Topical and intralesional immunotherapy in cutaneous infections

Immunotherapy has revolutionized the treatment of extensive and resistant warts. Promising results have extended the role of immunotherapy to other infections such as extensive molluscum contagiosum, recurrent herpes simplex infections, and cutaneous leishmaniasis, which are resistant to standard treatment. This review focuses on topical and intralesional immunotherapy in the management of cutaneous infections.

Dysfunctional Senescent Herpes Simplex Virus Specific CD57+CD8+ T cells are Associated with Recurrent Symptomatic Herpes in Humans

Herpes simplex virus (HSV)-specific CD8+ T cells protect mice from herpes infection and disease. However, the phenotype and function of HSV-specific CD8+ T cells that play a key role in the "natural" protection seen in HSV-1-seropositive healthy asymptomatic (ASYMP) individuals (who have never had clinical herpes disease) remain to be determined. We previously reported that symptomatic (SYMP) patients (who have frequent bouts of recurrent herpes disease) had more less-differentiated and dysfunctional HSV-specific CD8+ T cells. In contrast, healthy ASYMP individuals maintained a significantly higher proportion of differentiated polyfunctional CD8+ T cells. Here we report that, HSV-specific CD8+ T cells from SYMP patients, but not from ASYMP individuals, have phenotypic and functional characteristics of cellular senescence, including: (i) high frequency of senescent (CD57+) and exhausted (PD-1+) CD8+ T cells; (ii) late terminally differentiated (KLRG1+), non-proliferating CD8+ T cells; (iii) HSV-specific CD8+ T cells were declined overtime and were not maintained homeostatistically (CD127+CD8+ T cells); (iv) loss of co-stimulatory molecule (CD28)on HSV-specific CD8+ T cells; (v) decreased production of effector molecules (granzyme B and perforin) by HSV-specific CD8+ T cells. Our findings provide insights into the role of senescence in HSV-specific CD8+ T cells in susceptibility to recurrent herpes and have implications for T-cell-based immunotherapeutic strategies against recurrent herpes in humans.

Recurrent herpes zoster with IgD deposits, multinucleated keratinocytes and overexpression of galectin and glypican 3 in a patient with SARS-COVID-19 infection

The novel coronavirus disease (COVID-19) that currently plagues the world and caused by SARS-CoV-2, has spread internationally since late 2019. The dermatologic manifestations of this virus are currently being identified. We describe a 73-year-old Caucasian female who presented to many physicians for recurrent Herpes zoster episodes that persisted, despite treatment with multiple antiviral medications. The patient was diagnosed with COVID-19 before an onset of vesicular pustular lesions. The clinical diagnoses were recurrent herpes zoster and recurrent varicella. A skin biopsy was obtained and stained with hematoxylin and eosin to confirm a diagnosis. Immunohistochemical stains for Ki-67, Phospho-Histone H3, galectin 3, glypican and IgD were positive in multinucleated cells of the skin, where the viral lesions were detected. Recidivated herpes zoster and varicella are currently being clinically associated with COVID- 19; the abnormal immune response in patients with COVID-19 may be due to the overexpression of molecules that facilitate the outbreak of these viruses.

Comparison of Serum and Dietary Selenium Levels in Participants with a Positive History of Recurrent Herpes Lesions and Healthy Individuals

Aim. In this study, we aimed to compare the level of serum and dietary selenium in participants with a positive history of recurrent herpes labial lesions and healthy controls. Materials and Methods. This cross-sectional study, conducted during 2020-2021, evaluated the selenium serum level of 40 participants with a positive history of recurrent herpes labial lesions who had referred to Motahhari Laboratory in Shiraz, compared with 38 healthy controls. The selenium level of the serum was assessed by an absorption device, Atomic Graphite Furnace Model FS-240-AAS, made by a US Company. Independent T -test was used to compare the selenium level of males and females. In order to assess the mean age value and gender distribution between the two evaluated groups, the independent T -test and chi-square test were used, respectively. The serum selenium level was compered between both control and test groups. Results. The level of serum selenium was not statistically correlated with its dietary level in group 1 (participants with recurrent herpes labialis, P value = 0.18) and group 2 (healthy controls, P value = 0.6). The serum selenium level was compared between groups 1 and 2, which was significantly higher in healthy controls ( P value < 0.0001). In contrast, dietary selenium level was not significantly different between patients with a history of herpes labialis and healthy controls ( P value = 0.48). The level of serum selenium was not statistically correlated with its dietary level in group 1 ( P value = 0.18) and group 2 ( P value = 0.6). Conclusion. Patients with recurrent herpes labialis had lower serum selenium level as compared to the healthy controls.

Recurrent Herpes Zoster in an Immunocompetent Male: A Case Report

Herpes zoster is an infection caused by reactivation of varicella-zoster virus presenting as multiple grouped vesicular eruptions in a dermatomal pattern with associated pain. Recurrent herpes zoster is an uncommon event in an immunocompetent host. Here, we report a case of a young male presenting with herpes zoster over the T9 and T10 dermatome with the previous scarring of herpes zoster over the T6 dermatome over the right upper trunk. The patient improved on treatment with oral acyclovir and analgesics. In any patient with recurrenrt hepes zoster, work-up should be done to rule out immunosuppresion.

Chronic and Recurrent Herpes Zoster Ophthalmicus

Background and Objectives: This study sought to investigate the natural course, the chronicity and recurrence rate, and the risk factors of chronic and recurrent herpes zoster ophthalmicus (HZO). We also evaluated the effects of long-term treatment for HZO. Materials and Methods: Patients diagnosed and treated for HZO were included in the retrospective medical chart review. Multivariable-adjusted logistic and Cox regression models were used to show risk factors for chronic and recurrent HZO along with hazard ratios (HRs) and 95% confidence intervals (CIs). Results: Among a total 130 of HZO patients, 31 patients (23.85%) had chronic disease and 19 patients (14.62%) had recurrent disease. The rate of chronic disease was higher in HZO with conjunctivitis, epithelial keratitis, and stromal keratitis. The recurrence rate increased in patients with chronic HZO (HR: 34.4, 95% CI: 3.6–324.6), epithelial keratitis (HR: 5.5, 95% CI: 1.3–30.0), stromal keratitis (HR: 18.8, 95% CI: 3.0–120.8), and increased intraocular pressure (IOP) (HR: 7.3, 95% CI: 1.6–33.2). Length of systemic antiviral therapy and anti-inflammatory eyedrop treatment were not associated with recurrent HZO (p = 0.847 and p = 0.660, respectively). The most common ocular manifestation for recurrent HZO was stromal keratitis. Conclusions: This study demonstrated a considerable frequency of chronic and recurrent HZO. Chronic HZO in the form of epithelial or stromal keratitis with increased IOP provoked a significant rise in the risk of recurrence.