurrent oral ulceration. The following types/etiologies of recurrent oral ulceration are covered: traumatic ulceration, chemical ulceration, recurrent aphthous stomatitis, medication-related ulceration, infectious ulceration, mucocutaneous disease, and autoimmune/systemic disease. A diagnostic algorithm for recurrent oral ulceration is also presented.
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Affiliation(s)
- Elizabeth A Bilodeau
- Department of Diagnostic Sciences, University of Pittsburgh School of Dental Medicine, Pittsburgh, Pennsylvania, USA
| | - Rajesh V Lalla
- Department of Oral Health and Diagnostic Sciences, University of Connecticut School of Dental Medicine, Farmington, Connecticut, USA
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39
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Shenoda B, Onwe IA, Mody T, Ply B, Degen K, Wilmoth J, Ford W, Braun T, Humayun W. A Case of Varicella-Zoster Meningoencephalitis Presented by Ramsay Hunt Syndrome. Indian J Otolaryngol Head Neck Surg 2019; 71:1508-1510. [DOI: 10.1007/s12070-019-01646-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 04/05/2019] [Indexed: 11/30/2022] Open
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40
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Abbas SA, El Helou J, Chalah MA, Hilal H, Saliba G, Abboud H, Ayache SS. Longitudinal Extensive Transverse Myelitis in an Immunocompetent Older Individual-A Rare Complication of Varicella-Zoster Virus Reactivation. ACTA ACUST UNITED AC 2019; 55:medicina55050201. [PMID: 31126152 PMCID: PMC6572170 DOI: 10.3390/medicina55050201] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 04/24/2019] [Accepted: 05/21/2019] [Indexed: 12/29/2022]
Abstract
Varicella-zoster virus (VZV) is a human neurotropic herpes virus that causes chickenpox in children. After becoming latent in dorsal root ganglia, it can reactivate to cause dermatological manifestations, the most common one being shingles or herpes zoster. Severe neurologic dysfunctions can occur in immunocompromised patients such as encephalitis, meningitis, myelitis and neuropathy. Longitudinal extensive transverse myelitis (LETM) is an unusual neurological complication mainly described in immunocompromised patients, with very few cases described in immunocompetent ones. We hereby report a case of VZV-induced LETM in an immunocompetent older adult—a situation rarely described in the literature. LETM is a rare complication of VZV and its pathogenesis; therapeutic interventions and prognosis are far from being fully clarified. However, a prompt diagnosis is needed to allow a rapid initialization of treatment and ensure a better outcome. Although the therapeutic lines are not clear, immunosuppressive agents may have their place in cases of unsuccessful results and/or relapses following acyclovir coupled with a well conducted methylprednisolone therapy. Further studies are highly needed to improve the current understanding of the disease course and mechanisms, and to optimize therapeutic strategies.
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Affiliation(s)
- Samar A Abbas
- Department of Neurology, Hôtel-Dieu de France Hospital, Faculty of Medicine, Saint-Joseph University, Beirut 1104-2020, Lebanon.
| | - Jeanine El Helou
- Department of Neurology, Hôtel-Dieu de France Hospital, Faculty of Medicine, Saint-Joseph University, Beirut 1104-2020, Lebanon.
| | - Moussa A Chalah
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, 94010 Créteil, France.
- Service de Physiologie-Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, 94010 Créteil, France.
| | - Hanine Hilal
- Department of Neurology, Bellevue Medical Center University Hospital, Beirut 1104-2020, Lebanon.
| | - Gaby Saliba
- Department of Infectious diseases, Hôtel-Dieu de France Hospital, Faculty of Medicine, Saint-Joseph University, Beirut 1104-2020, Lebanon.
| | - Halim Abboud
- Department of Neurology, Hôtel-Dieu de France Hospital, Faculty of Medicine, Saint-Joseph University, Beirut 1104-2020, Lebanon.
| | - Samar S Ayache
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, 94010 Créteil, France.
- Service de Physiologie-Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, 94010 Créteil, France.
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41
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Farshidpour M, Charabaty A, Mattar MC. Improving immunization strategies in patients with inflammatory bowel disease. Ann Gastroenterol 2019; 32:247-256. [PMID: 31040621 PMCID: PMC6479655 DOI: 10.20524/aog.2019.0351] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 11/11/2018] [Indexed: 02/06/2023] Open
Abstract
Patients with inflammatory bowel disease (IBD) are susceptible to varieties of opportunistic infections due to immunological changes in the setting of their disease and drug-induced immunosuppression. Even though numerous infections can be prevented by vaccine, vaccination in IBD patients is inadequate. Data showed only 9% were vaccinated against pneumococcal infection and 28% described commonly receiving influenza vaccine. This review article discusses the recent immunizations against influenza virus; pneumococcal infection; human papilloma virus; tetanus, diphtheria and pertussis; measles, mumps and rubella; varicella zoster; and herpes zoster for individuals diagnosed with IBD and those patients with drug-related immunosuppression. In addition, this review discusses concerns about IBD patients planning to travel abroad. Immunization status and screening for opportunistic infection need to be addressed in IBD patients at the time of diagnosis and they should be vaccinated accordingly. Generally, standard vaccination strategies should be pursued in IBD patients, although live vaccines should be avoided while they are not immunocompetent.
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Affiliation(s)
- Maham Farshidpour
- Department of Inpatient Medicine, Banner University Medical Center, University of Arizona, Tucson (Maham Farshidpour), USA
| | - Aline Charabaty
- Division of Gastroenterology, MedStar Georgetown University Hospital, Washington, DC, USA (Aline Charabaty, Mark C. Mattar), USA
| | - Mark C. Mattar
- Division of Gastroenterology, MedStar Georgetown University Hospital, Washington, DC, USA (Aline Charabaty, Mark C. Mattar), USA
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42
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Wu PH, Chuang YS, Lin YT. Does Herpes Zoster Increase the Risk of Stroke and Myocardial Infarction? A Comprehensive Review. J Clin Med 2019; 8:jcm8040547. [PMID: 31013629 PMCID: PMC6518274 DOI: 10.3390/jcm8040547] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 04/11/2019] [Accepted: 04/18/2019] [Indexed: 12/16/2022] Open
Abstract
Herpes zoster (HZ) caused by varicella zoster virus (VZV) reactivation is characterized as a vesicular rash of unilateral distribution that can also cause multiple complications; such as post-herpetic neuralgia; ophthalmic zoster; and other neurological issues. VZV can also increase incident hemorrhagic or ischemic complications by causing inflammatory vasculopathy. Thus; emerging epidemiological and clinical data recognizes an association between HZ and subsequent acute strokes or myocardial infarction (MI). This study reviewed published articles to elucidate the association between HZ and cerebrovascular and cardiac events. Individuals exposed to HZ or herpes zoster ophthalmicus had 1.3 to 4-fold increased risks of cerebrovascular events. Higher risks were noted among younger patients (age < 40 years) within one year after an HZ episode. The elevated risk of CV events diminished gradually according to age and length of time after an HZ episode. The putative mechanisms of VZV vasculopathy were also discussed. Several studies showed that the development of herpes zoster and herpes zoster ophthalmicus increased the risks of stroke; transient ischemic attack; and acute cardiac events. The association between VZV infection and cardiovascular events requires further studies to establish the optimal antiviral treatment and zoster vaccination to reduce zoster-associated vascular risk
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Affiliation(s)
- Ping-Hsun Wu
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan.
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan.
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan.
| | - Yun-Shiuan Chuang
- Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan.
| | - Yi-Ting Lin
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan.
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan.
- Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan.
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43
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Alves CAPF, Fragoso DC, Gonçalves FG, Marussi VH, Amaral LLFD. Cerebellar Ataxia in Children: A Clinical and MRI Approach to the Differential Diagnosis. Top Magn Reson Imaging 2018; 27:275-302. [PMID: 30086112 DOI: 10.1097/rmr.0000000000000175] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
: The cerebellum has long been recognized as a fundamental structure in motor coordination. Structural cerebellar abnormalities and diseases involving the cerebellum are relatively common in children. The not always specific clinical presentation of ataxia, incoordination, and balance impairment can often be a challenge to attain a precise diagnosis. Continuous advances in genetic research and moreover the constant development in neuroimaging modalities, particularly in the field of magnetic resonance imaging, have promoted a better understanding of cerebellar diseases and led to several modifications in their classification in recent years. Thorough clinical and neuroimaging investigation is recommended for proper diagnosis. This review outlines an update of causes of cerebellar disorders that present clinically with ataxia in the pediatric population. These conditions were classified in 2 major groups, namely genetic malformations and acquired or disruptive disorders recognizable by neuroimaging and subsequently according to their features during the prenatal and postnatal periods.
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Affiliation(s)
| | - Diego Cardoso Fragoso
- Division of Neuroradiology, Serviço de Diagnostico por Imagem, Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil
| | | | - Victor Hugo Marussi
- Neuroradiology Department - Medimagem, Hospital Beneficência Portuguesa de São Paulo, São Paulo, SP, Brazil
- Neuroradiology Department, Hospital Santa Catarina, São Paulo, SP, Brazil
| | - Lázaro Luís Faria do Amaral
- Neuroradiology Department - Medimagem, Hospital Beneficência Portuguesa de São Paulo, São Paulo, SP, Brazil
- Neuroradiology Department, Hospital Santa Catarina, São Paulo, SP, Brazil
- Neuroradiology Department, Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
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44
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Vieira MADCES, Castro AADS, Henriques DF, Silva EVPD, Tavares FN, Martins LC, Guimarães LM, Monteiro TAF, Azevedo RDSDS, Cruz ACR, Vasconcelos PFDC. Encephalitis associated with Zika virus infection and reactivation of the varicella-zoster virus in a Brazilian child. Rev Soc Bras Med Trop 2018; 51:390-392. [PMID: 29972576 DOI: 10.1590/0037-8682-0447-2017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 05/18/2018] [Indexed: 02/03/2023] Open
Abstract
We report a case of encephalitis associated with Zika virus infection and reactivation of varicella-zoster virus in the central nervous system of a Brazilian child. This case raises the possibility that reactivation of the latent varicella-zoster virus may be a mechanism of neurological impairment induced by acquired Zika virus infection.
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Affiliation(s)
- Marcelo Adriano da Cunha E Silva Vieira
- Instituto de Doenças Tropicais Natan Portella, Secretaria de Estado da Saúde do Piauí, Teresina, PI, Brasil.,Diretoria de Vigilância em Saúde, Fundação Municipal de Saúde de Teresina, Teresina, PI, Brasil.,Programa de Pós-Graduação em Virologia, Instituto Evandro Chagas, Ananindeua, PA, Brasil
| | | | | | | | | | - Lívia Carício Martins
- Seção de Arbovirologia e Febres Hemorrágicas, Instituto Evandro Chagas, Ananindeua, PA, Brasil
| | - Lucas Melo Guimarães
- Hospital de Urgências de Teresina Dr. Zenon Rocha Filho, Fundação Municipal de Saúde de Teresina, Teresina, PI, Brasil
| | - Talita Antonia Furtado Monteiro
- Programa de Pós-Graduação em Virologia, Instituto Evandro Chagas, Ananindeua, PA, Brasil.,Seção de Virologia Geral, Instituto Evandro Chagas, Ananindeua, PA, Brasil
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Abstract
PURPOSE OF REVIEW This article describes the diagnosis and management of neurologic problems during hematopoietic cell and solid organ transplantation using time elapsed since transplantation as a guide to expected complications, including drug toxicities, infections, strokes, autoimmune phenomena, disease recurrence, and secondary neoplasms. RECENT FINDINGS Growing clinical experience in the neurology of transplantation has led to appreciation of the diverse clinical and radiographic spectrum of calcineurin inhibitor-related posterior reversible encephalopathy syndrome (PRES) and progressive multifocal leukoencephalopathy. Novel autoimmune phenomena illustrate the delicate balance between adequate immunosuppression and necessary host inflammatory defenses that can lead to organ rejection. The spectrum of infectious complications has changed with the evolution of new conditioning regimens. SUMMARY Neurologic problems remain an important source of morbidity and mortality, both in the immediate transplantation period and for years after the procedure. As perioperative management has reduced the incidence of acute infections, graft versus host disease, and organ rejection, problems of long-term survivors require neurologic input into multidisciplinary management of chronic neurologic conditions impacting quality of life.
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Khaliq MF, Kochar T, John M. Varicella zoster meningitis: an atypical case of zoster reactivation in immunocompetent young adult. BMJ Case Rep 2018; 2018:bcr-2017-223257. [PMID: 29305370 DOI: 10.1136/bcr-2017-223257] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Varicella virus is a neurotropic virus that can reactivate later in life to cause zoster or shingles. Typically, it affects elderly, immunocompromised population. We report an unusual case of an immunocompetent young adult presenting with occipital headache and zoster rash, without preherpetic and postherpetic neuralgia, who was diagnosed with varicella meningitis on Polymerase chain reaction (PCR). He was treated with intravenous acyclovir and later discharged on famciclovir. Diagnosis of varicella meningitis is difficult in the absence of typical features of zoster rash and requires high index of suspicion. Rapid diagnostic tests including varicella PCR and antithecal antibody testing can help in the confirmation of varicella zoster meningitis.
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Affiliation(s)
- Muhammad Farhan Khaliq
- Internal Medicine, Charleston Area Medical Center, West Virginia University, Charleston, West Virginia, USA
| | - Tanureet Kochar
- Internal Medicine, Charleston Area Medical Center, West Virginia University, Charleston, West Virginia, USA
| | - Molly John
- Internal Medicine, Charleston Area Medical Center, West Virginia University, Charleston, West Virginia, USA
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47
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El Hamichi S, Messaoudi R, Moujahid B, Alsubari A, El Ouatassi N, Reda K, Oubaaz A. Orbital cellulitis due to ophthalmic herpes zoster in an immunocompetent child: A case report. J Fr Ophtalmol 2017; 40:e255-e256. [DOI: 10.1016/j.jfo.2016.07.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 06/17/2016] [Accepted: 07/07/2016] [Indexed: 10/19/2022]
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Nohr EW, Itani DM, Andrews CN, Kelly MM. Varicella-Zoster Virus Gastritis: Case Report and Review of the Literature. Int J Surg Pathol 2017; 25:449-452. [DOI: 10.1177/1066896917696751] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
We report varicella-zoster virus (VZV) gastritis in a 70-year-old woman postchemotherapy for lymphoma, presenting with abdominal pain, vomiting, and delirium without rash. A gastric biopsy demonstrated viral inclusions but posed a diagnostic challenge as immunohistochemistry for cytomegalovirus and herpes simplex virus were negative, and VZV immunohistochemistry was not available. The patient developed a vesicular rash 7 days after her symptoms began. Molecular testing of the gastric biopsy and a skin swab both confirmed VZV infection. She also had probable involvement of her liver and pancreas based on imaging and serum chemistry, and possible central nervous system involvement. She recovered with appropriate antiviral therapy but later developed a postherpetic neuralgia, and chronic intrahepatic biliary strictures; liver biopsy demonstrated a cholangiopathy of uncertain etiology. A literature review of the pathogenesis, epidemiology and sequelae of VZV infection is included.
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Abstract
Premise In this article we review some lesser known cranial neuralgias that are distinct from trigeminal neuralgia, trigeminal autonomic cephalalgias, or trigeminal neuropathies. Included are occipital neuralgia, superior laryngeal neuralgia, auriculotemporal neuralgia, glossopharyngeal and nervus intermedius neuralgia, and pain from acute herpes zoster and postherpetic neuralgia of the trigeminal and intermedius nerves. Problem Facial neuralgias are rare and many physicians do not see such cases in their lifetime, so patients with a suspected diagnosis within this group should be referred to a specialized center where multidisciplinary team diagnosis may be available. Potential solution Each facial neuralgia can be identified on the basis of clinical presentation, allowing for precision diagnosis and planning of treatment. Treatment remains conservative with oral or topical medication recommended for neuropathic pain to be tried before more invasive procedures are undertaken. However, evidence for efficacy of current treatments remains weak.
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Affiliation(s)
- Francis O'Neill
- 1 Department of Oral Surgery, Liverpool University Dental Hospital, Liverpool, UK.,2 Pain Research Institute, Clinical Sciences Centre, Fazakerley, Liverpool, UK
| | - Turo Nurmikko
- 2 Pain Research Institute, Clinical Sciences Centre, Fazakerley, Liverpool, UK.,3 Neuroscience Research, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Claudia Sommer
- 4 Department of Neurology, University of Würzburg, Germany
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D'Amico A, Russo C, Ugga L, Mazio F, Capone E, D'Arco F, Mankad K, Caranci F, Marano E, Brunetti A. Can pontine trigeminal T2-hyperintensity suggest herpetic etiology of trigeminal neuralgia? Quant Imaging Med Surg 2016; 6:490-495. [PMID: 27942467 DOI: 10.21037/qims.2016.01.07] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Trigeminal neuralgia (TN) is usually classified into two different categories: idiopathic and secondary. We have investigated the frequency of brainstem pontine lesions in patients with idiopathic TN without multiple sclerosis (MS) or stroke, and their association with herpes zoster (HZ) infection. METHODS Brain magnetic resonance imaging (MRI) studies of 28 patients with TN were retrospectively reviewed. RESULTS We found seven patients with clinical suspicion of HZ infection and pontine T2 hyperintense lesions, associated with nerve atrophy in one case. Fifteen patients had a neurovascular conflict (NVC) without brainstem involvement, two of them associated with trigeminal atrophy, while four patients had only volumetric reduction of the nerve. In all patients MRI findings were ipsilateral to the side of TN. CONCLUSIONS Pontine T2 hyperintensities could be considered as a MRI sign of TN in patients without NVCs. This "trigeminal pontine sign" (TPS) is frequently found in association with herpetic infections.
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Affiliation(s)
- Alessandra D'Amico
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Carmela Russo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Lorenzo Ugga
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Federica Mazio
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Elisa Capone
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Felice D'Arco
- Department of Neuroradiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Kshitij Mankad
- Department of Neuroradiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Ferdinando Caranci
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Enrico Marano
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Arturo Brunetti
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
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