scholarly journals Varicella Zoster Virus-Associated Meningitis as a Rebound Varicella Zoster Disease after Antiviral Discontinuation

2021 ◽  
pp. 148-153
Author(s):  
Tetsuko Sato ◽  
Takenobu Yamamoto ◽  
Yumi Aoyama
Keyword(s):  
Herpes Zoster ◽  
Early Diagnosis ◽  
Varicella Zoster Virus ◽  
Immunosuppressive Therapy ◽  
Unusual Case ◽  
Cranial Nerves ◽  
Skin Lesions ◽  
Immunocompromised Patients ◽  
Aggressive Treatment ◽  
Varicella Zoster

Varicella zoster virus (VZV)-associated meningitis is usually progressive and can be fatal, and early diagnosis and aggressive treatment with intravenous antivirals such as acyclovir (ACV) are required in immunocompromised patients. Patients receiving corticosteroids and immunosuppressive therapy have a significantly higher risk of VZV-associated meningitis. In this report, we describe an unusual case of herpes zoster (HZ) in a young woman who was first diagnosed during tapering of prednisone for dermatomyositis. The skin lesions affected the left L2 and L3 dermatomes, which is unusual in VZV-associated meningitis. Despite showing a good rapid response to antivirals, she developed VZV-associated meningitis immediately after discontinuation of ACV. This phenomenon is often called rebound VZV reactivation disease and occurs after discontinuation of antivirals. This case was notable in that the affected dermatomes were distant from the cranial nerves. Thus, progression of HZ to VZV reactivation-associated meningitis can occur even in appropriately treated HZ patients. Continuation of antivirals beyond 1 week in patients on immunosuppressive therapy may be associated with a decreased risk of severe rebound VZV disease, such as VZV-associated meningitis.

scholarly journals Age-Associated Differences in Infection of Human Skin in the SCID Mouse Model of Varicella-Zoster Virus Pathogenesis

2018 ◽  
Vol 92 (11) ◽  
Author(s):  
Leigh Zerboni ◽  
Phillip Sung ◽  
Gordon Lee ◽  
Ann Arvin
Keyword(s):  
Herpes Zoster ◽  
Varicella Zoster Virus ◽  
Human Skin ◽  
Inflammatory Responses ◽  
Skin Lesions ◽  
Type I ◽  
Older Individuals ◽  
Varicella Zoster ◽  
Adult Skin

ABSTRACTVaricella-zoster virus (VZV) is the skin-tropic human alphaherpesvirus responsible for both varicella-zoster and herpes zoster. Varicella-zoster and herpes zoster skin lesions have similar morphologies, but herpes zoster occurs disproportionally in older individuals and is often associated with a more extensive local rash and severe zoster-related neuralgia. We hypothesized that skin aging could also influence the outcome of the anterograde axonal transport of VZV to skin. We utilized human skin xenografts maintained in immunodeficient (SCID) mice to study VZV-induced skin pathologyin vivoin fetal and adult skin xenografts. Here we found that VZV replication is enhanced in skin from older compared to younger adults, correlating with clinical observations. In addition to measures of VZV infection, we examined the expression of type I interferon (IFN) pathway components in adult skin and investigated elements of the cutaneous proliferative and inflammatory response to VZV infectionin vivo. Our results demonstrated that VZV infection of adult skin triggers intrinsic IFN-mediated responses such as we have described in VZV-infected fetal skin xenografts, including MxA as well as promyelocytic leukemia protein (PML), in skin cells surrounding lesions. Further, we observed that VZV elicited altered cell signaling and proliferative and inflammatory responses that are involved in wound healing, driven by follicular stem cells. These cellular changes are consistent with VZV-induced activation of STAT3 and suggest that VZV exploits the wound healing process to ensure efficient delivery of the virus to keratinocytes. Adult skin xenografts offer an approach to further investigate VZV-induced skin pathologiesin vivo.IMPORTANCEVaricella-zoster virus (VZV) is the agent responsible for both varicella-zoster and herpes zoster. Herpes zoster occurs disproportionally in older individuals and is often associated with a more extensive local rash and severe zoster-related neuralgia. To examine the effect of skin aging on VZV skin lesions, we utilized fetal and adult human skin xenografts maintained in immunodeficient (SCID) mice. We measured VZV-induced skin pathology, examined the expression of type I interferon (IFN) pathway components in adult skin, and investigated elements of the cutaneous proliferative and inflammatory response to VZV infectionin vivo. Our results demonstrate that characteristics of aging skin are preserved in xenografts; that VZV replication is enhanced in skin from older compared to younger adults, correlating with clinical observations; and that VZV infection elicits altered cell signaling and inflammatory responses. Adult skin xenografts offer an approach to further investigate VZV-induced skin pathologiesin vivo.

Chronic Chest Wall Pain in Postherpetic Neuralgia

2018 ◽  
Author(s):  
Kenneth D. Candido ◽  
Teresa M. Kusper ◽  
Nebojsa Nick Knezevic
Keyword(s):  
Neuropathic Pain ◽  
Herpes Zoster ◽  
Varicella Zoster Virus ◽  
Chest Wall ◽  
Postherpetic Neuralgia ◽  
Early Treatment ◽  
Chemical Compounds ◽  
Skin Lesions ◽  
Varicella Zoster ◽  
Sensory Disturbances

Postherpetic neuralgia (PHN) is a debilitating condition that frequently arises after herpes zoster (HZ) caused by the varicella-zoster virus. It is characterized by severe neuropathic pain and sensory disturbances persisting after the resolution of characteristic vesicular skin lesions. Most commonly affected are the thoracic dermatomes. Trigeminal (V1), cervical, and lumbar nerves are other frequently affected sites. Early treatment shortens the duration of acute HZ and may prevent the onset of PHN. A variety of modalities are utilized to treat PHN, including chemical compounds, interventional pain techniques, and neuromodulation. HZ vaccine is recommended for individuals more than 60 years old, and it is currently the best method of averting HZ and consequent progression to PHN.

scholarly journals Herpes Zoster in an Immunocompetent Child without a History of Varicella

2021 ◽  
Vol 13 (2) ◽  
pp. 162-167
Author(s):  
Bing-Shiau Shang ◽  
Cheng-Jui Jamie Hung ◽  
Ko-Huang Lue
Keyword(s):  
Infectious Disease ◽  
Herpes Zoster ◽  
Varicella Zoster Virus ◽  
Pediatric Population ◽  
Skin Lesions ◽  
Subclinical Infection ◽  
Varicella Zoster ◽  
Immunocompetent Child ◽  
History Of ◽  
Skin Pain

Herpes zoster is a relatively rare infectious disease in the pediatric population, as compared with adults, which is due to the reactivation of latent Varicella−Zoster virus. We report a 7-year-old child without any history of varicella, who first experienced skin pain and later presented skin lesions in dermatomal distribution. Finally, the patient was diagnosed with herpes zoster. We aim to emphasize that herpes zoster could occur in immunocompetent children and may be due to the reactivation of the vaccine strain or previous subclinical infection.

scholarly journals Comparison of Intrathecal Concentrations of Acyclovir following Epidural and Intravenous Administration in Rats

2016 ◽  
Vol 4;19 (4;5) ◽  
pp. E613-E619
Author(s):  
Sang Sik Choi
Keyword(s):  
Herpes Zoster ◽  
Varicella Zoster Virus ◽  
Plasma Concentrations ◽  
Cranial Nerves ◽  
Group Iv ◽  
Epidural Administration ◽  
Varicella Zoster ◽  
Drug Concentrations ◽  
Median Plasma ◽  
Intrathecal Space

Background: Herpes zoster is a disease caused by reactivation of varicella-zoster virus in sensory cranial nerves and dorsal root ganglion. Our presumption was that epidural administration of acyclovir near the viral burden could be more advantageous than intravenous (IV) administration. The cerebrospinal fluid (CSF) concentration of acyclovir after epidural administration was determined to be higher than that after IV administration in rats. Objective: In this study, we tested the hypothesis that the concentration of acyclovir in CSF after epidural administration is higher than that achieved after IV administration in rats. Study Design: A randomized controlled animal trial. Methods: A total of 30 adult male Sprague-Dawley rats were used. The rats were randomly divided into 2 equal groups, epidural (Group Epi) and IV (Group IV) administration groups (n = 15). Group Epi was further subdivided into 3 groups according to acyclovir dosage; each group comprised 5 animals receiving injections at dosages of 0.3 mg, 0.6 mg, and 0.9 mg. Group IV was also subdivided into 3 groups receiving dosages of 3 mg, 6 mg, and 9 mg. We measured CSF and plasma acyclovir concentrations one hour after administration. Results: In Group Epi, the median plasma concentrations of acyclovir were lower than that in CSF (P < 0.05). In Group IV, the median plasma concentrations of acyclovir were significantly higher than that in CSF (P < 0.05). The CSF concentrations of acyclovir in Group Epi were significantly higher than that in Group IV (P < 0.05). The plasma concentrations of acyclovir in Group Epi were significantly lower than that in Group IV (P < 0.05). Limitations: There were no references of equivalent dosages of acyclovir between IV and epidural administration. However, it is obvious in this study that epidural administration of a low dose of acyclovir can more effectively increase its concentration in the intrathecal space than IV administration. Conclusions: Epidural administration of acyclovir provides superior drug concentrations in the intrathecal space compared to IV administration. Key words: Acyclovir, epidural injection, herpes zoster, varicella zoster virus

scholarly journals A rare case of herpes zoster maxillaris with cranial polyneuropathy

2017 ◽  
Vol 4 (1) ◽  
pp. 290
Author(s):  
Shubhransu Patro ◽  
Debananda Sahoo ◽  
Anil Kumar Dash ◽  
Biswamohan Mishra
Keyword(s):  
Herpes Zoster ◽  
Facial Nerve ◽  
Varicella Zoster Virus ◽  
Rare Case ◽  
Rare Complication ◽  
Cranial Nerves ◽  
Occurrence Rate ◽  
Varicella Zoster ◽  
High Affinity ◽  
Cranial Nerve Palsies

Varicella zoster virus has a high affinity for the ganglion and causes various neuropathies. About 12% of all peripheral facial nerve palsies are caused by varicella zoster virus, a rare complication due to reactivation of the herpes zoster virus in the geniculate ganglion of facial nerve. The occurrence rate of associated cranial polyneuropathy has been reported to be 1.8-3.2% and cranial nerves VII, VIII, IX and X are the ones most commonly affected. Here, we present a case of Herpes zoster maxillaris with cranial polyneuropathy who was improved with oral anti-viral drugs and steroid. Multiple cranial nerve palsies are being observed frequently in patients who were referred with a preliminary diagnosis of facial palsy. These patients are required to be examined in detail for involvement of other cranial nerves. Early diagnosis and treatment is required for reversing the functions of cranial nerves and decreasing the chance of developing other complications.

Oral manifestations of infections due to varicella zoster virus in otherwise healthy children

2002 ◽  
Vol 25 (2) ◽  
pp. 107-112 ◽  
Author(s):  
Alexandros Kolokotronis ◽  
Konstantinos Louloudiadis ◽  
Garyfalia Fotiou ◽  
Apostolos Matiais
Keyword(s):  
Herpes Zoster ◽  
Varicella Zoster Virus ◽  
Cranial Nerves ◽  
Differential Diagnostics ◽  
Oral Lesions ◽  
Healthy Children ◽  
Oral Manifestations ◽  
Normal Children ◽  
Varicella Zoster ◽  
Group B

Varicella zoster virus (VZV) causes varicella (or chickenpox) and establishes latency in nerve ganglia after the primary infection. The reactivation of virus later in life can cause mono- or polyneuropathy. The cranial nerves most commonly involved are five (herpes zoster or shingles), six, seven eight, nine and ten. In the present study we describe the oral lesions associated with VZV infections in normal children. In a 3 year period we examined 62 children, age 2 to 13 years old with diagnosed varicella and a 4 year old boy with herpes zoster at the 3rd branch of the trigeminal nerve. According to the clinical picture of varicella, the disease was defined as: (1) group A mild cases; (2) group B moderate cases; (3) group C severe. The manifestations of varicella were: mild varicella 19 children, moderate 26 children and severe 17 children. The results of the present study indicate that the prevalence of oral manifestations of varicella is related to the severity of the disease. In 17 severe cases, oral lesions were always present and the number was between 5 to 30. From 26 moderate cases, oral lesions were observed in 23 and the number was between 2 to 10. From 19 mild cases, oral lesions were present only in 6 cases and their number was 1 or 2. Often varicella's oral lesions resemble manifestations of other entities, and this may cause differential diagnostics problems.

Blistering Rash

2018 ◽  
pp. 240-243
Author(s):  
Ashley Sutherland
Keyword(s):  
Older Adults ◽  
Herpes Zoster ◽  
Herpes Simplex ◽  
Varicella Zoster Virus ◽  
Postherpetic Neuralgia ◽  
Skin Lesions ◽  
Stevens Johnson Syndrome ◽  
Previous Exposure ◽  
Varicella Zoster ◽  
Johnson Syndrome

This case reviews an eruption of herpes zoster (shingles) in an inpatient. It examines the clinical presentation, pathophysiology, and treatment of this condition. Herpes zoster is an acute, painful vesiculobullous eruption that is seen most commonly in older adults in the setting of previous exposure to varicella zoster virus. Classic features include painful vesicles on well-defined erythema, typically confined to a single dermatome. Initiation of antiviral therapy within 72 hours of the onset of skin lesions is given to reduce the duration of the eruption and decrease the incidence of postherpetic neuralgia. This case will also review how herpes zoster differs from other cutaneous eruptions that may look similar, such as herpes simplex or Stevens Johnson syndrome.

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