scholarly journals Viral Loads in Ocular Fluids of Acute Retinal Necrosis Eyes Infected by Varicella-Zoster Virus Treated with Intravenous Acyclovir Treatment

2020 ◽  
Vol 9 (4) ◽  
pp. 1204
Author(s):  
Tomohito Sato ◽  
Wataru Yamamoto ◽  
Atsushi Tanaka ◽  
Haruna Shimazaki ◽  
Sunao Sugita ◽  
...  
Keyword(s):  
Viral Load ◽  
Varicella Zoster Virus ◽  
Aqueous Humor ◽  
Acute Retinal Necrosis ◽  
Varicella Zoster ◽  
Viral Loads ◽  
Acyclovir Treatment ◽  
Intravenous Acyclovir ◽  
Ocular Fluids ◽  
Pcr Test

Acute retinal necrosis (ARN) is a rare viral endophthalmitis, and human herpesvirus is the principal pathogen. Early diagnosis and treatment are critical to avoid visual impairment by ARN, and pars plana vitrectomy (PPV) is required in advanced cases. In this study, we evaluated the transition of viral load in ocular fluids of ARN eyes with varicella-zoster virus (VZV) after intravenous acyclovir treatment. Fourteen eyes of 13 patients were analyzed retrospectively. All patients received intravenous acyclovir treatment, and eventually, all eyes underwent PPV. A polymerase chain reaction (PCR) test showed a 100% detection rate in all aqueous humor samples collected before the treatment (Pre-AH), as well as aqueous humor (Post-AH) and vitreous fluid samples (VF), collected during PPV conducted after the treatment. Within eight days or less of acyclovir treatment, viral loads both in AH and VF did not decrease significantly. Furthermore, the viral load of Pre-AH had a strong correlation with that of VH. These data suggest that in ARN eyes with VZV infection, the AH sample for the PCR test was reliable to confirm the pathogen. We propose that short-term treatment of intravenous acyclovir may be insufficient for reducing intraocular viral load, and the Pre-AH sample could be a predictor of viral activity in the eyes after acyclovir treatment.

scholarly journals Acute Retinal Necrosis Caused by Co-infection of Herpes Simplex Virus and Varicella-Zoster Virus: Case Report

2020 ◽  
Author(s):  
Kasra Cheraqpour ◽  
Aliasghar Ahmadraji ◽  
Ali Rashidinia ◽  
Maziyar Irannejad
Keyword(s):  
Herpes Simplex Virus ◽  
Herpes Simplex ◽  
Varicella Zoster Virus ◽  
Acute Retinal Necrosis ◽  
Optic Disk ◽  
Type I ◽  
Varicella Zoster ◽  
Intravenous Acyclovir ◽  
Simplex Virus ◽  
The Right

Abstract Background: Acute retinal necrosis is considered as a rare infectious uveitis. This condition is usually caused by Varicella-zoster virus or Herpes simplex virus. At the time being, acute retinal necrosis caused by co-infection of multiple viruses is sorely rare report. Herein, we report an immunocompetent patient who developed ARN with co-infection of Herpes Simplex Virus (type I and II) and Varicella-Zoster Virus (VZV).Findings: An adult immunocompetent man presented with complain of decreased vision of the right eye from 12 days before. Examination of the right eye revealed severe conjunctival injection, fine diffuse keratic precipitates, 3+ anterior chamber and vitreous cells, slightly elevated intraocular pressure (26), blurred optic disk with hemorrhagic patches, and occlusive vasculitis plus confluent necrotizing patches on the peripheral retina compatible with diagnosis of acute retinal necrosis. The patient has been admitted and underwent for sampling from intra-ocular fluids which showed presence of HSV I & II and VZV on real-Time PCR of vitreous specimens confirmed by rechecking. We used of intravenous acyclovir followed by oral acyclovir and oral prednisolone to control the disease which was successful. Conclusions: Although rare, we speculate multi viral infection may be considered in the physiopathology of acute retinal necrosis.

scholarly journals Deep Sequencing of Varicella-Zoster Virus in Aqueous Humor From a Patient With Acute Retinal Necrosis Presenting With Acute Glaucoma

2020 ◽  
Vol 7 (6) ◽  
Author(s):  
Joanna von Hofsten ◽  
Johan Ringlander ◽  
Peter Norberg ◽  
Madeleine Zetterberg ◽  
Maria Andersson ◽  
...  
Keyword(s):  
Varicella Zoster Virus ◽  
Aqueous Humor ◽  
High Throughput ◽  
Deep Sequencing ◽  
Viral Genome ◽  
High Throughput Sequencing ◽  
Acute Retinal Necrosis ◽  
Varicella Zoster ◽  
Acute Glaucoma ◽  
High Diversity

Abstract We report a case of acute retinal necrosis presenting with acute glaucoma preceding inflammatory signs by several days. High-throughput sequencing on aqueous humor revealed a low-level diversity in the viral genome comparable to diversity seen in cutaneous vesicles in contrast to high diversity in encephalitis.

scholarly journals Varicella Zoster Virus Encephalitis in Denmark From 2015 to 2019—A Nationwide Prospective Cohort Study

2020 ◽  
Author(s):  
Laura Krogh Herlin ◽  
Kristoffer Skaalum Hansen ◽  
Jacob Bodilsen ◽  
Lykke Larsen ◽  
Christian Brandt ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Varicella Zoster Virus ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Cerebral Vasculitis ◽  
Unfavorable Outcome ◽  
Varicella Zoster ◽  
Acyclovir Treatment ◽  
Intravenous Acyclovir

Abstract Background Knowledge of the epidemiology and clinical characteristics of varicella zoster virus (VZV) encephalitis remains limited. Methods Nationwide prospective cohort study of adults treated for microbiologically confirmed VZV encephalitis at Danish departments of infectious diseases from 2015 to 2019. Modified Poisson regression analysis was used to compute adjusted relative risks (RRs) of unfavorable outcome. Results We identified 92 adults (49% female) with VZV encephalitis, yielding an incidence of 5.3/1 000 000 per year (95% CI, 4.2–6.6). Median age was 75 years (IQR, 67–83) and immunocompromising conditions were frequent (39%). Predominant symptoms were confusion (76%), headache (56%), nausea (45%), gait disturbance (42%), and personality changes (41%). Cranial imaging showed cerebral vasculitis (including infarction and hemorrhage) in 14 (16%) patients and encephalitic abnormalities in 11 (13%) with predilection for the brainstem and deep brain structures. Intravenous acyclovir treatment was initiated a median (IQR) of 13.4 hours (5.2–46.3) since admission, while cranial imaging and lumbar puncture were performed after 6.3 hours (2.5–31.0) and 18.5 hours (4.9–42.0). In-hospital, 1-month, and 3-month mortalities were 4%, 9%, and 11%, respectively. Unfavorable outcome (Glasgow Outcome Score of 1–4) was found in 69% at discharge, with age (adjusted RR [aRR], 1.02; 95% CI, 1.01–1.03), vasculitis (aRR, 1.38; 95% CI, 1.02–1.86), and Glasgow Coma Scale (GCS) <15 (aRR, 1.32; 95% CI, 1.01–1.73) identified as independent risk factors. Conclusions VZV encephalitis occurs primarily in elderly or immunocompromised patients with a higher incidence than previously estimated. The diagnosis is often delayed; risk factors for unfavorable outcome are age, cerebral vasculitis, and GCS <15.

Observation of varicella zoster virus-induced acute retinal necrosis: viral load detection and visual outcome

Eye ◽  
2021 ◽  
Author(s):  
Boya Lei ◽  
Zhujian Wang ◽  
Qinmeng Shu ◽  
Ruiping Gu ◽  
Yanqiong Zhang ◽  
...  
Keyword(s):  
Viral Load ◽  
Varicella Zoster Virus ◽  
Visual Outcome ◽  
Acute Retinal Necrosis ◽  
Varicella Zoster ◽  
Load Detection

scholarly journals Flow cytometric analysis of T lymphocytes and cytokines in aqueous humor of patients with varicella zoster virus-mediated acute retinal necrosis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hao Kang ◽  
Yunbo Wei ◽  
Ming Liu ◽  
Di Yu ◽  
Yong Tao
Keyword(s):  
T Lymphocytes ◽  
Varicella Zoster Virus ◽  
Aqueous Humor ◽  
T Lymphocyte ◽  
Lymphocyte Subsets ◽  
Flow Cytometric Analysis ◽  
T Lymphocyte Subsets ◽  
Varicella Zoster ◽  
Flow Cytometric ◽  
Cd8 T Lymphocytes

Abstract Background The purpose of this study is to investigate the aqueous humor (AH) T lymphocyte subsets and cytokines of acute retinal necrosis (ARN) to elucidate the immunologic inflammatory features of this disorder. Methods Three patients with ARN infected with varicella zoster virus (VZV) who underwent multiple intravitreal injections of ganciclovir were enrolled in this study. The control group consisted of four non-infectious patients with acute anterior uveitis (AAU). Flow cytometric analysis was performed on the lymphocyte subsets from the AH and peripheral blood (PB) samples during the active phase of intraocular inflammation. Five inflammatory cytokines were measured in each AH sample and various clinical characteristics were also assessed. Results VZV deoxyribonucleic acid (DNA) was detected by real-time polymerase chain reaction (PCR) in AH from all the ARN patients, who showed higher CD8+ T lymphocytes population in AH than the AAU patients (p = 0.006). CD4/CD8 ratios of T lymphocytes and the percentage of CD8 + CD25+ T lymphocytes in AH were significantly lower in ARN than in AAU (p = 0.006; p = 0.012). In the ARN patients, the percentages of CD4+ and CD8+ T lymphocytes in AH were higher than those found in PB. The percentage of CD4 + CD25+ T lymphocytes in AH was significantly higher than the proportion in PB in the AAU patients (p = 0.001). Immunoregulatory cytokine Interleukin-10 in AH was significantly elevated in the ARN patients in comparison with the case of the AAU patients (p = 0.036). In ARN, the copy number of VZV DNA in AH positively correlated with the percentage of CD8+ T lymphocytes in AH and negatively correlated with the CD4/CD8 ratio in AH during the course of disease treatment (p = 0.009, r = 0.92; p = 0.039, r = − 0.834). Conclusion The ARN patients caused by VZV had different intraocular T lymphocyte subsets and cytokines profile than those of the non-infectious patients. High percentages of CD8+ T lymphocytes and low CD4/CD8 T cell ratios may be a potential biomarker for diagnosis of viral-infectious uveitis. T lymphocytes examination at the inflammatory sites has the potential to become a useful research tool for differentiating viral and non-viral uveitis.

scholarly journals Pharyngeal dysphagia due to Varicella zoster virus meningoradiculitis and full recovery: Case report and endoscopic findings

2018 ◽  
Vol 6 ◽  
pp. 2050313X1875656
Author(s):  
Paul Muhle ◽  
Sonja Suntrup-Krueger ◽  
Rainer Dziewas ◽  
Tobias Warnecke
Keyword(s):  
Varicella Zoster Virus ◽  
Brain Magnetic Resonance Imaging ◽  
Virus Reactivation ◽  
Swallowing Function ◽  
Percutaneous Gastrostomy ◽  
Negative Finding ◽  
Varicella Zoster ◽  
Fluid Analysis ◽  
Pharyngeal Dysphagia ◽  
Acyclovir Treatment

Varicella zoster virus reactivation is a rare cause of pharyngeal dysphagia with long-term sequelae persisting in most cases. A 76-year-old immunocompetent woman presented with a 4-week history of dysphagia and dysphonia. Brain magnetic resonance imaging displayed a negative finding. Fiberoptic endoscopic evaluation of swallowing showed a severe dysphagia leading to a percutaneous gastrostomy eventually. Cerebrospinal fluid analysis revealed a lymphocytic pleocytosis and polymerase chain reaction amplified Varicella zoster virus DNA. Eight months after Acyclovir treatment and despite a persisting impairment of the recurrent laryngeal nerve, regular swallowing function was regained and percutaneous gastrostomy could be removed.

Flow Cytometric Analysis of T Lymphocytes and Cytokines in Aqueous Humor of Patients with Varicella Zoster Virus-mediated Acute Retinal Necrosis

2020 ◽  
Author(s):  
Hao Kang ◽  
Yunbo Wei ◽  
Ming Liu ◽  
Di Yu ◽  
Yong Tao
Keyword(s):  
T Lymphocytes ◽  
Varicella Zoster Virus ◽  
Aqueous Humor ◽  
T Lymphocyte ◽  
Lymphocyte Subsets ◽  
Flow Cytometric Analysis ◽  
T Lymphocyte Subsets ◽  
Varicella Zoster ◽  
Flow Cytometric ◽  
Cd8 T Lymphocytes

Abstract Background: The purpose of this study is to investigate the aqueous humor (AH) T lymphocyte subsets and cytokines of acute retinal necrosis (ARN) to elucidate the immunologic inflammatory features of this disorder.Methods: Three patients with ARN infected with varicella zoster virus (VZV) who underwent multiple intravitreal injections of ganciclovir were enrolled in this study. The control group consisted of four non-viral infectious patients with acute anterior uveitis (AAU). Flow cytometric analysis was performed on the lymphocyte subsets from the AH and peripheral blood (PB) samples during the active phase of intraocular inflammation. Five inflammatory cytokines were measured in each AH sample and various clinical characteristics were also assessed.Results: VZV DNA was detected by real-time polymerase chain reaction (PCR) in AH from all the ARN patients, who showed higher CD8+ T lymphocytes population in AH than the AAU patients (p=0.006). CD4/CD8 ratios of T lymphocytes and the percentage of CD8+CD25+ T lymphocytes in AH were significantly lower in ARN than in AAU (p=0.006; p=0.012). In the ARN patients, the percentages of CD4+ and CD8+ T lymphocytes in AH were higher than those found in PB. The percentage of CD4+CD25+ T lymphocytes in AH was significantly higher than the proportion in PB in the AAU patients (p=0.001). Immunoregulatory cytokine Interleukin-10 in AH was significantly elevated in the ARN patients in comparison with the case of the AAU patients (p=0.036). In ARN, the copy number of VZV DNA in AH positively correlated with the percentage of CD8+ T lymphocytes in AH and negatively correlated with the CD4/CD8 ratio in AH during the course of disease treatment (p=0.009, r=0.92; p=0.039, r=-0.834).Conclusion: The ARN patients caused by VZV had different intraocular T lymphocyte subsets and cytokines profile than those of the non-viral infectious patients. High percentages of CD8+ T lymphocytes and low CD4/CD8 T cell ratios may be a potential biomarker for diagnosis of viral-infectious uveitis. T lymphocytes examination at the inflammatory sites has the potential to become a useful research tool for differentiating viral and non-viral uveitis.

Avoiding a lumbar puncture may be a rash decision: a case report of varicella-zoster virus-associated radiculopathy in advanced HIV infection

2019 ◽  
Vol 30 (10) ◽  
pp. 1031-1033
Author(s):  
Emma Wallis ◽  
Bahij Al-Hakim ◽  
Paul Holmes ◽  
Sam Douthwaite ◽  
Ranjababu Kulasegaram
Keyword(s):  
Varicella Zoster Virus ◽  
Lumbar Puncture ◽  
Case Reports ◽  
Response To Treatment ◽  
High Dose ◽  
Serum Samples ◽  
Cd4 Cell Count ◽  
Varicella Zoster ◽  
Intravenous Acyclovir ◽  
History Of

A 34-year-old man recently diagnosed with advanced human immunodeficiency virus infection (CD4 cell count of 139 cells/mm3), not yet started on antiretroviral medications, presented to hospital with a ten-day history of left leg weakness and difficulty walking. He described a childhood history of chickenpox with previous shingles over his buttock over three years ago. Examination revealed reduced power in the left hip and knee flexors and absent knee and adductor reflexes. Lumbar punctures were performed and polymerase chain reaction (PCR) detected varicella-zoster virus (VZV) DNA. Concurrent serum samples for VZV PCR were negative. The patient was diagnosed with VZV radiculopathy and treated with high-dose intravenous acyclovir. Within two days, neurological signs improved. Previous case reports define VZV radiculopathy by a temporal and geographical relationship with a zoster rash. Our diagnosis was based on a clinical picture of radiculopathy with virological evidence in CSF and confirmed by a dramatic clinical response to treatment. We propose that lumbar puncture and detection of VZV DNA by PCR in the cerebrospinal fluid (CSF) is an invaluable investigation that should be considered in the workup of immunosuppressed patients presenting with a radiculopathy.

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